The global burden of the respiratory syncytial virus (RSV) disproportionately affects low- and middle-income countries (LMICs). The World Health Organization's Strategic Advisory Group of Experts on Immunisation recently recommended the global implementation of emerging RSV immunisation strategies to protect infants. Cost of illness data are needed to estimate the economic burden of RSV and evaluate the introduction of these immunisation strategies in LMICs. Here, we estimated RSV-associated costs in Ghana. We measured resource utilisation from the societal, health system, and household perspectives for children <2 years old receiving care for (severe) acute respiratory infections at Africa's third largest referral centre located in Accra, Ghana. During the 2023 respiratory season, children were tested for RSV using molecular point-of-care testing at inpatient and outpatient facilities. Direct medical, direct non-medical, and indirect cost data were collected via questionnaire-based caregiver interviews and gathered from hospital records. Interviews took place at the index visit, upon discharge, and during follow-up (four-six weeks post discharge). Of 128 participating children, 59 (46%) and 69 (54%) received care at outpatient and inpatient facilities, respectively. RSV was detected in 58 (45%) children. From a societal perspective, the average cost per episode of RSV infection was USD 69 (95% confidence interval (CI) = 60-77) for outpatients and USD 488 (95% CI = 374-601) for inpatients. We estimated health system costs exceeding USD 30 and USD 200 on average for outpatient and inpatient care, respectively. Out-of-pocket costs borne by households were USD 32, (95% CI = 24-40) for outpatient care and USD 213 (95% CI = 158-269) for inpatient care. Household costs associated with RSV were equivalent to 88% (outpatients) and 592% (inpatients) of the Ghanaian monthly minimum wage in 2023. In this urban tertiary setting, we found a significant economic burden of medically attended RSV, carried by the Ghanaian health system and households. Our findings will be valuable to stakeholders in evaluating emerging interventions for RSV prevention in Ghana and comparable countries.
Interpreting radiological images, a primary responsibility of radiologists, is crucial for accurate diagnosis and informed clinical decisions. However, many low-and-middle-income countries (LMICs) face severe radiologist shortages, leading to diagnostic delays, uncertainty, and potential compromises in patient care. This study explored the perspectives of frontline medical doctors on the challenges posed by radiologist shortages in Ghana concerning image interpretation and its impact on healthcare delivery and patient care. A qualitative descriptive study was conducted using semi-structured interviews with eight medical doctors working across public and private healthcare facilities at different levels of the Ghanaian health system. Data were thematically analysed with NVivo 14, following Braun and Clarke's reflexive thematic analysis framework. Three key themes emerged: the vital role of radiological imaging in clinical practice, difficulties in accessing radiological reports, and suggested strategies to address the challenges posed by radiologist shortages. Subthemes identified include barriers such as delayed access to radiologist reports, underlying causes for report unavailability, insufficient training in image interpretation, and clinician burnout. Participants proposed expanding radiology training, strengthening radiology education in undergraduate medical curricula, involving trained radiographers in preliminary image evaluation, and integrating teleradiology and artificial intelligence technologies as potential solutions to these challenges. Radiologist shortages in Ghana significantly affect the availability and quality of image interpretation services, which impacts diagnostic accuracy and patient care. Addressing this gap requires a multifaceted approach involving radiologist workforce development and enhancing the image interpretation skills of front-line medical practitioners. Efforts should include enhancing radiology training in undergraduate medical education and expanding access to remote reporting technologies particularly in underserved areas.
Breast cancer (BC) is a serious public health concern in sub-Saharan Africa, with Ghana incurring a staggering 5026 cases and 2369 deaths in 2022. The insufficiency of accurate epidemiological information, limited access to health care, late diagnoses, and insufficient screening procedures hinder policy implementation. While numerous treatment methods, such as chemotherapy, radiation, and immunotherapy, exist, patients with BC respond differently. The variation in response can be accounted for by a combination of genetic, environmental, and socioeconomic factors specific to the Ghanaian population. This review examines the unique molecular and immunologic characteristics of BC in Ghana and their implications for therapeutic effectiveness in personalized treatment. Precision medicine is suggested as imperative in the design of biomarker-guided therapies to consider the BC molecular heterogeneity that is prevalent among Ghanaian patients. However, there is still a challenge of late-stage diagnosis due to insufficient diagnostic infrastructure. Early detection efforts through investment in next-generation sequencing and health care training are imperative. Besides, immune checkpoint inhibitors show promising therapeutic utility in triple-negative breast cancer (TNBC), and clinical trials in the Ghanaian population should be considered. This article emphasizes the need for community education to counteract misconceptions and ensure timely health care-seeking behaviours. To minimize mortality rates and improve patient care for BC in Ghana, a concerted approach through research funding, policy reform, and collaborative stakeholder engagement is imperative, in addition to advancements in diagnostics and therapeutics in the local context.
