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Thyrotoxic periodic paralysis (TPP) is an uncommon symmetrical paralysis usually affecting proximal muscles, which occurs in the hyperthyroid state with associated hypokalemia. It is more prevalent in East Asian males and extremely rare in blacks. Data on TPP is scarce in Africa and no report has been made in Ghana. We report a case of a middle-aged Ghanaian man who had three episodes of paralysis in all four limbs occurring at night with the second and third episodes requiring hospital visit. He had no clinical signs of hyperthyroidism during his first hospital visit but had developed clinical and biochemical evidence of hyperthyroidism on the second visit with serum potassium levels of 1.9 mmol/l; and he was eventually diagnosed with TPP. His paralysis resolved with correction of the hypokalemia. It is important to evaluate patients presenting with paralysis comprehensively. Less common differential diagnosis such as TPP may also be considered in such patients to ensure early diagnosis and treatment which can prevent complications.

Background Obesity is a complex and multifactorial disease marker, which has become a major threat to cardiovascular health. We sought to assess the correlation of obesity and other cardio-metabolic risk factors in patients seen at the outpatient specialist clinic in Ghana. Methods A prospective cross-sectional study was conducted on 395 patients at Precise Specialist Clinic in Kumasi, Ghana. A standardized questionnaire was used to obtain demographic, anthropometric and clinical data of patients. Fisher's exact test for statistical significance at a 95% confidence interval was used to evaluate associations between categorical variables. The associations between obesity indices and cardiovascular disease risk factors were analyzed by Pearson's correlation. Results Of the 395 participants, 187 were males and 208 were females. The mean (± standard deviation) age of study participants was 59.29 (± 13.93); more than half of the participants were between 50 and 69 years. The mean BMI of male participants was significantly lower than the mean BMI of female participants (28.18 kg/m2 vs 31.16 kg/m2, P-value < 0.0001). Gender was significantly associated with the weight categories (P = 0.0144). Obesity was seen more in females (49.0%) than in males (35.8%). The Pearson correlation analysis also showed a significant positive correlation between obesity, increasing systolic blood pressure (r = 0.1568, P-value = 0.0018) and increasing diastolic blood pressure (r = 0.2570, P-value < 0.0001). Conclusions Obesity was found to be significantly associated with female gender, increasing age, increasing systolic blood pressure, and increasing diastolic blood pressure. Efforts to step-up preventive measures to reduce the increasing prevalence of obesity in Ghana are highly recommended.

Isaac Kofi Owusu,1,2 Emmanuel Acheamfour-Akowuah,1,2 Yaw Amo Wiafe3 1Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 3Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaCorrespondence: Isaac Kofi Owusu, Email ikeowusu@yahoo.comBackground: Rheumatic heart disease (RHD) is mainly among populations in low-to-middle income nations. The burden of this disease on communities and even hospital settings is little understood. This study aimed at analysing the clinical and socio-demographic features of RHD patients in our adult outpatient cardiac department over a 3-year period.Methods: The study was conducted at the Komfo Anokye Teaching Hospital’s Adult Cardiac Clinic in Kumasi, Ghana. Medical records of patients seen at the adult cardiac clinic between 2016 and 2019 with the diagnosis of rheumatic heart disease were examined. The data were captured using EPI-DATA (version 3.1). Stata 14 was used in analysing the mean (standard deviation) and median of continuous variables (inter-quartile range). The frequency and percentages were used to describe categorical data. The Chi-square test was used to establish the statistical significance of a relationship, with a p-value of less than 0.05.Results: A total of 140 RHD cases were included in the study. The average age of patients was 39.7 years. Majority of the participants (82.9%) were from rural areas. Palpitation was the commonest symptom (54.29%), followed by chest pains (36.43%), dyspnoea (25.00%), and dizziness (24.29%). Over seventy-seven percent (77.14%) of the patients had moderate-to-severe rheumatic heart disease. The commonest valvular lesion was isolated mitral regurgitation (56.43%), followed by pure aortic regurgitation (30.71%), and isolated tricuspid regurgitation (12.14%).Conclusion: RHD occurred more commonly in the third decade of life. Rural participants, who are primarily females, were the most affected. Efforts to reduce prevalence rates should be stepped up.Keywords: rheumatic heart disease, acute rheumatic fever, heart failure, mitral regurgitation, echocardiography

