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Kachapila M, Oppong R, Ademuyiwa AO, Bhangu A, Dauda R, Ghosh DN, Kamarajah SK, Lawani I, Medina ARDL, Monahan M, Morton DG, Omar O, Picciochi M, Tabiri S, Roberts TE, Brocklehurst P, Chakrabortee S, Glasbey J, Hardy P, Harrison E, Lillywhite R, Magill L, Nepogodiev D, Simoes J, Smith D, Kadir B, Pinkney T, Brant F, Li E, Runigamugabo E, Bahrami-Hessari M, Bywater E, Martinez L, Habumuremyi S, Ntirenganya F, Williams E, Fourtounas M, Melic BKC, Ghosh DN, Suroy A, Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Dewamon H, Akpo I, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BBD, Guinnou R, Hamadou S, Kola H, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou Y, Agbanda L, Attinon J, Hounsou NR, Gbassi M, Adagrah A, Alhassan BBA, Amoako-Boateng MP, Appiah AB, Asante-Asamani A, Boakye B, Debrah SA, Ganiyu RA, Enti D, Koggoh P, Kpankpari R, Opandoh INM, Manu MA, Manu MPO, Mensah S, Morna MT, Nortey M, Nkrumah J, Ofori EO, Quartson EM, Acquah AO, Adam-Zakariah LI, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Twerefour EY, Ankomah J, Assah-Adjei F, Boakye AA, Fosu G, Serbeh G, Gyan KY, Nyarko IO, Robertson Z, Acheampong DO, Acquaye J, Adinku M, Agbedinu K, Agbeko AE, Amankwa EG, Amoah M, Amoah G, Appiah J, Arthur J, Ayim A, Ayodeji EK, Boakye-Yiadom J, Boateng EA, Dally C, Davor A, Gyasi-Sarpong CK, Hamidu NNN, Haruna I, Kwarley N, Lovi AK, Nimako B, Nyadu BB, Opoku D, Osabutey A, Sagoe R, Tuffour S, Tufour Y, Yamoah FA, Yefieye AC, Yorke J, Addo KG, Akosa EA, Boakye P, Coompson CL, Gyamfi B, Kontor BE, Kyeremeh C, Manu R, Mensah E, Solae FI, Toffah GK, Adu-Brobbey R, Coompson CL, Labaran AH, Owusu JA, Adobea V, Bennin A, Dankwah F, Doe S, Kantanka RS, Kobby E, Larnyor H, Owusu PY, Sie-Broni CA, Zume M, Abantanga FA, Abdulai DR, Acquah DK, Ayingayure E, Osman I, Kunfah S, Limann G, Mohammed SA, Mohammed S, Musah Y, Ofori B, Owusu EA, Saba AH, Seidu AS, Yakubu M, Yenli EMTA, Bhatti K, Dhiman J, Dhir K, Hans M, Haque PD, Jesudason EDM, Madankumar L, Mittal R, Nagomy I, Prasad S, Dasari A, Jacob P, Kurien E, Mathew A, Prakash D, Susan A, Varghese R, Ortiz RC, Gonzalez GH, Krauss RH, Miguelena LH, Romero MH, Gomez IB, Aguirre CC, Avendaño AC, Sansores LD, Mejia HO, Campo LUGD, Sánchez ID, Vazquez DG, Lara MM, Maldonado LMP, Fuente ANSDL, Medina ARDL, Adeleye V, Adeniyi O, Akinajo O, Akinboyewa D, Alasi I, Alakaloko F, Atoyebi O, Balogun O, Belie O, Bode C, Ekwesianya A, Elebute O, Ezenwankwo F, Fatuga A, Ihediwa G, Jimoh A, Kuku J, Ladipo-Ajayi O, Makanjuola A, Mokwenyei O, Nwokocha S, Ogein O, Ojewola R, Oladimeji A, Olajide T, Oluseye O, Seyi-Olajide J, Soibi-Harry A, Ugwu A, Williams E, Abdur-Rahman L, Adeleke N, Adesola M, Afolabi R, Agodirin S, Aremu I, Bello J, Lawal S, Lawal A, Raji H, Sayomi O, Shittu A, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah P, Opandoh INM, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, AkotoAmpaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Ciociano MCJMC, Valle CJZFD, Aziz HIAG, Calvillo MDCG, Iriarte DGIM, Namur LDCM, Medina ARDL, Mustapha BKLA, Utumatwishima AMJN, Abdul-Aziz IIA, Anasara GAG, Ogudi DKD, Quansah JIK, Kumar NAU, Mehraj IMA, Nayak SMP, Díaz KVA, Herrera VJA, Camacho FJB, Pérez IVB, Llamas MAC, Cardona GAC, Andrade LRC, Flores AOC, Torres EJC, Valadez TAC, Valadez AEC, Cardoza JAF, González LAG, Bojorquez JLG, Ponce FYG, Ramírez CSG, Barba JAG, Ramírez BGG, Ruvalcaba MJG, Alva DAH, Camargo SAI, Peña JCI, Pérez ZML, Tellez MPM, Ackerman RCM, Vallejo LRP, Bocanegra VHP, Navarro JVP, Posada FJP, Hernández MAQ, Gonzalez LRR, Elizalde EAR, Ascencio EVR, Velasco CBR, Martínez JAS, Pulido JIS, García AGS, Carreón LOS, Ávila JJT, Gastelum JOV, Ramirez MLV, Casas MFZ, Mata JAA, Vanegas MAC, Arias RGC, Barajas BVE, Angeles LOM, Lomeli AFM, Navarro JEO, Baolboa LGP, Dominguez ACG, Morales JFM, Pesquera JAA, Maldonado LMP, Fonseca RKC, Hernandez EEL, Ramirez JAR, Moscoso MRB, Duniya SAN, Adeleye GTC, Bakare TIB, Ohemu AA, Habumuremyi DUS, Seneza GNC, Haragirimana JDD, Ingabire AJC, Ekwunife OH, Acheampong DO, Agbeko AE, Gyamfi FE, Nyadu BB, Adu-Aryee NA, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Brown GD, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Olatola DO, Tsatsu SE, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Kantanka RS, Owusu PY, Acquah DK, Adams SM, Alhassan MS, Asirifi SA, Dery MK, Ofori BA, Sam NB, Seidu AS, Acquah EK, Coompson CL, Gyambibi AK, Kontor BE, Poonia DR, Rathod KK, Rodha MS, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Lokavarapu MJ, Seenivasagam RK, Kalyanapu JA, Gautham AK, Singh DS, Abraham ES, Gold CS, Joseph JN, Kurien EN, Mathew AJ, Mathew AE, Prakash DD, Hans MA, Haque PD, Sam VD, Thind RS, Veetil SK, Daniel ER, Jacob SE, Jesudason MR, Samuel VM, Sivakumar MV, Saluja SS, Attri AK, Pai MV, Prabhu PS, T SP, Alexander PV, Ismavel VA, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Malik MA, Peters NJ, Chowdri NA, Dar RA, Parray FQ, Shah ZA, Wani RA, Villaseñor SA, Hernández AB, Ahumada EB, Cardiel GC, Guevara GC, Perez EC, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Orozco CF, Reyna BG, Sánchez EG, Espinoza EG, Ojeda AG, Torres MI, Tornero JJ, País RM, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Bravo CR, Villaseñor GS, Tinajero CC, Samano FD, Banuelos GG, Ortiz FI, Ramirez ML, Arroyo GL, Perez JO, Ramirez DO, Lozano JP, Reyes GY, Castillo MN, Mellado DH, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Quiros BC, Ambriz-González G, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Aliyu MS, Balogun AO, Francis AA, Duromola KM, Gana SG, George MD, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Saidu IA, Sholadoye TT, Abdulkarim AA, Abdullahi LB, Tolani MA, Tukur AM, Umar AS, Umar AM, Yusuf SA, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Takai IU, Umar GI, Adze JA, Airede LR, Bature SB, Galadima MC, Hamza BK, Kache SA, Kagomi WY, Kene IA, Makama JG, Mohammed-Durosinlorun AA, Taingson MC, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Atobatele KM, Bakare OO, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Salami OS, Williams OM, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Oluseye OO, Orowale AA, Osinowo AO, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Eseile IS, Ogundoyin OO, Olulana DI, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Akaba GO, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Osagie OO, Sani SA, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Osagie OT, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Lawal SA, Raji HO, Igwe PO, Iweha IE, John RE, Okoro PE, Oriji VK, Oweredaba IT, Majyabere JP, Habiyakare JA, Nabada MG, Masengesho JP, Niyomuremyi JP, Uwimana JC, Maniraguha HL, Urimubabo CJ, Shyirakera JY, Adams MA, Ede CJ, Mathe MN, Nhlabathi NA, Nxumalo HS, Sethoana ME, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Abdulai S, Agboadoh N, Akoto E, Boakye-Yiadom K, Dedey F, Nsaful J, Wordui T, Abubakari F, Akunyam J, Ballu C, Ngaaso K, Adobea V, Bennin A, Doe S, Kobby E, Kyeremeh C, Osei E, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Amadu M, Awe M, Azanlerigu M, Edwin Y, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Yahaya S, Alhassan J, Boakye P, Jeffery-Felix A, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Sharma N, Sharma N, Huda F, Mishra N, Ranjan R, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kutma A, Philips S, Hepzibah A, Mary G, Chetana C, Dasari A, Dummala P, Jacob J, Mary P, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Goyal A, Goyal S, Jain D, Jain R, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Singh P, Suroy A, Williams R, D S, Kumari P, Mittal R, Prasad S, Shankar B, Sharma S, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Kumar P, S A, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Thomas J, Zechariah P, Kichu M, Joseph S, Pundir N, Samujh R, Kour R, Saqib N, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Roy B, Abdullahi A, Abubakar M, Awaisu M, Bakari F, Bashir M, Bello A, Daniyan M, Gimba J, Gundu I, Oyelowo N, Sufyan I, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Abdullahi M, Soladoye A, Yahaya A, Abdulrasheed L, Aminu B, Bello-Tukur F, Chinyio D, Joshua S, Lawal J, Mohammed C, Nuwam D, Sale D, Sani A, Tabara S, Usam E, Yakubu J, Adegoke F, Ige O, Bakare A, Akande O, Anyanwu N, Eke G, Oyewole Y, Abunimye E, Adeoluwa A, Adesiyakan A, Amao M, Ashley-Osuzoka C, Gbenga-Oke C, Makanjuola A, Olanrewaju O, Olayioye O, Olutola S, Onyekachi K, Osariemen E, Osunwusi B, Owie E, Okoro C, Ugwuanyi K, Ugwunne C, Olasehinde O, Akinloye A, Akinniyi A, Ejimogu J, Okedare A, Omotola O, Sanwo F, Awodele K, Aisuodionoe-Shadrach O, Alfred J, Atim T, Mbajiekwe N, Olori A, Suleiman S, Sunday H, Ida G, Oruade D, Osemwegie O, Ajibola G, Elemile P, Fakoya A, Ojediran O, Olagunju N, Bello R, Lawal A, Ojajuni A, Oyewale S, Sayomi O, Shittu A, Abhulimen V, Okoi N, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Byaruhanga A, Dukuzimana R, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Mpirimbanyi C, Mukamazera L, Mukangabo C, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Dusabe M, Izabiriza E, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Dieudonne A, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Batangana M, Bucyibaruta G, Habumuremyi S, Imanishimwe A, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Dusabimana A, Kanyesigye S, Munyaneza R, Fourtounas M, Hyman G, Moore R, Sentholang N, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R, Cook J, Jayne D, Laurberg S, Brown J, Smart N, Cousens S. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet Glob Health 2024; 12:e235-e242. [PMID: 38245114 DOI: 10.1016/s2214-109x(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. METHODS A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). FINDINGS In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. INTERPRETATION Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. FUNDING National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.
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Price MD, Rositch AF, Dedey F, Mali ME, Brownson KE, Nsaful J, Tounkara M, Price RR, Sutherland EK. Availability and Geographic Access to Hospital-Based Breast Cancer Diagnostic Services in Ghana. JCO Glob Oncol 2024; 10:e2300231. [PMID: 38330275 PMCID: PMC10860977 DOI: 10.1200/go.23.00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion. METHODS A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, <80%, or not available. ArcGIS was used to identify the proportion of the population within 20 and 45 km of services. RESULTS Most hospitals in Ghana participated in this survey (95%; 328 of 346). Of these, 12 met full NCCN Basic criteria >80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km. CONCLUSION Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.
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Affiliation(s)
- Matthew D. Price
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Anne F. Rositch
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Meghan E. Mali
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
| | - Kirstyn E. Brownson
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Mamadou Tounkara
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Raymond R. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Edward Kofi Sutherland
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Ensign Global College Ghana, Kpong, Ghana
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Addo-Lartey AA, Bonful HA, Sefenu RS, Abagre TA, Asamoah A, Bandoh DA, Awua AK, Adu-Aryee NA, Dedey F, Adanu RMK, Okuyemi KS. Effectiveness of a culturally tailored text messaging program for promoting cervical cancer screening in accra, Ghana: a quasi-experimental trial. BMC Womens Health 2024; 24:22. [PMID: 38172883 PMCID: PMC10765844 DOI: 10.1186/s12905-023-02867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Despite breakthroughs in cervical cancer detection, resource-constrained countries continue to have a disproportionately high incidence and death rate. Mhealth has been identified as an important tool for increasing cervical cancer screening rates in Sub-Saharan Africa. We determined whether sending Ghanaian women culturally tailored one-way mobile phone SMS text messages about cervical cancer would encourage the uptake of the human papillomavirus (HPV) test. METHODS From August to November 2016, 88 women aged 18 to 39 living or working in an urban community (Accra, Ghana) participated in a quasi-experimental study. For 8 weeks, 32 SMS messages regarding cervical cancer were developed and sent to the personal phones of intervention arm participants (n = 42). Women in the control group (n = 46) received SMS texts with general health and lifestyle advice. Fischer's exact tests were performed to assess cervical cancer screening uptake and associated reasons for non-uptake between the intervention and control groups (p < 0.05). RESULTS At the baseline, women differed in terms of ethnicity and wealth. After the intervention, participants' self-reported risk factors for cervical cancer, such as early menarche, usual source of medical treatment, family history of cancer, smoking, and alcohol history, changed. None of the women in the intervention group sought cervical cancer screening after the intervention, but only one (2.2%) of the control arm participants did. Almost all the women (> 95%) agreed that an HPV test was essential and that regular healthcare check-ups could help prevent cervical cancer. Some women believed that avoiding particular foods could help prevent cervical cancer (23.8% intervention vs. 58.7% control, p < 0.001). Time constraints and out-of-pocket expenses were significant barriers to cervical cancer screening. CONCLUSION A one-way SMS delivered to urban women did not increase cervical cancer screening attendance. The time spent in screening facilities and the lack of coverage by the National Health Insurance Scheme limited screening uptake. We urge for the establishment of screening centers in all healthcare facilities, as well as the inclusion of cervical cancer screening in healthcare programs through cost-sharing.
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Affiliation(s)
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana.
| | - Ransford Selasi Sefenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Timothy Agandah Abagre
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Alexander Asamoah
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Delia Akosua Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Adolf Kofi Awua
- Cellular and Clinical Research Center, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission. Kwabenya, Accra, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Richard Mawuena Kofi Adanu
- Department of Population and Family Health, University of Ghana School of Public Health to Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Kolawole Stephen Okuyemi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, USA
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4
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Olivos N, Banta JE, Spencer-Hwang R, Ansong D, Beane Freeman LE, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Ahearn TU, Biritwum R, Yarney J, Awuah B, Nyarko K, Garcia-Closas M, Abubakar M, Brinton LA, Figueroa JD, Wiafe S. Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study. Breast Cancer Res 2023; 25:150. [PMID: 38082317 PMCID: PMC10714652 DOI: 10.1186/s13058-023-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.
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Affiliation(s)
- Naomie Olivos
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jim E Banta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA.
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5
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Schoenhals S, Mali ME, Sutherland EK, Sorenson J, Dedey F, Nellermoe J, Flores-Huidobro Martinez A, Tounkara MD, Price RR, Brownson KE. Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey. PLoS One 2023; 18:e0291454. [PMID: 37713441 PMCID: PMC10503733 DOI: 10.1371/journal.pone.0291454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
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Affiliation(s)
- Sarah Schoenhals
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Meghan E. Mali
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Edward K. Sutherland
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Ensign Global College, Kpong, Eastern Region, Ghana
| | - Justin Sorenson
- J.Willard Marriot Library, University of Utah, Salt Lake City, Utah, United States of America
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Greater Accra, Ghana
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Jonathan Nellermoe
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | | | - Mamadou D. Tounkara
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Raymond R. Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- General Surgery, Intermountain Medical Center, Murray, Utah, United States of America
| | - Kirstyn E. Brownson
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, Huntsman Cancer Institute at University of Utah, Salt Lake City, Utah, United States of America
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6
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Wu Z, Pfeiffer RM, Byrd DA, Wan Y, Ansong D, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Dagnall CL, Jones K, Hutchinson A, Hicks BD, Ahearn TU, Knight R, Biritwum R, Yarney J, Wiafe S, Awuah B, Nyarko K, Garcia-Closas M, Sinha R, Figueroa JD, Brinton LA, Trabert B, Vogtmann E. Associations of Circulating Estrogens and Estrogen Metabolites with Fecal and Oral Microbiome in Postmenopausal Women in the Ghana Breast Health Study. Microbiol Spectr 2023; 11:e0157223. [PMID: 37341612 PMCID: PMC10433996 DOI: 10.1128/spectrum.01572-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
The human fecal and oral microbiome may play a role in the etiology of breast cancer through modulation of endogenous estrogen metabolism. This study aimed to investigate associations of circulating estrogens and estrogen metabolites with the fecal and oral microbiome in postmenopausal African women. A total of 117 women with fecal (N = 110) and oral (N = 114) microbiome data measured by 16S rRNA gene sequencing, and estrogens and estrogen metabolites data measured by liquid chromatography tandem mass spectrometry were included. The outcomes were measures of the microbiome and the independent variables were the estrogens and estrogen metabolites. Estrogens and estrogen metabolites were associated with the fecal microbial Shannon index (global P < 0.01). In particular, higher levels of estrone (β = 0.36, P = 0.03), 2-hydroxyestradiol (β = 0.30, P = 0.02), 4-methoxyestrone (β = 0.51, P = 0.01), and estriol (β = 0.36, P = 0.04) were associated with higher levels of the Shannon index, while 16alpha-hydroxyestrone (β = -0.57, P < 0.01) was inversely associated with the Shannon index as indicated by linear regression. Conjugated 2-methoxyestrone was associated with oral microbial unweighted UniFrac as indicated by MiRKAT (P < 0.01) and PERMANOVA, where conjugated 2-methoxyestrone explained 2.67% of the oral microbial variability, but no other estrogens or estrogen metabolites were associated with any other beta diversity measures. The presence and abundance of multiple fecal and oral genera, such as fecal genera from families Lachnospiraceae and Ruminococcaceae, were associated with several estrogens and estrogen metabolites as indicated by zero-inflated negative binomial regression. Overall, we found several associations of specific estrogens and estrogen metabolites and the fecal and oral microbiome. IMPORTANCE Several epidemiologic studies have found associations of urinary estrogens and estrogen metabolites with the fecal microbiome. However, urinary estrogen concentrations are not strongly correlated with serum estrogens, a known risk factor for breast cancer. To better understand whether the human fecal and oral microbiome were associated with breast cancer risk via the regulation of estrogen metabolism, we conducted this study to investigate the associations of circulating estrogens and estrogen metabolites with the fecal and oral microbiome in postmenopausal African women. We found several associations of parent estrogens and several estrogen metabolites with the microbial communities, and multiple individual associations of estrogens and estrogen metabolites with the presence and abundance of multiple fecal and oral genera, such as fecal genera from families Lachnospiraceae and Ruminococcaceae, which have estrogen metabolizing properties. Future large, longitudinal studies to investigate the dynamic changes of the fecal and oral microbiome and estrogen relationship are needed.
