Joe Clegg-lamptey - Academia.edu (original) (raw)

Papers by Joe Clegg-lamptey

Postgraduate Medical Journal of Ghana

Background: Breast cancer is the second most common cancer globally and the most frequent cancer ... more Background: Breast cancer is the second most common cancer globally and the most frequent cancer among women. It is associated with significant psychological morbidity including anxiety and depression. The extent of this burden has however not been documented in the Ghanaian setting. This study aimed at determining the prevalence of anxiety and depression amongst patients with breast cancer at the Korle Bu Teaching Hospital (KBTH).Design and Subjects: A cross-sectional study was carried out among 120 breast cancer patients using a structured questionnaire to obtain socio-demographic characteristics of patients. The hospital anxiety and depression scale (HADS) was used to assess fordepression and anxiety in these patients. Results: The overall prevalence of depression was 84.2%, while that for anxiety was 92.5%. Forty-four percent of the study participants had both anxiety and depression. There was no significant difference in depression (p=0.796) and anxiety (p=0.999) prevalencebetw...

West African journal of medicine, 2009

Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disea... more Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses ...

BMC Women's Health, Jan 3, 2023

Background: Breast cancer is the commonest cancer diagnosed globally and the second leading cause... more Background: Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancerrelated mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC). Methods: A descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p < 0.05. Results: A total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (< 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma-No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormonereceptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 > 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC. Conclusion: EOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies

Open Journal of Social Sciences, 2023

Introduction: Road traffic injuries (RTI) are projected to become the 7th leading cause of mortal... more Introduction: Road traffic injuries (RTI) are projected to become the 7th leading cause of mortality worldwide by the year 2030. It is projected that 90% of the global road traffic injury burden will be borne by Low and Middle-Income countries (LMICs), including sub-Saharan Africa. We undertook a systematic literature review to assess the effectiveness of implemented traffic injury prevention initiatives in sub-Saharan Africa. Methodology: A systematic review of the English literature was undertaken per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were identified by searching the electronic databases Embase, Pubmed, Medline, The Cochrane Library and an additional review of reference lists. In addition, published studies from 1990 to 2020 were extracted and analysed. Results: The literature search generated 638 articles. Twenty-two duplicates were removed, and after title and abstract screening and full-text screening, 22 articles were retained. The interventions were broadly categorised into education, enforcement, Legislation, speed control, road safety and combined interventions. Conclusion: Combined multi-faceted injury prevention strategies are most effective in Sub-Saharan Africa. Enforcement of safety regulations ensures compliance and sustainability of prevention interventions. Speed control measures are useful in calming vehicular speeds, but poor design and citing can endanger road users. Road safety, education and Legislation have little to no effect when

International journal of clinical medicine, 2014

PubMed, Sep 1, 2013

Objectives: To document the mammographic patterns in females seeking medical attention in Accra. ... more Objectives: To document the mammographic patterns in females seeking medical attention in Accra. Design: An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. Setting: The radiology departments of Korle-Bu Teaching Hospital the Trust Hospital and Medical Imaging Ghana all located in Accra. Results: One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41-50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41-50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain. Conclusion: The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.

PubMed, Sep 1, 2009

Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu... more Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu Teaching Hospital (KBTH), and reasons for patients absconding before and during treatment. Design: Questionnaire survey. Setting: Out patient departments and surgical wards of KBTH. Participants: Women newly diagnosed with breast cancer and breast cancer patients who previously absconded and were returning for treatment. Results: Sixty six newly-diagnosed patients aged between 20 and 84 (mean 44.8, median 43) years and 35 previous absconders aged 20 to 74 (mean 44.5, median 44) years were interviewed. The causes of delayed presentation were: previous medical consultations 26(29.4%), ignorance 19(28.8%), fear of mastectomy 16(24.2%), herbal treatment 13(19.7%), prayer/prayer camps 13(19.7%) and financial incapability 12(18.2%). Fear of mastectomy 20(57.1%), herbal treatment 13(37.1%), financial incapability 11(31.4%) and prayers/prayer camps 10(28.6%) which were prominent causes of late presentation, were the main reasons for absconding. Newly diagnosed patients had duration of symptoms one week to five years (mean 46, median 34 weeks). Those whose lumps were found by clinical breast examination in the community presented to hospital between six weeks to two years (mean 47, median 39 weeks). Married women were more likely to abscond (p=0.001). Conclusions: There are similar reasons for delayed presentation and absconding among Ghanaian patients. These must be addressed in outreach programmes, and patients must be counselled at time of diagnosis. Dealing with the causes of delayed presentation appears more important than attempts to screen for breast cancer, since patients identified through community screening still present late to hospital.

Postgraduate Medical Journal of Ghana

Background: Surgeons carry out procedures on patients daily, many of which are invasive and may b... more Background: Surgeons carry out procedures on patients daily, many of which are invasive and may be associated with some risks and complications. The concept of informed consent in surgical practice was introduced after certain legal issues arose. Today patients areentitled to know and be accorded the right to determine what happens to their bodies. This study set out to determine if there had been any improvement in the informed consent process over the years, taking a closer look at the various aspects of the information given.Method: This was a cross-sectional study carried out at the Department of Surgery, Korle Bu Teaching Hospital. One hundred consecutive post-operative patients were recruited and interviewed on information discussed at various stages during the preoperative period and on the administration of the consent form.Results: Thirty seven (66.0%) out of 56 elective cases felt they had been given enough information to their understanding to enable them give informed co...

The Lancet

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

Social Science Research Network, 2022

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.

British Journal of Surgery, 2019

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...

BMC Cancer

Introduction Globally breast cancer is the leading cause of cancer with an estimated 2.3 million ... more Introduction Globally breast cancer is the leading cause of cancer with an estimated 2.3 million new cases and 685,000 deaths in 2020. Late presentation is the hallmark of breast cancer in Ghana for which ignorance and fear are the major reasons fuelled largely by myths and misconceptions. Breast cancer awareness and education needs to start early to bring about a change in knowledge, attitude and practices. However, Breast cancer awareness activities in Ghana have usually targeted adult women. This study assessed the impact of breast cancer education among adolescent high school girls in Ghana. Methodology A pre- post-test quasi experimental study was conducted at two senior high schools. A self-administered pre-educational questionnaire was followed by an educational intervention consisting of a drama, PowerPoint lecture, question and answer session and distribution of breast cancer information leaflets. After 3 months the same questionnaire was administered as a post-education te...

Ghana medical journal

SUMMARY We report a case of a 35-year-old man who pre-sented with haematemesis, chest pain and a ... more SUMMARY We report a case of a 35-year-old man who pre-sented with haematemesis, chest pain and a very high fever following the swallowing of a fishbone five days previously. He was correctly diagnosed as having a mediastinitis but had an exsanguinating haematemesis and died within 24 hours of arrival in hospital. Post mortem revealed mediasinitis and an aorto-oesophageal fistula. The difficulty in making the diagnosis of this condition and the often-resulting catastrophic haemorrhage that occurs are discussed. It is a condition that should be considered in a patient presenting with fresh haematemesis and a history of ingestion of a for-eign body five to seven days previously.

Pan African Medical Journal

Lancet (London, England), Jan 3, 2018

There is a need to increase access to surgical treatments in African countries, but perioperative... more There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared u...

Tropical Doctor, 2007

Discussion Widow inheritance is clearly still practiced in south-western Uganda despite campaigns... more Discussion Widow inheritance is clearly still practiced in south-western Uganda despite campaigns directed at behaviour-al change to combat HIV/AIDS. It mainly involves widows of childbearing age and sexual relations are mandatory. This practice of sexual networking whereby men ...

East African Medical Journal, 2008

East African Medical Journal, 2010

Objectives: To evaluate psychosocial influences and effects of breast cancer treatment. Design: C... more Objectives: To evaluate psychosocial influences and effects of breast cancer treatment. Design: Cohort questionnaire survey.

Postgraduate Medical Journal of Ghana

Background: Breast cancer is the second most common cancer globally and the most frequent cancer ... more Background: Breast cancer is the second most common cancer globally and the most frequent cancer among women. It is associated with significant psychological morbidity including anxiety and depression. The extent of this burden has however not been documented in the Ghanaian setting. This study aimed at determining the prevalence of anxiety and depression amongst patients with breast cancer at the Korle Bu Teaching Hospital (KBTH).Design and Subjects: A cross-sectional study was carried out among 120 breast cancer patients using a structured questionnaire to obtain socio-demographic characteristics of patients. The hospital anxiety and depression scale (HADS) was used to assess fordepression and anxiety in these patients. Results: The overall prevalence of depression was 84.2%, while that for anxiety was 92.5%. Forty-four percent of the study participants had both anxiety and depression. There was no significant difference in depression (p=0.796) and anxiety (p=0.999) prevalencebetw...

West African journal of medicine, 2009

Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disea... more Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses ...

BMC Women's Health, Jan 3, 2023

Background: Breast cancer is the commonest cancer diagnosed globally and the second leading cause... more Background: Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancerrelated mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC). Methods: A descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p < 0.05. Results: A total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (< 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma-No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormonereceptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 > 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC. Conclusion: EOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies

Open Journal of Social Sciences, 2023

Introduction: Road traffic injuries (RTI) are projected to become the 7th leading cause of mortal... more Introduction: Road traffic injuries (RTI) are projected to become the 7th leading cause of mortality worldwide by the year 2030. It is projected that 90% of the global road traffic injury burden will be borne by Low and Middle-Income countries (LMICs), including sub-Saharan Africa. We undertook a systematic literature review to assess the effectiveness of implemented traffic injury prevention initiatives in sub-Saharan Africa. Methodology: A systematic review of the English literature was undertaken per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were identified by searching the electronic databases Embase, Pubmed, Medline, The Cochrane Library and an additional review of reference lists. In addition, published studies from 1990 to 2020 were extracted and analysed. Results: The literature search generated 638 articles. Twenty-two duplicates were removed, and after title and abstract screening and full-text screening, 22 articles were retained. The interventions were broadly categorised into education, enforcement, Legislation, speed control, road safety and combined interventions. Conclusion: Combined multi-faceted injury prevention strategies are most effective in Sub-Saharan Africa. Enforcement of safety regulations ensures compliance and sustainability of prevention interventions. Speed control measures are useful in calming vehicular speeds, but poor design and citing can endanger road users. Road safety, education and Legislation have little to no effect when

International journal of clinical medicine, 2014

PubMed, Sep 1, 2013

Objectives: To document the mammographic patterns in females seeking medical attention in Accra. ... more Objectives: To document the mammographic patterns in females seeking medical attention in Accra. Design: An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. Setting: The radiology departments of Korle-Bu Teaching Hospital the Trust Hospital and Medical Imaging Ghana all located in Accra. Results: One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41-50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41-50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain. Conclusion: The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.

PubMed, Sep 1, 2009

Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu... more Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu Teaching Hospital (KBTH), and reasons for patients absconding before and during treatment. Design: Questionnaire survey. Setting: Out patient departments and surgical wards of KBTH. Participants: Women newly diagnosed with breast cancer and breast cancer patients who previously absconded and were returning for treatment. Results: Sixty six newly-diagnosed patients aged between 20 and 84 (mean 44.8, median 43) years and 35 previous absconders aged 20 to 74 (mean 44.5, median 44) years were interviewed. The causes of delayed presentation were: previous medical consultations 26(29.4%), ignorance 19(28.8%), fear of mastectomy 16(24.2%), herbal treatment 13(19.7%), prayer/prayer camps 13(19.7%) and financial incapability 12(18.2%). Fear of mastectomy 20(57.1%), herbal treatment 13(37.1%), financial incapability 11(31.4%) and prayers/prayer camps 10(28.6%) which were prominent causes of late presentation, were the main reasons for absconding. Newly diagnosed patients had duration of symptoms one week to five years (mean 46, median 34 weeks). Those whose lumps were found by clinical breast examination in the community presented to hospital between six weeks to two years (mean 47, median 39 weeks). Married women were more likely to abscond (p=0.001). Conclusions: There are similar reasons for delayed presentation and absconding among Ghanaian patients. These must be addressed in outreach programmes, and patients must be counselled at time of diagnosis. Dealing with the causes of delayed presentation appears more important than attempts to screen for breast cancer, since patients identified through community screening still present late to hospital.

Postgraduate Medical Journal of Ghana

Background: Surgeons carry out procedures on patients daily, many of which are invasive and may b... more Background: Surgeons carry out procedures on patients daily, many of which are invasive and may be associated with some risks and complications. The concept of informed consent in surgical practice was introduced after certain legal issues arose. Today patients areentitled to know and be accorded the right to determine what happens to their bodies. This study set out to determine if there had been any improvement in the informed consent process over the years, taking a closer look at the various aspects of the information given.Method: This was a cross-sectional study carried out at the Department of Surgery, Korle Bu Teaching Hospital. One hundred consecutive post-operative patients were recruited and interviewed on information discussed at various stages during the preoperative period and on the administration of the consent form.Results: Thirty seven (66.0%) out of 56 elective cases felt they had been given enough information to their understanding to enable them give informed co...

The Lancet

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

Social Science Research Network, 2022

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.

British Journal of Surgery, 2019

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...

BMC Cancer

Introduction Globally breast cancer is the leading cause of cancer with an estimated 2.3 million ... more Introduction Globally breast cancer is the leading cause of cancer with an estimated 2.3 million new cases and 685,000 deaths in 2020. Late presentation is the hallmark of breast cancer in Ghana for which ignorance and fear are the major reasons fuelled largely by myths and misconceptions. Breast cancer awareness and education needs to start early to bring about a change in knowledge, attitude and practices. However, Breast cancer awareness activities in Ghana have usually targeted adult women. This study assessed the impact of breast cancer education among adolescent high school girls in Ghana. Methodology A pre- post-test quasi experimental study was conducted at two senior high schools. A self-administered pre-educational questionnaire was followed by an educational intervention consisting of a drama, PowerPoint lecture, question and answer session and distribution of breast cancer information leaflets. After 3 months the same questionnaire was administered as a post-education te...

Ghana medical journal

SUMMARY We report a case of a 35-year-old man who pre-sented with haematemesis, chest pain and a ... more SUMMARY We report a case of a 35-year-old man who pre-sented with haematemesis, chest pain and a very high fever following the swallowing of a fishbone five days previously. He was correctly diagnosed as having a mediastinitis but had an exsanguinating haematemesis and died within 24 hours of arrival in hospital. Post mortem revealed mediasinitis and an aorto-oesophageal fistula. The difficulty in making the diagnosis of this condition and the often-resulting catastrophic haemorrhage that occurs are discussed. It is a condition that should be considered in a patient presenting with fresh haematemesis and a history of ingestion of a for-eign body five to seven days previously.

Pan African Medical Journal

Lancet (London, England), Jan 3, 2018

There is a need to increase access to surgical treatments in African countries, but perioperative... more There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared u...

Tropical Doctor, 2007

Discussion Widow inheritance is clearly still practiced in south-western Uganda despite campaigns... more Discussion Widow inheritance is clearly still practiced in south-western Uganda despite campaigns directed at behaviour-al change to combat HIV/AIDS. It mainly involves widows of childbearing age and sexual relations are mandatory. This practice of sexual networking whereby men ...

East African Medical Journal, 2008

East African Medical Journal, 2010

Objectives: To evaluate psychosocial influences and effects of breast cancer treatment. Design: C... more Objectives: To evaluate psychosocial influences and effects of breast cancer treatment. Design: Cohort questionnaire survey.