Isaac Kofi Owusu,1 Yaw Amo Wiafe,2 Stephen Opoku,2 Enoch Odame Anto,2 Emmanuel Acheamfour-Akowuah1 1Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaCorrespondence: Isaac Kofi Owusu, Email ikeowusu@yahoo.comPurpose: This study determined electrocardiographic and echocardiographic abnormalities of people living with HIV (PLWHIV); comparing the findings of PLWHIV on HAART versus treatment naïve groups.Patients and Methods: In a prospective cross-sectional study, we recruited 157 PLWHIV on Highly Active Antiretroviral Therapy (HAART) and 28 HAART naïve PLWHIV. Clinical examination, electrocardiography and echocardiography were performed on study participants at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Sociodemographic data and information about the use of HAART or otherwise was obtained. The Chi and Fisher Exact tests were used to find the significance of difference in proportions of abnormalities between PLWHIV on HAART and treatment naïve groups. Statistical analyses were performed on SPSS version 25.0 and GraphPad Prism version 8.0. P-values less than 0.05 were considered to be statistically significant.Results: Echocardiographic abnormalities in the HAART and treatment naïve groups were 54.1% and 60.7%, respectively. Electrographic abnormalities in the HAART and treatment naïve groups were 45.9% and 50%, respectively. Sinus bradycardia was the most prevalent ECG abnormality in the treatment naïve. Nonspecific T-wave changes (36.1%) and sinus tachycardia (30.6%) were the most common ECG abnormalities seen in HAART treated group. The common echocardiographic abnormalities were pulmonary hypertension (22.7%), pericardial effusion (22.2%) and left ventricular systolic dysfunction (17.8%). There was no significant difference in the proportions of echocardiographic abnormalities between PLWHIV on HAART and the treatment naïve groups (p > 0.05).Conclusion: Cardiac abnormalities are common in PLWHIV regardless of treatment with HAART. Echocardiographic and electrographic assessments are highly recommended for all PLWHIV.Keywords: Ghana, echocardiographic abnormalities, electrocardiographic abnormalities, HIV, treatment naïve

This paper presents findings of a study that explored the challenges and coping strategies of parents of children with mental disorders. In-depth interviews were conducted with 35 parents of childr...

BACKGROUND፡ Efficacies of community-based exercise programmes have been well reported, but there is scarce information on the expediency of community-based rehabilitation in a society where many children with disabilities live in poorly resourced settings with extremely limited rehabilitative services. This study investigated the effects of community-based functional aerobic exercise (CBFAE) on gross motor function, walking distance, and quality of life of children with cerebral palsy (CP).METHODS: Quasi-experimental design was used. Children with gross motor function classification system (GMFCS) levels I – II participated in eight weeks CBFAE training four times/week, 50 minutes/day at 40-80% maximum heart rate. Gross motor function (GMF), walking distance and quality of life were assessed pre and post CBFAE training.RESULTS: Significant improvement was observed in GMF (Dstanding) (8.2%, P=.000), GMF (E-walking + running+ jumping (5.12%, P=.004), walking distance (6.09%, P=.009). Higher significant positive effects of CBFAE were observed in Social wellbeing and acceptance (107.10%, P=.000), and participation and physical health (105.04%, P=.005) by children parent proxy. Self-reported results showed that for CBFAE, significant positive improvements were higher in pain and impact of disability (67.93%, P=.049) and participation and physical health (60.00%, P=.042).CONCLUSION: CBFAE training contributes majorly to improved standing, walking, jumping and running and selfesteem, quality of life of children with spastic CP. Clinicians and exercise therapists should essentially incorporate CBFAE training and activities into the management of children with CP for improved mobility and functional performances.

Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (-6.2 mm Hg, P < .01) and in the uncontrolled subgroup (-8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.

This paper explores the impact of selected factors that affect the adoption of E-commerce among small and medium-sized enterprises (SMEs) in Ghana, with emphasis on access to electricity. The data included figures for the country’s population growth (PG), secondary education (SEC), individuals using the internet (IUI), broadband subscriptions both fixed and mobile (BBS), access to electricity (AE) and secure internet servers (SIS). The data was from the year 2007 up to 2017. The main objective is to identify the various factors that impact e-commerce adoption in Ghana. This study uses regression to conduct an empirical analysis on the impact these factors have on e-commerce in Ghana. The study found that access to electricity had a strong positive relationship with e-commerce adoption in the country. This can explain why e-commerce has not been broadly adopted and used in Ghana since the country has been experiencing a huge power crisis for the past decade. Broadband subscription and secure internet servers also impacted e-commerce adoption at various percentages but access to electricity was statistically significant. Based on the findings, the author suggests that the government, policymakers and other stakeholders make great efforts to solve the power crises in the country as doing such will give businesses an incentive to conduct business online.

This research examines the determinants of consumer impulsive purchasing behaviour of Ghanaian shoppers. Churchill’s and Peter’s [1] conceptual model was adapted and modified as the study proposed model to verify empirical data. A sample size of 129 out of 180 was obtained from Ghanaian shoppers at medium shopping malls located in Accra and Kumasi cities in February, 2019 using a survey method. Data analysis was performed using AMOS in Statistical Packages for Social Sciences’ (SPSS) software. Correlational and multiple regression analysis was used to determine the relationship and the impact between consumer’s impulsive purchasing behaviour and five factors influencing consumer urge to purchase. The results showed a significant impact of the impulsive purchasing behaviour among three out of five variables used. The results findings support the assertion that store atmosphere, sales persons and sales promotion influence consumer impulsive purchasing behavior. The findings have significant marketing implication and highlight the need for business owners, financial institutions and marketers to exploit and improve marketing strategies in creating brand trust that the product and services offer.

Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the single most important modifiable risk. Assessment of an individual’s “total” predicted risk of developing a CVD event in 5- or 10-years using risk scores has been identified as an accurate measure of CVD risk. Using the latest Framingham risk score we assessed the risk among patients attending two cardiac clinics in Kumasi.Methods: We conducted a hospital-based cross-sectional study among 441 patients attending two cardiac clinics in Kumasi, the Ashanti region of Ghana. Hospital records were reviewed and information on demography, social history and laboratory results for the lipid profile tests were extracted.Results: The prevalence of low, medium and high risk were 41.5%, 28.1% and 30.4% respectively. More men were at high risk compared to females (36.0% vs 23.9%, p=0.003). The risk score showed good discrimination for cardiovascular risk stratification with an overall area under the curve of 0.95; 0.97 and 0.94 for males and females respectively. The sensitivity and specificity of the Framingham risk score were 89.5% and 86.3%, respectively.Conclusion: Majority of our study participants were at moderate to high risk with men being the most affected. The Framingham risk score proved to be a useful tool in predicting the 10-year total cardiovascular disease risk.Keywords: cardiovascular diseases, hypertension, Kumasi, total risk, Framingham risk scoreFunding: Not indicated

