Health Belief Model variables as predictors of screening mammography utilization

Despite its efficacy, screening mammography is not widely utilized due to various factors. The Health Belief Model (HBM) has previously been used as one conceptualization of relevant patient attitudes. No psychometrically validated measure of these variables has previously been utilized, however, nor have prospective studies of women all of whom have been referred by their physicians for mammography been reported. The research reported here addressed both of those issues. A psychometrically validated measure of the HBM variables, perceived susceptibility, barriers, and benefits, was used, along with age, education, ethnicity, and family breast cancer history to predict mammography utilization in a prospective study of hospital employees. Being white, perceiving fewer benefits of and barriers to mammography, and having a family history of breast cancer were predictive of noncompliance. The avoidant behavior of employees with a family history of breast cancer must be addressed in attempts to increase mammography utilization. In addition, results of the study imply the need for full discussion with women referred for mammography of all issues related to its use, both its benefits and possible barriers.

Simple questionnaire and urine reagent strips compared to microscopy for the diagnosis of Schistosoma haematobium in a community in northern Ghana

OBJECTIVES

To evaluate the utility of a simple questionnaire and urine reagent strip testing for the rapid diagnosis of Schistosoma haematobium in rural northern Ghana.

METHODS

Cross-sectional parasitological and questionnaire survey in a community in northern Ghana. Participants provided two urine specimens that were examined under a microscope using a centrifugation method. The first urine sample was additionally subjected to reagent strip testing. A short questionnaire was administered to all participants.

RESULTS

Microscopy of urine samples obtained from 208 individuals aged 1-77 years revealed an S. haematobium prevalence of 6.8%. The presence of any blood or protein on a urine reagent strip was 100% and 42% sensitive, and 93% and 80% specific for S. haematobium diagnosis. Questionnaires were completed by 198 individuals. Self-reported haematuria showed a sensitivity of 53% and a specificity of 85%. A dichotomous two-question panel was helpful in S. haematobium diagnosis, with working and playing near the river significantly associated with S. haematobium infection (P < 0.001).

CONCLUSION

The use of urine reagent strips, coupled with questions pertaining to water contact patterns, might be considered for point-of-contact diagnosis of S. haematobium where microscopy is unavailable.

Seroprevalence and risk factors of Hepatitis B and Hepatitis C infections among pregnant women in the Asante Akim North Municipality of the Ashanti region, Ghana; a cross sectional study

BACKGROUND

Viral hepatitis is a serious public health problem affecting billions of people globally with maternal-fetal transmission on the rise.

OBJECTIVES

This study sought to determine the prevalence and factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among pregnant women in the Asante Akim North Municipality, in the Ashanti region of Ghana.

METHODS

In this cross-sectional study 168 pregnant women were recruited from the Agogo Presbyterian hospital. Blood samples were collected for the detection of Hepatitis B Surface Antigen (HBsAg) and anti-HCV antibodies. A pretested questionnaire was used to obtain demographic data and identify the risk factors associated with the two infections.

RESULTS

Of the 168 participants studied, 16 (9.5%) tested positive for HBV and 13 (7.7%) tested positive for HCV representing 9.5% and 7.7% respectively. A participant tested positive for both HBV and HCV co-infection representing 0.6%. Undertaking blood transfusion, tattooing and sharing of needles were associated with hepatitis C infection (P=0.001). HBV was not associated with any of the risk factors (P>0.05).

CONCLUSION

Our findings suggest a high prevalence of hepatitis B and hepatitis C among pregnant women; blood transfusion, tattooing and sharing of hypodermic needles were associated with hepatitis C infection. Measures to reduce the disease and transmission burden must be introduced.

COVID-19 restrictions amidst cyclones and volcanoes: A rapid assessment of early impacts on livelihoods and food security in coastal communities in Vanuatu

Coastal communities in regions like the Pacific have been impacted by COVID-19 related public health measures that limit the movement of people, trade and access to resources. In disaster-prone countries, like Vanuatu, such measures add to existing pressures on coastal communities' adaptive capacity. To understand how coastal communities in Vanuatu were impacted in the immediate period after COVID-19 measures were placed, and how people responded to the changing circumstances, a rapid appraisal survey was carried out following a nationally declared state of emergency in March 2020. Results reveal changes in village population, loss of cash income, difficulties in accessing food and shifting pressures on particular resources and habitats. The findings provide insights into the ways local adaptive capacity to satisfy livelihood and food security needs differed among rural contexts. From this we argue that broad quantitative impact assessments are important in guiding strategic and longer term responses and adaptations, but that these are made more useful when complemented with qualitative insights on people and place in the short-term.

