Priscillia Nortey

Prevalence of hepatitis B virus co-infection among HIV-seropositive persons attending antiretroviral clinics in the Eastern Region of Ghana

Introduction Hepatitis B and HIV infections are endemic in sub-Saharan Africa including Ghana. Understanding the extent of the co-infection is critical to the optimal care of persons living with HIV and AIDS (PLHIV). We determined the prevalence and risk factors of HBV co-infection in PLHIV and assessed the knowledge of health care workers (HCW) in Antiretroviral Therapy (ART) clinics regarding the co-infection. Methods A cross sectional study was conducted in five ART clinics to obtain data from a systematic random sample of PLHIV in the Eastern region of Ghana from March to June 2012. We used self-administered questionnaires to assess knowledge of HCW on knowledge and management of the co-infection. Descriptive statistics and logistic regression models were used for analysis at 5% significance level. Results Of 320 PLHIV recruited into study, with median age of 40 years (IQR: 33-50 years), 28 tested positive for HBsAg giving an overall prevalence of 8.8%. There were significant associations between HBV infection and being an adult (p=0.004), increasing serum ALT levels (p=0.002) and partner with history of HBV infection (p=0.010). HCW obtained 84.2% (SD± 20.53; 95% CI: 89-98.1) and 53.1% (SD± 35.06; 95% CI: 13.0-88.9) in the “general knowledge” and “management practice” indexes respectively. Conclusion Prevalence of HBV-HIV co-infection was relatively high among PLHIV in Eastern region. Knowledge of HCW on management practices of HBV-HIV co-infection and HBV vaccination coverage among PLHIV were found to be relatively low. Regular trainings of HCW and a HBV vaccination programme targeted at PLHIV should be considered.

Assessment of the Tamale West Hospital laboratory, Ghana, 2017

Introduction : medical laboratory plays a crucial role in the diagnosis and treatment of patients. This role means that medical laboratories require accreditation, constant monitoring and assessment to ensure that their Results: are of the highest quality to inform the appropriate public health action. There is an urgent need, therefore, to strengthen laboratory systems and services in the country. Laboratories in Ghana generally do not go through assessment-based accreditation before they start operations. As a result, a lot of the laboratories in the country are not accredited. In recent times, however, there has been a clarion call for the assessment-based accreditation of both public and private medical laboratories. We conducted this study to assess the preparedness of the Tamale West Hospital laboratory toward accreditation. Methods : we conducted a cross-sectional survey from the 9th to 13th January 2017. We used the World Health Organization Stepwise Laboratory (Quality) Improvement Process towards Accreditation (WHO-SLIPTA) checklist to collect information on the twelve areas of quality laboratory management systems. Each area assessed was scored and the laboratory rated on a scale of no star (0-142 points) to five stars (244- 258 points). Results : the overall assessment score was 34.9% (90/258). There was no evidence of management reviews, client management, occurrence management and internal audit. The laboratory scored good marks in organization and personnel (65%) and information management (66.7) but scored poorly in document and record (0%) and internal audit (0%). The laboratory was rated no stars. Conclusion : the laboratory performed poorly in most areas of assessment and is at the lowest level of strength. It is recommended that the hospital management provides opportunities for laboratory staff to be trained on quality laboratory management systems.

Neonatal death surveillance system evaluation, Kintampo North Municipality, Ghana, 2017

Introduction : globally, estimated 2.9 million newborns die annually within the first 28 days of life. Most deaths (99%) occur in low-and-middle-income countries. Neonatal Mortality Rate (NMR) in Kintampo North Municipality (KNM) is high. The aim mof the Neonatal surveillance system is to estimate and monitor neonatal death rates, identify risk factors and high risk areas for neonatal deaths to inform program actions. This surveillance system is part of the Integrated Disease Surveillance and Response in Ghana. This system has not been evaluated in the past six years. We evaluated the system to determine its usefulness and whether it is meeting stated objectives. Methods : we reviewed the 2012-2016 neonatal death surveillance data in the KIntampo North Municipality. Surveillance staff were interviewed using semi-structured questionnaire. Registers and reporting forms at reporting sites were inspected and compared to the aggregate data in the District Health Information Management System (DHIMS 2) for data consistency. We assessed system attributes including sensitivity, data quality, representativeness and completeness. Descriptive analysis was done with Stata 14 and complemented with the interviews and record inspection to describe the systems attributes. Results : between 2012 and 2016, a total of 175 neonatal deaths occurred. Most deaths (90.8%) occurred in the early neonatal period (0-6 days). The NMR in the Municipality within the five years ranged from 13-21 deaths per 1000 live births with 2015 recording the highest rate. Less than ten variables are required to complete a neonatal death report. The municipal hospital recorded > 90% of deaths. None of the four private facilities in the municipality reports to the health directorate. There was no evidence of action by the health directorate to address the high NMR. Data inconsistencies and missed reporting exist at community, sub-district and facility levels. Conclusion : the system is not meeting its objectives and also not useful in decision-making in the municipality. The Municipal Health Directorate has planned to train key health staff and periodically supervise them to improve on the performance of the system in the Municipality. We sensitized the private facilities owners to report neonatal deaths to the health directorate.

Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy

Background Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. Methods A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Results One out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs)—46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83–33.72]. Those from a district level mission hospital (St. Martin’s ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074–9.120). Conclusion The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics.

Antimicrobial drug usage and poultry production: case study in Ghana

Antimicrobial use in food animal production could lead to the occurrence of antimicrobial residues in the animal products. In Ghana, there is no monitoring program for antimicrobial residue in foods of animal origin. We determined the types of antimicrobial drugs used in poultry production in Dormaa municipality and the levels of residue found in poultry products. Performing a cross-sectional study, a structured questionnaire and direct observation methods were used to assess antimicrobial usage, knowledge of and adherence to withdrawal periods in randomly selected poultry farms. Eggs and ready-for-sale broilers were purchased from selected respondents’ farms for detection and quantification of residues using the microbial inhibition plate assay. A total of 132 farmers were interviewed from 115 farms. Farms (86%) administered drugs to birds for prophylactic purposes. A total of 28 (24.3%) farms had tetracycline residue in eggs, 25 (21.7%) in kidney and 14 (12.2%) in liver. Mean (±s.d.) tetracycline concentration (μg/g) found were: eggs 0.02 ± 0.003; kidneys 0.02 ± 0.01; and liver 0.01 ± 0.008. Twenty-six farms (92.9%; ρ > 0.05) that had residues in eggs had sold eggs during treatment of the laying birds. A disinfectant and two antibiotics in human formulations were administered to birds in 44.3%, 17.4% and 2.6% farms respectively on an extra-label basis. Tetracyclines were the main antimicrobial drugs used in poultry farming in the study area with little or no regard to withdrawal periods. Tetracycline residue was found in poultry but below the Maximum Residue Level set by Codex Alimentarius. Extra-label use of disinfectant to water-medicate birds poses a health hazard to farmers and consumers alike.

Hepatitis B virus genotypes among chronic hepatitis B patients reporting at Korle-Bu teaching hospital, Accra, Ghana

Introduction Knowledge of hepatitis B virus (HBV) genotype is an important predictive variable which might have an impact in management and treatment of patients with chronic hepatitis B infection. In Ghana very little information is available on hepatitis B genotypes. This study was conducted to determine the distribution of HBV genotypes circulating among chronic hepatitis B patients reporting at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. Methods Blood samples (10 ml) were collected from 250 consenting patients. DNA was extracted and amplified using polymerase chain reaction technique. Restriction fragment length polymorphism (RFLP) was used for the detection of genotypes. Results Out of the 250 chronic hepatitis B patients who were HBsAg positive, 91 (36.4%) were males aged 29.8 ± 9.1 and 159 (63.6%) females aged 33± 12.1 years. HBV DNA was detected in 111 (44.4%) but only 58 (52%) of these were typeable. These were classified as genotype A, 8 (7.2%); genotype D, 3 (2.7%) and genotype E, 47 (42.3%). Our results did not show any association between the infecting genotype and age (X2= 0.923; p-value=0.623) or gender (X2= 0.283, p= 0.579). Conclusion Consistent with similar studies worldwide, the results suggest that genotypes A, D and E were the genotypes circulating among chronic hepatitis B patients who reported to the Korle-Bu Teaching Hospital with genotype E being the most predominant and therefore constitutes an important public health concern. We recommend further epidemiological studies to understand the implication of genotype E in terms of disease progression and treatment.