Introduction: Ghana is one of the fastest growing economies in sub-Saharan Africa which is expected to undergo a significant epidemiologic transition because of industrialisation and economic development. Having transitioned from low to middle income status recently, this study investigated the epidemiology of left ventricular dysfunction (LVD) in patients who were referred for echocardiography. Material and Methods: We conducted a retrospective cross-sectional study on an out-patient population who were referred to the Precise Specialist Clinic in Kumasi, Ghana for echocardiography, from January 2016 to December 2018. Descriptive statistical analyses were performed and the results summarised in the proportions, tables and pie charts. Categorical variables and proportions were compared using Fisher’s exact test and test of proportions respectively. P-value Results: The results show that 61% of the out-patient population referred for echocardiography between 2016 and 2018 had LVD at a mean age of 59 years. In this LVD population, Heart Failure with preserved ejection fraction (HFpEF) and Heart Failure with reduced ejection fraction (HFrEF) accounted for 73% and 27% respectively. The majority of patients with HFrEF also had left ventricular diastolic dysfunction, mitral regurgitation and tricuspid regurgitation.Conclusion: This study shows that, HFpEF was seen in over 70% of patients with LVD, and it occurred at a relatively younger age. Efforts should be made for prevention, early detection and control of conditions such as hypertension, diabetes and obesity which have been shown to be associated with HFpEF.

Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients’ demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with a standard deviation of 19.96. The ages ranged between 3 years and 96 years with the age group 31 to 40 years being the modal age group. Males recorded the highest number of cases with 92 (59.35%) compared to females with 63 (40.65%). Respiratory disorders, of which pneumonia is the most prevalent, are the leading clinical condition that is often misdiagnosed in place of pulmonary thromboembolism. Conclusion: VTE is a major health problem especially among the elderly, but unfortunately the clinical diagnosis is usually missed by clinicians hence the need to maintain a high suspicion index.

George Asafu Adjaye Frimpong,1,2 Isaac Kofi Owusu,3 Ijeoma Chinedum Anyitey-Kokor,4 Caitlin Selassie Naa Sarku Wiafe-Kwakye,2 Evans Aboagye,2,5 Nana Esi Coleman,2 Pierre Amankwah,4 Nakao Kuukua Abaidoo6 1Department of Radiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Spectra Health Imaging and Interventional Radiology, Kumasi, Ghana; 3Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 4Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 5Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 6Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana Background: Distribution of coronary artery calcium (CAC) has been determined in different heterogeneous populations in the Multi-Ethnic Study of Atherosclerosis (MESA). Based on findings showing that geography and culture can influence CAC scoring beyond traditional race groups, we determined the distribution of CAC in a homogenous black African population to provide an initial basis for a larger CAC score study in Africa. Methods and results: This is a preliminary study using computed tomography to determine the CAC scores within a black African population who were referred to our center. Other information on patients were recorded through a combination of one-on-one interviews and medical records. A total of 170 patients were involved in our study, including 60.6% males, with an average age of 53.9 ± 9.2years. The majority (78.8%) had a zero calcium score, with patients within the age group of 55–64years dominating the non-zero calcium score population. Males were found to have higher calcium levels compared to females, and coronary artery calcification and prevalence steadily rose with the increasing age. However, P-values of 0.328 and

Cardiovascular diseases (CVDs) are increasingly emerging as a major health problem in sub-Saharan Africa, but information on the epidemiology, clinical characteristics and spectrum of the diseases are scanty. Epidemiological data regarding the incidence and prevalence of CVDs in different geographical regions are essential to our understanding of global distribution and evolution of CVDs. We conducted a retrospective observational study to determine the prevalence and spectrum of cardiovascular diseases in patients seen at the out-patient cardiac clinic of the Directorate of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 432 patients selected from the cardiac clinic using simple random sampling. The medical history, including the socio-demographic information, was examined. The results of the patients’ laboratory tests, chest X-ray, electrocardiography, M-mode and two-dimensional echocardiography with Doppler and colour flow imaging of the patients were also examined. The patients were aged between 13 - 97 years with the mean age (±standard deviation) of 55.35 (±19) years. There were more females (53%; n = 229) than males (47%; n = 203). The main cardiovascular diseases seen included: hypertensive heart disease (35.6%; n = 154), valvular heart disease (19.7%; n = 85), cardiomyopathies (18.5%; n = 80), arrhythmias (6.3%; n = 27) and coronary artery disease (4.2%; n = 18). The most common causes of valvular heart disease, cardiomyopathies and arrhythmias were rheumatic heart disease, dilated cardiomyopathy and complete heart block respectively. In conclusion, our study has shown that hypertensive heart disease, rheumatic heart disease and cardiomyopathies were the main cardiovascular diseases,seen in 73.8% of the patients in this study.

Background Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony’s Hospital, Dzodze, in the Volta Region of Ghana. Methods A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony’s Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. Results The findings revealed that partographs were used by midwives at St Anthony’s Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35–14.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011–16.04)]. Conclusion Midwives used partographs during labour at St Anthony’s Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases.

Background: The renin-angiotensin-system (RAS), endothelial dysfunction and sympathetic nervous system are mechanistic risk factors of hypertension. The study sought to elucidate the interplay of adipokines in the pathogenesis of essential hypertension.Methodology: This comparative cross-sectional study recruited 200 confirmed hypertensive patients from the KATH and 50 age-matched normotensives. Participants’ blood pressures, anthropometric and socio-demographic information were voluntarily obtained. Serum levels of adiponectin, leptin and resistin of the participants were quantified using the ELISA. Renal function, lipid profile and glycemic status of all subjects were also analyzed.Results: Hypertensive patients showed a significantly higher anthropometric indices of adiposity compared to normotensives, CI (p < 0.0001), BAI (p < 0.0001) and AVI (p = 0.002). Adiponectin levels (p < 0.0001) were significantly lower in the hypertensive relative to the normotensives. Furthermore, significantly higher concentrations of serum leptin (p = 0.016) and the leptin-adiponectin ratio (p = 0.001) were observed among the hypertensive compared to the normotensives. The study further observed a direct association between serum leptin and weight (r = 0.111, p = 0.022), BMI (r = 0.129, p = 0.009) and WHtR (r = 0.098, p = 0.045) but inverse relationship with height (r = -0.134, p = 0.006) among the hypertensive. Serum leptin has a significant negative correlation with HDL-C among the hypertensive (r = -0.174, p = 0.013). The fully aOR for hypertension as predicted by resistin and adiponectin were 1.12 (95% Cl, 1.02–1.25); p = 0.019) and 0.93 (95% Cl, 0.91–0.95); p = 0.0001) respectively.Conclusion: We found that elevations in serum levels of leptin and resistin, and low levels of adiponectin may play a role in the pathogenesis of essential hypertension. Therefore, adipokines may offer themselves as potential indices for early and accurate detection of high blood pressure. At the same time our presentresults also confirm the conclusions with respect to correlation of leptin and obesity. Further longitudinal studies in a larger population are warranted to investigate the physiological and pathological functions of adipokines in hypertension.Keywords: Adipokines, Hypertension, Leptin, Adiponectin, Resistin

Objective: A novel locally appropriate hypertension management model of care was developed and tested in the Republic of Ghana to address specific socioeconomic and community-related barriers to blood pressure (BP) control. Design and Methods: Patients with a history of hypertension were enrolled and each agreed to visit a participating nearby community pharmacy at least once per week for 6 months for a BP check, symptom review, and medication monitoring. Weekly pharmacy visit data were manually logged into a mobile application by the pharmacy staff. Guideline based logic in the application provided immediate feedback to the patient and transmitted data to the primary physician. Electronic prescriptions, from the primary physician, were accessible to participating pharmacies. Clinic blood pressure from the prior 6 months was also retrieved from patient records. Results: Compliance with weekly BP assessments in the 150 enrolled patients (57± 8 years; 73% Female) was 61% and 2705 total pharmacy BP assessments were conducted. Improvement in overall health awareness was reported in 82% of the patients and 95% indicated a desire to continue using the model of care in the future. During the 6-month voluntary program period, the number of scheduled office visits decreased by 60% compared to standard monthly visits. Despite fewer in clinic visits, average systolic BP decreased significantly from the 6-month pre-trial period baseline (137.4±14.0 to 129.8± 16.3 mmHg, p 75% controlled BP also improved in the subset of patients with BP below target at enrollment from 52% to 76% (p Conclusions: The care model applied in this hypertensive West African resulted in fewer clinic visits and high patient and clinician satisfaction as well decreased systolic blood pressure and increased proportion of time with controlled blood pressure.

Malaria is a disease caused by the Plasmodium genus that is transmitted between humans by Anopheles mosquitoes. The study sought to assess the trends of Malaria incidence in Kumasi Metropolis and forecast future incidence. A retrospective comparative study design was employed using data from the Regional Health Directorate from January 2010 to December 2016. Trend of malaria prevalence was analysed and compared by years and months. Data used for the study was entirely secondary which was gathered from recorded monthly malaria cases at various hospitals in Kumasi. The Quadratic model was used for the forecasting of the half year incidence of Malaria while Auto regressive integrated moving average (ARIMA) (1, 1, 2) was used for forecasting monthly malaria incidence for the years 2018 and 2019 in Kumasi Metropolis. For the general pattern, July recorded the highest number of cases whereas January recorded the lowest cases in each year. Also, 2010 was the best performing year since it recorded the lowest number of malaria cases (10,336). The projected malaria cases for the first half year of 2018 is expected to be 61,371.8, while the second half year is expected to be 77,842.0. This model is recommended to the metropolitan health directorate and researchers who want to monitor the malaria reported cases in the metropolis and other parts of the world. It is suggested that measures should be put in place to curb malaria incidence during the period of the year when high incidence were recorded.

Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana/Komfo Anokye Teaching Hospital, Kumasi, Ghana. Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 3 Emena Diagnostic Centre, Aninwah Medical Centre, Kumasi, Ghana. Department of Clinical Biochemistry, Diagnostic Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana. Department of Medical Laboratory Science, School of Allied Health Sciences, University of Health and Allied Health Sciences, Ho, Ghana. 6 School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 7 Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Ghana.

Background Randomized control trials of statins have not demonstrated significant benefits in outcomes of heart failure ( HF ). However, randomized control trials may not always be generalizable. The aim was to determine whether statin and statin type–lipophilic or –hydrophilic improve long‐term outcomes in Africans with HF . Methods and Results This was a retrospective longitudinal study of HF patients aged ≥18 years hospitalized at a tertiary healthcare center between January 1, 2009 and December 31, 2013 in Ghana. Patients were eligible if they were discharged from first admission for HF (index admission) and followed up to time of all‐cause, cardiovascular, and HF mortality or end of study. Multivariable time‐dependent Cox model and inverse‐probability‐of‐treatment weighting of marginal structural model were used to estimate associations between statin treatment and outcomes. Adjusted hazard ratios were also estimated for lipophilic and hydrophilic statin compared with no statin use. The study included 1488 patients (mean age 60.3±14.2 years) with 9306 person‐years of observation. Using the time‐dependent Cox model, the 5‐year adjusted hazard ratios with 95% CI for statin treatment on all‐cause, cardiovascular, and HF mortality were 0.68 (0.55–0.83), 0.67 (0.54–0.82), and 0.63 (0.51–0.79), respectively. Use of inverse‐probability‐of‐treatment weighting resulted in estimates of 0.79 (0.65–0.96), 0.77 (0.63–0.96), and 0.77 (0.61–0.95) for statin treatment on all‐cause, cardiovascular, and HF mortality, respectively, compared with no statin use. Conclusions Among Africans with HF , statin treatment was associated with significant reduction in mortality.

Foreign direct investment is seen by many countries as an important source of capital. The flow of foreign direct investment in the world has been increasing over the past couple of years and many countries have adopted various institutional policies with the hope of attracting more foreign direct investment. Besides capital, these countries also get to benefit from the other advantages that these investments bring with them, such as the newest technology and managerial skills. FDI, besides boosting capital formation, also increases the quality of capital stock. Countries can only reap all the benefits of foreign direct investment if they have a sufficient amount of human capital. Human capital is seen by many researchers as one of the most important determinants of FDI. With the world becoming more knowledge-based and globalized the importance of human capital became very significant not only to individuals, but also to countries in their competitive advantages. The purpose of this research is to find out what the relationship is between foreign direct investment and human capital in the Netherlands. The Netherlands is a small country in Europe which has been a global leader in the inflow and outflow of FDI the past couple of years. This study uses the Augmented Dickey-Fuller test and the Johansen cointegration test to determine whether or not there is a causal relationship between the variable’s foreign direct investment and secondary school enrollment, which is used as a proxy for human capital. The study observed that there is no causal relationship between foreign direct investment and human capital in the Netherlands. The inflow of human capital into the Netherlands is determined by other factors.

Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF).We conducted a retrospective longitudinal cohort study of individuals aged ≥18years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF40%) [HFrEF], 265(17.8%) with mid-range LVEF (40%≥LVEF50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF≥50%) [HFpEF]. Kaplan-Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57-0.94) p=0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF.This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.

The surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney disease has been linked with modifiable lifestyle practices and increased body fat. This study sought to compare the association between different modifiable lifestyle practices, adiposity indices, renal function parameters, and hypertension as well as the predictive implications for levels of these parameters in target cardiac organ damage among an urban Ghanaian hypertensive population. Using a hospital-based case-control study design, 241 Ghanaian indigenes from the Kumasi metropolis were recruited for this study. The case group was made up of 180 hypertensives and 61 normotensives served as controls. In addition to sociodemographic data, standard haemodynamic, anthropometric, renal function, and cardiac organ damage assessments were done. The prevalence of chronic kidney disease (CKD) ranged from 13.3% to 16.6% depending on the equation used in estimating the glomerular filtration rate (eGFR). Percentage cluster distribution by chronic kidney disease was observed to be significantly tilted toward the upper quartiles (3rd and 4th) of the haemodynamic parameters measured. Chronic kidney disease was significantly higher among self-reported smokers and alcoholic hypertensives. In this urban population, adiposity was associated with hypertension and renal insufficiency. Chronic kidney disease was associated with hypertension and cardiac abnormalities.

The resting 12-lead Electrocardiogram (ECG) is very useful in the diagnosis, prognosis and treatment of heart failure. There are limited data on the prevalence of ECG abnormalities in heart failure in Ghana. This retrospective study was therefore designed to determine the prevalence of ECG abnormalities among heart failure patients attending a cardiac clinic at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 398 patients diagnosed with heart failure were selected from the cardiac clinic, using simple random sampling. The demographic, clinical and chest X-ray characteristics of the patients were examined. The 12-lead resting ECGs were obtained from 394 of the patients. The ECGs were abnormal in 93% (n=367) of the patients. The main ECG abnormalities included: left ventricular hypertrophy (43.7%), left axis deviation (39.6%), left bundle branch block (19.2%), and left atrial enlargement (25.6%). Arrhythmias seen included: ventricular extrasystoles (11.2%), atrial fibrillation (8.9%), complete heart block (5.3%), and ventricular tachycardia (3.6%). In conclusion, our study has shown that ECG abnormalities are very common among heart failure patients attending cardiac clinic in Kumasi, Ghana

Human immunodeficiency virus (HIV) infection is a global public health issue and a major problem in sub- Saharan Africa. This study was a descriptive cross-sectional study designed to determine the prevalence of cardiovascular abnormalities in HIV positive patients using echocardiography. The study was carried out at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Treatment naive HIV positive patients aged between 16 and 82 years were recruited from the HIV clinic using simple random sampling. Disease history documentation, physical examination and trans-thoracic echocardiography were performed on all study participants. Two hundred (200) patients were studied. They were aged between 16 and 82 years with the mean age (± SD) of 40.6 (± 10.5) years. There were more females (74.5%; n=149) than males (25.5%; n=51). The overall prevalence of cardiovascular abnormalities was 55.5% (n=111). The cardiovascular abnormalities seen were pulmonary hypertension (38.50%), dilated cardiomyopathy (34%), pericardial effusion (23.50%), left ventricular systolic dysfunction (17.50 %) and left ventricular diastolic dysfunction (9.50%). Moderate pericardial effusion was seen in 9.5% of the patients whilst minimal pericardial effusion was seen in 14%. No patient was seen with severe pericardial effusion. For the patients with pulmonary hypertension, the mean (± SD) right ventricular systolic pressure (RVSP) was 51.5 (± 7.8) mmHg, (range; 40-70 mmHg). In conclusion, there was a high prevalence of cardiovascular abnormalities among adult HIV positive patients attending the HIV clinic at KATH, Kumasi, Ghana. The main cardiovascular abnormalities were pulmonary hypertension, dilated cardiomyopathy and pericardial effusion.

The burden of advanced heart failure includes debilitating symptoms, frequent re-hospitalization and high rates of mortality. The most common causes of this preventable rehospitalization are patient’s failure to adhere to prescribed medicines and diet regimen. It is imperative that any medication counseling and educational program seeks to assess the patients understanding of their medical conditions and ability to appreciate the importance of medication compliance to their condition. A prospective cohort study involving 583 patients aged ≥ 30 years who met clinical criteria for presence of advanced heart failure on admission was done to assess the outcome of the program on mortality and re-hospitalization. 497 patients were discharge to the cardiac clinic for a 6-month follow up during which period they were taken through medication counseling and education on; Medication Compliance, Smoking, Alcohol, Diet and Nutrition, Salt restriction, Fluid intake, Weight loss and Exercise. The study showed 97.6% decrease in re-hospitalization rate and 12.4% decrease in mortality. Patients had also significantly improved in subjective and objective indices to functional status. 93.8% were classified within NYHA function class II and 6.2% in function class III. None of the patients remained in functional class IV as compared to 46.5% of the patients before discharge. The study showed that management of heart failure patients based on well structured medication education and counseling modalities can contribute to improved patients outcomes, including reduced morbidity and mortality rates, improved functional status and quality of life.

Heart failure is a major clinical problem worldwide. It has been recognized as a contributor to cardiovascular disease burden in Africa for many years. There are no data on the prevalence of heart failure in Ghana; and the prevalence of heart failure among patients attending out-patient clinics in Ghana is unknown. This study was designed to determine the prevalence and aetiology of heart failure among patients attending a cardiac clinic in the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 524 patients were selected from the cardiac clinic, using simple random sampling. The demographic, clinical, chest X-ray, electrocardiographic and echocardiographic characteristics of the patients was examined. Among the 524 patients, 398 of the patients had heart failure according to the modified Framingham criteria for the diagnosis of heart failure; giving rise to a prevalence of 76%. The heart failure patients were aged between 13-97 years with the mean age (± standard deviation) of 56.5 (± 19) years. There were more females (53.6%; n=213) than males (46.4%; n=185). Majority (45%) of the patients had New York Heart Association (NYHA) Functional class 2. The main aetiologies of heart failure were: hypertension (45%; n=179), rheumatic heart disease (23%; n=90), cardiomyopathy (15%; n=58). Other emerging aetiologies of heart failure in Africa seen in these patients were degenerative valvular disease (7.6%; n=31) and ischemic heart disease (2.3%; n=10).

We have tested 186 individuals from Ghana, 95 indigenous and 91 who have settled in the United Kingdom, for the presence of the T594M mutation in the beta-subunit of the epithelial sodium channel, which is associated with hypertension in black populations. The group living in Ghana had a mean age of 27 years and were normotensive, but had an increased frequency of the T allele compared to the London-based population. If this is reflected in larger studies, and the link with hypertension is maintained in the Ghanaian population, this mutation could be a significant cause of hypertension in Ghana.

Correspondence: Charles Anane Department of Pharmacy, Clinical Pharmacy Office Komfo Anokye Teaching Hospital P.O. Box 1934 Kumasi. Ghana West Africa Tel +0233 02