Factors influencing urban malaria: a comparative study of two communities in the Accra Metropolis

BACKGROUND

As urban centres in Ghana continue to grow, the scale and impact of urban malaria is increasing.

OBJECTIVE

To compare the prevalence of malaria in two communities and how this may be affected by knowledge, attitudes, socioeconomic status and preventive practices of residents in two communities within the Accra metropolis.

METHODS

Giemsa-stained thick blood films were examined for malaria parasites in 400 people (200 each from townships with high and low urban status) from May to November 2009. Questionnaires were administered to determine and evaluate demographics of the participants. All participants lived within the two catchment areas, about 20 km apart.

RESULTS

Average malaria prevalence among participants was 8.75%. Prevalence in Kaneshie (12%: p=0.032) was significantly higher compared to Airport West (5.5%). Illiteracy rate (17.5%), self-medication (81.5%) and the use of coils (21.0%) as a control mechanism was higher among residents of Kaneshie than Airport West. Most of the people (40%) in Kaneshie did not use any form of malaria control method. Insecticide spray was the most preferred malaria control mechanism by the Airport West residents (60.5%). Overall knowledge about malaria, employment status, housing conditions, level of overcrowding and the cost of treatment of malaria was better in Airport West than at Kaneshie.

CONCLUSION

Malaria prevalence and factors influencing its transmission differs within communities in the same urban area. It is therefore essential to develop control and prevention strategies based on the needs of specific communities.

Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of acute kidney injury

Background

Acute kidney injury (AKI) is routinely diagnosed by creatinine-based guidelines, which is sub-optimal marker after injury due to renal and non-renal factors. This has necessitated the need for more specific and sensitive biomarkers for early detection of AKI in at risk patients. This prospective cross-sectional study used the biomarkers of cell cycle arrest and Neutrophil Gelatinase Associated Lipocalin (NGAL) to assess AKI among hospitalized patients.

Methods

We conveniently enrolled 151 in-patients at the Trauma and Specialist Hospital, Winneba in Ghana. Socio-demographic and clinical information were collected using structured questionnaires. Blood samples were collected for the estimation of serum creatinine, and AKI diagnosed and staged using the KDIGO guideline. Fresh urine samples were collected and urinary NGAL, TIMP-2 (tissue inhibitor metalloproteinase 2) and IGFBP-7 (insulin-like growth factor binding protein 7) were estimated using ELISA kits.

Results

The cell cycle arrest biomarkers and NGAL were significantly (P < 0.001) higher among participants with AKI than those without AKI. [TIMP-2]∗[IGFBP-7] showed the best diagnostic performance (AUC = 0.94, CI = 0.90–0.98) followed by [IGFBP-7]∗NGAL] (AUC = 0.93, CI = 0.87–0.99), with NGAL having the least (AUC = 0.62, CI = 0.46–0.78). The cut-off for [TIMP-2]∗[IGFBP-7] showed the best predictive ability (95.8% sensitivity, 77.2% specificity, 44.2% PPV and 99% NPV). The cut-off for NGAL, on the other hand, showed the least predictive ability (62.5% sensitivity, 42.5% specificity, 17.0% PPV and 85.7% NPV).

Conclusion

Tissue inhibitor metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) best predicts the development of AKI, and can be used in high risk patients for early diagnosis of AKI.

Multicenter evaluation of training of non-endoscopists in 30-cm flexible sigmoidoscopy

An estimated 145,000 patients will be diagnosed with colorectal cancer in the United States in 1987. Although half of these cancers are potentially detectable by sigmoidoscopy, rigid sigmoidoscopy is not widely used for early detection, largely because of discomfort it causes patients. Flexible sigmoidoscopy has been shown to be more acceptable and more efficient in detecting cancers. In order for flexible sigmoidoscopy to be of more value in cancer control, however, primary care physicians must learn the technique and incorporate it into their complete physical examinations. This paper reports the results of a multicenter trial that evaluated the training required for non-endoscopists to learn how to use the 30-cm flexible sigmoidoscope. Instructions with plastic models, followed by an average of six supervised patient examinations, proved sufficient for them to learn the necessary skills.