Dyslipidaemia is a major modifiable risk factor for cardiovascular disease and has become an increasing public health concern in sub-Saharan Africa. Rapid urbanisation, dietary transitions, and sedentary lifestyles have contributed to the rising incidence of cardiometabolic diseases in Ghana. However, evidence on the overall burden and patterns of dyslipidaemia in adults remains unclear. This systematic review aimed to synthesise the evidence on the prevalence and lipid profile patterns of adult Ghanaians. A comprehensive search of PubMed, Scopus, Web of Science, African Journals Online, Africa-Wide Information and African Index Medicus databases was conducted for studies published between January 1980 and November 2025. Eligible studies reported the prevalence or distribution of dyslipidaemia in Ghanaian adults (≥ 18 years). Two reviewers independently screened, extracted, and assessed the quality of included studies. Findings were synthesised narratively and summarised in descriptive tables and figures, due to heterogeneity in study designs and data reporting. Twenty-four studies published between 2003 and 2023, comprising approximately 11,400 participants, met the inclusion criteria. Across the included studies, the reported prevalence of dyslipidaemia ranged from 3.0% to 72.4%, reflecting differences in study populations, diagnostic criteria and study settings. Low high-density lipoprotein cholesterol (HDL-C) was the most frequent abnormality, followed by elevated total and low-density lipoprotein cholesterol (LDL-C), whereas hypertriglyceridaemia was the least common. Studies from southern and middle regions-particularly Ashanti, Brong-Ahafo, and Greater Accra-reported a higher dyslipidaemia prevalence than those from northern Ghana. Considerable variation in diagnostic criteria, study populations and sampling strategies limited comparability and precluded meta-analysis. Dyslipidaemia is common among adult Ghanaians, with low HDL-C emerging as the predominant abnormality. Methodological differences and sampling biases limit the precise estimation of the national burden, but the available evidence indicates a growing cardiometabolic risk. Future studies should prioritise community-based sampling and context-appropriate lipid thresholds to support evidence-based cardiovascular risk-reduction strategies.
To estimate overall survival among patients with breast cancer in Ghana by synthesizing time-to-event data from published studies using reconstructed individual patient data. We conducted a search of PubMed, SCOPUS and Embase for studies published from inception to November 28, 2025. Eligible studies directly provided Kaplan-Meier survival curves for overall survival (OS) for patients with breast cancer. Pseudo-individual patient data were digitized from published survival curves using WebPlotDigitizer, and survival curves were reconstructed with the IPDfromKM method and a one-stage Cox proportional hazards model with random effects was used to pool survival estimates. Exploratory meta-regression analyses were performed to assess sources of heterogeneity. This study was registered with PROSPERO, CRD420251243132. Six observational studies (2114 patients) conducted across major referral centers in four regions of Ghana (Greater Accra, Eastern, Ashanti, and Volta) met inclusion. The mean age was 47.3 years, with most patients presenting with stage III disease (47.2%). The pooled median OS was 4.4 years (95% CI: 4.0-5.0), and the estimated 5-year survival rate was 46.5%. Substantial heterogeneity in survival outcomes was observed across studies, with 5-year OS ranging from 1.6% to 78.8%. Meta-regression identified median follow-up as a significant moderator of mortality rates accounting for 89.46% of between-study heterogeneity. This study provides an estimate of breast cancer survival in Ghana and shows poor long-term breast cancer survival in Ghana, although interpretation should be cautious given the substantial heterogeneity across studies and potential immortal time bias in one included study. These findings highlight the need for improved survival reporting, and stronger population-based cancer registries to better benchmark outcomes and guide breast cancer control efforts in Ghana.
