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Newman N, Beyuo TK, Nartey BA, Segbedzi-Rich E, Pangori A, Moyer CA, Lori JR, Oppong SA, Lawrence ER. Facilitators and barriers to home blood pressure monitoring among pregnant women in Ghana: a mixed-methods analysis of patient perspectives. BMC Pregnancy Childbirth 2024; 24:208. [PMID: 38504214 PMCID: PMC10949704 DOI: 10.1186/s12884-024-06421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The benefit of home blood pressure monitoring during pregnancy and in low-resource settings is incompletely understood. The objective of this study was to explore the experiences, barriers, and facilitators of home blood pressure monitoring among pregnant women in Ghana. METHODS This concurrent triangulation mixed-methods study was conducted at an urban tertiary hospital in Ghana. Participants were recruited from adult pregnant women presenting for routine antenatal care. Upon enrollment, participants' demographics and history were collected. At the next study visit, participants received audiovisual and hands-on training on using an automatic blood pressure monitor; they then monitored and logged their blood pressure daily at home for 2-4 weeks. At the final study visit, verbally administered surveys and semi-structured interviews assessed participant's experiences. Quantitative data were analyzed using R version 4.2.2, and frequencies and descriptive statistics were calculated. Qualitative data were imported into DeDoose 9.0.78 for thematic analysis. RESULTS Of 235 enrolled participants, 194 completed surveys; of those, 33 completed in-depth interviews. Participants' mean age was 31.6 (SD 5.3) years, 32.1% had not previously given birth, and 31.1% had less than a senior high school education. On a 4-point Likert scale, the majority reported they "definitely" were able to remember (n = 134, 69.1%), could find the time (n = 124, 63.9%), had the energy (n = 157, 80.9%), could use the blood pressure monitor without problems (n = 155, 79.9%), and had family approval (n = 182, 96.3%) while engaging in home blood pressure monitoring. 95.88% (n = 186) believed that pregnant women in Ghana should monitor their blood pressure at home. Qualitative thematic analysis demonstrated that most participants liked home blood pressure monitoring because of increased knowledge of their health during pregnancy. While most participants found measuring their blood pressure at home doable, many faced challenges. Participants' experiences with five key factors influenced how easy or difficult their experience was: 1) Time, stress, and daily responsibilities; 2) Perceived importance of BP in pregnancy; 3) Role of family; 4) Capability of performing monitoring; 5) Convenience of monitoring. CONCLUSIONS Among pregnant women in urban Ghana, home blood pressure monitoring was perceived as positive, important, and doable; however, challenges must be addressed.
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Affiliation(s)
- Noah Newman
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, 48109, USA
| | - Titus K Beyuo
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana.
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana.
| | - Betty A Nartey
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Elorm Segbedzi-Rich
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Andrea Pangori
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI, 48109, USA
| | - Jody R Lori
- University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48104, USA
| | - Samuel A Oppong
- University of Ghana Medical School, P.O. Box 4236, Korle Bu, Accra, Ghana
- Korle Bu Teaching Hospital, Department of Obstetrics and Gynecology, University of Ghana Medical School, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Lawrence ER, Parekh BJ, Owusu-Antwi R, Newman N, Russell CB, Beyuo TK, Yeboah M, Oppong SA, Moyer CA. "If You Need a Psychiatrist, It's BAD": Stigma Associated with Seeking Mental Health Care Among Obstetric Providers in Ghana. Int J Womens Health 2024; 16:131-141. [PMID: 38283998 PMCID: PMC10822084 DOI: 10.2147/ijwh.s440224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024] Open
Abstract
Purpose Globally, the COVID-19 pandemic has brought attention to the impact of negative patient outcomes on healthcare providers. In Ghana, obstetric providers regularly face maternal and neonatal mortality, yet limited research has focused on provision of mental health support for these providers. This study sought to understand how obstetric providers viewed seeking mental health support after poor clinical outcomes, with a focus on the role of mental health stigma. Patients and Methods Participants were 52 obstetric providers (20 obstetrician/gynecologists and 32 midwives) at two tertiary care hospitals in Ghana. Five focus groups, led by a trained facilitator and lasting approximately two hours, were conducted to explore provider experiences and perceptions of support following poor maternal and neonatal outcomes. Discussions were audiotaped and transcribed verbatim, then analyzed qualitatively using grounded theory methodology. Results Most participants (84.3%, N=43) were finished with training, and 46.2% (N=24) had been in practice more than 10 years. Emerging themes included pervasive stigma associated with seeking mental health care after experiencing poor clinical outcomes, which was derived from two overlapping dimensions. First, societal-level stigma resulted from a cultural norm to keep emotions hidden, and the perception that psychiatry is equated with severe mental illness. Second, provider-level stigma resulted from the belief that healthcare workers should not have mental health problems, a perception that mental health care is acceptable for patients but not for providers, and a fear about lack of confidentiality. Despite many providers acknowledging negative mental health impacts following poor clinical outcomes, these additive layers of stigma limited their willingness to engage in formal mental health care. Conclusion This study demonstrates that stigma creates significant barriers to acceptance of mental health support among obstetric providers. Interventions to support providers will need to respect provider concerns without reinforcing the stigma associated with seeking mental health care.
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Affiliation(s)
- Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Bela J Parekh
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ruth Owusu-Antwi
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology/ Psychiatry Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Noah Newman
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Colin B Russell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Titus K Beyuo
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Michael Yeboah
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
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Klein LJ, Ayete-Nyampong JB, Williams AM, Harding LA, Oppong SA, Acra S, DeBaun MR, Imdad A. Epidemiology of Maternal Nutritional Status and Risk of Adverse Birth Outcomes in Undernourished Mothers with Sickle Cell Disease: A Systematic Review and Meta-Analysis Protocol. Methods Protoc 2023; 6:88. [PMID: 37736971 PMCID: PMC10514847 DOI: 10.3390/mps6050088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
In pregnancies complicated by sickle cell disease (SCD), the maternal-fetal dyad is at high risk for mortality and morbidity. In healthy pregnancies, maternal nutritional status is a critical factor for the healthy growth and development of the fetus. However, there are no reviews of the current research on the nutritional status of pregnant women with SCD and pregnancy outcomes. First, we aim to assess the burden of malnutrition in pregnant women with SCD. Next, we aim to systematically evaluate if pregnant women with SCD who have poor nutritional status are at increased risk for adverse birth outcomes compared to pregnant women with sickle cell disease and normal nutritional status. We will systematically search multiple electronic databases. Our exposure is pregnant women with SCD and poor nutritional status. The primary outcomes of interest include low birth weight (categorical) and birth weight z-scores (continuous). We will also evaluate maternal and perinatal outcomes as secondary outcomes. We will evaluate the risk of bias and overall certainty of evidence with Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I), and the overall evidence will be assessed using Grading of Recommendation Assessment, Development, and Evaluation (GRADE) criteria. We will pool findings with a meta-analysis if sufficient homogeneity exists among studies. Findings will be published in a peer-reviewed journal and disseminated to SCD advocacy groups. PROSPERO registration number: 429412.
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Affiliation(s)
- Lauren J. Klein
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN 37232, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | | | - Annette M. Williams
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lori A. Harding
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra P.O. Box 77, Ghana;
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra P.O. Box 77, Ghana
| | - Sari Acra
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN 37232, USA
| | - Michael R. DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Aamer Imdad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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Beyuo TK, Lawrence ER, Oppong SA, Kobernik EK, Amoakoh-Coleman M, Grobbee DE, Browne JL, Bloemenkamp KWM. Impact of antenatal care on severe maternal and neonatal outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. Pregnancy Hypertens 2023; 33:46-51. [PMID: 37586135 DOI: 10.1016/j.preghy.2023.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To explore how specific measures of antenatal care utilization are associated with outcomes in pregnancies complicated by preeclampsia and eclampsia in Ghana. STUDY DESIGN Participants were adult pregnant women with preeclampsia or eclampsia at a tertiary hospital in Ghana. Antenatal care utilization measures included timing of first visit, total visits, facility and provider type, and referral status. Antenatal visits were characterized by former and current World Health Organization recommendations, and by gestational age-based adequacy. MAIN OUTCOME MEASURES Composites of maternal complications and poor neonatal outcomes. Multivariate logistic regressions identified associations with antenatal care factors. RESULTS Among 1176 participants, median number of antenatal visits was 5.0 (IQR 3.0-7.0), with 72.9% attending ≥4 visits, 19.4% attending ≥8 visits, and 54.9% attending adequate visits adjusted for gestational age. Care was most frequently provided in a government polyclinic (n = 522, 47.2%) and by a midwife (n = 704, 65.1%). Odds of the composite maternal complications were lower in women receiving antenatal care at a tertiary hospital (aOR 0.47, p = 0.01). Odds of poor neonatal outcomes were lower in women receiving antenatal care at a tertiary hospital (aOR 0.56, p < 0.001), by a specialist Obstetrician/Gynecologist (aOR 0.58, p < 0.001), and who attended ≥8 visits (aOR 0.67, p = 0.04). Referred women had twice the odds of a maternal complication (aOR 2.12, p = 0.007) and poor neonatal outcome (aOR 1.68, p = 0.002). CONCLUSIONS Fewer complications are seen after receiving antenatal care at tertiary facilities. Attending ≥8 visits reduced poor neonatal outcomes, but didn't impact maternal complications. Quality, not just quantity, of antenatal care is essential.
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Affiliation(s)
- Titus K Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA.
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana.
| | - Emily K Kobernik
- Department of Learning Health Sciences, University of Michigan, 1111 East Catherine Street, Ann Arbor, MI 48109 USA
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - K W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
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Lawrence ER, Beyuo TK, Newman N, Klutse MA, Asempa JK, Pangori A, Moyer CA, Lori JR, Oppong SA. Ability and accuracy of patient-performed blood pressure monitoring among pregnant women in urban Ghana. AJOG Glob Rep 2023; 3:100243. [PMID: 37645652 PMCID: PMC10461245 DOI: 10.1016/j.xagr.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Patient-performed blood pressure monitoring in pregnancy is rarely performed in low- and middle-income country settings, including Ghana. The clinical efficacy of home blood pressure monitoring relies on a pregnant patient being able to independently execute the correct steps to position and use a blood pressure monitor and to achieve accurate blood pressure measurements. OBJECTIVE This study aimed to (1) assess whether pregnant women can correctly use an automatic blood pressure monitor to check their blood pressure before and after a brief training and (2) determine whether blood pressure values measured by pregnant women using an automatic monitor are similar to values measured by a healthcare provider using a standard clinic monitor. STUDY DESIGN This was a cross-sectional study conducted at the Korle Bu Teaching Hospital, a tertiary hospital in Accra, Ghana. Participants were adult pregnant women presenting for their first prenatal care visit. Data collection was performed by 2 Ghanaian physicians. Information on demographics, obstetrical history, and past medical history was collected. A brief training was provided on the correct use of the blood pressure monitor, including a verbal script, annotated photographs, and a hands-on demonstration. Pre- and posttraining assessments using a 9-item checklist of correct preparation, position, and use of an automatic blood pressure monitor were performed. Following a modified British Hypertension Society protocol, a series of 4 blood pressure measurements were taken, alternating between provider performed using a clinic monitor and patient performed using an automatic monitor intended for individual use and validated in pregnancy. RESULTS Among 176 participants, the mean age was 31.5 years (±5.6), and 130 (73.9%) were multiparous. Regarding socioeconomic characteristics, 128 (72.7%) were married, 171 (97.2%) had public insurance, and 87 (49.7%) had completed ≤9 years of formal education. Regarding clinical blood pressure issues, 19 (10.9%) had a history of a hypertensive disorder in a previous pregnancy, and 6 (3.4%) had chronic hypertension. Before receiving any training, 21 participants (12.1%) performed all 9 steps correctly to prepare, position, and use the automatic blood pressure monitor. Comparing pretraining vs posttraining ability, statistically significant increases were seen in the correct performance of each step and the mean number of steps performed correctly (6.1±1.8 vs 9.0±0.2, respectively; P<.001) and proportion performing all 9 steps correctly (12.1% vs 96.6%, respectively; P<.001). The mean difference between doctor-performed and patient-performed blood pressure measurements was 5.6±4.8 mm Hg for systolic blood pressure values and 3.4±3.08 mm Hg for diastolic blood pressure values, with most differences within 5 mm Hg for both systolic blood pressure values (102/176 [58.0%]) and diastolic blood pressure values (141/176 [80.1%]). CONCLUSION After a brief training, pregnant women in Ghana demonstrated that they are able to use an automatic blood pressure monitor to check their blood pressure correctly and accurately.
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Affiliation(s)
- Emma R. Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Titus K. Beyuo
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Noah Newman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Makafui Aku Klutse
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Joshua Kafui Asempa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Andrea Pangori
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Cheryl A. Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
| | - Jody R. Lori
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Lawrence, Ms Pangori, and Dr Moyer)
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana (Drs Beyuo and Oppong)
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana (Drs Beyuo, Klutse, Asempa, and Oppong)
- University of Michigan Medical School, Ann Arbor, MI (Mr Newman)
- University of Michigan School of Nursing, Ann Arbor, MI (Dr Lori)
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Piel FB, Rees DC, DeBaun MR, Nnodu O, Ranque B, Thompson AA, Ware RE, Abboud MR, Abraham A, Ambrose EE, Andemariam B, Colah R, Colombatti R, Conran N, Costa FF, Cronin RM, de Montalembert M, Elion J, Esrick E, Greenway AL, Idris IM, Issom DZ, Jain D, Jordan LC, Kaplan ZS, King AA, Lloyd-Puryear M, Oppong SA, Sharma A, Sung L, Tshilolo L, Wilkie DJ, Ohene-Frempong K. Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission. Lancet Haematol 2023; 10:e633-e686. [PMID: 37451304 DOI: 10.1016/s2352-3026(23)00096-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Frédéric B Piel
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - David C Rees
- Department of Paediatric Haematology, King's College London, King's College Hospital, London, UK
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence for Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Obiageli Nnodu
- Department of Haematology and Blood Transfusion, College of Health Sciences and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Brigitte Ranque
- Department of Internal Medicine, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris Centre, University of Paris Cité, Paris, France
| | - Alexis A Thompson
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell E Ware
- Division of Hematology and Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, and Sickle Cell Program, American University of Beirut, Beirut, Lebanon
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC, USA
| | - Emmanuela E Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania
| | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Connecticut, USA
| | - Roshan Colah
- Department of Haematogenetics, Indian Council of Medical Research National Institute of Immunohaematology, Mumbai, India
| | - Raffaella Colombatti
- Pediatric Oncology Hematology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Nicola Conran
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Fernando F Costa
- Department of Clinical Medicine, School of Medical Sciences, Center of Hematology and Hemotherapy (Hemocentro), University of Campinas-UNICAMP, Campinas, Brazil
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mariane de Montalembert
- Department of Pediatrics, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris Centre, Paris, France
| | - Jacques Elion
- Paris Cité University and University of the Antilles, Inserm, BIGR, Paris, France
| | - Erica Esrick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anthea L Greenway
- Department Clinical Haematology, Royal Children's Hospital, Parkville and Department Haematology, Monash Health, Clayton, VIC, Australia
| | - Ibrahim M Idris
- Department of Hematology, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - David-Zacharie Issom
- Department of Business Information Systems, School of Management, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | - Dipty Jain
- Department of Paediatrics, Government Medical College, Nagpur, India
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zane S Kaplan
- Department of Clinical Haematology, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Allison A King
- Departments of Pediatrics and Internal Medicine, Divisions of Pediatric Hematology and Oncology and Hematology, Washington University School of Medicine, St Louis, MO, USA
| | - Michele Lloyd-Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leon Tshilolo
- Institute of Biomedical Research/CEFA Monkole Hospital Centre and Official University of Mbuji-Mayi, Mbuji-Mayi, Democratic Republic of the Congo
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Kwaku Ohene-Frempong
- Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania, USA; Sickle Cell Foundation of Ghana, Kumasi, Ghana
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Kaba G, Stevenson A, Sakyi SA, Konney TO, Bhatia R, Titiloye NA, Oppong SA, Agyemang-Yeboah F, Cuschieri K, Graham SV. Diversity of cervicovaginal human papillomavirus (HPV) genotypes and naturally occurring E6/E7 DNA polymorphisms of HPV-16 in Ghana. Tumour Virus Res 2023; 15:200261. [PMID: 37179021 PMCID: PMC10209332 DOI: 10.1016/j.tvr.2023.200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/12/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023] Open
Abstract
Human papillomavirus (HPV) E6 and E7 oncogene expression is essential for cervical carcinogenesis. Evidence exists that E6/E7 variants may have different transforming activities while the risk of HPV-16 variants (A/D) differs by race/ethnicity. We determined the type-specific diversity of HPV infection in women with high grade cervical disease or cervical cancer in Ghana and investigated naturally occurring E6/E7 DNA variants in this population. HPV genotyping was carried out on 207 cervical swab samples collected from women referred to a gynaecology clinic at two teaching hospitals in Ghana. HPV-16, HPV-18 and HPV-45 were detected in 41.9%, 23.3% and 16.3% of cases respectively. HPV-16 E6/E7 DNA sequencing was performed in 36 samples. Thirty samples contained E6/E7 variants of the HPV-16-B/C lineage. 21/36 samples were of the HPV-16C1 sublineage variant and all contained the E7 A647G(N29S) single nucleotide polymorphism (SNP). This study reveals the diversity of E6/E7 DNA and the dominance of HPV16 B/C variants in cervicovaginal HPV infection in Ghana. Type-specific HPV diversity analysis indicates that most Ghanaian cervical disease cases are vaccine preventable. The study provides an important baseline from which for the impact of vaccine and antivirals on clinically relevant HPV infection and associated disease can be measured.
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Affiliation(s)
- Gladys Kaba
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Andrew Stevenson
- Centre for Virus Research, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, Garscube Estate, University of Glasgow, Scotland, G61 1QH, UK
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Okpoti Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ramya Bhatia
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Scotland, EH16 4SA, UK
| | - Nicholas A Titiloye
- Department of Pathology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology Kumasi, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital and University of Ghana Medical School, Accra, Ghana
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, University of Edinburgh, Scotland, EH16 4SA, UK
| | - Sheila V Graham
- Centre for Virus Research, School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, Garscube Estate, University of Glasgow, Scotland, G61 1QH, UK.
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Swarray-Deen A, Attah DA, Sefogah PE, Oduro NE, Nuamah HG, Nuamah MA, Adzadi C, Oppong SA. Corrigendum: Perinatal autopsy in Ghana: healthcare workers knowledge and attitude. Front Glob Womens Health 2023; 4:1196549. [PMID: 37325794 PMCID: PMC10266093 DOI: 10.3389/fgwh.2023.1196549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fgwh.2022.1021474.].
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Affiliation(s)
- Alim Swarray-Deen
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Dzifa A. Attah
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Promise E. Sefogah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Nana E. Oduro
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Hanson G. Nuamah
- Department of Epidemiology & Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mercy A. Nuamah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Catherine Adzadi
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
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9
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Atluri N, Beyuo TK, Oppong SA, Moyer CA, Lawrence ER. Challenges to diagnosing and managing preeclampsia in a low-resource setting: A qualitative study of obstetric provider perspectives from Ghana. PLOS Glob Public Health 2023; 3:e0001790. [PMID: 37130091 PMCID: PMC10153692 DOI: 10.1371/journal.pgph.0001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
Preeclampsia is a leading cause of global maternal morbidity and mortality. The greatest burden of disease is in low- and middle-income countries where healthcare providers face significant, understudied, challenges to diagnosing and managing preeclampsia. This qualitative study used semi-structured interviews to explore the challenges of diagnosing and managing preeclampsia from the perspectives of obstetric doctors. Participants were doctors who provide obstetric care at the Korle Bu Teaching Hospital, an urban tertiary hospital in Ghana. Purposive sampling identified doctors with meaningful experience in managing patients with preeclampsia. Thematic saturation of data was used to determine sample size. Interviews were audio recorded, transcribed verbatim, coded using an iteratively-developed codebook, and thematically analyzed. Interviews were conducted with 22 participants, consisting of 4 house officers, 6 junior obstetrics/gynecology residents, 8 senior obstetrics/gynecology residents, and 4 obstetrics/gynecology consultants. Doctors identified critical challenges faced at the patient, provider, and systems levels in detecting and managing preeclampsia, each of which mediates the health outcomes of a pregnancy complicated by preeclampsia. Challenges centered around three overarching global themes: (1) low education levels and health literacy among women, (2) insufficient number of healthcare providers highly trained in obstetric care, and (3) inadequate health infrastructure to support critically ill patients with preeclampsia. Recognizing and addressing root challenges to preeclampsia care has great potential to improve outcomes in pregnancies complicated by preeclampsia in low-resource settings.