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Affiliation(s)
- Zeni Wu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Doratha A. Byrd
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Yunhu Wan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey L. Dagnall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Belynda D. Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Thomas U. Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | | | | | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | | | | | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, University of Utah, and Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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7
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Ahogni D, Ahounou A, Boukari KA, Gbehade O, Hessou TK, Nindopa S, Nontonwanou MJB, Guessou NO, Sambo A, Tchati SV, Tchogo A, Tobome SR, Yanto P, Gandaho I, Hadonou A, Hinvo S, Hodonou MA, Tamou SB, Lawani S, Kandokponou CMB, Dossou FM, Gaou A, Goudou R, Kouroumta MC, Lawani I, Malade E, Dikao ASM, Nsilu JN, Ogouyemi P, Akpla M, Mitima NB, Kovohouande B, Kpangon C, Loupeda SL, Agbangla MV, Hedefoun SE, Mavoha T, Ngaguene J, Rugendabanga J, Soton RR, Totin M, Agbadebo M, Akpo I, Dewamon H, Djeto M, Hada A, Hollo M, Houndji A, Houndote A, Hounsa S, Kpatchassou E, Yome H, Alidou MM, Bara EJ, Yovo BTBD, Guinnou R, Hamadou S, Kola HP, Moussa N, Cakpo B, Etchisse L, Hatangimana E, Muhindo M, Sanni K, Yevide AB, Agossou H, Musengo FB, Behanzin H, Seto DM, Alia BA, Alitonou A, Mehounou YE, Agbanda L, Attinon J, Gbassi M, Hounsou NR, Acquah R, Banka C, Esssien D, Hussey R, Mustapha Y, Nunoo-Ghartey K, Yeboah G, Aniakwo LA, Adjei MNM, Adofo-Asamoah Y, Agyapong MM, Agyen T, Alhassan BAB, Amoako-Boateng MP, Appiah AB, Ashong J, Awindaogo JK, Brimpong BB, Dayie MSCJK, Enti D, Ghansah WW, Gyamfi JE, Koggoh P, Kpankpari R, Kudoh V, Mensah S, Mensah P, Morkor Opandoh IN, Morna MT, Nortey M, Odame E, Ofori EO, Quaicoo S, Quartson EM, Teye-Topey C, Yigah M, Yussif S, Adjei-Acquah E, Agyekum-Gyimah VO, Agyemang E, Akoto-Ampaw A, Amponsah-Manu F, Arkorful TE, Dokurugu MA, Essel N, Ijeoma A, Obiri EL, Ofosu-Akromah R, Quarchey KND, Adam-Zakariah L, Andoh AB, Asabre E, Boateng RA, Koomson B, Kusiwaa A, Naah A, Oppon-Acquah A, Oppong BA, Agbowada EA, Akosua A, Armah R, Asare C, Awere-Kyere LKB, Bruce-Adjei A, Christian NA, Gakpetor DA, Kennedy KK, Mends-Odro J, Obbeng A, Ofosuhene D, Osei-Poku D, Robertson Z, Acheampong DO, Acquaye J, Appiah J, Arthur J, Boakye-Yiadom J, Agbeko AE, Gyamfi FE, Nyadu BB, Abdulai S, Adu-Aryee NA, Agboadoh N, Akoto E, Amoako JK, Aperkor NT, Asman WK, Attepor GS, Bediako-Bowan AA, Boakye-Yiadom K, Brown GD, Dedey F, Etwire VK, Fenu BS, Kumassah PK, Larbi-Siaw LA, Nsaful J, Olatola DO, Tsatsu SE, Wordui T, Abdul-Aziz IIA, Abubakari F, Akunyam J, Anasara GAG, Ballu C, Barimah CG, Boateng GC, Kwabena PW, Kwarteng SM, Luri PT, Ngaaso K, Ogudi DKD, Adobea V, Bennin A, Doe S, Kantanka RS, Kobby E, Kyeremeh C, Osei E, Owusu PY, Owusu F, Sie-Broni C, Zume M, Abdul-Hafiz S, Acquah DK, Adams SM, Alhassan MS, Amadu M, Asirifi SA, Awe M, Azanlerigu M, Dery MK, Edwin Y, Francis AA, Limann G, Maalekuu A, Malechi H, Mohammed S, Mohammed I, Mumuni K, Ofori BA, Quansah JIK, Seidu AS, Tabiri S, Yahaya S, Acquah EK, Alhassan J, Boakye P, Coompson CL, Gyambibi AK, Jeffery-Felix A, Kontor BE, Manu R, Mensah E, Naah G, Noufuentes C, Sakyi A, Chaudhary R, Misra S, Pareek P, Pathak M, Poonia DR, Rathod KK, Rodha MS, Sharma N, Sharma N, Soni SC, Varsheney VK, Vishnoi JR, Garnaik DK, Huda F, Lokavarapu MJ, Mishra N, Ranjan R, Seenivasagam RK, Singh S, Solanki P, Verma R, Yhoshu E, John S, Kalyanapu JA, Kutma A, Philips S, Gautham AK, Hepzibah A, Mary G, Singh DS, Abraham ES, Chetana C, Dasari A, Dummala P, Gold CS, Jacob J, Joseph JN, Kurien EN, Mary P, Mathew AJ, Mathew AE, Prakash DD, Samuel O, Sukumar A, Syam N, Varghese R, Bhatt A, Bhatti W, Dhar T, Ghosh DN, Goyal A, Goyal S, Hans MA, Haque PD, Jain D, Jain R, Jyoti J, Kaur S, Kumar K, Luther A, Mahajan A, Mandrelle K, Michael V, Mukherjee P, Rajappa R, Sam VD, Singh P, Suroy A, Thind RS, Veetil SK, Williams R, Sreekar D, Daniel ER, Jacob SE, Jesudason MR, Kumari P, Mittal R, Prasad S, Samuel VM, Shankar B, Sharma S, Sivakumar MV, Surendran S, Thomas A, Trinity P, Kanchodu S, Leshiini K, Saluja SS, Attri AK, Bansal I, Gupta S, Gureh M, Kapoor S, Aggarwal M, Kanna V, Kaur H, Kumar A, Singh S, Singh G, John V, Adnan M, Agrawal N, Kumar U, Kumar P, Abhishek S, Sehrawat V, Singla D, Thami G, Kumar V, Mathew S, Pai MV, Prabhu PS, Sundeep PT, Akhtar N, Chaturvedi A, Gupta S, Kumar V, Prakash P, Rajan S, Singh M, Tripathi A, Alexander PV, Thomas J, Zechariah P, Ismavel VA, Kichu M, Solomi CV, Alpheus RA, Choudhrie AV, Gunny RJ, Joseph S, Malik MA, Peters NJ, Pundir N, Samujh R, Ahmed HI, Aziz G, Chowdri NA, Dar RA, Kour R, Mantoo