Private sector contributions and their effect on physician emigration in the developing world [Las contribuciones del sector sanitario privado y su efecto sobre la emigración de médicos de países en desarrollo]
Loh L.C.,University of Toronto |
Ugarte-Gil C.,Cayetano Heredia Peruvian University |
Darko K.,Korle Bu Teaching Hospital
Bulletin of the World Health Organization | Year: 2013
The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide.
Kingham T.P.,Sloan Kettering Cancer Center |
Alatise O.I.,Obafemi Awolowo University |
Vanderpuye V.,Korle Bu Teaching Hospital |
Casper C.,Fred Hutchinson Cancer Research Center |
And 6 more authors.
The Lancet Oncology | Year: 2013
Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. Surgeons are often central to cancer care in the region, since they can be the only physician a patient sees for diagnosis, treatment (including chemotherapy), and palliative care. Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer care in the region. © 2013 Elsevier Ltd.
Labi A.-K.,Korle Bu Teaching Hospital |
Obeng-Nkrumah N.,University of Ghana |
Addison N.O.,Korle Bu Teaching Hospital |
Donkor E.S.,University of Ghana
BMC Infectious Diseases | Year: 2014
Background: Despite the clinical significance of infections, surveillance data worldwide remains limited and is more so exemplified by the lack of reports from Africa especially in eastern, central and western Africa. This study reports on Salmonella serotypes as significant causes of blood stream infections (BSI) and multidrug antibiotic resistance at Korle-Bu Teaching Hospital in Accra, Ghana. Methods: Antibiogram patterns, seasonal variations in disease incidence and predisposing factors for infection with Salmonella serotypes were analyzed retrospectively over a 4-year period from January 2010 to December 2013. Blood cultures were processed with BACTEC 9240 blood culture system. Speciation was done with BBL Crystal Enteric/Nonfermenter identification system ®, and with slide agglutination using specific antisera. Antimicrobial susceptibility testing was carried out by the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute guidelines. Results: We report a 6.5% (n = 181/2768) prevalence of Salmonella bacteraemia at the Korle-Bu Teaching Hospital; with a preponderance of non-typhoidal salmonellae (NTS) over typhoidal salmonella (TS) (n = 115/181, 63.5% versus n = 66/181, 36.5%; P-value <0.002). Children under 5 years bore the brunt of the disease (n = 93/174, 53.4%). Resistance to ciprofloxacin (n = 1/127, 0.7%), amikacin (n = 3/81, 3.7%), and cefotaxime (n = 6/99, 6.1%) remained low, despite high levels of multidrug resistant Salmonella phenotypes (n = 81/181, 44.2%). In multivariate analysis, and among patients with Salmonella BSI, those < 1 year old had reduced risk of non-typhoidal infections [Odds ratio, 0.51; 95% confidence interval (95% CI), 0.16-0.92, P-value 0.021]. Similarly, patients with cefuroxime resistant strans were at increased risk of having multidrug resistant Salmonella BSI (OR, 8.97; 95% CI, 3.62-24.15; P-value, 0.001). Conclusions: Salmonellae, predominantly NTS, account for a reasonable low proportion of positive blood cultures in our tertiary care setting; but with significant multidrug resistant phenotypes and low ciprofloxacin and cefotaxime resistance. © Labi et al.
Dey D.,University College London |
Kenu E.,Korle Bu Teaching Hospital |
Isenberg D.A.,University College London
Lupus | Year: 2013
Objectives: We determined whether any individual cancers are increased or decreased in a cohort of 595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the University College London Hospitals Lupus Clinic, looking for any associated clinical or serological factors and the prognosis after cancer diagnosis. Methods: We undertook a careful retrospective review of the medical records and identified all individuals diagnosed with cancer. For controls, we selected three other patients in the cohort who had not developed cancer, carefully matched for age, sex, ethnicity and disease duration, to determine if any obvious differences emerged in a nested case-control design. Results: Thirty-three patients developed cancer after being diagnosed with SLE. There was a statistically insignificant small increase in overall cancer risk, standardized incidence ratios (SIRs) 1.05 (95% CI 0.52-1.58) and increased SIRs for cervical, prostate, anal and pancreatic cancers and reduction in breast cancer SIRs. Haematological and musculoskeletal manifestations, anticardiolipin and antithyroid globulin antibodies were found to be positively associated with cancer risk in multivariate analysis. There was no drug, dose or duration was associated with cancer risk. There was a reduction in survival with a cancer fatality rate of 84.2% (p0.0001). Conclusion: We found a very small but statistically insignificant increased cancer risk with reduction in survival. Whereas some cancers appear to be more common in SLE, notably prostate and cervical cancer, others, particularly breast cancer, are less frequent. Multiple clinical and serological factors are involved in the increased risk of malignancy in SLE. No drug dose or duration effect was identified. © The Author(s) 2013.