Impact of the initial phase of COVID-19 pandemic on surgical oncology services at a tertiary care center in Eastern India

BACKGROUND

The COVID-19 pandemic has caused a global health emergency and affected the resources in both the public and private health sectors significantly. The present study aims to assess the impact of the pandemic on the services by the department in the first 3 months since the first COVID case in the region.

METHODS

The study period was from 16 March to 15 June 2020. We queried the database for data on site of the tumor, diagnosis, stage, tumor board decisions and planning, surgical procedures, adjuvant treatment, and follow-up details. The change in tumor board decision and actual treatment taken by the patient were all recorded, taking into consideration the COVID-19 pandemic.

RESULTS

Among the 1567 patient contacts, 1306 were out-patient visits and 261 teleconsultations. Fifty-four patients underwent surgery from the 87 admitted to the hospital. Ten preoperative patients and two postoperative patients were tested for COVID and reported to be negative.

CONCLUSIONS

The dilemma of providing cancer surgery services to the patients in this pandemic has been global. Strict measures and guidelines can help to overcome the COVID pandemic time, keeping in mind the locoregional logistics.

Vitamin D Deficiency Is Common in Ghana despite Abundance of Sunlight: A Multicentre Comparative Cross-Sectional Study

BACKGROUND

Vitamin D is a steroid hormone important for the normal functioning of the body. It is produced through skin exposure to sunlight and from the diet. Although Ghana is located in the tropics where sunlight is abundant, factors like culture, diet, skin pigmentation, variation in the ozone layer, and geographical area influence the optimization of vitamin D concentration. It is imperative to evaluate the interplay between sunshine exposure, proinflammatory cytokines, and mediators of vitamin D metabolism and their relationship to vitamin D status in three geographical sections among apparent healthy Ghanaians.

METHODS AND RESULTS

In a cross-sectional study, a total of five hundred (500) healthy blood donors from three geographical areas in Ghana were enrolled. Their age ranged from 17 to 55 years with a mean age of 27.97 ± 8.87 years. The overall prevalence rate of vitamin D deficiency was 43.6% (218/500), with 41.2% (91/221), 45.3% (63/139), and 45.7% (64/140) of vitamin D deficiency being recorded in participants from the Northern Sector (NS), Middle Belt (MB), and Southern Sector (SS), respectively. However, there were no significant differences in the proportions of vitamin D deficiency across various geographical sectors. The median 25-hydroxyvitamin D serum levels were compared among geographical areas (NS, MB, and SS) and there were no significant differences (P=0.275) after adjusting for confounding factors. 25-Hydroxyvitamin D correlated positively with corrected ionized calcium (rs = 0.622, P ≤ 0.001) and phosphorus (rs = 0.299, P ≤ 0.001) and negatively correlated with SBP (rs = -0.092, P=0.039), vitamin D binding protein (VDBP) (rs = -0.421, P ≤ 0.001), intact parathyroid hormone (iPTH) (rs = -0.0568, rs ≤ 0.001), IFN-gamma (rs = -0.684, P ≤ 0.001), and TNF-alpha (rs = -0.600, P ≤ 0.001). After adjusting for possible confounders, not having knowledge about vitamin D foods, taking fewer vitamin D foods, and higher levels of IF-γ and IL-10 were associated with a higher risk of having vitamin D deficiency.

CONCLUSION

The prevalence of 25-hydroxyvitamin D deficiency is high among the general adult population in Ghana despite the abundance of sunlight. Increasing knowledge on vitamin D diet coupled with a daily intake of vitamin D dietary supplements is likely to reduce the risk of developing 25-hydroxyvitamin D deficiency.

Profiling vitamin D, its mediators and proinflammatory cytokines in rheumatoid arthritis: A case-control study

INTRODUCTION

The active form of vitamin D has immunomodulatory and anti-inflammatory effect. Vitamin D is implicated in pathogenesis of rheumatoid arthritis (RA) and its deficiency leads to increased inflammation. Moreover, its production is dependent on concentration of calcium, phosphorus, and parathyroid hormone (PTH). Cytokines mediates inflammation in RA synovium. This study evaluated vitamin D, its mediators and proinflammatory cytokines among RA patients.

METHODS

In a case-control study, 78 RA patients from Komfo Anokye Teaching Hospital rheumatology clinic and 60 healthy blood donors were recruited. Chemistry analyzer and enzyme-linked immunosorbent assay kits were used to measure biochemical parameters and cytokines.