Maternal health remains a critical indicator of health system performance globally, yet its outcomes remain suboptimal in low-resource settings. In Ghana, pregnancy complications contribute to over 12% of maternal deaths among women aged 15-49 years and are a key driver of maternal morbidity. This study examined the health system and socio-demographic correlates of self-reported pregnancy complications in two rural districts in Ghana. A cross-sectional quantitative study was conducted among 274 women aged 15-49 years in the Wa West and Mamprugu Moagduri districts of Ghana. Data were collected via structured interviewer-administered questionnaires and analysed using STATA 17. Binary logistic regression was applied, with statistical significance set at p < 0.05 and 95% confidence intervals to determine associated factors of self-reported pregnancy complications. Overall, 38.7% of the respondents reported experiencing at least one pregnancy complication during their last birth. Stillbirth (63.2%) and miscarriage (26.4%) were the most reported pregnancy complications. Sub-district variations showed sharp differences within and across districts on pregnancy-related complications. Statistically significant socio-demographic correlates of pregnancy complications included being married (AoR = 0.16; 95% CI: 0.04-0.65), primiparous (AoR = 4.26; 95% CI:1.14-15.89), multiparity (AoR = 9.94; 95% CI: 2.80-35.3), higher income (AoR = 2.84; 95% CI: 1.49-5.41) and limited decision-making autonomy (AoR = 1.82; 95% CI: 1.37-3.99). Early antenatal care (ANC) initiation (AoR = 2.86; 95% CI: 1.08-7.54), and long distance to health facility (AoR = 2.12; 95% CI: 1.13-3.99) were associated with higher pregnancy complications, but facility-based pregnancy confirmation (AoR = 0.26, 95% CI: 0.12-0.59) was associated with lower reports of pregnancy complications. The high burden of self-reported pregnancy complications underscores systemic gaps in service delivery, workforce distribution, and governance. Geographic disparities reflect systemic inequities in resource allocation and supervision. Strengthening ANC outreach, empowering women through gender-responsive governance, and leveraging digital health innovations for early detection and referral coordination are essential to improving maternal outcomes and Ghana's progress toward SDG 3.1. Not applicable.
Stillbirth remains a major global health challenge, with approximately 2.6 million cases reported annually, 98% of which occur in low- and middle-income countries. Autopsy after stillbirth is essential for understanding the underlying causes and informing preventive strategies. In Ghana, autopsies after stillbirth are rarely offered, and many families decline the option even when available. However, research on postmortem uptake in Ghana and sub-Saharan Africa remains limited. This study aimed to explore the perspectives and perceptions of bereaved mothers regarding autopsy after stillbirth in Ghana. A qualitative exploratory design was employed to examine mothers' perspectives on autopsy after stillbirth at the Korle Bu Teaching Hospital between January 2020 and June 2021. Participants were identified through hospital labour and delivery records. Convenience sampling was used to recruit mothers for in-depth interviews until data saturation was achieved. Fifteen (15) mothers were interviewed in English. The interviews were transcribed verbatim and analysed using thematic analysis. The desire for emotional resolution and preventive value was as a key motivating factor for mothers who consented or indicated willingness to consent to autopsy. Many participants expressed that understanding the cause of stillbirth would provide closure and inform precautionary measures for future pregnancies. On the other hand, mistrust in healthcare personnel, financial constraints, assumptions about the cause of death, and perceived irrelevance of autopsy influenced decisions to decline autopsy after still birth. Cultural norms surrounding death also shaped perceptions, with some mothers viewing autopsy as intrusive once life was considered irreversibly lost. Communication gaps and limited knowledge regarding the availability and purpose of autopsy further contributed to low uptake. Autopsy after stillbirth uptake in Ghana is shaped by emotional, cultural, financial, and systemic factors. Strengthening provider-parent communication, addressing financial barriers, and integrating culturally sensitive bereavement counseling into post-stillbirth care may improve informed decision-making and enhance efforts to prevent future stillbirths.