Kyerewaa Edwin A.,Korle Bu Teaching Hospital
The Pan African medical journal | Year: 2011
Sickle Cell Disease (SCD) is a significant public health burden in Ghana. Recent studies indicate that 2% of Ghanaian newborns are affected by SCD; one in three Ghanaians has the hemoglobin S and/or C gene. As a means of controlling the disease, some authorities have recommended prenatal diagnosis (PND) and selective abortion. In the current era, SCD has a good prognosis and fairly reasonable quality of life. Advances in bone marrow transplantation have shown the disease is curable in selected patients. PND and selective abortion therefore raises a myriad of ethical dilemmas which are considered in this review. In the light of the demonstration of improved prognosis in recent times, PND and selective abortion appears to be applying capital punishment to the unborn child for "crimes" only the parents can be responsible for. In this review, we recommend control of SCD on three levels--preconception genetic testing and strategic reproductive choices, PND and education for carrier parents, and holistic management of persons with SCD. We emphasize the critical importance of self-management, especially self-awareness, in assuring a good quality of life for persons with SCD. We believe such an approach is cost-effective, and consistent with sound ethical principles and good conscience.
Ametefe M.K.,Korle bu Teaching Hospital
Spinal Cord | Year: 2016
Introduction:Spinal cord injury (SCI) is a devastating injury, with its effect going beyond the injured patient to the care givers and family and with economic implications that can be long lasting. The study determined the occurrence and patterns of SCI and spine injury patterns, treatment and treatment outcomes in a large tertiary health facility in Ghana.Methods:This was a retrospective review of health records of patients at the Korle bu Teaching Hospital, Ghana. Data on 185 patients were collected over a period of 18 months from September 2012 to February 2014. Data were collected on basic demographic characteristics (age distribution), cause of SCI, type and severity of injuries, mode of transportation to the hospital and treatment modalities. In addition, data were collected on the imaging techniques used, waiting time and delays encountered, complications and follow-up. Descriptive statistics were used to analyze data using Windows Excel 2007 version.Results:A total of 185 patients were treated in the study period, 125 (67.6%) patients had cervical spine injury, 33 (17.8%) had thoracic spine injuries and 27 (14.6%) had lumbar injuries. In all, 141 (76%) were males. The age range of patients was 4 years to 86 years; mean age was 36.25±13.62 years. Spinal injuries were most common in the 31–45-year age group, followed by 16–30-year group. Most prevalent cause of spinal injury was road traffic accident (RTA), 130 (70.3%), whereas assault was the least common, 5 (2.7%). Delay in getting imaging studies conducted was high; 43 (23%) of the computed tomography scans required were performed after 48 h of admission. Only 76 (41%) patients were able to afford the cost of magnetic resonance imaging. Pressure sore (23%) and pneumonia (21%) were the most common complication during admission.Conclusion:RTA was the most common cause of spinal injuries and occurred in the relatively young population, especially among men. Structured public education and enforcement of road safety measures are imperative. Rapid response to management of patients with SCI at the teaching hospital needs attention by hospital management.Spinal Cord advance online publication, 3 May 2016; doi:10.1038/sc.2016.57. © 2016 International Spinal Cord Society
Yawson A.E.,Korle Bu Teaching Hospital |
Hesse A.A.J.,Korle Bu Teaching Hospital
Journal of Infection in Developing Countries | Year: 2013