I, Mehraj A, Parray FQ, Saqib N, Shah ZA, Wani RA, Raul S, Rautela K, Sharma R, Singh N, Vakil R, Chowdhury P, Chowdhury S, Mathai S, Nayak P, Roy B, Alvarez Villaseñor AS, Ascencio Díaz KV, Avalos Herrera VJ, Barbosa Camacho FJ, Hernández AB, Ahumada EB, Brancaccio Pérez IV, Calderón Llamas MA, Cardiel GC, Cervantes Cardona GA, Guevara GC, Perez EC, Chávez M, Chejfec Ciociano JM, Cifuentes Andrade LR, Cortés Flores AO, Cortes Torres EJ, Cueto Valadez TA, Cueto Valadez AE, Martinez EC, Barradas PD, Estrada IE, Becerril PF, Flores Cardoza JA, Orozco CF, García González LA, Reyna BG, Sánchez EG, González Bojorquez JL, Espinoza EG, Ojeda AG, González Ponce FY, Guerrero Ramírez CS, Guzmán Barba JA, Guzmán Ramírez BG, Guzmán Ruvalcaba MJ, Hérnandez Alva DA, Ibarra Camargo SA, Ibarrola Peña JC, Torres MI, Tornero JJ, Lara Pérez ZM, País RM, Mellado Tellez MP, Miranda Ackerman RC, Santana DM, Villela GM, Hinojosa RN, Escobar CN, Rodríguez IO, Flores OO, Barreiro AO, Rubio JO, Pacheco Vallejo LR, Pérez Bocanegra VH, Pérez Navarro JV, Plascencia Posada FJ, Quirarte Hernández MA, Ramirez Gonzalez LR, Reyes Elizalde EA, Romo Ascencio EV, Bravo CR, Ruiz Velasco CB, Sánchez Martínez JA, Villaseñor GS, Sandoval Pulido JI, Serrano García AG, Suárez Carreón LO, Tijerina Ávila JJ, Vega Gastelum JO, Vicencio Ramirez ML, Zarate Casas MF, Zuloaga Fernández del Valle CJ, Mata JAA, Vanegas MAC, Arias RGC, Tinajero CC, Samano FD, Zepeda FD, Barajas BVE, Banuelos GG, Calvillo MDCG, Ortiz FI, Ramirez ML, Arroyo GL, Angeles LOM, Morales Iriarte DGI, Lomeli AFM, Navarro JEO, Perez JO, Ramirez DO, Baolboa LGP, Lozano JP, Reyes GY, Castillo MN, Dominguez ACG, Mellado DH, Morales JFM, del Carmen H Namur L, Pesquera JAA, Maldonado LMP, De la Medina AR, Bozada-Gutierrez K, Casado-Zarate AF, Delano-Alonso R, Herrera-Esquivel J, Moreno-Portillo M, Trejo-Avila M, Fonseca RKC, Hernandez EEL, Quiros BC, Ramirez JAR, Ambriz-González G, Becerra Moscoso MR, Cabrera-Lozano I, Calderón-Alvarado AB, León-Frutos FJ, Villanueva-Martínez EE, Abdullahi A, Abubakar M, Aliyu MS, Awaisu M, Bakari F, Balogun AO, Bashir M, Bello A, Daniyan M, Duromola KM, Gana SG, George MD, Gimba J, Gundu I, Iji LO, Jimoh AO, Koledade AK, Lawal AT, Lawal BK, Mustapha A, Nwabuoku SE, Ogunsua OO, Okafor IF, Okorie EI, Oyelowo N, Saidu IA, Sholadoye TT, Sufyan I, Tolani MA, Tukur AM, Umar AS, Umar AM, Umaru-Sule H, Usman M, Yahya A, Yakubu A, Yusuf SA, Abdulkarim AA, Abdullahi LB, Abdullahi M, Ado KA, Aliyu NU, Anyanwu LJC, Daneji SM, Magashi MK, Mohammad MA, Muhammad AB, Muhammad SS, Muideen BA, Nwachukwu CU, Sallau SB, Sheshe AA, Soladoye A, Takai IU, Umar GI, Yahaya A, Abdulrasheed L, Adze JA, Airede LR, Aminu B, Bature SB, Bello-Tukur F, Chinyio D, Duniya SAN, Galadima MC, Hamza BK, Joshua S, Kache SA, Kagomi WY, Kene IA, Lawal J, Makama JG, Mohammed C, Mohammed-Durosinlorun AA, Nuwam D, Sale D, Sani A, Tabara S, Taingson MC, Usam E, Yakubu J, Adegoke F, Ige O, Odunafolabi TA, Okereke CE, Oladele OO, Olaleye OH, Olubayo OO, Abiola OP, Abiyere HO, Adebara IO, Adeleye GTC, Adeniyi AA, Adewara OE, Adeyemo OT, Adeyeye AA, Ariyibi AL, Awoyinka BS, Ayankunle OM, Babalola OF, Bakare A, Bakare TIB, Banjo OO, Egharevba PA, Fatudimu OS, Obateru JA, Odesanya OJ, Ojo OD, Okunlola AI, Okunlola CK, Olajide AT, Orewole TO, Salawu AI, Abdulsalam MA, Adelaja AT, Ajai OT, Akande O, Anyanwu N, Atobatele KM, Bakare OO, Eke G, Faboya OM, Imam ZO, Nwaenyi FC, Ogunyemi AA, Oludara MA, Omisanjo OA, Onyeka CU, Oshodi OA, Oshodi YA, Oyewole Y, Salami OS, Williams OM, Abunimye E, Ademuyiwa AO, Adeoluwa A, Adesiyakan A, Adeyeye VI, Agbulu MV, Akinajo OR, Akinboyewa DO, Alakaloko FM, Alasi IO, Amao M, Ashley-Osuzoka C, Atoyebi OA, Balogun OS, Bode CO, Busari MO, Duru NJ, Edet GB, Elebute OA, Ezenwankwo FC, Fatuga AL, Gbenga-Oke C, Ihediwa GC, Inyang ES, Jimoh AI, Kuku JO, Ladipo-Ajayi OA, Lawal AO, Makanjuola A, Makwe CC, Mgbemena CV, Nwokocha SU, Ogunjimi MA, Ohazurike EO, Ojewola RW, Badedale ME, Okeke CJ, Okunowo AA, Oladimeji AT, Olajide TO, Olanrewaju O, Olayioye O, Oluseye OO, Olutola S, Onyekachi K, Orowale AA, Osariemen E, Osinowo AO, Osunwusi B, Owie E, Oyegbola CB, Seyi-Olajide JO, Soibi-Harry AP, Timo MT, Ugwu AO, Williams EO, Duruewuru IO, Egwuonwu OA, Ekwunife OH, Emeka JJ, Modekwe VI, Nwosu CD, Obiechina SO, Obiesie AE, Okafor CI, Okonoboh TO, Okoro C, Okoye OA, Onu OA, Onyejiaka CC, Uche CF, Ugboajah JO, Ugwu JO, Ugwuanyi K, Ugwunne C, Adeleke AA, Adepiti AC, Aderounmu AA, Adesunkanmi AO, Adisa AO, Ajekwu SC, Ajenifuja OK, Alatise OI, Badmus TA, Mohammed TO, Olasehinde O, Salako AA, Sowande OA, Talabi AO, Wuraola FO, Adegoke PA, Akinloye A, Akinniyi A, Ejimogu J, Eseile IS, Ogundoyin OO, Okedare A, Olulana DI, Omotola O, Sanwo F, Adumah CC, Ajagbe AO, Akintunde OP, Asafa OQ, Awodele K, Eziyi AK, Fasanu AO, Ojewuyi OO, Ojewuyi AR, Oyedele AE, Taiwo OA, Abdullahi HI, Adewole ND, Agida