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BACKGROUND: Despite being a preventable and treatable disease, tuberculosis (TB) is a leading cause of death among young people globally. Each year, an estimated 1.8 million adolescents and young adults (AYAs; 10–24 years old) develop TB. In 2019, an estimated 161,000 AYAs died of the disease. AYAs have unique developmental, psychosocial, and healthcare needs, but these needs have been neglected in both TB care and research agendas. In order to improve outcomes in this age group, the specific needs of AYAs must be considered and addressed. METHODS: Through a consensus process, an international panel of 34 clinicians, researchers, TB survivors, and advocates with expertise in child/adolescent TB and/or adolescent health proposed interventions for optimizing AYA engagement in TB care. The process consisted of reviewing the literature on TB in AYAs; identifying and discussing priority areas; and drafting and revising proposed interventions until consensus, defined a priori, was reached. RESULTS: The panel acknowledged the dearth of evidence on best practices for identifying and managing AYAs with TB. The final consensus statement, based on expert opinion, proposes nine interventions to reform current practices that may harm AYA health and well-being, and nine interventions to establish high-quality AYA-centered TB services. CONCLUSION: AYA-specific interventions for TB care and research are critical for improving outcomes in this age group. In the absence of evidence on best practices, this consensus statement from an international group of experts can help address the needs of AYA with TB or at risk for TB.

Objectives: This study aimed to examine the association between Family Adaptability, Partnership, Growth, Affec-tion and Resolve (Family APGAR) and HIV treatment outcomes.Design: A cross-sectional study using the Family APGAR questionnaireSetting: The study was conducted in Kumasi, Ghana, at the Komfo Anokye Teaching Hospital and the Kwame Nkru-mah University of Science and Technology HospitalParticipants: Consenting HIV-positive patients who had been on treatment for at least 12 months were recruited.Main outcome measures: The Family APGAR questionnaire was administered, and relevant data were extracted from hospital records and analysed using STATA® software. The relationship between Family APGAR and treatment outcomes was determined using Chi-squared tests or Fisher’s exact test.Results: Approximately 70.1% of 304 participants were females with a mean age of 41.8 years (±9.9). At treatment initiation, 47.4% of the patients presented at World Health Organisation (WHO) clinical stages I and II and had a CD4 count ≥ 200 cells/mm3. Females were less likely (Odds Ratio= 0.52; 95% CI=0.31 – 0.90, p = 0.018) to report late for treatment compared with the males. After 12 months of treatment, approximately 70% recorded undetectable viral load. Patients with functional families constituted 70.4%, which had a statistically significant relationship with viral load (p = 0.041).Conclusion: HIV care providers should incorporate family functionality evaluation into clinical practice and provide early essential support to enhance treatment outcomes.

BackgroundThe Global Point Prevalence Study (PPS) provides a platform for institutions to register and add clinical information on antimicrobial usage and determine variables related to proper antimicrobial stewardship.ObjectiveTo assess the trends in antimicrobial usage and quality indicators in antimicrobial prescriptions at our hospital.MethodWe retrospectively compared data collected at Komfo Anokye Teaching Hospital (KATH) during the Global PPS in 2015 and 2019. Both surveys took place on a day in September of the respective year. Medical records of all in-patients on admission at 0800 hours on a specific day were reviewed for antimicrobial use in the survey. Data on antibiotic use, including indications for use and the presence of quality indicators, were recorded.ResultsThe total number of patients on admission in 2015 and 2019 were 386 and 630, respectively. The proportion of patients on at least one antimicrobial was 64% (247/386) and 58.4% (368/630) in 2015 and 2019, respectively. Pneumonia was the most common medical condition for which antimicrobial was prescribed for 2015, 30(16.9%) and 2019, 44(23.0%), respectively. There was a decrease in Hospital-acquired infections from 2015, 6.2% (24/386) to 4.8% (30/630) in 2019. The use of biomarkers increased from 4.9% (12/247) to 7.6% (28/368).ConclusionOver 50% of hospitalised patients were on antimicrobials for both years. The inauguration of the antimicrobial stewardship committee at KATH will improve these quality indicators.

Background:Alcohol consumption accounts for major health related morbidity and mortality in the world with more than 3 million deaths and increasing global disease burden. The use of alcohol among the youth is very crucial due to prolonged complications established throughout the entire life of the individual. Objectives:This study aims to determine the factors that influence alcohol use among the youth in the Bosomtwe district of Ashanti Region, Ghana. Method:A cross- sectional study design was used for this study. The sample size estimated was 383 using the StatCalc tool on Epi Info 7, for the estimated population size with a 5% error margin. P-value of £0.05 was considered statistically significant at 95% confidence interval. Responses were collected from participants who consented to the study. The participant selection was dependent on the eligibility criteria for the study. The data was processed and analyzed with STATA 14. Chi- squared analysis was done to establish association between the independent and dependent variables. Results:51.7% of the participants from the Bosomtwe district had consumed alcoholic beverage before with 71.86% currently consuming alcoholic beverage. Majority (63.70%) of the participants knew alcohol had adverse effect on the various organs of the human body. 50.51% were introduced to alcohol use by their peers with 51.51% of them being influenced by their peers on the choice of alcoholic beverage. Most of the participants (45.45%) consumed alcoholic beverage due to the content displayed during advertisement with 66.16% being influenced to consume alcoholic beverage following bereaved family member or friend. Almost 70% of the participants consumed their first alcoholic drink between the age of 20-24years. Majority (64.14%) of the participants consumed alcohol just for fun. The significant factors influencing alcohol use in the study were educational status of the participants, gender, information gathered about alcoholic beverages and during bereavement. There were significant association between information regarding alcohol use, policies on alcohol consumption, bereavement of family members and current alcohol consumption with p-values of 0.008, 0.019 and 0.001 respectively. Conclusion:More than 70% of the participants in the Bosomtwe district were currently consuming alcoholic beverage with 53.55% of them engaging in binge drinking. Most of the participants had suffered some complications following alcohol use. There is the need for appropriate interventions in this area to reduce the morbidity and mortality related to alcohol use.

Background Each year, approximately 15 million babies are born too early. Mortality associated with preterm birth is the highest contributor to under five mortality globally. At Komfo Anokye Teaching Hospital (KATH), preterm birth remains the leading cause of admission to the Mother and Baby Unit (MBU) and is the highest contributor to neonatal mortality. Objectives To determine the precipitating factors for preterm birth at KATH and to evaluate factors that influence the outcome of preterm babies admitted to the MBU. Methods A descriptive cross-sectional study was conducted on 80 babies delivered before 33 weeks gestation who were admitted to the MBU between January and March, 2021.Babies were selected prospectively by simple random sampling and their birth weight, gender, initial temperature, precipitating factors for delivery, admission and discharge/death dates were recorded on a case-record form and analysed using excel version 2016. Results Among the 80 cases studied, 56% were males, 54% were born vaginally and 42% were referred. Their gestational ages ranged from 25 to 32weeks (average 29 weeks). Their mean birth weight was 1.12kg (range 0.6kg to 1.9kg). Eighty-four percent of recruits had temperatures below 36.50C.Premature rupture of membranes (63%) was the leading precipitating factor and hypertensive disorders was associated with the highest mortality (55%). Conclusions The precipitating factors for preterm birth can be predominantly attributed to maternal infections therefore a comprehensive antenatal care with active screening and management of maternal infections can lead to a decline in preterm birth and its complications. Majority of babies were hypothermic on admission. The deleterious effect of hypothermia on the preterm infant has been widely studied. Robust interventions must be put in place especially during transfer of preterm infants to maintain their temperatures within the normal range. These can lead to improved outcomes which will contribute favourably to achieving the third sustainable development goal.

BackgroundWorld Health Organizations aims to eliminate mother to child transmission of HIV by 2030. Timely HIV infant diagnostics are required to save the lives of HIV-infected babies which fits into Sustainable development goal 3 (Good health and wellbeing). This study reviews early infant diagnosis (EID) practices at Komfo Anokye Teaching Hospital from January 2020 to August 2021 to assess how this aligns with national policy and its impact on infected infants.MethodsEarly Infant diagnosis tests done on KATH samples were extracted focusing on age, gender, dates sample was drawn/ PCR test was done, and results of tests. Dates were converted to days since birth. Descriptive and inferential statistics were used with statistical significance at p< 0.05 ResultsA total of 400 infants had samples within study period. Test results were available for 98% (392). Data on gender was available for 37% (148) only. Positive results were 8.9% (35/392). By the time infants were sampled for storage, 24.5% (96/392) were within 6 weeks and 8.7% (34/392) were 9 months. The rest, 66.8% (262/392) deviated from protocol. By the time PCR test was done on stored samples, 5.6% (22/392) were within 6 weeks and 3.1% (12/392) were 9 months. The rest, 91.3% (358/392) deviated from protocol. Positive PCR results for deviated protocol was 8.9% (32/358)The median duration from birth to getting samples taken for positive EID case was 97 days compared to 52 days for negative results, p< 0.002. The median duration from birth to getting test results for positive EID case was 186 days compared to 88 days for negative results, p< 0.0002. ConclusionProtocol deviations from EMTCT policy due to delay in reporting contributes to positive EID results. Delay in testing affects start in treatment and negatively impacts neurodevelopment. Positive EID should be fully audited to identify risks.

BackgroundAlthough there has been a decrease in mother to child transmission (MTCT) of HIV, new pediatric infections still occur especially during the postnatal period. Prevention of vertical transmission is a key strategy in reducing the incidence which is 15-30% during pregnancy and delivery and 5-20% during breastfeeding. Early infant diagnosis and prompt initiation of antiretroviral are among some of the interventions that help to reduce the risk of transmission.ObjectivesThe purpose of the study is to assess the prevalence of HIV infection and the socio-demographic characteristics of HIV exposed infants presenting to KATH infectious disease clinic. MethodsA retrospective review of folders of exposed infants presenting to the infectious disease clinic from September 2019 to September 2021 was done. Data was entered onto excel sheet and exported to SPSS version 20 for analysis. Descriptive statistics were used. ResultsA total of 245 HIV exposed infants were seen within study period of which 54.35 (133/245) were males. The mean (SD) of birth weight was 3.07 (0.50). The median (IQR) age in months were 2.3 (1.5-3.3) at first visit to the HIV exposed clinic. Mode of delivery was by spontaneous vaginal delivery for 50.6% (124/245) and by caesarian section for 36.3% (89/245). Exclusive breastfeeding was initiated in 72.7% (178/245), formula feeding in 6.1% (15/245), and mixed feeding in 4.1% (10/245). Antiretroviral were initiated at birth for 95.9% (235/245) of infants. Septrin prophylaxis was initiated at 6 weeks for 60% (147/245). A major limitation of this records review was high level of data missingness. Most of the early infant diagnosis results were missing. The very few recorded were negative making it impossible to evaluate the true status of the exposed infants.ConclusionEven though infants exposed to mothers with HIV are seen regularly at KATH, the quality of the data collections must improve to estimate accurately the prevalence and determinants of HIV infection in exposed infants.

Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January–December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.