Interprofessional education (IPE) has been commonly employed to facilitate preparation for collaborative practice among medical students. However, differences in IPE implementation and a lack of synthesis of student experiences continue to influence its integration into medical education. The scoping review was conducted following the Arksey and O'Malley guidelines and was reported according to the PRISMA-ScR extension. Electronic databases such as PubMed, Scopus, and Web of Science were searched to include studies published between 2014 and 2024. The search yielded eight studies that met the inclusion criteria for this review. The results were synthesized to explore students' experiences, challenges, and facilitators regarding IPE. The review found that medical students generally reported having a positive orientation towards collaborative practice and valued the opportunity to learn with others. However, understanding of professional roles was more inconsistent. Identified challenges included ambiguity of roles, hierarchy of professions, and constraints of time and organization. Enablers included integration into the curriculum, learning in practice, interaction and support. IPE facilitates learning in collaborative practice, and its effectiveness relies on its development and implementation. Further consideration should be given to role clarification, learning, and integration in medical education programs. Future research should focus on the long-term effects of IPE on professional practice.
Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a significant cause of morbidity and mortality worldwide. However, epidemiological data and access to diagnostics and management of VTE remain limited in sub-Saharan Africa. This multicentre initiative aimed at strengthening capacity, enhancing management and establishing epidemiological data on VTE-focusing on DVT-in Ghana. The DVT network was established in nine hospitals across Ghana from 2018 to 2022. The initiative involved capacity building, technical infrastructure, including a train-the-trainers approach, mentorship, awareness workshops and campaigns. Epidemiological data were collected from patients with suspected DVT in two study phases. Among 1422 patients with suspected DVT, diagnosis was confirmed by ultrasound in 44% (624/1422). Before the onset of symptoms suggestive of DVT, 25% of inpatients with active cancer (37/146) and 27% of inpatients with a history of DVT (8/30) were receiving anticoagulation. Following VTE confirmation, 96% (370/384) of patients who were assessed in the second phase of the project received anticoagulation. The all-cause in-hospital mortality rate evaluated in the second phase was found to be significantly higher among inpatients with confirmed VTE than in patients without (19%, 57/295 vs 4%, 15/415, p<0.001). Fifty-nine (19%) patients with DVT received a 3-month follow-up; 34% (20/59) experienced complete resolution; at 6 months, complete resolution increased to 71% (32/45). The high rate of confirmed DVT in suspected cases in Ghana highlights the need for targeted screening. Standardised capacity-building initiatives can be implemented across multiple hospitals, enhancing access to high-quality healthcare. While establishing specialised 'DVT centres' provides qualified management for referred patients, underdiagnosis of DVT and limited prophylaxis remain major challenges, underscoring the need to enhance nationwide thromboprophylaxis and healthcare access for patients with suspected DVT.
Scabies is a neglected tropical disease with substantial public health impact, especially in resource-limited countries like Ghana. Worldwide, more than 300 million people are affected by scabies. In Ghana, scabies outbreaks have been occurring frequently, especially among school-going children. This study assessed scabies burden, diagnostic accuracy, and the effect of ivermectin-based Mass Drug Administration (MDA) on scabies prevalence in the Sefwi Wiawso Municipality of the Western North Region of Ghana. A total of 341 participants were recruited at health facilities within the Municipality between October 2022 and October 2023. Scabies was diagnosed using the 2020 The International Alliance for the Control of Scabies (IACS) consensus criteria, and demographic data were collected. Health facility diagnoses were compared with study findings, and the relationship between MDA intake and scabies occurrence was also assessed. There was equal representation of both males (N = 172) and females (N = 169) with the mean ages of recruited male and female participants being 23.49 ± 14.26 years and 25.28 ± 13.68, respectively. IACS consensus criteria assessment of all participants showed 83% had clinical scabies and 10% had suspected scabies. Participants with basic education (JHS and primary) were disproportionately more likely to be diagnosed with either clinical or suspected scabies (p = 0.006). Ivermectin MDA intake was significantly associated with scabies diagnosis (p = 0,001). Study participants who had received at least 3 rounds of ivermectin MDA over the years were less likely to be diagnosed with either clinical (18.73%) or suspected (14.71%) scabies (p = 0.009). Study participants who reported more than 3 skin condition symptoms were significantly more likely to be diagnosed with clinical scabies (89.4%) compared to suspected scabies (64.71%) (p < 0.001). Clinical and suspected scabies were also only correctly diagnosed in 43.82% and 14.71% of participants, respectively, prior to training of health workers on the IACS consensus criteria tool (p < 0.001). Scabies is often overlooked in health facilities in Ghana, highlighting the need for better diagnostic capacity. The observed reduction in scabies burden with ivermectin MDA supports its use in integrated control programs for neglected tropical diseases.
Enterococcus species are part of normal microbiota but can cause severe infections, especially among hospital-adapted strains. In Ghana, data on their dynamics, including prevalence and resistance patterns, remain limited. This systematic review and meta-analysis is the first to assess the current scope and identify gaps in One-Health research on Enterococcus. We searched PubMed/MEDLINE, Scopus, and Web of Science following PRISMA 2020 guidelines for studies published up to October 24, 2024 (search conducted October 12-24, 2024). A random-effects model with restricted maximum likelihood was used to pool prevalence and antimicrobial resistance. Sixty-nine studies met the inclusion criteria with nineteen eligible for meta-analysis. The pooled prevalence of Enterococcus was 6.76% (CI: 1.19-16.39, I2 = 99.3%, p < 0.0001) while adjusted vancomycin-resistance isolates was 0.06% (CI: 0.00-27.86; I2 = 99.4%, p < 0.0001). Antibiotic resistance rates were comparable across human and animal studies, often higher in animals. Ciprofloxacin showed the lowest resistance (1.30%), while cloxacillin had the highest (17.46%). This review underscores the one-sided focus on humans, limiting understanding of transmission within the One-Health spectrum. We advocate integrating genomic approaches, particularly environmental genomics, into One-Health frameworks to resolve transmission pathways, inform policy, and strengthen antimicrobial resistance control in Ghana. Enterococcus bacteria usually live harmlessly in humans and animals but can cause serious infections and drug resistance. We reviewed studies from Ghana and found limited, human-focused data. Our results show similar resistance across humans and animals, highlighting the need for environmental and genomic approaches within One Health surveillance.
Colorectal cancer is the third most common cancer worldwide, with increasing incidence and mortality expected in the coming decades. In Ghana, its burden is growing, and this has been addressed through training skilled colorectal surgeons and adopting international protocols. This study aimed to evaluate adherence to the American Society of Colon and Rectal Surgeons preoperative colorectal cancer checklist and its association with postoperative outcomes in two teaching hospitals in Ghana. A cross-sectional study was conducted on rectal cancer patients treated at two major teaching hospitals in Ghana. Chart reviews were done retrospectively to assess the completion of checklist items and their relationship with 30-day morbidity and mortality, comparing patients who completed the median number or more items to those who completed fewer. Fifty-two rectal cancer cases were included. Males (53. 9%) were the majority, with a mean age of 56 years. Most patients were diagnosed at stage III (69. 2%). The median number of completed checklist items was 6, with no patient completing all 10 items. The checklist items with the highest completion rates were clinical tumor staging (100%) and pathology review (100%). Assessments of family history, stool continence, sexual function, and stoma site marking were the least frequently completed. There was a significant difference in checklist completion between the two hospitals (p = 0.030). Checklist adherence was not significantly linked to postoperative morbidity or mortality. Adherence to the preoperative checklist provides a systematic approach to patient evaluation in preparation for surgery, though it did not influence morbidity or mortality in this study. Establishing dedicated colorectal units is a key step toward improving surgical outcomes and overall patient survival.
Friedewald's equation remains the most widely used method for estimating LDL-C in clinical settings, despite the availability of several homogeneous direct assays. However, its accuracy declines under certain clinical conditions, such as unusually high or low levels of triglycerides and total cholesterol. Recently, several novel population-specific equations have been reported to outperform the Friedewald equation. This study therefore is aimed at evaluating and comparing the accuracy of 13 LDL-C estimation equations within the Ghanaian population. A cross-sectional study was conducted among 976 individuals at Suntreso Government Hospital, Kumasi, Ghana. Fasting venous blood samples were analyzed for lipid profiles. Direct LDL-C was enzymatically measured and compared with values calculated using 13 equations. Performance was assessed with Pearson correlations, Bland-Altman plots, and Wilcoxon signed-rank tests. All 13 equations correlated significantly with direct LDL-C (r = 0.563-0.857, p < 0.001), with DeLong, Puavilai, Vujovic, Sampson, Choi, and Martin showing the strongest correlations (r = 0.857). Ahmadi (71.39 mg/dL), Hattori (44.93 mg/dL), Rao (25.8 mg/dL), and Choi (19.58 mg/dL) were the most overestimated LDL-C formulas, while de Cordova (-5.59 mg/dL) underestimated the direct LDL-C measurement. Subgroup analyses by age, triglyceride, and total cholesterol levels revealed that the Friedewald and Chen and Zhang formulas exhibited nonsignificant median differences (p > 0.05) in individuals aged 18-55 years and those with triglyceride levels ≥ 200 mg/dL. The Sampson, Martin, and Puavilai equations demonstrated the most reliable and consistent performance across age and lipid subgroups and should be considered preferred methods for LDL-C estimation in clinical and research settings in Ghana. Although Friedewald and Chen and Zhang performed adequately in younger adults and individuals with elevated triglycerides, their overall agreement was weaker, highlighting the broader utility of the Sampson, Martin, and Puavilai equations.
Despite global commitments to eliminate mother-to-child transmission of HIV and syphilis, political and resource prioritization remains uneven across low- and middle-income countries. This has led to disparities in financial investment, policy implementation, and health outcomes. This study examines the factors shaping political prioritization of prevention of mother-to-child transmission (PMTCT) in Ghana, Mozambique, and Sudan using the Shiffman and Smith framework to understand how political, institutional, and contextual forces interact to influence national responses. A qualitative, cross-country comparative policy analysis was conducted based on document review from 3 data sources. Across countries, we included 21 government documents, 22 documents from non-governmental organizations, and 15 peer-reviewed articles selected through theoretical sampling. Both inductive and deductive thematic analyses were applied, with the latter guided by the Shiffman and Smith framework. Political prioritization of PMTCT was influenced by interrelated domains including actor power, ideas, political context, information systems, and financial resources. Ghana and Mozambique achieved higher prioritization through cohesive advocacy networks, effective issue framing, strong political commitment, reliable data, and sustained donor support. In contrast, Sudan's limited progress reflected low political commitment due to fragmented leadership, weak coordination, inadequate data, and chronic resource constraints. The findings illustrate that progress depends not only on individual determinants but also on their interaction within national policy systems. Political prioritization of PMTCT results from the interaction of multiple interlinked factors rather than any single determinant. Strong advocacy, effective framing, reliable data, and sustained funding within supportive political environments foster commitment, as seen in Ghana and Mozambique. Coordinated advocacy, credible evidence, and predictable investment are essential to strengthen the PMTCT program by translating the global elimination goals into actionable national strategies.
Thousands of women die annually from preventable pregnancy-related complications. The high cost of treating complications in pregnancy remains a significant setback to improving maternal health and averting maternal mortality. Efforts by the government of Ghana to improve access to skilled maternal health care led to the provision of free maternal health care under the National Health Insurance Scheme in 2012. However, household costs associated with pregnancy-related conditions is not well researched in Ghana. Therefore, this paper estimated the cost of treating pregnancy-related complications in Ghanaian households. A descriptive cross-sectional design was employed to estimate the household cost of treating pregnancy complications (PRCs) at the Korle Bu Teaching Hospital (KBTH). A systematic sampling technique was adopted to sample 102 pregnant women who received treatment for pregnancy-related complications between March and November 2022. A structured questionnaire was used to collect data from respondents. Data analysis was done using Microsoft Excel version 16 and STATA, 16. Sensitivity analysis was conducted by varying the cost of drugs at 9% and productivity loss due to absenteeism at the daily minimum wage. The average cost of treating PRC was estimated at GHS 2,003.95 (US$265.07). The direct cost of treating PRCs accounts for 77.7%, while the indirect cost accounts for 22.2% of the total economic cost. The main drivers of the direct and indirect costs were the cost of feeding GHS 106,159.00 ($14,042.20) (41.7%) and productivity loss due to absenteeism at GHS57,906.34 ($7,659.57) (22.2%), respectively. The household cost of treating PRCs at the KBTH was very high, and policies and programs are required to support families to ease the economic burden on them.
Ghana exhibits geographic variation across northern and southern regions alongside differences between urban and rural communities, which may influence SARS-CoV-2 exposure and immune response. This study aimed to assess the differences in seroprevalence, and seroconversion status after exposure to SARS-CoV-2 in selected urban and rural Ghanaian communities. A longitudinal study design was employed. Serum samples (n = 987) were collected during a baseline survey (August 2023-February 2024) with longitudinal follow-up (n = 212) sampling after one year (August 2024-February 2025) among consenting community participants aged ≥10 years selected through household-based sampling in urban and rural settings. Socio-demographic data, clinical symptoms, and vaccination status were collected using structured questionnaires. Serum samples were inactivated and tested with semi-quantitative Anti-SARS-CoV-2 IgG ELISA assays targeting spike (S) and nucleocapsid (N) proteins. Presence of SARS-CoV-2 neutralizing antibodies in serum was determined by a surrogate virus neutralization assay. Of 987 participants aged 10-88 years (67.3% female), SARS-CoV-2 seroprevalence was comparable between urban (47.4%) and rural (47.7%) areas. Among the 212 participants followed longitudinally, 50.9% (108 participants) had both infection or vaccine-induced anti-spike and infection-induced anti-nucleocapsid antibodies after one year, indicating sustained immune responses from prior exposure or vaccination. There was a significant increase in paired spike and nucleocapsid antibody responses between baseline and follow-up (McNemar's test, χ²(1) = 104.00, p < 0.0001), reflecting ongoing immune boosting despite evidence of antibody waning. Neutralizing antibodies, were detected in 147/148 (99.3%) individuals at timepoint-1 and in all 12 (100%) selected individuals for follow-up at timepoint-2, demonstrating robust functional immunity. This study demonstrates widespread serological evidence of prior SARS-CoV-2 exposure and vaccine-induced immunity in both urban and rural Ghana. Functional neutralising antibodies were detected in a longitudinal subset, suggesting persistence of antibody-mediated protection in some individuals. Larger longitudinal studies with repeated functional immune assessments are needed to better define durable protection in West African settings.
Additional investigation is needed to better understand the associations between prenatal and early child malaria and early childhood growth outcomes. We leveraged the Ghana Randomized Air Pollution and Health Study which enrolled 1414 pregnant women from Kintampo, Ghana, and followed the mother-child dyads through the child's first year of life. We defined prenatal malaria exposure by histopathological examination of placenta tissue. We defined early child malaria exposure by active health surveillance over the child's first year of life and malaria rapid diagnostic testing when clinically indicated. We employed latent class growth analyses to construct growth trajectories for each anthropometric measure (weight and height and corresponding WHO z-scores, mid-upper arm circumference and head circumference (HC)), which we measured at birth, 3, 6, 9 and 12 months of age. We then used unadjusted and adjusted ordinal and multinomial regression to identify associations between prenatal and early child malaria growth trajectories, considered separately. Of the 1306 live births, 1144 children had prenatal and early child malaria exposure and growth data and were included in the analysis; 250 (21.9%) had prenatal malaria exposure, and 525 (45.9%) had early child malaria infection. Children with prenatal malaria as compared to those without had higher risk for poorer length growth (OR=1.46, 95% CI 1.08 to 1.98; multivariable OR=1.46, 95% CI 1.05 to 2.02), poorer length-for-age z-scores (OR=1.43, 95% CI 1.09 to 1.88; multivariable OR=1.53 95% CI 1.14 to 2.05) and smaller HC (OR=1.56, 95% CI 1.16 to 2.09; multivariable OR=1.43, 95% CI 1.04 to 1.98). Children with early childhood malaria as compared to those without had higher risk for poorer length-for-age z-score (OR=1.13, 95% CI 1.03 to 1.24; multivariable OR=1.12, 95% CI 1.01 to 1.24). Children with prenatal malaria as compared to without showed a trend for persistent stunting (multivariable OR=1.63, 95% CI 0.98 to 2.71). Malaria beginning in pregnancy was associated with poorer growth outcomes. Public health preventative strategies beginning in pregnancy may reduce malaria incidence and improve early childhood growth.
Previous studies have shown significant gaps in the timely delivery of pediatric neurosurgical-oncologic care in sub-Saharan Africa despite the significant patient volume. The study aims to elucidate how the healthcare system and sociocultural norms and religious beliefs determine the outcomes of pediatric central nervous system (CNS) tumor care in Ghana based on the experiences of healthcare professionals. This was a qualitative descriptive study; 15 healthcare professionals at Komfo Anokye Teaching Hospital (KATH) recruited through purposive sampling underwent audio-recorded semi-structured in-depth interviews. Interviews took place at the administrative offices of participants located on-site at KATH. Interviews were conducted by 2 co-investigators who had a professional relationship with the participants. Thematic saturation was reached after 9 interviews. Recordings were transcribed verbatim and coding and inductive thematic analysis was manually completed following Braun and Clarke's 6-step method. Thematic analysis yielded 3 overarching themes and 7 sub-themes with each illustrated with comments from study participants. The 3 overarching themes were: (1) The limitations of the healthcare system including limited availability of cancer treatment centers (2) Societal structures and norms which influence gender roles and healthcare decision making. (3) The impact of structural and social barriers to care leading to a 2 to 12 months delay in diagnosis with resultant poor treatment outcomes. The study adds to our understanding of the multifaceted barriers associated with pediatric neurosurgical-oncologic care in Ghana and how these barriers interact to impact outcomes. The study findings facilitate a comprehensive approach to designing and implementing health systems strengthening interventions to improve access to care.
Maternal anaemia remains a pressing global health challenge, with a notable burden in low- and middle-income countries. Existing studies in sub-Saharan Africa have largely relied on average associations, thereby concealing key variation among women and failing to account for heterogeneity. To assess the association between completing at least eight antenatal care (ANC) contacts and maternal anaemia in Ghana and to explore heterogeneity in this association using causal machine learning. An institution-based cross-sectional study was conducted using a retrospective review of medical records and causal machine learning analysis. Juaben Government Hospital. Of 2326 women who delivered at the hospital, 2114 with complete data on the main exposure and outcome variables were included in the analysis. Completion of at least eight ANC contacts. ANC contact was defined as the in-person visit to the clinic with a healthcare professional for routine ANC services and follow-up. Maternal anaemia, defined as a haemoglobin level below 11 g/dL in the last ANC before delivery. A causal forest model was used to estimate the association between completing at least eight ANC contacts and maternal anaemia. Conditional average treatment effects were used to explore individual-level variation in these associations, providing policy-relevant insights. Completing ≥8 ANC contacts was associated with a 6 percentage-point lower probability of maternal anaemia compared with having fewer visits (average treatment effect: -0.06, 95% CI -0.11 to -0.02). Predicted individual-level effects ranged from -0.21 to 0.09. Participants' age, malaria prophylaxis, marital status, parity and educational level were the five most important contributors to the observed heterogeneity. This study demonstrated that completing ≥8 ANC contacts is associated with a lower probability of maternal anaemia, with heterogeneity across subgroups. We recommend differentiated, context-specific ANC interventions that focus on high-impact subgroups while strengthening the effectiveness and quality of care delivered at each visit.
Caesarean section (CS) rates are increasing globally. Though CSs are known to contribute to improving maternal and neonatal outcomes, they can result in short and long term complications. We sought to find out the maternal complications associated with primary CSs within six weeks post-delivery in a unique cohort. This was a prospective cohort study conducted at the Korle Bu Teaching hospital, Accra, Ghana. A total of 1013 women who had their primary CS procedure carefully documented between 1st January, 2018 to 14th January, 2020 were followed up to six weeks post -delivery and CS complications observed and documented. Adjusted Poisson Model with Robust Standard Error was used to determine incidence risk ratios for CS complications. The primary CS maternal complication rate was 12.3% (CI-10.3-14.4). Surgical site infection (SSI) rate was 32/989(3.2%) and constituted 32/65(49.2%) of all the post-operative complications. Positive cultures for bacteria were obtained in 4/32(12.5%) of the women who had SSI. Factors associated with CS complications include: age 30-34 years compared to teenagers IRR 0.24 [CI: 0.08-0.73], being widowed IRR 7.09 [CI: 1.22-41.38], abnormal vaginal discharge during pregnancy IRR 2.13 [CI: 1.094.17] and electrocoagulation for dissection of subcutaneous tissue IRR 0.44 [CI: 0.21-0.91]. Primary CS complication rate within the first 6 weeks post- partum is relatively low with the majority being surgical site infections. The risk factors associated with CS complications are; being a teenager, women who are widowed and recurrent abnormal vaginal discharge during pregnancy. The use of diathermy for CS is associated with less risk of CS complications. Identification of these factors and provision of appropriate support and treatment will help to reduce the complications associated with CSs at Ghana's largest referral teaching hospital and enable women have a more positive pregnancy experience.