Introduction: Nosocomial infections have long been neglected in Sub-Saharan Africa, and hand hygiene (HH) is usually neglected in hospital settings. This study aimed to provide baseline data on HH compliance among health workers and HH resources in a large West African teaching hospital. Methodology: A cross-sectional, unobtrusive observational study assessed personal and care-related HH compliance among doctors and nurses and HH resources in 15 service provision centres of the Korle-Bu Teaching Hospital (KBTH), Ghana, in 2011. Data was collected with an infection prevention checklist and health worker HH compliance form, based on World Health Organization guidelines. Results: Care-related HH compliance of doctors and nurses was low and basic HH resources were deficient in all 15 service centres. Care-related HH compliance among doctors ranged from 9.2% to 57% and 9.6% to 54% among nurses. HH compliance was higher when risk was perceived to be higher (i.e., in the emergency and wound dressing/treatment rooms and labour wards). The neonatal intensive care unit (NICU) showed the highest level of compliance among health workers. Facilities for HH, particularly alcohol hand rub and liquid soap dispensers were shown to be deficient. Conclusion: Care-related HH compliance among doctors and nurses in this large West African hospital is low; however, the NICU, which had implemented HH interventions, had better HH compliance. HH intervention programs should be designed and promoted in all service centres. Also, the introduction of alcohol-based hand rubs as an accessible and effective HH alternative in Korle-Bu Teaching Hospital is recommended. © 2013 Yawson et al.
Baidoo K.K.,Korle Bu Teaching Hospital
Ghana medical journal | Year: 2012
Recurrent respiratory papillomatosis is a benign disease of the aero digestive tract which is caused by the human papilloma virus type 6 and 11 and mainly affects children. The aim of this study is to describe the pattern of recurrent respiratory papillomatosis at the E.N.T Unit Korle Bu Teaching Hospital, Accra. This is a retrospective study of theatre records of patients managed for respiratory papillomata from January 1995 to December 2004 at the E.N.T Unit of Korle Bu Teaching Hospital, Accra which is a tertiary facility. These records were studied and we obtained information on gender, age, number of surgeries and the presence of tracheotomy. Sixty-nine patients were identified over the period. Thirty-three males and 36 females with a M:F ratio 1:1.1, and ages ranging from 2 to 54 years. The mean age was 12.3 years and a median age of 8.5 years.Children less than 10 years accounted for 69% and 46.4% had repeated surgery with overall tracheotomy rate of 14.5%. Recurrent Respiratory Papillomatosis is primarily a paediatric disease. Locally, its distribution is comparable to others in the sub region and worldwide and surgery is the mainstay of treatment.
Ganyaglo G.Y.K.,Korle Bu Teaching Hospital |
Hill W.C.,Sarasota Memorial Hospital
Seminars in Perinatology | Year: 2012
A 6-year (2004-2009) review of maternal deaths is presented to establish particular trends at the eastern regional hospital (1 of 10 regional hospitals in Ghana). There were a total of 191 maternal deaths over the period, with a total of 19,965 live births, giving a maternal mortality ratio of 957 per 100,000 live births. The main causes of maternal deaths were postpartum hemorrhage (22.5%), abortion-related causes (19.3%), hypertensive disorders in pregnancy (17.8%), and puerperal sepsis (8.9%). The study revealed that the highest number of deaths was recorded in the period following termination of pregnancy (abortion or delivery). Timely referral of patients to this hospital could help reduce preventable maternal deaths. © 2012 Elsevier Inc.
Mensah Y.,Korle Bu Teaching Hospital
Ghana medical journal | Year: 2011
Intussusceptions is the telescoping or invagination of a portion of intestine (intussusceptum) into an adjacent segment (intussuscipiens). It is one of the common causes of bowel obstruction in infants and toddlers.Sonography has now been accepted as a method for guiding hydrostatic reduction of intussusception with tap water, normal saline or Ringer's lactate solution. This method is currently being used at Korle Bu Teaching Hospital. It is a very simple, efficient, economical and quick method of managing intussusception. The duration of the procedure ranges between two minutes and thirty minutes, with the majority being under ten minutes. A total of twenty intussusceptions were managed in eighteen patients over a nine month period. In fifteen patients (75%) the intussusception was reduced successfully. In five patients (25%), the procedure failed to reduce the intussusceptions.