RESULTS

We found significantly higher levels of interleukin (IL)-1β, interferon gamma (IFN-γ), and tumor necrosis factor-α (TNF-α) in RA patients compared with controls (p < .05). There was a significant positive correlation between intact parathyroid hormone (iPTH) and IL-10 (r = .30, p < .05) and a negative correlation between IL-6 (r = -0.28, p > .05), IL-1β (r = -0.25, p > .05), TNF-α (r = -0.26, p > .05), IFN-γ (r = -0.24, p > .05), and iPTH. There was a significant negative correlation between IL-1β (r = -0.33, p < .05), IFN- γ (r = -0.29, p < .05), and calcium.

CONCLUSION

Reduced PTH, calcium, and phosphorus is associated with higher levels of proinflammatory cytokines which may worsen RA disease condition. Vitamin D is therefore not an independent regulator of proinflammatory cytokines in RA.

Knowledge and utilization of family planning services among tertiary students in Northern Ghana: The case of College of Nursing and Midwifery, Nalerigu

Though tertiary students studying health-related programs are assumed knowledgeable about family planning, this does not always translate to increased use of family planning services. In a cross-sectional survey, this study assessed 411 nursing, midwifery and allied health students' knowledge of family planning, contraceptive use, perceptions, and factors affecting the utilisation of family planning services. Each student completed a 24-itemised questionnaire in a Computer-Assisted Personal Interviewing Survey. The data was analysed with Stata /IC version 16. Statistical significance was set at p<0.05. Overall knowledge of family planning was 99.7%, commonly gained in school (51.8%), followed by clinics and hospitals (41.4%). Only 21.7% of the students used family planning services. Menstrual cramps (57.9%), infertility (33.1%), and weight gain (32.5%) were the commonly perceived side effects of contraceptive use. The high proximity of participants to family planning service providers and lack of community, family, and partner acceptance of modern contraceptives were associated with underutilisation. Despite the high level of knowledge of family planning, the student's utilisation of family planning services was poor. To boost family planning service uptake among tertiary health students, it is essential to tackle barriers related to community, family, and partner acceptance. This can be achieved through educational programs that involve men in family planning discussions and by enhancing service accessibility.

Comparison of Modified Manual Acid-Phenol Chloroform Method and Commercial RNA Extraction Kits for Resource Limited Laboratories

Method

In a comparative experimental cross-sectional study, RNA was extracted from oral swabs and blood samples from 25 healthy individuals at the Department of Molecular Medicine, KNUST. RNA was extracted by the manual AGPC extraction method and commercial RNA extraction kits. The quantity (ng/μl) and purities (260/280 nm) of the extracted RNA were measured spectrophotometrically using the IMPLEN NanoPhotometer® N60. The presence of RNA in the extracts was confirmed using 2% agarose gel electrophoresis. Statistical analyses were conducted using R language.

Results

The yield of RNA extracted from blood and oral swab samples using modified AGPC was significantly higher compared to the commercial methods (p < 0.0001). However, the purity of RNA extracted by the manual AGPC method from blood was significantly lower than the commercial methods (p < 0.0001). Moreover, the purity from oral swabs using the manual AGPC method was significantly lower compared to QIAamp (p < 0.0001) and the OxGEn kits method (p < 0.001).

Conclusion

The modified manual AGPC method has a very high yield of RNA extracts using blood samples, which could serve as an alternate cost-effective method for RNA extraction in resource-limited laboratories; however, its purity may not be suitable for downstream processes. Moreover, the manual AGPC method may not be suitable for extracting RNA from oral swab samples. Future investigation is needed to improve the purity of the manual AGPC RNA extraction method and also confirmation of the obtained results by PCR amplification and RNA purity verification by sequencing.

Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study

INTRODUCTION

Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana.

METHODS

A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1-12.0 mmol/L, HbA1c < 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c > 7%) and good glycaemic controls (GC) (FBG = 4.1-6.0 mmol/L, HbA1c < 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p < .05 was considered statistically significant.

RESULTS

There were no significant differences in age (years) between patients in the various glycaemic groups (p = .9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p < .0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p < .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04-17.36), p < .0001] and FT3 [aOR = 2.77, 95% CI (1.11-6.92), p = .0290] were significantly and independently associated with increased odds of hyperglycaemia.

CONCLUSION

The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana.