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Owusu H, Thekkur P, Ashubwe-Jalemba J, Hedidor GK, Corquaye O, Aggor A, Steele-Dadzie A, Ankrah D. Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019-2021. Int J Environ Res Public Health 2022; 19:12413. [PMID: 36231716 PMCID: PMC9566282 DOI: 10.3390/ijerph191912413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5-7 days in females and 10-14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10-14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.
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Affiliation(s)
- Helena Owusu
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union South-East Asia Office (The USEA), New Delhi 110016, India
| | | | - George Kwesi Hedidor
- World Health Organization Country Office, Roman Ridge, Accra P.O. Box MB142, Ghana
| | - Oksana Corquaye
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Asiwome Aggor
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Allen Steele-Dadzie
- Polyclinic/Family Medicine Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
| | - Daniel Ankrah
- Pharmacy Department, Korle Bu Teaching Hospital, Accra P.O. Box KB77, Ghana
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Tetteh FKM, Fatchu R, Ackah K, Philips TJ, Shewade HD, Fenny AP, Timire C, Edwards JK, Parbie EA. Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times. Int J Environ Res Public Health 2022; 19:11659. [PMID: 36141932 PMCID: PMC9517560 DOI: 10.3390/ijerph191811659] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017-2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.
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Affiliation(s)
| | - Raymond Fatchu
- Pathology Division, 37 Military Hospital, Neghelli Barracks, Accra GA 01, Ghana
| | - Kingsley Ackah
- Pathology Division, 37 Military Hospital, Neghelli Barracks, Accra GA 01, Ghana
| | - Trudy Janice Philips
- Clinical Pathology Department, Noguchi Memorial Institute for Medical Research, P.O. Box LG 581, Accra GA 01, Ghana
| | - Hemant Deepak Shewade
- Division of Health System Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economic Research, University of Ghana, P.O. Box LG 1181, Accra GA 01, Ghana
| | - Collins Timire
- International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France
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Banu RA, Alvarez JM, Reid AJ, Enbiale W, Labi AK, Ansa EDO, Annan EA, Akrong MO, Borbor S, Adomako LAB, Ahmed H, Mustapha MB, Davtyan H, Owiti P, Hedidor GK, Quarcoo G, Opare D, Kikimoto B, Osei-Atwenebanoa MY, Schmitt H. Extended Spectrum Beta-Lactamase Escherichia coli in River Waters Collected from Two Cities in Ghana, 2018-2020. Trop Med Infect Dis 2021; 6:105. [PMID: 34203078 DOI: 10.3390/tropicalmed6020105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination of E. coli (Ec) and ESBL-Ec in two rivers in Ghana (Odaw in Accra and Okurudu in Kasoa) that receive effluents from human and animal wastewater hotspots over a 12-month period. Concentrations of Ec, ESBL-Ec and percent ESBL-Ec/Ec were determined per 100 mL sample. Of 96 samples, 94 (98%) were positive for ESBL-Ec. concentrations per 100 mL (MCs100) of ESBL-Ec and %ESBL-Ec from both rivers were 4.2 × 104 (IQR, 3.1 × 103–2.3 × 105) and 2.79 (IQR, 0.96–6.03), respectively. MCs100 were significantly lower in upstream waters: 1.8 × 104 (IQR, 9.0 × 103–3.9 × 104) as compared to downstream waters: 1.9 × 106 (IQR, 3.7 × 105–5.4 × 106). Both human and animal wastewater effluents contributed to the increased contamination downstream. This study revealed high levels of ESBL-Ec in rivers flowing through two cities in Ghana. There is a need to manage the sources of contamination as they may contribute to the acquisition and spread of ESBL-Ec in humans and animals, thereby contributing to AMR.
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Vidhubala E, Niraimathi K, Shewade HD, Mahadevan S. Cervical Cancer Care Continuum in South India: Evidence from a Community-based Screening Program. J Epidemiol Glob Health 2021; 10:28-35. [PMID: 32175707 PMCID: PMC7310805 DOI: 10.2991/jegh.k.191111.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 07/24/2019] [Indexed: 11/01/2022] Open
Abstract
In India, cervical cancer screening is conducted at various levels; however, after screening, the adherence to the cancer care continuum is barely understood. This study evaluated a community-based cancer screening program conducted in a rural setting (Tirunelveli and Tuticorin districts) in South India and reviewed the completion of care continuum. In this longitudinal descriptive study involving secondary data collection, data from the case records of 2192 women who were consecutively screened between March 2015 and May 2016 were included. All women underwent conventional cytology-based screening (Pap smear) and Visual Inspection with Acetic Acid (VIA). Those for whom either test was positive were referred for histopathological confirmation. Patients with confirmed precancerous conditions and unsatisfactory Pap smears were referred for further management. In total, 2192 women were screened [age range, 17-69 years; mean (standard deviation), 39.2 (8.5)]. Common symptom and sign were white discharge per vaginum (34.9%) and cervical erosion (34.4%), respectively. The VIA was positive for 24% (523/2178; 14 women did not cooperate for VIA) and 113 (5.1%) had epithelial cell abnormality in the Pap smear test. Per histopathology findings, one woman had non-keratinizing squamous cell carcinoma. Seven, three, and four had cervical intraepithelial neoplasia I, II and III, respectively. Of 2192, 807 were eligible for referral (597 had positive results on either Pap or VIA). Among the 807 women referred, only 74 (9.2%) women visited the referral center. The follow-up rate was very poor accounting to fragmentation of care continuum. The success of the screening program depends on the completion of the care continuum.
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Affiliation(s)
- E Vidhubala
- Nellai Cancer Care Center, Udhavum Ullangal, Tirunelveli, Tamil Nadu, India.,Fenivi Research Solutions, Chennai, Tamil Nadu, India
| | - K Niraimathi
- Fenivi Research Solutions, Chennai, Tamil Nadu, India
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi, India.,Karuna Trust, Bengaluru, Karnataka, India
| | - Sankar Mahadevan
- Nellai Cancer Care Center, Udhavum Ullangal, Tirunelveli, Tamil Nadu, India
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Makoni TM, Thekkur P, Takarinda KC, Xaba S, Ncube G, Zwangobani N, Samuelson J, Mangombe A, Mabaya S, Tapera T, Matambo R, Ameyan W, Mugurungi O. Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study. BMJ Open 2020; 10:e033035. [PMID: 32371506 PMCID: PMC7223012 DOI: 10.1136/bmjopen-2019-033035] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES WHO recommended strengthening the linkages between various HIV prevention programmes and adolescent sexual reproductive health (ASRH) services. The Smart-LyncAges project piloted in Bulawayo city and Mt Darwin district of Zimbabwe established a referral system to link the voluntary medical male circumcision (VMMC) clients to ASRH services provided at youth centres. Since its inception in 2016, there has been no assessment of the performance of the referral system. Thus, we aimed to assess the proportion of young (10-24 years) VMMC clients getting 'successfully linked' to ASRH services and factors associated with 'not being linked'. DESIGN This was a cohort study using routinely collected secondary data. SETTING All three VMMC clinics of Mt Darwin district and Bulawayo province. PRIMARY OUTCOME MEASURES The proportion of 'successfully linked' was summarised as the percentage with a 95% CI. Adjusted relative risks (aRR) using a generalised linear model was calculated as a measure of association between client characteristics and 'not being linked'. RESULTS Of 1773 young people registered for VMMC services, 1478 (83%) were referred for ASRH services as they had not registered for ASRH previously. Of those referred for ASRH services, the mean (SD) age of study participants was 13.7 (4.3) years and 427 (28.9%) were out of school. Of the referred, 463 (31.3%, 95% CI: 30.0 to 33.8) were 'successfully linked' to ASRH services and the median (IQR) duration for linkage was 6 (0-56) days. On adjusted analysis, receiving referral from Bulawayo circumcision clinic (aRR: 1.5 (95% CI: 1.3 to 1.7)) and undergoing circumcision at outreach sites (aRR: 1.2 (95% CI: 1.1 to 1.3)) were associated with 'not being linked' to ASRH services. CONCLUSION Linkage to ASRH services from VMMC is feasible as one-third VMMC clients were successfully linked. However, there is need to explore reasons for not accessing ASRH services and take corrective actions to improve the linkages.
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Affiliation(s)
- Talent M Makoni
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Harare, Zimbabwe
- World Health Organization Regional Office for Africa, Harare, Harare, Zimbabwe
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| | | | | | - Getrude Ncube
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
| | | | | | | | - Simbarashe Mabaya
- World Health Organization Regional Office for Africa, Harare, Harare, Zimbabwe
| | - Talent Tapera
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
| | | | - Wole Ameyan
- World Health Organization, Geneve, GE, Switzerland
| | - Owen Mugurungi
- Ministry of Health and Child Care, Harare, Harare, Zimbabwe
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Aung NHHL, Soe KT, Kumar AMV, Saw S, Aung ST. What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar. Trop Med Infect Dis 2020; 5:E41. [PMID: 32182967 DOI: 10.3390/tropicalmed5010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Antiretroviral therapy (ART) coverage among HIV-infected tuberculosis (HIV-TB) patients has been suboptimal in Myanmar and the reasons are unknown. We aimed to assess the ART uptake among HIV-TB patients in public health facilities of Ayeyawady Region from July 2017-June 2018 and explore the barriers for non-initiation of ART. We conducted an explanatory mixed-methods study with a quantitative component (cohort analysis of secondary programme data) followed by a descriptive qualitative component (thematic analysis of in-depth interviews of 22 providers and five patients). Among 12,447 TB patients, 11,057 (89%) were HIV-tested and 627 (5.7%) were HIV-positive. Of 627 HIV-TB patients, 446 (71%) received ART during TB treatment (86 started on ART prior to TB treatment and rest started after TB treatment). Among the 181 patients not started on ART, 60 (33%) died and 41 (23%) were lost-to-follow-up. Patient-related barriers included geographic and economic constraints, poor awareness, denial of HIV status, and fear of adverse drug effects. The health system barriers included limited human resource, provision of ART on 'fixed' days only, weaknesses in counselling, referral and feedback mechanism, and clinicians' reluctance to start ART early due to concerns about immune reconstitution inflammatory syndrome. We urge the national TB and HIV programs to take immediate actions to improve the ART uptake.
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Ayiraveetil R, Sarkar S, Chinnakali P, Jeyashree K, Vijayageetha M, Thekkur P, Lakshminarayanan S, Knudsen S, Hochberg NS, Horsburgh CR, Ellner J, Roy G. Household food insecurity among patients with pulmonary tuberculosis and its associated factors in South India: a cross-sectional analysis. BMJ Open 2020; 10:e033798. [PMID: 32114470 PMCID: PMC7050349 DOI: 10.1136/bmjopen-2019-033798] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Food insecurity is 'the limited or uncertain availability of nutritionally adequate, safe foods or inability to acquire foods in socially acceptable ways'. Majority of tuberculosis (TB) cases of resource-poor settings experience food insecurity, which impacts treatment adherence and outcomes. We aimed to determine level of household food insecurity (HFI) and its associated factors in patients with pulmonary TB. DESIGN This is a cross-sectional analysis of data from an ongoing cohort study. SETTING National Tuberculosis Programme (NTP) in three districts of South India. PARTICIPANTS All newly diagnosed pulmonary TB cases of the cohort enrolled in the NTP at the Designated Microscopy Centres (DMCs) and Primary Health Centres (PHCs) from October 2015 to October 2018. PRIMARY OUTCOME MEASURES The proportion of baseline HFI assessed using a validated HFI Access Scale was summarised as percentage with 95% CI. Possible association of sociodemographic, morbidity and behavioural characteristics with HFI was assessed using χ2 test, and unadjusted prevalence ratios with 95% CI were calculated. The characteristics with values of p<0.2 in the univariate model were included in the multivariable generalised linear model (binomial function, log link) to derive adjusted prevalence ratios (aPRs) with 95% CI. RESULT Of a total of 765 patients, 261 had HFI and the proportion was 34.1% (95% CI 30.8% to 37.6%). Mild, moderate and severe food insecurity was found in 17 (2.2%), 67 (8.8%) and 177 (23.1%) TB cases, respectively. Patients with TB who had monthly family income less than rupees 3000 (aPR 2.0; 95% CI 1.3 to 3.0), Karnofsky Score of 60 or less (aPR 1.5; 95% CI 1.1 to 1.9) and those who were employed (aPR 1.4; 95% CI 1.0 to 2.0) were independently associated with HFI. CONCLUSIONS A high level of food insecurity was seen in households with TB cases. Additional food or cash assistance for this subgroup might improve food insecurity and thereby nutritional status.
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Affiliation(s)
- Reshma Ayiraveetil
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kathiresan Jeyashree
- Department of Community Medicine, Velammal Medical College, Madurai, Tamilnadu, India
| | - Mathavaswami Vijayageetha
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Selby Knudsen
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts, United States
| | - Natasha S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts, United States
- Department of Epidemiology, Boston University School of Public Health, Massachusetts, United States
| | - C Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts, United States
- Department of Epidemiology, Boston University School of Public Health, Massachusetts, United States
- Department of Global Health, Boston University School of Public Health, Massachusetts, United States
| | - Jerrold Ellner
- Department of Medicine, Rutgers University, New Jersey, United States
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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