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As life expectancy in Ghana improves, a large and growing population of older adults require healthcare. Despite governmental support for the care of older adults, there have been no geriatricians and no in-country educational path for those desiring to become specialists in this field. In fact, 23 of 54 countries in sub-Saharan Africa (SSA) lack even a single geriatrician. We describe a novel and collaborative approach used to develop the first geriatric training fellowship in Ghana. Faculty from the Ghana College of Physicians and Surgeons and the University of Michigan worked together to develop a rigorous and evidence-based geriatrics curriculum, based on US standards but adapted to be appropriate for the cultural, economic, educational, and social norms in Ghana. This approach led to a strong training model for care of older adults while also strengthening the ongoing collaboration between the two partner universities in Ghana and the United States. The fellowship has been inaugurated in Ghana and can serve as a concrete educational model for other countries in SSA. J Am Geriatr Soc 67:1718-1723, 2019.

The 2019 corona virus disease (COVID-19) has wreaked havoc on countries, communities and households. Its effect on individuals and their families, although enormous, has not been adequately explored. We thus present a report on the illness experiences of three families in Ghana who had at least one member diagnosed with COVID-19. We interviewed them and recorded their commonest fears, such as death, stigmatisation and collapse of family business. Respondents had a fair idea about symptoms of COVID-19, mode of transmission and safety precautions. Family separation and loss of income were some of the adverse effects expressed. Majority of them were hopeful that family members with COVID-19 would recover and be reunited. The biopsychosocial impact of COVID-19 is tremendous and family physicians and other primary care workers have an essential role to play in addressing this.

Background: The occurrence of burnout amongst African health professionals has been widely anticipated, but there is a dearth of published data, especially amongst doctors. Burnout has been reported to be as high as 53% amongst doctors in the United States. If not detected, it can result in prescription errors, work-related accidents, substance abuse and depression. Aim: The aim of this study was to determine the prevalence of burnout and its associated factors amongst a sample of physicians in Ghana. Setting: This study was conducted in Kumasi amongst physicians attending a conference organised by the West African College of Physicians, Ghana Chapter. Method: A cross-sectional study. Of the 90 physicians who registered for the conference, 60 responded to a self-administered Maslach Burnout Inventory questionnaire. Data were analysed descriptively and inferentially using STATA ® version 14. Results: Approximately 52% of respondents had been in medical practice for 10–19 years (mean 15.4 years). All the major medical specialties were represented. Internal Medicine had the highest number of participants (48.3%). With respect to the components of burnout, 5.5% of respondents experienced depersonalisation, 7.8% had a lack of personal achievement and 10.8% experienced emotional exhaustion. The association between burnout and age, sex, years of practice and clinical specialty was not found to be statistically significant. Conclusion: This pilot study has shown burnout to be common amongst physicians in Ghana. It is recommended that further studies are conducted, involving a larger cross-section of doctors in various parts of Africa.

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has necessitated an interim restructuring of the healthcare system in accordance with public health preventive measures to mitigate spread of the virus while providing essential healthcare services to the public. This article discusses how the Palliative Care Team of the Komfo Anokye Teaching Hospital in Ghana has modified its services in accordance with public health guidelines. It also suggests a strategy to deal with palliative care needs of critically ill patients with COVID-19 and their families.

Background: Family instability and partner conflicts are reportedly common in serodiscordant relationships. To date, the family adaptability, partnership, growth, affection and resolve (Family APGAR), a standardised tool for assessing family function, has not been used in any published literature involving this peculiar group. Aim: The aim of this study was to determine the predictors of family functionality and its association with human immunodeficiency virus (HIV) serodiscordance. Setting: The study was undertaken at the Kwame Nkrumah University of Science and Technology Hospital and Komfo Anokye Teaching Hospital in Kumasi, Ghana. Method: This was a cross-sectional study. A systematic sampling method was used to select HIV-positive clients whose partners were seropositive (concordant) or seronegative (discordant). A standardised format was used to extract relevant data. All data were analysed using STATA ® (version 14). Results were reported as odds ratios with 95% confidence intervals for study and outcome variables. Results: The study recruited 374 respondents, of which 52% (195) were in HIV-discordant relationships. Approximately 68% (254) of the respondents rated their families as functional, 15% (57) rated as moderately dysfunctional and 17% (63) rated as severely dysfunctional. A statistically significant relationship was found between family functionality and gender, as well as between family functionality and HIV status disclosure to the partner. No association was found between the Family APGAR and HIV serodiscordance. Conclusion: Amongst HIV couples, the strongest predictors of family functionality are gender and status disclosure. Healthcare providers should invest efforts into addressing gender-based challenges, utilise the Family APGAR and support disclosure of HIV status, especially amongst discordant couples.

Background Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saharan Africa. Apart from the few population based studies available, not many have investigated the burden of these viruses in jaundiced patients. Among the few studies, hepatitis E is the least studied among jaundiced patients. This study was aimed at describing the frequency, distribution and risk of the different hepatitis viruses among jaundiced patients reporting to the second largest teaching hospital in Ghana. Methods From November, 2015 to April, 2016, a cross-sectional study was conducted among jaundiced patients attending the Komfo Anokye Teaching Hospital. Between 3–5 ml of blood was collected from each patient and screened for viral hepatitis agents using both serologic and molecular-based assays. Results In the 155 patients recruited, hepatitis B was the most prevalent [54.2% (95% CI = 46.0%–62.2%)] followed by hepatitis E [32.9% (95% CI = 25.6–40.9%)]. Most cases of hepatitis E occurred as co-infections with hepatitis B (18%), with the predominant clinical feature being hepatocellular carcinoma. Risk factor variable analysis showed middle and older aged individuals were more at risk of hepatitis B exposure whereas younger age groups (

Intimate partner violence (IPV) is a major public health problem estimated to affect 15%-71% of women worldwide. We sought to elicit IPV risks among mothers of sick newborns in Ghana. As part of a broader study on postpartum depression, we conducted semistructured surveys of 153 women in a mother-baby unit, assessing demographics, depression, social support, and IPV with the present partner. Forty-six percent of mothers reported some form of violence, mostly emotional (34%), followed by physical (17%), and sexual (15%). The study highlights the frequency of perinatal IPV and the associated risk factors of depression and poor social support.

Rabies is a source of concern for Public Health Officials. It is known to have a case fatality of 100% worldwide. Of all cases reported, 95% occurred in Africa and Asia put together. The Ghana Office of Rabies in West Africa (RIWA) suggests that the numbers in Ghana maybe underreported due to ineffective surveillance systems. The study therefore reviewed medical records of all suspected rabies cases and case-based forms filed by Disease Control Officers to the Disease Surveillance Unit of the Ghana Health Service. Twenty-one cases of suspected human rabies cases were reported in the Komfo Anokye Teaching Hospital (KATH) from January 2013 to January 2015. A little of 50% of cases were males. A third of the cases did not receive PEP though they reported to a health facility. On the average cases were reported 2 months after the exposure. This study also reported 100% fatality with 60% dying within 24 hours post admission. It is recommended that there is effort aimed at Public Education and also to control stray dogs. Governments are also admonished to make available PEPs at health facilities.

Objective: This study assessed the perception of risk of cervical cancer and existence of risk factors for cervical cancer based on five known risk factors among women attending the Tamale Teaching Hospital in Tamale, Ghana. Methods: A consecutive sample of 300 women was interviewed using a semi structured questionnaire to inquire about risk factors and perception of risk of cervical cancer. Specific risk factors that were explored included early coitarche, multiple sexual partners, polygamous relationships, history of smoking, and having a current partner who had multiple sexual partners. Results: Sixty-one per cent of women reported that they had no personal risk for cervical cancer. 27% of respondents were in polygamous relationships, and of those, more than half didn’t think they were at an increased risk of cervical cancer. 2 women had a total of ≥ 5 sexual partners in their lifetime and neither believed they were at any risk for cervical cancer. 23% said their current partner had had at least 2 sexual partners in his lifetime, and of those, (61%) thought they were at no risk for cervical cancer. 46% of respondents reported not having any of the risk factors listed in the study. 23% of respondents reported having one risk factor while 21% had two risk factors and 11% had three or more risk factors. Conclusion: Women’s perception of personal risk for cervical cancer is lower than their actual risk based on the five behavioural risk factors assessed and a lack of knowledge of the personal factors for the disease Funding: This project was supported by NIH Research Training Grant #R25 TW009345 funded by the Fogarty International Centre, in partnership with several NIH Institutes (NIMH, NIGMS, NHLBI, OAR and OWH) Keywords: Cervical Cancer, Risk, Perceptions, Northern Ghana

To describe the prevalence of and risk factors for depression in a high-risk population of mothers of ill newborns in Ghana.Semi-structured interviews were conducted with women who had a hospitalized newborn at a tertiary teaching hospital in Kumasi, Ghana. Surveys included information on maternal demographics, pregnancy and delivery, interpersonal violence, and social support. Postpartum depression was measured with the Patient Health Questionnaire (PHQ)-9. Bivariable analysis was conducted using analysis of variance, χ(2), and Fisher exact tests; multivariable analysis was performed using multinomial logistic regression.In total, 153 women completed the survey. Fifty (32.7%) had PHQ-9 scores of 5-9, indicating mild depression; 42 (27.4%) had PHQ-9 scores of 10-14, indicating moderate depression; and 15 (9.8%) had scores of 15 or higher, indicative of moderate/severe depression. History of interpersonal violence with current partner predicted depression.Mothers of sick infants in Ghana are at high risk for symptoms of clinical depression. This is of critical importance because maternal depression affects infant health outcomes and may be particularly important for mothers of sick infants.

Background A key strategy for minimizing HIV infection rates especially via reduction of Mother– to-Child transmission is by reducing the unmet need for family planning. In Ghana, the integration of family planning services into Antiretroviral Therapy services for persons living with HIV/AIDS has largely been ignored. We set out to measure the prevalence of modern methods of contraception, the unmet need for family planning and to identify factors associated with the use of modern methods of contraception among HIV positive women on anti retroviral therapy. Methods This was a descriptive cross sectional study of HIV positive women in their reproductive ages accessing care at an adult Antiretroviral Therapy Clinic in Kumasi, Ghana. Data was collected using a structured questionnaire. Data analysis was conducted using Epi Info version 7.1.2.0. Results A total of 230 women were included in the study. Fifty six percent were in the 30–39 year age group. The mean age (SD) was 36.3 (5.4) years. While 53.5% of respondents desired to have children, partner desire for children was reported by 54.6% of respondents with partners. About 74% had received information on contraception from their provider. 42.6% of participants and/or their partners were using a contraception method at the time of study; the male condom (79.6%) being the most commonly used method. The estimated unmet need for contraception was 27.8%. Contraceptive use was strongly associated with partner knowledge of HIV status (AOR = 3.64; 95% CI 1.36–9.72; p = 0.01) and use of a contraceptive method prior to diagnosis of HIV (AOR = 6.1; 2.65–14.23; p

Background: Maternal knowledge about serious infant illnesses has significant implications for care after discharge, particularly in countries with high infant mortality rates. No existing studies on this topic in lowincome countries were identified. The study sought to identify the level of maternal understanding about why a newborn was hospitalized and how mothers in Ghana attributed blame for the illness. Methods: The project team conducted semi-structured interviews with mothers aged 18 and older who had infants hospitalized in a tertiary care facility in Kumasi, Ghana, and collected data on demographics, pregnancy and delivery, and beliefs about their infant’s illness. Infant charts were abstracted to identify medical reasons for hospitalization for comparison with the mother’s understanding, and levels of understanding were coded as ‘none’, ‘partial’ or ‘full’. Results: 153 mothers were interviewed and their average age was 28. For 27%, this was their first pregnancy. Forty per cent of mothers had no understanding of why their infant was in the hospital and 28% had only partial understanding. One-third of the women reported blaming themselves for the child’s illness. In multivariable analysis, demographic factors including maternal age, education, primiparous status, and urban vs rural residence did not predict maternal understanding or self-blame. Conclusions: Sick newborns in low-income countries are at very high risk of adverse outcomes. Mothers who lack a clear understanding of why their infant is in the hospital might have difficulty communicating preferences about care, understanding the type of care that is being given, and recognizing future warning signs of illness. Such gaps in understanding could put the discharged infant at significant risk.

The objective was to determine the pattern of health service utilization by the injured in Kumasi, Ghana and thus to gain information useful for the strengthening of trauma care in that environment. A household survey was utilized as it was anticipated that many injured might not receive formal medical care and a total of 11,663 persons living in 264 clusters in Kumasi were surveyed. One-third of all injured did not receive any formal medical care, mainly due to financial constraints. Altogether, 37% of the injured attended a hospital and 34% attended a clinic. Among the severely injured (> or =1 month disability) attending a clinic, most (76%) used it as the sole source of care. Most (54%) of these clinics were private. Efforts to strengthen trauma care in urban Africa need to address financial barriers to care and need to consider clinics, as well as the main hospitals.

Background Preferred methods of contraception vary from country to country. Family Planning services have been available on a large scale in Ghana since the 1980’s and their use has contributed to gradual decline in the total fertility rate from 6.4 in 1988 to 4.2 in 2014. Since their introduction in Ghana in the early 1990’s, Injectable contraceptives have seen increasing patronage and are currently the most preferred method of contraception. We set out to identify possible factors contributing to the preference for injectable contraceptives among women in Ghana. Methods We conducted a descriptive cross-sectional survey of women accessing contraceptive services at the Family Planning Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Women who reported for the second dose of their injections were eligible to be selected for participation in the study. Informed consent was obtained from eligible participants. Data was collected using a structured questionnaire in January and February 2011. Data captured included age, marital status, highest level of education completed, religion, ethnicity and employment status, previous contraceptive use, sources of contraceptive information and reasons for choosing injectable contraceptives. Quantitative data was entered into a Microsoft Access Database and analysed using Epi Info Version 7.1.4. Qualitative data was analysed thematically. Results A total of 247 respondents participated in the study. One hundred and seventy three (70.0 %) were using Depot Medroxyprogesterone Acetate and 74 (30.0 %) were using NorethisteroneEnanthate/Estradiol Valerate. The mean age for women on Depot Medroxyprogesterone Acetate was higher than those on NorethisteroneEnanthate/Estradiol Valerate (p