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Affiliation(s)
- Namratha Atluri
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Titus K. Beyuo
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra, Ghana
| | - Cheryl A. Moyer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emma R. Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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10
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Moyer CA, Lawrence ER, Beyuo TK, Tuuli MG, Oppong SA. Stalled progress in reducing maternal mortality globally: what next? Lancet 2023; 401:1060-1062. [PMID: 36924780 DOI: 10.1016/s0140-6736(23)00518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Cheryl A Moyer
- University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - Emma R Lawrence
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Titus K Beyuo
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Methodius G Tuuli
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
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Mocking M, Adu-Bonsaffoh K, Osman KA, Tamma E, Ruiz AM, van Asperen R, Oppong SA, Kleinhout MY, Gyamfi-Bannerman C, Browne JL. Causes, survival rates, and short-term outcomes of preterm births in a tertiary hospital in a low resource setting: An observational cohort study. Front Glob Womens Health 2023; 3:989020. [PMID: 36817873 PMCID: PMC9932588 DOI: 10.3389/fgwh.2022.989020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and long-term disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana. Materials and methods An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test. Results Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28-31 weeks), and 130 (73%) moderate to late preterm (GA 32-37 weeks) births. Most deliveries (n = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy (n = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% (n = 52/62) at six weeks corrected age in this group. Most infants (90%, n = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis. Conclusions The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.
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Affiliation(s)
- Martina Mocking
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands,Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana,Correspondence: Kwame Adu-Bonsaffoh kadu-bonsaffoh@@ug.edu.gh
| | - Kwabena A. Osman
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Evelyn Tamma
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Alexa M. Ruiz
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ruth van Asperen
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego, San Diego CA, United States
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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12
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Atluri N, Beyuo TK, Oppong SA, Compton SD, Moyer CA, Lawrence ER. Benefits and barriers of home blood pressure monitoring in pregnancy: perspectives of obstetric doctors from a Ghanaian tertiary hospital. BMC Pregnancy Childbirth 2023; 23:42. [PMID: 36658509 PMCID: PMC9854160 DOI: 10.1186/s12884-023-05363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Delayed diagnosis of preeclampsia contributes to maternal morbidity and mortality. Patient-performed home blood pressure monitoring facilitates more frequent monitoring and earlier diagnosis. However, challenges may exist to implementation in low- and middle income-countries. METHODS This cross-sectional mixed methods study evaluated obstetric doctors' perspectives on the benefits of and barriers to the implementation of home blood pressure monitoring among pregnant women in Ghana. Participants were doctors providing obstetric care at Korle Bu Teaching Hospital. Electronic surveys were completed by 75 participants (response rate 49.3%), consisting of demographics and questions on attitudes and perceived benefits and challenges of home BP monitoring. Semi-structured interviews were completed by 22 participants to expand on their perspectives. RESULTS Quantitative and qualitative results converged to highlight that the current state of blood pressure monitoring among pregnant women in Ghana is inadequate. The majority agreed that delayed diagnosis of preeclampsia leads to poor health outcomes in their patients (90.6%, n = 68) and earlier detection would improve outcomes (98.7%, n = 74). Key qualitative benefits to the adoption of home blood pressure monitoring were patient empowerment and trust of diagnosis, more quantity and quality of blood pressure data, and improvement in systems-level efficiency. The most significant barriers were the cost of monitors, lack of a communication system to convey abnormal values, and low health literacy. Overall, doctors felt that most barriers could be overcome with patient education and counseling, and that benefits far outweighed barriers. The majority of doctors (81.3%, n = 61), would use home BP data to inform their clinical decisions and 89% (n = 67) would take immediate action based on elevated home BP values. 91% (n = 68) would recommend home BP monitoring to their pregnant patients. CONCLUSION Obstetric doctors in Ghana strongly support the implementation of home blood pressure monitoring, would use values to inform their clinical management, and believe it would improve patient outcomes. Addressing the most significant barriers, including cost of blood pressure monitors, lack of a communication system to convey abnormal values, and need for patient education, is essential for successful implementation.
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Affiliation(s)
- Namratha Atluri
- grid.214458.e0000000086837370University of Michigan Medical School, 1301 Catherine St, MI 48109 Ann Arbor, USA
| | - Titus K. Beyuo
- grid.8652.90000 0004 1937 1485Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra, P.O. Box 4236, Ghana
| | - Samuel A. Oppong
- grid.8652.90000 0004 1937 1485Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra, P.O. Box 4236, Ghana
| | - Sarah D. Compton
- grid.214458.e0000000086837370Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, 48109 Ann Arbor, MI USA
| | - Cheryl A. Moyer
- grid.214458.e0000000086837370Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, 48109 Ann Arbor, MI USA
| | - Emma R. Lawrence
- grid.214458.e0000000086837370Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr, 48109 Ann Arbor, MI USA
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13
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Thompson NN, Mumuni K, Oppong SA, Sefogah PE, Nuamah MA, Nkyekyer K. Effect of intimate partner violence in pregnancy on maternal and perinatal outcomes at the Korle Bu teaching hospital, Ghana: An observational cross sectional study. Int J Gynaecol Obstet 2023; 160:297-305. [PMID: 35900103 DOI: 10.1002/ijgo.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/03/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the association between intimate partner violence and pregnancy outcomes. METHODS This was a descriptive study of sociodemographic characteristics of participants, their partners and intimate partner violence. Participants' delivery records were reviewed for additional medical and obstetric information and abused women and their neonates followed until discharge. χ2 and Student t test were used to assess associations, followed by logistic regression with odds ratio (OR) and 95% confidence intervals (CI). A value of P less than 0.05 was considered statistically significant. RESULTS The study included 270 participants of whom 84 (31.1%) reported experiencing domestic violence during pregnancy. One hundred and fourteen (42%) had experienced domestic violence pre-pregnancy and 69 (60.5%) of these women experienced further domestic violence during pregnancy. Emotional violence was commonest 80/270 (29.6%) and no sexual violence was reported. Domestic violence declined from 42% (pre-pregnancy) to 31.1% (in-pregnancy) (P = 0.009). Risk factors during pregnancy were young age (15-24 years; OR 5.8, 95% CI1.65-20.38), nulliparity (OR 3.75, 95% CI 1.90-7.41), and partner's alcohol consumption (OR 5.04, 95% CI 2.50-10.13). Associated outcomes included late prenatal booking, gestational hypertension, and cephalopelvic disproportion. CONCLUSION We found high prevalence of domestic violence during pregnancy, preponderance of emotional abuse, and decline of physical abuse. Nulliparity, younger age, and partner's alcohol consumption predicted abuse. Late-booking, gestational hypertension, cephalopelvic disproportion, and fetal distress were associated.
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Affiliation(s)
- Ngozi N Thompson
- Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kareem Mumuni
- Department of Obstetrics and Gynecology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Promise E Sefogah
- Department of Obstetrics and Gynecology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mercy A Nuamah
- Department of Obstetrics and Gynecology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kobinah Nkyekyer
- Department of Obstetrics and Gynecology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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15
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Adu-Amankwah A, Bellad MB, Benson AM, Beyuo TK, Bhandankar M, Charanthimath U, Chisembele M, Cole SR, Dhaded SM, Enweronu-Laryea C, Freeman BL, Freeman NLB, Goudar SS, Jiang X, Kasaro MP, Kosorok MR, Luckett D, Mbewe FM, Misra S, Mutesu K, Nuamah MA, Oppong SA, Patterson JK, Peterson M, Pokaprakarn T, Price JT, Pujar YV, Rouse DJ, Sebastião YV, Spelke MB, Sperger J, Stringer JSA, Tuuli MG, Valancius M, Vwalika B. Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study. Gates Open Res 2022; 6:115. [PMID: 36636742 PMCID: PMC9822935 DOI: 10.12688/gatesopenres.13716.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.
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Affiliation(s)
- Amanda Adu-Amankwah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mrutunjaya B. Bellad
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Aimee M. Benson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Titus K. Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Manisha Bhandankar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Umesh Charanthimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Maureen Chisembele
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Stephen R. Cole
- Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Sangappa M. Dhaded
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Christabel Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bethany L. Freeman
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Nikki L. B. Freeman
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Margaret P. Kasaro
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,UNC Global Projects Zambia, LLC, Lusaka, Zambia
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Daniel Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | | | - Sujata Misra
- Fakir Mohan Medical College and Hospital, Balasore, India
| | - Kunda Mutesu
- Women and Newborn Hospital, University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Mercy A. Nuamah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Jackie K. Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Marc Peterson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Joan T. Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, India
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Yuri V. Sebastião
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - M. Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - John Sperger
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Jeffrey S. A. Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, 02903, USA
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA,Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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Swarray-Deen A, Attah DA, Sefogah PE, Oduro NE, Nuamah HG, Nuamah MA, Adzadi C, Oppong SA. Perinatal autopsy in Ghana: Healthcare workers knowledge and attitude. Front Glob Womens Health 2022; 3:1021474. [PMID: 36589149 PMCID: PMC9794746 DOI: 10.3389/fgwh.2022.1021474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background Perinatal mortality refers to stillbirths and early neonatal deaths. Stillbirth, the death of a foetus from 28 weeks or with a birth weight below 1,000 g, and early neonatal deaths, the death of a new-born within 24 h of delivery, are among the most distressing global health problems, with approximately 2 million stillbirths occurring annually. Although a post-mortem examination of the stillborn baby is essential for understanding and learning the cause of stillbirth, many couples decline the procedure. Sub-Saharan Africa has one of the highest stillbirth rates in the world, yet there is a dearth of studies on post-mortem uptake from the region. Aim To explore healthcare professionals' views and perceptions of perinatal autopsy in Ghana. Methods Mixed-method approach consisted of semi-structured interviews and an electronic cross-sectional survey to evaluate the views and perceptions of healthcare professionals at Korle-Bu Teaching Hospital on autopsy for stillbirths and early neonatal deaths. Descriptive quantitative data were summarised in frequencies and percentages, and statistical results and descriptions were tabulated and coded in terms of types of barriers. For the qualitative aspect, the audio-taped interviews were transcribed, themes generated, and direct quotes and descriptions were coded for all knowledge, beliefs, attitudes and practices concerning the barriers and facilitators for post-mortem. Results Ninety-nine healthcare professionals participated. No participant had formal training regarding counselling for perinatal autopsy and 40% had " no idea " who is responsible for counselling and obtaining consent for a perinatal autopsy. Forty-four percent (44%) of the participants knew of only the "Conventional/ Full" autopsy and <4% were aware of less invasive methods of performing an autopsy. Qualitative data showed healthcare worker influence, religious and financial considerations impede the implementation of perinatal autopsies. Despite the low uptake of perinatal autopsies, interviews from healthcare workers suggest acceptance rates would improve if parents knew about different options, especially less invasive procedures. Conclusion At Ghana's largest referral centre, perinatal autopsy counselling and uptake are at extremely low levels. Most healthcare professionals have little knowledge, skills, and capacity to advise parents regarding perinatal autopsies. Training is needed to update the workforce on recommended perinatal autopsy practices.
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Affiliation(s)
- Alim Swarray-Deen
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Dzifa A. Attah
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Promise E. Sefogah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana,Correspondence: Promise E. Sefogah
| | - Nana E. Oduro
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Hanson G. Nuamah
- Department of Epidemiology & Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mercy A. Nuamah
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Catherine Adzadi
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics & Gynaecology, University of Ghana Medical School, Accra, Ghana
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17
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Beyuo TK, Lawrence ER, Kobernik EK, Oppong SA. Clinical presentation and predictors of eclampsia among women with hypertensive disorders of pregnancy in Ghana. Pregnancy Hypertens 2022; 30:171-176. [DOI: 10.1016/j.preghy.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
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18
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Lawrence ER, Beyuo T, Kobernik EK, Moyer CA, Oppong SA. A Comparative Analysis of Neonatal Outcomes in Pregnancies Complicated by Preeclampsia and Eclampsia in Ghana. AJOG Global Reports 2022; 2:100061. [PMID: 36276785 PMCID: PMC9563915 DOI: 10.1016/j.xagr.2022.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Worldwide, hypertensive disorders of pregnancy are a serious complication of pregnancy, and contribute to poor maternal and neonatal outcomes. The most significant consequences of hypertensive disorders of pregnancy are observed in sub-Saharan Africa, where neonatal outcomes have not been fully described. Understanding relationships between maternal disease severity and neonatal outcomes can guide patient counseling and allow the targeting of limited resources to the most at-risk neonates. OBJECTIVE To describe and compare neonatal outcomes in pregnancies complicated by preeclampsia with severe features and eclampsia. STUDY DESIGN This study is a secondary analysis of data collected as part of a randomized controlled trial at the Korle-Bu Teaching Hospital in Ghana. Participants were adult pregnant women with preeclampsia with severe features or eclampsia and their neonates. Data include prospectively collected medical and obstetrical history, intrapartum events, and neonatal outcomes. The main outcome of this secondary analysis was a composite of poor neonatal outcomes, defined as 1 or more of the following: stillbirth, very low birthweight (<1500 g), 5-minute Apgar score <7, neonatal intensive care unit admission, or a live birth with a subsequent death before discharge. RESULTS Median gestational age at delivery was 36.6 weeks (interquartile range, 33.3–38.9). Median birthweight was 2.3 kg (interquartile range, 1.6–3.0), with 227 (19.0%) birthweights <1500 g. There were 162 neonates (15.5%) with an Apgar score <7 at 5 minutes and 144 (11.9%) were stillbirths. Of live births, half (n=524, 50.3%) were admitted to the neonatal intensive care unit and 7.9% (n=91) died before discharge. A composite of poor neonatal outcomes was experienced by 58.2% (n=707) of neonates and was twice as likely with a maternal diagnosis of eclampsia (odds ratio, 1.91; P=.04). For each additional week of gestational age, the probability of a poor neonatal outcome was reduced by 39% (odds ratio, 0.61; P<.0001). CONCLUSION Poor neonatal outcomes were experienced by more than half of pregnancies complicated by preeclampsia with severe features or eclampsia. Even after controlling for gestational age, pregnancies complicated by eclampsia were twice as likely to have poor neonatal outcomes.
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19
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Beyuo TK, Lawrence ER, Kobernik EK, Oppong SA. A novel 12-hour versus 24-hour magnesium sulfate regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): A randomized controlled trial. Int J Gynaecol Obstet 2022; 159:495-504. [PMID: 35304745 DOI: 10.1002/ijgo.14181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We compared the efficacy of a 12-h versus 24-h regimen of intramuscular magnesium sulfate in the management of eclampsia and preeclampsia. METHODS This is an open-labeled parallel randomized controlled trial conducted in Accra, Ghana from November 2018 to November 2020. Participants were adult pregnant women admitted to the Korle Bu Teaching Hospital (KBTH) with a diagnosis of antepartum, intrapartum, or postpartum eclampsia or preeclampsia with severe features, having received no more than a loading dose of magnesium sulfate prior to admission at KBTH. Participants in the standard 24-h group received a loading dose of magnesium sulfate 4 g intravenous and 10 g intramuscular (5 g in each buttock) followed by six, 5 g intramuscular maintenance doses over 24 h. Participants in the 12-h intervention group received the same loading dose followed by three, 5 g intramuscular maintenance doses over 12 h. The primary outcome was occurrence of seizure after completion of the assigned magnesium sulfate regimen. Secondary outcomes were magnesium sulfate toxicity, magnesium sulfate side effects, maternal outcomes (mode of delivery, duration of inpatient admission, duration of urethral catheterization), maternal complications (pulmonary edema, acute kidney injury, intensive care unit admission, death), and neonatal outcomes. RESULTS Among 1176 total participants, we found no difference in occurrence of seizure after completion of the assigned regimen in the 24-h group (n = 5, 0.9%) versus the 12-h group (n = 2, 0.3%), P = 0.29; RR 0.40, 95% CI 0.08, 2.04), or in occurrence of seizure any time after enrollment (n = 9, 1.5% vs. n = 5, 0.9%, P = 0.28, RR 0.55, 95% CI 0.19-1.64). Participants in the 12-h group had a shorter duration of inpatient admission (9.4 ± 8.8 vs. 7.7 ± 6.5 days, P = 0.0009) and urethral catheterization (2.1 ± 1.0 vs. 1.9 ± 1.3 days, P < 0.0001). Rates of side effects from magnesium sulfate were lower in the 12-h group: pain at the injection site (94.8% (n = 548) vs. 91.5% (n = 540), P = 0.03), inflammation (62.2% (n = 358) vs. 40.0% (n = 237), P < 0.0001), and bleeding or bruising at the injection site (25.1% (n = 144) vs. 14.4% (n = 85), P < 0.0001). CONCLUSIONS Compared with 24 h, 12 h of intramuscular magnesium sulfate showed similar rates of seizures, with fewer side effects and shorter inpatient admission. TRIAL REGISTRATION Prospective registration was with Pan African Clinical Trial Registry (PACTR201811515303983): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4690.
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Affiliation(s)
- Titus K Beyuo
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.,Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily K Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.,Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
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20
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Joshi A, Beyuo TK, Oppong SA, Moyer CA, Lawrence ER. 'I don't really understand this BP': Women's knowledge, attitudes, and experiences with preeclampsia in Ghana. PLOS Glob Public Health 2022; 2:e0000121. [PMID: 36962267 PMCID: PMC10022332 DOI: 10.1371/journal.pgph.0000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
Preeclampsia and eclampsia are common and serious complications of pregnancies, often presenting as obstetric emergencies. In low- and middle-income countries, limited numbers of healthcare providers and a high volume of critically ill patients can negatively impact provider communication and counseling. Lack of knowledge or awareness of preeclampsia and eclampsia among pregnant women can lead to delays in health seeking behavior. Our study uses grounded theory to explore patients' experience of preeclampsia and eclampsia in a low-resource setting. Participants were postpartum women diagnosed with preeclampsia or eclampsia at Korle Bu Teaching Hospital in Ghana. Interviews consisted of semi-structured, open-ended questions regarding participant understanding of their diagnosis of preeclampsia and eclampsia; counseling from their healthcare providers; and experiences with their delivery, monitoring, and treatment. Qualitative thematic analysis was performed according to the Attride-Sterling analytical framework, using NVivo 12. A total of 45 women were interviewed, 88.9% with preeclampsia and 11.1% with eclampsia. Major themes identified include participants' low general knowledge of their diagnosis, inadequate counseling from healthcare providers, and resulting emotional distress. Women desire more information regarding their diagnosis and associate their health-seeking behaviors with counseling they receive from healthcare providers. Women also acknowledge the systemic barriers that make patient care and counseling challenging for providers, especially in low- and middle-income countries. These findings highlight the need for improved models of counseling and health education for women with pregnancies complicated by preeclampsia and eclampsia.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Titus K Beyuo
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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21
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Hayfron‐Benjamin CF, Asare EV, Boafor T, Olayemi E, Dei‐Adomakoh Y, Musah L, Mensah E, Beyuo T, Kassim AA, Rodeghier M, DeBaun MR, Oppong SA. Low FEV 1 is associated with fetal death in pregnant women with sickle cell disease. Am J Hematol 2021; 96:E303-E306. [PMID: 33984165 DOI: 10.1002/ajh.26236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Charles F. Hayfron‐Benjamin
- Department of Physiology University of Ghana Medical School Accra Ghana
- Department of Anesthesia Korle‐Bu Teaching Hospital Accra Ghana
| | - Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics, Korle‐Bu Accra Ghana
- Department of Hematology Korle‐Bu Teaching Hospital Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology Korle‐Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics, Korle‐Bu Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Yvonne Dei‐Adomakoh
- Ghana Institute of Clinical Genetics, Korle‐Bu Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Latif Musah
- Department of Physiology University of Ghana Medical School Accra Ghana
| | - Enoch Mensah
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Titus Beyuo
- Department of Obstetrics and Gynecology Korle‐Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
| | - Adetola A. Kassim
- Vanderbilt‐Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center Nashville Tennessee USA
| | | | - Michael R. DeBaun
- Vanderbilt‐Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center Nashville Tennessee USA
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology Korle‐Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
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22
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Segbefia CI, Goka B, Welbeck J, Amegan-Aho K, Dwuma-Badu D, Rao S, Salifu N, Oppong SA, Odei E, Ohene-Frempong K, Odame I. Implementing newborn screening for sickle cell disease in Korle Bu Teaching Hospital, Accra: Results and lessons learned. Pediatr Blood Cancer 2021; 68:e29068. [PMID: 33890391 DOI: 10.1002/pbc.29068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early diagnosis of sickle cell disease (SCD) through newborn screening (NBS) is a cost-effective intervention, which reduces morbidity and mortality. In sub-Saharan Africa (SSA) where disease burden is greatest, there are no universal NBS programs and few institutions have the capacity to conduct NBS. We determined the feasibility and challenges of implementing NBS for SCD in Ghana's largest public hospital. PROCEDURE The SCD NBS program at Korle Bu Teaching Hospital (KBTH) is a multiyear partnership between the hospital and the SickKids Center for Global Child Health, Toronto, being implemented in phases. The 13-month demonstration phase (June 2017-July 2018) and phase one (November 2018-December 2019) focused on staff training and the feasibility of universal screening of babies born in KBTH. RESULTS During the demonstration phase, 115 public health nurses and midwives acquired competency in heel stick for dried blood spot sampling. Out of 9990 newborns, 4427 babies (44.3%) were screened, of which 79 (1.8%) were identified with presumptive SCD (P-SCD). Major challenges identified included inadequate nursing staff to perform screening, shortage of screening supplies, and delays in receiving screening results. Strategies to overcome some of the challenges were incorporated into phase one, resulting in increased screening coverage to 83.7%. CONCLUSIONS Implementing NBS for SCD in KBTH presented challenges with implications on achieving and sustaining universal NBS in KBTH and other settings in SSA. Specific steps addressing these challenges comprehensively will help build on the modest initial gains, moving closer toward a sustainable national NBS program.
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Affiliation(s)
- Catherine I Segbefia
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Bamenla Goka
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Jennifer Welbeck
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Sudha Rao
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Eric Odei
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Isaac Odame
- Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Haematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Boafor TK, Ntumy MY, Asah-Opoku K, Sepenu P, Ofosu B, Oppong SA. Maternal mortality at the Korle Bu Teaching Hospital, Accra, Ghana: A five-year review. Afr J Reprod Health 2021; 25:56-66. [PMID: 34077111 DOI: 10.29063/ajrh2021/v25i1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990's, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73- 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths.
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Affiliation(s)
- Theodore K Boafor
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra Ghana.,Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
| | - Michael Y Ntumy
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra Ghana.,Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra Ghana.,Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
| | - Perez Sepenu
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
| | - Bernice Ofosu
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Korle Bu, Accra Ghana.,Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra Ghana
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Nsaful J, Vanderpuye V, Scott AA, Dedey F, Oppong SA, Appiah-Danquah R, Damale N, Fenu B, Wordui T, Yarney J, Clegg-Lamptey JN. Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases. Ecancermedicalscience 2020; 14:1140. [PMID: 33281932 PMCID: PMC7685764 DOI: 10.3332/ecancer.2020.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the commonest female cancer worldwide and the most common malignancy during pregnancy. The current management of breast cancer is based on patient and tumour characteristics, preferences and disease stage. In pregnancy-associated breast cancer, the gestational age influences treatment options. Sequencing of therapies is guided by safe imaging options, timing of delivery and prognosis. Systemic therapy options in the neoadjuvant, adjuvant and palliative settings are limited due to safety concerns of the unborn foetus. In resource-constrained regions, the application of safe options may be challenging. This paper reports four of such cases managed in Ghana using a multidisciplinary approach and local resource-appropriate evidence-based practices. Maternal and foetal outcomes were acceptable with none resulting in termination of pregnancy.
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Affiliation(s)
- Josephine Nsaful
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Aba Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Florence Dedey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Rita Appiah-Danquah
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Nelson Damale
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Benjamin Fenu
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Theodore Wordui
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joe Nat Clegg-Lamptey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
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Joshi A, Beyuo T, Oppong SA, Moyer CA, Lawrence ER. Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana. BMC Pregnancy Childbirth 2020; 20:625. [PMID: 33059625 PMCID: PMC7566025 DOI: 10.1186/s12884-020-03316-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients' perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale ('Counseling Composite Score'). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points ('Preeclampsia/Eclampsia Knowledge Score' (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p < 0.001) and higher level of education (β 1.3, SE 0.48, p = 0.008). CONCLUSIONS Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01655, USA
| | - Titus Beyuo
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana.
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana.
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Joshi A, Beyuo T, Oppong SA, Owusu A, Moyer CA, Lawrence E. Exploring self-blame and the perceived causes of preeclampsia in urban Ghana. Int J Gynaecol Obstet 2020; 152:280-281. [PMID: 32860718 DOI: 10.1002/ijgo.13358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Titus Beyuo
- University of Ghana School of Medicine and Dentistry, Accra, Ghana.,Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Accra, Ghana.,Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Andrews Owusu
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emma Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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27
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Swarray-Deen A, Nkyekyer K, Seffah JD, Mumuni K, Mensah-Brown SA, Tuuli MG, Oppong SA. Cerebro-placental ratio as a prognostic factor of fetal outcome in pregnancy complicated by maternal sickle cell disease. Int J Gynaecol Obstet 2020; 150:248-253. [PMID: 32415985 DOI: 10.1002/ijgo.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the role of the cerebro-placental ratio (CPR) in predicting adverse fetal outcomes among women with sickle cell disease (SCD). METHODS A prospective cohort study at Korle-Bu Teaching Hospital, Accra, Ghana, between January and June 2016. Pregnant women with SCD at 34 gestational weeks or more underwent weekly fetal umbilical and middle cerebral artery Doppler assessment until delivery. Participants were categorized into two study arms based on CPR (<1.1 or ≥1.1). The primary outcome, a composite of adverse perinatal outcomes including intrauterine growth restriction, stillbirth, low birthweight, and neonatal intensive care unit admission, was compared between groups. RESULTS Overall, 48 pregnant women with SCD were enrolled, and 5 had a fetus with CPR less than 1.1. Low CPR (<1.1) had a sensitivity and specificity of 29.4% and 100%, respectively, for predicting composite adverse perinatal outcomes. Sensitivity and specificity were, respectively, 100% and 93.5% for predicting stillbirth, and 40.2% and 97.4% for predicting low birthweight. Perinatal outcomes did not differ between the two major sickle cell genotypes (hemoglobin SS and hemoglobin SC). CONCLUSIONS Among women with SCD, CPR less than 1.1 was associated with adverse perinatal outcomes, particularly low birthweight and stillbirth.
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Affiliation(s)
- Alim Swarray-Deen
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Kobinah Nkyekyer
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Joseph D Seffah
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Kareem Mumuni
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | | | - Methodius G Tuuli
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel A Oppong
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
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Abstract
Preterm birth is highly prevalent in Ghana. It is a major public health concern because of the high burden as well as the associated immediate and long-term consequences including increased healthcare cost. Studies conducted in high-income countries may not be sufficiently generalizable in our context. Locally generated evidence-based interventions will be indispensable in improving the clinical management and prevention of preterm birth in the country. However, there are limited published literature on preterm birth and prematurity in the country. This review seeks to discuss the major challenges associated with preterm birth research in Ghana and proposes evidence-based strategies to improve biomedical and epidemiological research on preterm birth and prematurity. The limited high quality preterm birth research is partly attributable to a variety of challenges related to accurate gestational age estimation, research training, capacity and support including funding, efficient ethics committees, local and international collaboration as well as effective health management information systems. Other related challenges include unavailability of reliable internet connectivity, poor compensation for researchers and lack of conductive research environment. There is the need to expedite advocacy on implementation of practical interventions and strategies aimed at increasing high quality research in the area of preterm birth and prematurity in the country. A paradigm shift in preterm birth research with appropriate integration of concerted multidisciplinary research groups should be constituted to put basic science research to clinical practice as well as the prevention of preterm birth in the country.
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Affiliation(s)
- K Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - S A Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - E T Dassah
- School of Public Health, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Obstetrics & Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - J D Seffah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Bell AJ, Arku Z, Bakari A, Oppong SA, Youngblood J, Adanu RM, Moyer CA. 'This sickness is not hospital sickness': a qualitative study of the evil eye as a source of neonatal illness in Ghana. J Biosoc Sci 2020; 52:159-167. [PMID: 31203826 PMCID: PMC6917980 DOI: 10.1017/s0021932019000312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous research has described the evil eye as a source of illness for pregnant women and their newborns. This study sought to explore the perceptions of the evil eye among mothers whose newborns had experienced a life-threatening complication across three regions of Ghana. As part of a larger, quantitative study, trained research assistants identified pregnant and newly delivered women (and their newborns) who had survived a life-threatening complication at three tertiary care hospitals in southern Ghana to participate in open-ended, qualitative interviews about their experiences in March-August 2015. All interviews were audio-recorded and transcribed verbatim into English and analysis using the constant comparative method of theme generation. A total of 37 mothers were interviewed, 20 about neonatal illnesses and 17 about maternal illnesses. Six of the 20 mothers interviewed about their newborn's illnesses spoke at length about the evil eye being a potential cause of newborn illness. The evil eye was described in a variety of terms, but commonalities included a person looking at a pregnant woman, her newborn baby, the baby's clothes and even the mother's food, causing harm, even unintentionally. Prevention required mothers covering themselves while pregnant and keeping the baby away from others until it was old enough to ward off the evil eye. Treatment required traditional medicine, yet some indicated that allopathic medicine could help. The evil eye appears to serve a social control mechanism, encouraging pregnant women to dress modestly, stay indoors as much as possible and behave appropriately. The evil eye is a pervasive, universally understood phenomenon across three regions of Ghana, even amongst a hospitalized population receiving allopathic health care for life-threatening complications of childbirth. Understanding the role of the evil eye in newborn illness attribution is important for clinicians, researchers and programmatic staff to effectively address barriers to care seeking.
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MESH Headings
- Adolescent
- Adult
- Cross-Sectional Studies
- Culture
- Female
- Ghana/epidemiology
- Hospitals, Teaching
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/mortality
- Infant, Newborn, Diseases/prevention & control
- Interpersonal Relations
- Medicine, African Traditional/methods
- Parturition
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications/etiology
- Pregnancy Complications/mortality
- Pregnancy Complications/prevention & control
- Qualitative Research
- Tertiary Care Centers
- Young Adult
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Affiliation(s)
| | - Zelda Arku
- University of Cape Coast, Cape Coast, Ghana
| | - Ashura Bakari
- Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - Samuel A. Oppong
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Oppong SA, Torto M, Beyuo T. Risk factors and pregnancy outcome in women aged over 40 years at Korle-Bu Teaching Hospital in Accra, Ghana. Int J Gynaecol Obstet 2020; 149:56-60. [PMID: 31837234 DOI: 10.1002/ijgo.13087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/14/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the risk factors and pregnancy outcomes in women aged 40 years and older at the Korle-Bu Teaching Hospital, Accra, Ghana. METHODS A descriptive case-control study comparing women aged 40 years and older at the time of delivery with those between 20 and 34 who delivered at the Korle-Bu Teaching Hospital between April 1, 2014 and March 31, 2015. Data were collected using interviewer-administered questionnaires and supplemented with information from patients' medical records. A multivariate logistic regression was used to estimate the odds ratio and the 95% confidence interval of various risk factors and complications associated with delivery in women aged 40 years or older. Statistical significance was set at P<0.05. RESULTS There were 339 women in the study of which 113 were aged 40 years or older and 226 were aged between 20 and 34 years. Delivery at age 40 years or older was associated with grand multiparity, and unplanned and undesirable pregnancy. There was a higher incidence of gestational diabetes (7.1% vs 2.2%, P=0.036), cesarean delivery (70.1% vs 57.1%, P=0.018), and venous thromboembolism (VTE) (7.1% vs 1.3%, P=0.008) among women older than 40 years. VTE risk was increased sixfold in the women older than 40 years compared with the younger ones. CONCLUSION Women delivering after age 40 years had a higher incidence of gestational diabetes, cesarean delivery, and VTE compared with younger women. VTE risk increased sixfold in the older women.
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Affiliation(s)
- Samuel A Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.,Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Magdalene Torto
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Titus Beyuo
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.,Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
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Dei-Tutu SA, Manful A, Heimburger DC, Malechi H, Moore DJ, Oppong SA, Russell WE, Aliyu MH. Correlating maternal iodine status with neonatal thyroid function in two hospital populations in Ghana: a multicenter cross-sectional pilot study. BMC Pediatr 2020; 20:26. [PMID: 31964362 PMCID: PMC6974977 DOI: 10.1186/s12887-020-1932-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Congenital hypothyroidism is a common, yet easily treatable cause of poor growth and intellectual disability. Newborn screening programs play an important role in the early detection and treatment of congenital hypothyroidism. However, an estimated 71% of children are born in countries such as Ghana, which does not have a screening program. Iodine deficiency, a common cause of congenital hypothyroidism, is present in the Ghanaian population. Mild to moderate maternal iodine deficiency may negatively impact cognitive function in children. A structured approach to examine the association between maternal iodine levels and infant thyroid function may have important ramifications on our understanding of congenital hypothyroidism in Ghana. We investigated the hypothesis that maternal iodine deficiency impacts infant thyroid function, using Thyroid Stimulating Hormone (TSH) as a marker of thyroid function. We also explored potential opportunities and barriers to newborn screening for congenital hypothyroidism in Ghana. Methods This was a cross-sectional, multicenter pilot study of 250 women and their neonates recruited from post-natal clinics in Accra and Tamale, Ghana. We compared maternal urine iodine concentration and infant TSH, as well as maternal sociodemographic and nutrition information. Regression models were used to model the relationship between variables. Results Median infant TSH was 4.7 μIU/ml (95% CI: 3.9–5.5) in Accra. In Tamale, the median infant TSH was 3.5 μIU/ml (95%CI: 3.3 to 3.6) (Δ: 1.3 μIU/ml, 95% CI: 0.5–2.1, p = 0.002). Median maternal urine iodine concentrations were 141.0 μg/L (95% CI: 115.7 to 166.3) and 142.5 μg/L (95% CI: 125.1 to 160.0) in Accra and Tamale, respectively (Δ: − 1.5 μIU/ml, 95% CI: − 32.2 – 29.2, p = 0.925). There was a weakly positive correlation between maternal urine iodine and infant TSH (rho 0.1, p = 0.02). Almost one-third (30%) of women in both locations had biochemical evidence of iodine deficiency. Mothers with any formal education were more likely to have higher iodine levels than their counterparts who had no formal education (coefficient 0.31, p = 0.006). Conclusions Maternal iodine deficiency is prevalent in Ghana and is correlated to infant thyroid function. We recommend studies with larger sample sizes to assess the true scope of this relationship.
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Affiliation(s)
- Selorm A Dei-Tutu
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Baylor College of Medicine, Section of Pediatric Diabetes and Endocrinology, Houston, TX, USA.
| | - Adoma Manful
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Hawa Malechi
- Department of Obstetrics and Gynecology, Tamale Teaching Hospital, Tamale, Ghana
| | - Daniel J Moore
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - William E Russell
- Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, TN, USA
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Bakari A, Bell AJ, Oppong SA, Bockarie Y, Wobil P, Plange-Rhule G, Goka BQ, Engmann CM, Adanu RM, Moyer CA. Neonatal near-misses in Ghana: a prospective, observational, multi-center study. BMC Pediatr 2019; 19:509. [PMID: 31870340 PMCID: PMC6927122 DOI: 10.1186/s12887-019-1883-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Background For every newborn who dies within the first month, as many as eight more suffer life-threatening complications but survive (termed ‘neonatal near-misses’ (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April – July 2015. Newborns with evidence of complications and those admitted to the NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed near-misses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55: 1, yet this varied across the study sites. Conclusions This research suggests that the NNMAT is an effective tool for assessing neonatal near-misses in low-resource settings. We believe this approach has significant systems-level, continuous quality improvement, clinical and policy-level implications.
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Affiliation(s)
- Ashura Bakari
- Department of Child Health, Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - April J Bell
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, Medical School, University of Ghana, Accra, Ghana
| | - Yemah Bockarie
- Department of Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gyikua Plange-Rhule
- Department of Child Health, Komfo Anokye Teaching Hospital / Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bamenla Q Goka
- Department of Child Health, Medical School, University of Ghana, Accra, Ghana
| | - Cyril M Engmann
- Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA.,Maternal, Newborn Childhealth and Nutrition, PATH, Seattle, WA, USA
| | - Richard M Adanu
- Population, Family and Reproductive Health Department, University of Ghana School of Public Health, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA. .,Departments of Learning Health Sciences and Obstetrics & Gynecology, University of Michigan Medical School, 1111 E. Catherine Street, 231 Victor Vaughan Bldg, Ann Arbor, MI, 48109, USA.
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Asare EV, Olayemi E, Boafor T, Dei‐Adomakoh Y, Mensah Dip E, Benjamin CH, Covert B, Kassim AA, James A, Rodeghier M, DeBaun MR, Oppong SA. Third trimester and early postpartum period of pregnancy have the greatest risk for ACS in women with SCD. Am J Hematol 2019; 94:E328-E331. [PMID: 31571271 DOI: 10.1002/ajh.25643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology Korle Bu Teaching Hospital Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology Korle Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
| | - Yvonne Dei‐Adomakoh
- Ghana Institute of Clinical Genetics Korle Bu Teaching Hospital Accra Ghana
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Enoch Mensah Dip
- Department of Hematology University of Ghana Medical School Accra Ghana
| | - Charles Hayfron Benjamin
- Department of Physiology University of Ghana Medical School Accra Ghana
- Department of Anesthesia Korle Bu Teaching Hospital Accra Ghana
| | - Brittany Covert
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | - Adetola A. Kassim
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | | | | | - Michael R. DeBaun
- Vanderbilt‐Meharry, Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville Tennessee
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology Korle Bu Teaching Hospital Accra Ghana
- Department of Obstetrics and Gynecology University of Ghana Medical School Accra Ghana
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Beyuo T, Lawrence E, Langen ES, Oppong SA. Open-labelled randomised controlled trial of 12 hours versus 24 hours modified Pritchard regimen in the management of eclampsia and pre-eclampsia in Ghana (MOPEP Study): study protocol. BMJ Open 2019; 9:e032799. [PMID: 31641005 PMCID: PMC6830657 DOI: 10.1136/bmjopen-2019-032799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hypertensive disorders of pregnancy continue to be a major contributor to maternal and perinatal morbidity and mortality. Magnesium sulfate therapy is the standard of care for seizure prophylaxis and treatment for pre-eclampsia and eclampsia respectively, despite wide disparities in dosing regimens and routes of administration. This study compares the clinical efficacy of magnesium sulfate in the reduction of seizure occurrence or recurrence with the 12 hours versus 24 hours modified Pritchard regimens in the management of severe pre-eclampsia and eclampsia. METHODS AND ANALYSIS This study is an open labelled randomised controlled trial. The study participants are patients admitted to the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana with a diagnosis of antepartum, intrapartum or postpartum eclampsia or pre-eclampsia with severe features. All study participants will be administered a loading dose of magnesium sulfate, followed by maintenance dosing. Participants in the control group will receive magnesium sulfate for 24 hours after diagnosis, while those in the treatment group will receive magnesium sulfate for 12 hours after diagnosis. The primary outcome of this study is the occurrence of a seizure any time after the completion of treatment in the assigned group. Secondary outcome measures include maternal health outcomes, magnesium sulfate toxicities and fetal health outcomes. Data collection was started in October 2018 with a target enrolment of 1245 participants with severe pre-eclampsia and 844 participants with eclampsia with a projected study period of 2-3 years. ETHICS AND DISSEMINATION Ethical approval was obtained from the KBTH Institutional Review Board (IRB) in Ghana. University of Michigan involvement is limited to protocol development and statistical analysis of de-identified data, and has been granted a Not Regulated Determination by the University of Michigan IRB. Results of the study will be shared at clinical forums at the KBTH and will be submitted for publication in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER Pan African Clinical Trial Registry through the South African Medical Research Council (PACTR201811515303983).
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Affiliation(s)
- Titus Beyuo
- Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Emma Lawrence
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth S Langen
- Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel A Oppong
- Obstetrics and Gynaecology, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Asah-Opoku K, Oppong SA, Ameme DK, Nuamah MA, Mumuni K, Yeboah AO, Ndanu TA, Nkyekyer K. Risk factors for ectopic pregnancy among pregnant women attending a tertiary healthcare facility in Accra, Ghana. Int J Gynaecol Obstet 2019; 147:120-125. [PMID: 31344263 DOI: 10.1002/ijgo.12928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate risk factors for ectopic pregnancy among pregnant women attending the Korle-Bu Teaching Hospital, Accra, Ghana. METHODS In an unmatched case-control study from September to November 2015, 104 women with ectopic pregnancy (cases) were compared with 208 women with intrauterine pregnancy (controls). Data were collected by interviewer-administered questionnaire and record review. Bivariable analysis was used to compare characteristics. Multivariate logistic regression was used to assess associations between risk factors and ectopic pregnancy. Adjusted odds ratios (aORs) and 95% confidence interval (CIs) were reported. RESULTS Risk factors for ectopic pregnancy were being single (aOR, 5.5; 95% CI, 2.15-14.65), sexual debut at younger than 15 years (aOR, 36.4; 95% CI, 2.49-532.49), multiple sexual partners (aOR, 4.8; 95% CI, 1.76-13.36), previous instrumental evacuation of uterus (aOR, 5.8; 95% CI, 1.20-27.99); previous diagnosis of infertility (aOR, 6.1; 95% CI, 1.36-27.28), being uninsured (aOR, 11.8; 95% CI, 4.23-32.74), and condom use (aOR, 6.1; 95% CI, 1.36-27.28). CONCLUSION Women who were single with early sexual intercourse, multiple partners, instrumental evacuation of the uterus, and diagnosis of infertility were at risk of ectopic pregnancy. Identification of these factors should facilitate early diagnosis and treatment of ectopic pregnancy.
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Affiliation(s)
- Kwaku Asah-Opoku
- Department of Obstetrics & Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel A Oppong
- Department of Obstetrics & Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Donne K Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Mercy A Nuamah
- Department of Obstetrics & Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kareem Mumuni
- Department of Obstetrics & Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alexander O Yeboah
- Department of Obstetrics and Gynecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Tom A Ndanu
- School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kobinah Nkyekyer
- Department of Obstetrics & Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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Beyuo T, Oppong SA, Samba A, Beyuo VM. Chlamydia trachomatis infection among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility. Int J Gynaecol Obstet 2019; 146:200-205. [PMID: 31162639 DOI: 10.1002/ijgo.12875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/01/2019] [Accepted: 05/30/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the prevalence of Chlamydia trachomatis infection and the correlates of tubal pathology among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility. METHODS A cross-sectional study was conducted among 189 women with infertility who underwent hysterosalpingography at Korle Bu Teaching Hospital, Ghana, from September 1 to November 30, 2016. Demographic data; obstetric and gynecologic history; and hysterosalpingography findings were collected using a structured questionnaire. Endocervical swabs were tested for the presence of Chlamydia trachomatis using a rapid antigen-based diagnostic kit. Associations between the variables were assessed using bivariate analysis. RESULTS Positive test results for Chlamydia trachomatis were recorded among 15 participants, giving an overall prevalence of 7.9% (95% confidence interval [CI] 4.1%-11.7%). In all, 67 (35.4%) participants had abnormal findings on hysterosalpingography, with 40 (21.2%) displaying bilateral tubal occlusion. The remaining 122 (64.6%) women had normal findings on hysterosalpingography. Eight participants with normal tubal appearance tested positive for Chlamydia trachomatis (prevalence 6.6%, 95% CI 2.2%-11.0%), whereas seven participants with abnormal tubal appearance tested positive (prevalence 10.4%, 95% CI 3.1%-17.7%; P=0.402). No associations were found between participant characteristics and tubal pathology. CONCLUSION The prevalence of Chlamydia trachomatis did not differ by hysterosalpingography findings.
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Affiliation(s)
- Titus Beyuo
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Korle Bu Accra, Ghana.,Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Korle Bu Accra, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Korle Bu Accra, Ghana.,Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Korle Bu Accra, Ghana
| | - Ali Samba
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Korle Bu Accra, Ghana.,Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Korle Bu Accra, Ghana
| | - Vera M Beyuo
- Department of Ophthalmology, Korle Bu Teaching Hospital, Korle Bu Accra, Ghana
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Akorsu EE, Acquaye JK, Benneh AA, Oppong SA, Olayemi E. Fetomaternal hemorrhage among pregnant women in Accra, Ghana. Int J Gynaecol Obstet 2019; 146:333-338. [PMID: 31206635 DOI: 10.1002/ijgo.12890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 04/18/2019] [Accepted: 06/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the occurrence of and risk factors for fetomaternal hemorrhage (FMH) among pregnant women at Korle Bu Teaching Hospital in Accra, Ghana. METHODS A prospective study of FMH among pregnant women without hemoglobinopathies in the second trimester attending prenatal care between October 2015 and May 2016 performed using the Kleihauer-Betke test. Volume of FMH was estimated; ABO and Rh blood groups of participants were determined. A data extraction form and structured questionnaire were used to collect demographic and clinical information, and data on risk factors. RESULTS Of 151 participants, 32 (21.2%) had FMH. Almost 18% (n=27) had FMH at baseline (16-24 weeks), 10% (10/100) at 28-32 weeks, and 11.1% (11/99) at 34-37 weeks of pregnancy. Volume of FMH was less than 30 mL in 30 (19.9%) women, whereas it was greater than 30 mL in 2 (1.3%) women. No identifiable patient-specific factors were associated with occurrence of FMH. CONCLUSION FMH is common among pregnant women in Ghana and can occur as early as 16 weeks, without identifiable risk factors. RhD negative women who may be pregnant with RhD positive fetuses should be screened early in pregnancy, not only at delivery, for occurrence of FMH.
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Affiliation(s)
- Elliot E Akorsu
- Department of Hematology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Joseph K Acquaye
- Department of Hematology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Amma A Benneh
- Department of Hematology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel A Oppong
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Edeghonghon Olayemi
- Department of Hematology, College of Health Sciences, University of Ghana, Accra, Ghana
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Oppong SA, Asare EV, Olayemi E, Boafor T, Dei-Adomakoh Y, Swarry-Deen A, Mensah E, Osei-Bonsu Y, Crabbe S, Musah L, Hayfron-Benjamin C, Covert B, Kassim AA, James A, Rodeghier M, Audet C, DeBaun MR. Multidisciplinary care results in similar maternal and perinatal mortality rates for women with and without SCD in a low-resource setting. Am J Hematol 2019; 94:223-230. [PMID: 30456766 DOI: 10.1002/ajh.25356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/05/2022]
Abstract
In Africa, the maternal mortality rate in sickle cell disease (SCD) is ~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes. A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD, ~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD.
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Affiliation(s)
- Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Eugenia V. Asare
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Yvonne Dei-Adomakoh
- Ghana Institute of Clinical Genetics; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Alim Swarry-Deen
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Enoch Mensah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | | | | | - Latif Musah
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
- Department of Anesthesia; Korle-Bu Teaching Hospital; Accra Ghana
| | - Brittany Covert
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola A. Kassim
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
| | - Andra James
- Department of Obstetrics and Gynaecology; Duke University; Durham North Carolina
| | | | - Carolyn Audet
- Global Health Institute; Vanderbilt University Medical Center; Nashville Tennessee
| | - Michael R. DeBaun
- Department of Medicine and Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease; Vanderbilt University Medical Center; Nashville Tennessee
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Oppong SA, Bakari A, Bell AJ, Bockarie Y, Adu JA, Turpin CA, Obed SA, Adanu RM, Moyer CA. Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study. BJOG 2019; 126:755-762. [PMID: 30548506 DOI: 10.1111/1471-0528.15578] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the incidence and factors associated with maternal near-miss. DESIGN Cross-sectional study with an embedded case-control study. SETTING Three tertiary referral hospitals in southern Ghana. POPULATION All women admitted to study facilities with pregnancy-related complications or for birth. METHODS An adapted version of the WHO Maternal Near Miss Screening Tool was used to identify maternal near-miss cases. These were compared with unmatched controls (uncomplicated deliveries) in a ratio of 1:2. MAIN OUTCOME MEASURES Incidence of maternal near-miss, maternal near-miss to maternal mortality ratio, and cause of and factors associated with maternal near-miss. RESULTS Out of 8433 live births, 288 maternal near-miss cases and 62 maternal deaths were identified. In all, 454 healthy controls were recruited for comparison. Maternal near-miss and maternal death incidence ratios were 34.2 (95% CI 30.2-38.1) and 7.4 (95% CI 5.5-9.2) per 1000 live births, respectively with a maternal near-miss to mortality ratio of 4.6:1. Cause of near-miss was pre-eclampsia/eclampsia (41.0%), haemorrhage (12.2%), maternal sepsis (11.1%) and ruptured uterus (4.2%). A major factor associated with maternal near-miss was maternal fever within the 7 days before birth (OR 5.95, 95%CI 3.754-9.424). Spontaneous onset of labour was protective against near-miss (OR 0.09 95% CI 0.057-0.141). CONCLUSION For every maternal death, there were nearly five maternal near-misses. Women having a fever in the 7 days before delivery were six times more likely to experience a near-miss than women not having fever. TWEETABLE ABSTRACT Maternal near-miss exceeds maternal death by 5:1, with the leading cause of maternal near-miss was pre-eclampsia/eclampsia.
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Affiliation(s)
- S A Oppong
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - A Bakari
- Suntresu Government Hospital, Ghana Health Service, Kumasi, Ghana
| | - A J Bell
- University of Michigan, Ann Arbor, MI, USA
| | - Y Bockarie
- Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - J A Adu
- School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - C A Turpin
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S A Obed
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - R M Adanu
- School of Public Health, University of Ghana, Accra, Ghana
| | - C A Moyer
- University of Michigan, Ann Arbor, MI, USA
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Asare EV, Olayemi E, Boafor T, Dei-Adomakoh Y, Mensah E, Osei-Bonsu Y, Crabbe S, Musah L, Hayfron-Benjamin C, Covert-Greene B, Kassim AA, James A, Rodeghier M, DeBaun MR, Oppong SA. A case series describing causes of death in pregnant women with sickle cell disease in a low-resource setting. Am J Hematol 2018; 93:E167-E170. [PMID: 29659044 DOI: 10.1002/ajh.25115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/07/2018] [Accepted: 04/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics, Korle- Bu; Accra Ghana
- Department of Hematology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics, Korle- Bu; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Yvonne Dei-Adomakoh
- Ghana Institute of Clinical Genetics, Korle- Bu; Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Enoch Mensah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | | | - Selina Crabbe
- Ghana Institute of Clinical Genetics, Korle- Bu; Accra Ghana
| | - Latif Musah
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
- Department of Anesthesia; Korle-Bu Teaching Hospital; Accra Ghana
| | - Brittany Covert-Greene
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville
| | - Adetola A. Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville
| | | | | | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
- Department of Obstetrics and Gynecology; School of Medicine and Dentistry, University of Ghana; Accra Ghana
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Bell AJ, Wynn LV, Bakari A, Oppong SA, Youngblood J, Arku Z, Bockarie Y, Adu J, Wobil P, Plange-Rhule G, Goka B, Adanu RM, Moyer CA. "We call them miracle babies": How health care providers understand neonatal near-misses at three teaching hospitals in Ghana. PLoS One 2018; 13:e0198169. [PMID: 29847603 PMCID: PMC5976150 DOI: 10.1371/journal.pone.0198169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
Neonatal mortality is a significant problem in many low-resource countries, yet for every death there are many more newborns who suffer a life-threatening complication but survive. These "near-misses" are not well defined, nor are they well understood. This study sought to explore how health care providers at three tertiary care centers in Ghana (each with neonatal intensive care units (NICUs)) understand the term "near-miss." Eighteen providers from the NICUs at three teaching hospitals in Ghana (Korle Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and Cape Coast Teaching Hospital in Cape Coast) were interviewed in depth regarding their perceptions of neonatal morbidity, mortality, and survival. Near the end of the interview, they were specifically asked what they understood the term "near-miss" to mean. Participants included nurses and physicians at various levels and with varying years of practice (mean years of practice = 9.33, mean years in NICU = 3.66). Results indicate that the concept of "near-misses" is not universally understood, and providers differ on whether a baby is a near-miss or not. Providers disagreed on the utility of a near-miss classification for clinical practice, with some suggesting it would be helpful to draw their attention to those at highest risk of dying, with others suggesting that the acuity of illness in a NICU means any baby could become a 'near-miss' at any moment. Further efforts are needed to standardize the definitions of neonatal near-misses, including developing criteria that are able to be assessed in a low-resource setting. In addition, further research is warranted to determine the practical implications of using a near miss tool in the process of providing care in a resource-limited setting and whether it might be best reserved as a retrospective indicator of overall quality of care provided.
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Affiliation(s)
- April J. Bell
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Lynette V. Wynn
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | - Ashura Bakari
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Child Health Department, Suntresu Hospital, Ghana Health Service, Kumasi, Ghana
| | - Samuel A. Oppong
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Jessica Youngblood
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Zelda Arku
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Yemah Bockarie
- Neonatal Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joseph Adu
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Priscilla Wobil
- Child Health Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Bamenla Goka
- Department of Child Health, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | - Cheryl A. Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Medical School, University of Michigan, Ann Arbor, MI, United States of America
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
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Amoakoh-Coleman M, Ogum-Alangea D, Modey-Amoah E, Ntumy MY, Adanu RM, Oppong SA. Blood pressure patterns and body mass index status in pregnancy: An assessment among women reporting for antenatal care at the Korle-Bu Teaching hospital, Ghana. PLoS One 2017; 12:e0188671. [PMID: 29211781 PMCID: PMC5718510 DOI: 10.1371/journal.pone.0188671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/10/2017] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Maternal obesity in pregnancy has been linked with increased risk of pregnancy induced hypertension (PIH). In some tertiary referral hospitals in Ghana, PIH is the leading cause of institutional maternal mortality. OBJECTIVE To evaluate blood pressure changes during pregnancy amongst different body mass index (BMI) groups and how this relates to the risk of developing PIH. METHODS Women who had a dating ultrasound before 20 weeks gestation and registering for antenatal care at the Korle-Bu Teaching Hospital in Accra, between February and December 2013 and met the inclusion criteria were recruited into a cohort study. BMI was assessed at baseline. Blood pressure measurements were taken at (±2) 24, 28 and 36 weeks. Primary outcome measure of interest during follow-up was a diagnosis of PIH at these points. BP changes during follow up at the three points were measured. Descriptive analysis of baseline factors was carried out and compared for the BMI groups. Relative risk (RR) of PIH was estimated at 95% confidence interval. RESULTS Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight and obese respectively at baseline. Pregnant women who were obese at baseline had a three-fold increased risk of PIH compared to those with normal BMI [RR = 3.01 (1.06-8.52), p = 0.04]. CONCLUSION Obese women have a significantly increased risk of PIH. Women should be screened at booking for obesity status. Antenatal protocols should have interventions for prevention or early detection of obesity and management of obesity to improve outcomes.
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Affiliation(s)
- Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Deda Ogum-Alangea
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Emefa Modey-Amoah
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Michael Yao Ntumy
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Richard M. Adanu
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Lari NF, DeBaun MR, Oppong SA. The emerging challenge of optimal blood pressure management and hypertensive syndromes in pregnant women with sickle cell disease: a review. Expert Rev Hematol 2017; 10:987-994. [DOI: 10.1080/17474086.2017.1379895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nabilah F. Lari
- Department of Family Medicine, Meharry Medical College, Nashville, TN, USA
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Asare EV, Olayemi E, Boafor T, Dei-Adomakoh Y, Mensah E, Ghansah H, Osei-Bonsu Y, Crabbe S, Musah L, Hayfron-Benjamin C, Covert B, Kassim AA, James A, Rodeghier M, DeBaun MR, Oppong SA. Implementation of multidisciplinary care reduces maternal mortality in women with sickle cell disease living in low-resource setting. Am J Hematol 2017; 92:872-878. [PMID: 28512745 DOI: 10.1002/ajh.24790] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/12/2022]
Abstract
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic. The pre-intervention period was assessed through a retrospective chart review to identify every death and the post-intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre- and post- intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre-intervention to 1176 per 100 000 at post-intervention, representing a risk reduction of 89.1% (P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre-intervention to 23.0 per 1000 at post-intervention, representing a risk reduction of 62.2% (P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low-resource setting.
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Affiliation(s)
- Eugenia Vicky Asare
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Edeghonghon Olayemi
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Theodore Boafor
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - Yvonne Dei-Adomakoh
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Enoch Mensah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | - Harriet Ghansah
- Department of Hematology, College of Health Sciences; University of Ghana; Accra Ghana
| | | | - Selina Crabbe
- Ghana Institute of Clinical Genetics; Korle-Bu Accra Ghana
| | - Latif Musah
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, School of Biomedical and Allied Health Sciences; University of Ghana; Accra Ghana
- Department of Anesthesia; Korle-Bu Teaching Hospital; Accra Ghana
| | - Brittany Covert
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Adetola A. Kassim
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | | | | | - Michael R. DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center; Nashville Tennessee
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology; Korle-Bu Teaching Hospital; Accra Ghana
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry; University of Ghana; Accra Ghana
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Boafor TK, Olayemi E, Galadanci N, Hayfron-Benjamin C, Dei-Adomakoh Y, Segbefia C, Kassim AA, Aliyu MH, Galadanci H, Tuuli MG, Rodeghier M, DeBaun MR, Oppong SA. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG 2015; 123:691-8. [DOI: 10.1111/1471-0528.13786] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- TK Boafor
- Department of Obstetrics and Gynaecology; Korle-Bu Teaching Hospital; Accra Ghana
| | - E Olayemi
- Department of Haematology; University of Ghana Medical School; Accra Ghana
| | - N Galadanci
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - C Hayfron-Benjamin
- Department of Physiology; University of Ghana Medical School; Accra Ghana
| | - Y Dei-Adomakoh
- Department of Haematology; University of Ghana Medical School; Accra Ghana
| | - C Segbefia
- Department of Child Health; University of Ghana Medical School; Accra Ghana
| | - AA Kassim
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - MH Aliyu
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | | | - MG Tuuli
- Department of Obstetrics and Gynecology; Washington University in St Louis; St Louis MO USA
| | | | - Michael R DeBaun
- Vanderbilt Center of Excellence in Sickle Cell Disease; Vanderbilt Children's Hospital and Vanderbilt University School of Medicine; Nashville TN USA
| | - SA Oppong
- Department of Obstetrics and Gynaecology; University of Ghana Medical School; Accra Ghana
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Oppong SA, Ntumy MY, Amoakoh-Coleman M, Ogum-Alangea D, Modey-Amoah E. Gestational diabetes mellitus among women attending prenatal care at Korle-Bu Teaching Hospital, Accra, Ghana. Int J Gynaecol Obstet 2015; 131:246-50. [PMID: 26321217 DOI: 10.1016/j.ijgo.2015.05.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/01/2015] [Accepted: 08/06/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the burden of gestational diabetes mellitus (GDM) among pregnant women in Accra, Ghana. METHODS The present cross-sectional study enrolled women at 20-24 weeks of pregnancy attending their first prenatal clinic at Korle-Bu Teaching Hospital, Accra, between March and November 2013. Participants underwent a 2-hour, 75-g oral glucose tolerance test between 24 and 28 weeks. The odds of GDM among different body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) groupings were calculated in a multiple logistic regression model. RESULTS Among 399 women screened, 37 (9.3%) had GDM. Compared with women with a BMI in the normal range (18.50-24.99), obese women (BMI >30.0) had an increased risk of GDM (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.08-8.20; P=0.034]; overweight women (BMI 25.00-29.99) had a slightly elevated risk (OR 1.20, 95% CI 0.41-3.55; P=0.742). Maternal age, parity, education, employment status, place of residence, and previous pregnancy complications did not affect the risk of GDM. CONCLUSION GDM was found in 10% of pregnant women in Accra. Women who were obese by 20-24 weeks of pregnancy had a significantly increased risk of GDM.
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Affiliation(s)
- Samuel A Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - Michael Y Ntumy
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, School of Public Health, University of Ghana, Legon, Ghana
| | - Deda Ogum-Alangea
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Emefa Modey-Amoah
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
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Oppong SA, Tuuli MG, Seffah JD, Adanu RMK. Is there a safe limit of delay for emergency caesarean section in Ghana? Results of analysis of early perinatal outcome. Ghana Med J 2015; 48:24-30. [PMID: 25320398 DOI: 10.4314/gmj.v48i1.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the limits of delaying caesarean section in a busy obstetric unit in a developing country setting that is not associated with neonatal survival. METHODS Retrospective cohort study of emergency cesarean sections. Indications were sub-divided into imminent threat and no imminent threat to fetal wellbeing. The primary outcomes was a composite measure of adverse perinatal outcome including stillbirth, 5-minute Apgar score < 7 and neonatal intensive care unit admission. Effect of decision-to-delivery interval on perinatal outcomes was evaluated using Kaplan-Meier survival analysis. RESULTS 495 women met inclusion criteria (142 'imminent threat' group, 353 'no imminent threat' group). The median decision-to-delivery interval was significantly shorter in the 'imminent threat' group (2.25 [95% CI 1.38 - 5.83] versus 3.42 [95% CI 1.83 - 5.85] hours, p <0.001). Only 1.7% and 12.7% sections were performed within 30 minutes and 1 hour, respectively. Risk of the composite outcome was significantly higher in the 'imminent threat group (46.5% versus 31.2%, RR=1.49 [95% CI 1.18 - 1.89], p=0.001). A 95% probability of 'live intact' survival occurred at 1 hr and 2 hrs respectively, for the imminent threat and the no imminent threat groups. CONCLUSION Increasing decision-to-delivery interval is associated with higher risk of adverse perinatal outcomes, but a 95% live intact survival can be achieved if the delivery occurs within 2 hours.
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Affiliation(s)
- S A Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - M G Tuuli
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Washington University School of Medicine, St Louis, Missouri, USA
| | - J D Seffah
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - R M K Adanu
- School of Public Health, University of Ghana, Accra, Ghana
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Adu-Bonsaffoh K, Oppong SA, Binlinla G, Obed SA. Corrigendum to “Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana” [Int J Gynecol Obstet 123 (2013) 110-113]. Int J Gynaecol Obstet 2014. [DOI: 10.1016/j.ijgo.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Adu-Bonsaffoh K, Oppong SA, Samuel OA, Binlinla G, Obed SA, Samuel OA. Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana. Int J Gynaecol Obstet 2013; 123:110-3. [PMID: 23969337 DOI: 10.1016/j.ijgo.2013.05.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/01/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the contribution of hypertensive disorders of pregnancy to maternal deaths at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. METHODS The retrospective descriptive study conducted at KBTH during 2010-2011 involved a comprehensive review of all maternal deaths attributable to hypertensive disorders. RESULTS There were 21 385 deliveries, 21742 live births, and 199 maternal deaths, resulting in a maternal mortality ratio of 915.3 per 100000 live births. In total, 63 (31.7%) maternal deaths were attributable to hypertensive disorders with a case fatality rate of 3.9%. The incidence of hypertensive disorders of pregnancy was 7.6%. Hypertensive disorders were the most common direct cause of maternal death followed by obstetric hemorrhage (26.6%), unsafe abortion (11.1%), and puerperal sepsis (3.5%). Most (38.1%) hypertension-related maternal deaths occurred within 24hours of admission and the majority (79.4%) had been referred. Eclampsia was the leading immediate cause of hypertension-related death (23.8%), followed by acute renal failure (20.6%), intracerebral hemorrhage (15.9%), and pulmonary edema (12.7%). CONCLUSION Hypertensive diseases are the leading cause of maternal death at KBTH, having overtaken obstetric hemorrhage, with eclampsia, acute renal failure, intracerebral hemorrhage, and pulmonary edema representing the major immediate causes of hypertension-related maternal death.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
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