TE, Ailunia EE, Aisuodionoe-Shadrach O, Akaba GO, Alfred J, Atim T, Bawa KG, Chinda JY, Daluk EB, Eniola SB, Ezenwa AO, Garba SE, Mbajiekwe N, Mshelbwala PM, Ndukwe NO, Ogolekwu IP, Ohemu AA, Olori S, Osagie OO, Sani SA, Suleiman S, Sunday H, Tabuanu NO, Umar AM, Agbonrofo PI, Arekhandia AI, Edena ME, Eghonghon RA, Enaholo JE, Ida G, Ideh SN, Iribhogbe OI, Irowa OO, Isikhuemen ME, Odutola OR, Okoduwa KO, Omorogbe SO, Oruade D, Osagie OT, Osemwegie O, Abdus-Salam RA, Adebayo SA, Ajagbe OA, Ajao AE, Ajibola G, Ayandipo OO, Egbuchulem KI, Ekwuazi HO, Elemile P, Fakoya A, Idowu OC, Irabor DO, Lawal TA, Lawal OO, Ogundoyin OO, Ojediran O, Olagunju N, Sanusi AT, Takure AO, Abdur-Rahman LO, Adebisi MO, Adeleke NA, Afolabi RT, Aremu II, Bello JO, Bello R, Lawal A, Lawal SA, Ojajuni A, Oyewale S, Raji HO, Sayomi O, Shittu A, Abhulimen V, Igwe PO, Iweha IE, John RE, Okoi N, Okoro PE, Oriji VK, Oweredaba IT, Mizero J, Mutimamwiza I, Nirere F, Niyongombwa I, Majyabere JP, Byaruhanga A, Dukuzimana R, Habiyakare JA, Nabada MG, Uwizeye M, Ruhosha M, Igiraneza J, Ingabire F, Karekezi A, Masengesho JP, Mpirimbanyi C, Mukamazera L, Mukangabo C, Niyomuremyi JP, Ntwari G, Seneza C, Umuhoza D, Habumuremyi S, Imanishimwe A, Kanyarukiko S, Mukaneza F, Mukantibaziyaremye D, Munyaneza A, Ndegamiye G, Nyirangeri P, Tubasiime R, Uwimana JC, Dusabe M, Izabiriza E, Maniraguha HL, Mpirimbanyi C, Mutuyimana J, Mwenedata O, Rwagahirima E, Zirikana J, Sibomana I, Rubanguka D, Umuhoza J, Uwayezu R, Uzikwambara L, Hirwa AD, Kabanda E, Mbonimpaye S, Mukakomite C, Muroruhirwe P, Butana H, Dusabeyezu M, Mukasine A, Utumatwishima JN, Batangana M, Bucyibaruta G, Habumuremyi S, de Dieu Haragirimana J, Imanishimwe A, Ingabire AJC, Mukanyange V, Munyaneza E, Mutabazi E, Mwungura E, Ncogoza I, Ntirenganya F, Nyirahabimana J, Nyirasebura D, Urimubabo CJ, Dusabimana A, Kanyesigye S, Munyaneza R, Shyirakera JY, Fourtounas M, Adams MA, Ede CJ, Hyman G, Mathe MN, Moore R, Nhlabathi NA, Nxumalo HS, Sentholang N, Sethoana ME, Wondoh P, Ally Z, Domingo A, Munda P, Nyatsambo C, Ojo V, Pswarayi R. Strategies to minimise and monitor biases and imbalances by arm in surgical cluster randomised trials: evidence from ChEETAh, a trial in seven low- and middle-income countries. Trials 2023; 24:259. [PMID: 37020311 PMCID: PMC10077601 DOI: 10.1186/s13063-022-06852-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/19/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cluster randomised controlled trials (cRCT) present challenges regarding risks of bias and chance imbalances by arm. This paper reports strategies to minimise and monitor biases and imbalances in the ChEETAh cRCT. METHODS ChEETAh was an international cRCT (hospitals as clusters) evaluating whether changing sterile gloves and instruments prior to abdominal wound closure reduces surgical site infection at 30 days postoperative. ChEETAh planned to recruit 12,800 consecutive patients from 64 hospitals in seven low-middle income countries. Eight strategies to minimise and monitor bias were pre-specified: (1) minimum of 4 hospitals per country; (2) pre-randomisation identification of units of exposure (operating theatres, lists, teams or sessions) within clusters; (3) minimisation of randomisation by country and hospital type; (4) site training delivered after randomisation; (5) dedicated 'warm-up week' to train teams; (6) trial specific sticker and patient register to monitor consecutive patient identification; (7) monitoring characteristics of patients and units of exposure; and (8) low-burden outcome-assessment. RESULTS This analysis includes 10,686 patients from 70 clusters. The results aligned to the eight strategies were (1) 6 out of 7 countries included ≥ 4 hospitals; (2) 87.1% (61/70) of hospitals maintained their planned operating theatres (82% [27/33] and 92% [34/37] in the intervention and control arms); (3) minimisation maintained balance of key factors in both arms; (4) post-randomisation training was conducted for all hospitals; (5) the 'warm-up week' was conducted at all sites, and feedback used to refine processes; (6) the sticker and trial register were maintained, with an overall inclusion of 98.1% (10,686/10,894) of eligible patients; (7) monitoring allowed swift identification of problems in patient inclusion and key patient characteristics were reported: malignancy (20.3% intervention vs 12.6% control), midline incisions (68.4% vs 58.9%) and elective surgery (52.4% vs 42.6%); and (8) 0.4% (41/9187) of patients refused consent for outcome assessment. CONCLUSION cRCTs in surgery have several potential sources of bias that include varying units of exposure and the need for consecutive inclusion of all eligible patients across complex settings. We report a system that monitored and minimised the risks of bias and imbalances by arm, with important lessons for future cRCTs within hospitals.
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Dedey F, Gyedu A. Inspirational Women in Surgery: Prof. Afua A.J. Hesse, Paediatric Surgeon, Ghana. World J Surg 2023; 47:833-834. [PMID: 36729163 DOI: 10.1007/s00268-023-06929-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana.
| | - Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Geczik AM, Falk RT, Xu X, Wiafe-Addai B, Yarney J, Awuah B, Biritwum R, Vanderpuye V, Dedey F, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Titiloye N, Edusei L, Nyarko K, Clegg-Lamptey JN, Wiafe S, Ansong D, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana. J Expo Sci Environ Epidemiol 2023; 33:301-310. [PMID: 34992224 PMCID: PMC9256865 DOI: 10.1038/s41370-021-00407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity. OBJECTIVES To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels. METHODS We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate adjusted geometric means (GM) and 95% confidence intervals of individual circulating estrogen levels by hair relaxer/skin lightener exposure categories. RESULTS Of the 585 postmenopausal women included in our analysis, 80.2% reported hair relaxer use and 29.4% skin lightener use. Ever hair relaxer use was positively associated with estriol (adjusted GM 95.4 pmol/L vs. never 74.5, p value = 0.02) and 16-epiestriol (20.4 vs. 16.8, p value = 0.05) particularly among users of lye-based hair relaxers. Positive associations between scalp burns and unconjugated estrogens were observed (e.g., unconjugated estrone: 5+ scalp burns 76.9 [59.6-99.2] vs. no burns 64.0 [53.7-76.3], p-trend = 0.03). No association was observed between use of skin lighteners and circulating estrogens. SIGNIFICANCE This study presents evidence that circulating 16-pathway estrogens (i.e., estriol and 16-epiestriol) may be increased in users of lye-based hair relaxer products. Among hair relaxer users, unconjugated estrogen levels were elevated in women with a greater number of scalp burns. IMPACT STATEMENT In this population-based study of hair relaxer and skin lightener use among postmenopausal women in Ghana, altered estrogen metabolism was observed with hair relaxer use, particularly among women using lye-based products or with a greater number of scalp burns. In contrast, skin lightener use was not associated with differences in estrogen metabolism in this population. Continued investigation of the potential biological impact on breast cancer risk of hair relaxer use is warranted.
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Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xia Xu
- Protein Characterization Laboratory, Leidos-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonine Figueroa
- The University of Edinburgh, Cancer Research UK Edinburgh Center, Edinburgh, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Geczik AM, Falk RT, Xu X, Wiafe-Addai B, Yarney J, Awuah B, Biritwum R, Vanderpuye V, Dedey F, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Titiloye N, Edusei L, Nyarko K, Clegg-Lamptey JN, Wiafe S, Ansong D, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Correction to: Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana. J Expo Sci Environ Epidemiol 2023; 33:311. [PMID: 35094015 DOI: 10.1038/s41370-022-00415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xia Xu
- Protein Characterization Laboratory, Leidos-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonine Figueroa
- The University of Edinburgh, Cancer Research UK Edinburgh Center, Edinburgh, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Akakpo PK, Imbeah EG, Edusei L, Naporo S, Ulzen-Appiah K, Clegg-Lamptey JN, Dedey F, Nsaful J, Affram N, Wiafe B, Mensah S, Nortey M, Sheriff M, Amponsah-Manu F, Agbedinu K, Jiagge EM. Clinicopathologic characteristics of early-onset breast cancer: a comparative analysis of cases from across Ghana. BMC Womens Health 2023; 23:5. [PMID: 36597014 PMCID: PMC9808934 DOI: 10.1186/s12905-022-02142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancer-related 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 hormone-receptor-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 to understand the molecular genetic drivers of the general poorer pathological features of EOBCs and its relation to patient outcome in our setting is needed.
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Affiliation(s)
- Patrick Kafui Akakpo
- grid.413081.f0000 0001 2322 8567Department of Pathology, University of Cape Coast/Cape Coast Teaching Hospital, Cape Coast, Ghana ,ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana ,Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Emmanuel Gustav Imbeah
- ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana ,Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Lawrence Edusei
- Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Simon Naporo
- Pathologists Without Borders Ltd, A585/4 Eduardo Mohdlana St. Laterbiokoshie, Accra, Ghana
| | - Kofi Ulzen-Appiah
- grid.413081.f0000 0001 2322 8567Department of Pathology, University of Cape Coast/Cape Coast Teaching Hospital, Cape Coast, Ghana ,ACT Pathology Consult, Pedu Estate, Cape Coast, Ghana
| | - Joe Nat Clegg-Lamptey
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Florence Dedey
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Josephine Nsaful
- grid.8652.90000 0004 1937 1485Department of Surgery, University of Ghana Medical School/Korle Bu Teaching Hospital Accra, Accra, Ghana
| | - Nelson Affram
- Department of Surgery, Ho Teaching Hospital, Ho, Ghana
| | | | - Samuel Mensah
- grid.9829.a0000000109466120Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Nortey
- grid.413081.f0000 0001 2322 8567Department of Surgery, University of Cape Coast / Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Mohammed Sheriff
- grid.460777.50000 0004 0374 4427Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Kwabena Agbedinu
- grid.415450.10000 0004 0466 0719Department of Surgery, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - Evelyn Mawunyo Jiagge
- grid.446722.10000 0004 0635 5208Henry Ford Cancer Institute/Henry Ford Health System, 2799W Grand Blvd, Detroit, MI USA
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Andoh AB, Atindaana Francis A, Abdulkarim AA, Adesunkanmi AO, Salako AA, Soladoye A, Sheshe AA, Sani A, Lawal AO, Lawal A, Tripathi A, S A, Akinloye A, Olajumoke Balogun A, Ariyibi AL, Okunlola AI, Ojewuyi AR, Oyedele AE, Sakyi A, Oladimeji AT, Bala Muhammad A, Yahaya A, Soibi-Harry AP, Gyambibi AK, Adeniyi AA, Adeoluwa A, Olumide Osinowo A, Salawu AI, Fatuga AL, Adesiyakan A, Fakoya A, Naah A, Adeyeye AA, Talabi AO, Fasanu AO, Ayoola Orowale A, Ojajuni A, Adelaja AT, Ademuyiwa AO, Jimoh AI, Aderounmu AA, Adisa AO, Ajagbe AO, Olajide AT, Bakare A, Okunowo AA, Tchogo A, Koledade AK, Barthelemy Yevide A, Bello A, Shehu Umar A, Lawal AT, Obiesie AE, Dieudonne Hirwa A, Domingo A, Mustapha A, Abdullahi A, Hada A, Ijeoma A, Adeleke AA, Adepiti AC, Ajao AE, Sanusi AT, Houndji A, Bernal Hernández A, González Ojeda A, Serrano García AG, Ohemu AA, Arekhandia AI, Yakubu A, Hepzibah A, Bhatt A, Muhammad Tukur A, Ingabire AJC, Okechukwu Ugwu A, Karekezi A, Maalekuu A, Imanishimwe A, Bruce-Adjei A, Obbeng A, Akosua A, Jeffery-Felix A, Mohammed-Durosinlorun AA, Jimoh AO, Umar AM, Umar AM, Mahajan A, Eziyi AK, Bennin A, Dasari A, Okedare A, Mathew AE, Florencia Casado-Zarate A, Calderón-Alvarado AB, Dominguez ACG, Cortés Flores AO, Dusabimana A, Kutma A, Byaruhanga A, Houndote A, Cueto Valadez AE, Alvarez Villaseñor AS, Bhangu A, Ortega Barreiro A, Mortola Lomeli AF, Luther A, Yahya A, Eseenam Agbeko A, Thomas A, Goyal A, Mkoh Dikao AS, Appiah AB, Gaou A, Bediako-Bowan AA, Ramos De la Medina A, Seidu AS, Munyaneza A, Ahounou A, Akoto-Ampaw A, Hadonou A, Alitonou A, Sambo A, Mathew AJ, Chaturvedi A, Gautham AK, Choudhrie AV, Attri AK, Kumar A, Sukumar A, Mehraj A, Shittu A, Mukasine A, Oppon-Acquah A, Kusiwaa A, Suroy A, Ezenwa AO, Takure AO, Akinniyi A, Ogunyemi AA, Makanjuola A, Dossou Yovo BB, Alhassan BAB, Hamza BK, Awoyinka BS, Koomson B, Aminu B, Abodunde Muideen B, Osunwusi B, García Reyna B, Oppong BA, Brimpong BB, Fenu BS, Ofori BA, Guzmán Ramírez BG, Nyadu BB, Shankar B, Lawal BK, Armstrong Alia B, Roy B, Kontor BE, Kovohouande B, Cakpo B, Enriquez Barajas BV, Crocco Quiros B, Kadir B, Mohammed C, Nwachukwu CU, Colunga Tinajero C, Ruiz Velasco CB, Zuloaga Fernández del Valle CJ, Noufuentes C, Solomi CV, Okunlola CK, Seneza C, Okafor CI, Nuño Escobar C, Banka C, Barimah CG, Chetana C, Nyatsambo C, Okeke CJ, Jeffrey Ede C, Nwosu CD, Victoria Mgbemena C, Onyeka CU, Gold CS, Faith Uche C, Chigoze Makwe C, Urimubabo CJ, Coompson CL, Ashley-Osuzoka C, Gbenga-Oke C, Bidemi Oyegbola C, Mukakomite C, Mpirimbanyi C, Asare C, Bode CO, Ugwunne C, Onyejiaka CC, Okoro C, Okereke CE, Mukangabo C, Sie-Broni C, Ballu C, Fuentes Orozco C, Kyeremeh C, Adumah CC, Ruelas Bravo C, Bokossa Kandokponou CM, Guerrero Ramírez CS, Teye-Topey C, Kpangon C, Chinyio D, Orozco Ramirez D, Mora Santana D, Nyirasebura D, Hérnandez Alva DA, Acquah DK, Prakash DD, Sale D, Olulana DI, Oruade D, Jayne D, Morales Iriarte DGI, Ogudi DKD, Olatola DO, Akinboyewa DO, Irabor DO, Nuwam D, Mukantibaziyaremye D, Jain D, Singla D, Garnaik DK, Singh DS, Gakpetor DA, Esssien D, Rubanguka D, Poonia DR, Ghosh D, Ahogni D, Morton D, Umuhoza D, Morel Seto D, Nepogodiev D, Enti D, Smith D, Osei-Poku D, Acheampong DO, Mellado DH, Ofosuhene D, Cortes Torres EJ, Efren Lozada E, Gómez Sánchez E, González Espinoza E, Osei E, Mensah E, Rwagahirima E, Quartson EM, Li E, Kurien EN, Bonilla Ahumada E, Kabanda E, Odame E, Izabiriza E, Hatangimana E, Osariemen E, Reyes Elizalde EA, Agbowada EA, Usam E, Sylvester Inyang E, Owie E, Ojo Williams E, Munyaneza E, Mutabazi E, Kojo Acquah E, Obiri EL, Ofori EO, Runigamugabo E, Yhoshu E, Malade E, Cervantes Perez E, Kobby E, Okwudiri Ohazurike E, Jerry Bara E, Agyemang E, Akoto E, Villanueva-Martínez EE, Mwungura E, Cueva Martinez E, Asabre E, Adjei-Acquah E, Abunimye E, Daluk EB, Daniel ER, Ike Okorie E, Ailunia EE, Abraham ES, Romo Ascencio EV, Harrison E, Kpatchassou E, Bakari F, González Ponce FY, Huda F, Abubakari F, Ntirenganya F, Ingabire F, Parray FQ, Brant F, Alakaloko FM, Diaz Samano F, Duque Zepeda F, Bello-Tukur F, Basirwa Musengo F, Dedey F, Adegoke F, Amponsah-Manu F, Mukaneza F, Chinonso Ezenwankwo F, Sanwo F, Dossou FM, Nwaenyi FC, Ibanez Ortiz F, Barbosa Camacho FJ, León-Frutos FJ, Plascencia Posada FJ, Nirere F, Owusu F, Gyamfi FE, Wuraola FO, Cervantes Guevara G, Ntwari G, Ambriz-González G, Hyman G, Umar GI, Thami G, Adeleye GTC, Limann G, Ajibola G, Ida G, Ihediwa GC, Brown GD, Bucyibaruta G, Gallardo Banuelos G, Lopez Arroyo G, Ndegamiye G, Naah G, Morgan Villela G, Edet G, Attepor GS, Akaba GO, Aziz G, Yeboah G, Mary G, Eke G, Castillo Cardiel G, Yanowsky Reyes G, Sanchez Villaseñor G, Cervantes Cardona GA, Singh G, Boateng GC, Kola H, Abdullahi HI, Olaide Raji H, Ahmed HI, Umaru-Sule H, Kaur H, Malechi H, Sunday H, Abiyere HO, Butana H, Agossou H, Samkelisiwe Nxumalo H, Maniraguha HL, Dewamon H, Yome H, Behanzin H, Ekwuazi HO, Oweredaba IT, Mohammed I, Sufyan I, Saidu IA, Abdul-Aziz IIA, Eseile IS, Ogolekwu IP, Adebara IO, Usman Takai I, Fidelis Okafor I, Kene IA, Enyinnaya Iweha I, Mutimamwiza I, Mantoo I, Duruewuru IO, Akpo I, Niyongombwa I, Brancaccio Pérez IV, Esparza Estrada I, Gundu I, Morkor Opandoh IN, Ncogoza I, Sibomana I, Bansal I, Cabrera-Lozano I, Ishola Aremu I, Gandaho I, Lawani I, Ochoa Rodríguez I, Alasi IO, Alhassan J, Mends-Odro J, Osuna Rubio J, Orozco Perez J, González Bojorquez JL, Rodriguez Ramirez JA, Glasbey J, Emeka JJ, Lawal J, Acquaye J, Alfred J, Rugendabanga J, Mizero J, Ingabire JCA, Aimable Habiyakare J, Claude Uwimana J, de Dieu Haragirimana J, Yves Shyirakera J, Utumatwishima JN, Niyomuremyi JP, Majyabere JP, Masengesho JP, Nyirahabimana J, Vishnoi JR, Kalyanapu JA, Joseph JN, Makama JG, Pizarro Lozano J, Aguilar Mata JA, Morales JFM, Vega Gastelum JO, Oyekunle Bello J, