Ethics of Managing Unintended Consequences in Global Health Research: A Case Study

In a study of dietary supplementation among women in Ghana, a disproportionately high number of pregnant study participants were found to no longer be pregnant, leading researchers to suspect that the very early identification of pregnancy status made possible by study participation may have contributed to an elevated incidence of elective abortion among study participants. While abortion is legal in Ghana under certain circumstances, misinformation regarding its legality and persistent stigmatization result in many Ghanaian women choosing abortion methods that are unsafe and often illegal. While the study of the potential benefits of dietary supplementation during pregnancy initially appeared to pose very little risk to participants, the unintended and unforeseen consequence of unsafe abortions required researchers to reevaluate study protocol. In the following discussion of this case, we explore the ethical considerations researchers must address when unintended consequences emerge in global health research.

Prevalence of pneumonia and risk factors of pneumonia mortality among children under five years

Prevalence of pneumonia and risk factors of pneumonia mortality among children under five years.

Background

Pneumonia remains the foremost cause of death in children under 5 years of age especially in sub-Saharan Africa killing nearly 1 million annually.

Aim

Identify pneumonia prevalence, mortality rate and associated factors among children under five admitted to Komfo Anokye Teaching Hospital (KATH) in Ghana.

Methods

Using a prospective cross-sectional study method, a consecutive sample of 157 children under 5 admitted to the KATH for pneumonia from June to August 2016 was selected. A structured questionnaire was used to collect primary data from their caregivers and secondary data from the patient record using a structured data extraction form. Continuous and categorical variables were described and chi-square test employed to determine the associated factors of pneumonia mortality. Multivariate logistics regression model was used to test for the strength of the association to unearth the risk factors of pneumonia mortality.

Results

The study found a prevalence of pneumonia of 18.40% with a mortality rate of 12.74%. Pneumonia mortality was found to be associated with maternal education (p<0.001), occupation (p=0.01), income (p=0.02), pneumonia severity (p<0.001) and number of rooms occupied by a household (p=0.01). In multivariate regression, severe pneumonia increased the odds of pneumonia mortality (OR=18.23, 95% CI= 4.37-76.10, p<0.001). However, maternal education showed reduced likelihood of pneumonia mortality (OR=0.59, 95% CI= 0.36-0.97, p=0.039). Conclusion Pneumonia places a high burden on the health of children under five years admitted to KATH. Health workers need to sensitize caregivers on the signs and symptoms of pneumonia to aid early detection and reporting which could reduce mortality.

Prevalence and characteristics of congenital talipes equinovarus (clubfoot) in Northern Ghana: a two year retrospective descriptive study

Prevalence and characteristics of congenital talipes equinovarus (clubfoot) in Northern Ghana: a two year retrospective descriptive study

Objective: This study aimed to determine the prevalence and phenotypic characteristics of clubfoot in the Northern Region, one of the most deprived regions of Ghana.

Method: Parameters of interest included sex distribution, laterality, types of clubfoot, annual trends and prevalence rate. Data was collected in the sole clubfoot clinic for the region from January 2015 to December 2016. A descriptive statistical analysis of the data was conducted using SPSS version 16.

Result: A total of 112 cases were recorded, resulting in a prevalence rate of 0.9 per 1000 live births. The highest number of cases for both years was recorded in January. Twice the number of males were affected as females and bilateral clubfoot formed 65.5% of case presentations while idiopathic clubfoot made up 67.9% of total clubfoot types. Almost same numbers of left (n=19) feet were affected as right (n=20) in unilateral clubfoot.

Conclusions: The phenotypic characteristics were similar to findings in other parts of Ghana, Africa and the world although the prevalence rate was lower than expected. Future investigations into associated risk factors and the influencers of the phenotypic and annual trends are therefore warranted.

A 10-Year retrospective review of renal cases seen in a Tertiary Hospital in West Africa.

A 10-Year retrospective review of renal cases seen in a Tertiary Hospital in West Africa.

Introduction

Renal diseases commonly present to the Komfo Anokye Teaching Hospital (KATH). There has not been a comprehensive analysis of the number of renal cases managed. We set out to analyze comprehensively the renal cases seen at KATH to describe the trends a decade.

Methods

A retrospective study was conducted from January 2006 to December 2016. We collected secondary data from the records on the wards, outpatient clinics and hemodialysis unit from the KATH annual reports. Trends in renal cases were then plotted.

Results

Renal outpatient clinics started in 2007. There were an average of 65,273 medical out patients seen yearly with renal conditions accounting for 5,397 (8.3%). Renal clinic patients increased by 271% from 710 in 2007 to 1927 in 2016.

The average yearly medical admission was 6,880 patients of which renal admissions accounted for 276 (4.0%). The average position of renal admissions was 6th (range 2nd-10th) of total medical admissions. The average annual mortality rate of renal admissions was 32.7%. The average mortality of general medical cases was 23.8% annually.

Hemodialysis services commenced in 2006. Patients on haemodialysis have increased by 50 times from 8 in 2006 to 407 in 2016. Hemodialysis session also increased by 38.8 times from 59 in 2006 to 2350 in 2016. The average number of patients on hemodialysis per year was 211.5.

Conclusion

Renal disease is a common condition in KATH associated with significant morbidity and mortality. A concerted effort is needed to enhance the diagnosis and management of renal diseases in Ghana.

Transportation: Barrier to Maternal and Child Healthcare Service in Rural sub-Saharan Africa

Maternal and infant mortality has reduced over the years in sub-Saharan African but it is still the highest globally. Maternal Mortality Ratio in this region was approximately 66% (201,000) with 45% decrease in Infant Mortality rate between the periods of 1990 and 2015. Women on this part of the world face 15 times the dangers of childbirth and pregnancy situations as compared to those in the developed countries, children on the other hand are more than 14 times more likely to die before attaining age 5 than children in the developed world. This is partly because of challenges of patient referral. Referral is when a health professional at a lower health facility requests that a patient should seek for healthcare services at a higher health facility. The key among other challenges in referring a patient to a higher health facility from rural communities in sub-Saharan is the means of transport. This significantly and negatively affected the achievement of Maternal and Child health outcome in spite of the good works ongoing in sub-Saharan Africa. Therefore, for countries in sub-Saharan Africa to achieve the targets of the goal 3 of the Sustainable Development Goal (SDG) which is to Ensure Healthy Lives and Wellbeing for all at all ages, the issue of geographic and physical barriers to healthcare facilities should be well looked into. Government and non-governmental organizations should help in the building of health facilities in rural and deprived communities, provide ambulance services, provide adequate health officers and drugs. All these coupled with good road network would help people in these communities. Also, primary healthcare should be placed within the cultural settings of these people, so that they can embrace and easily access it to save mothers and children from preventable deaths. Finally, other sub-Saharan African countries should adopt the Community-based Health Planning and Services (CHPS) compound system of primary healthcare provision introduced in Ghana to help reduce the maternal and infant mortality rate drastically by 2030.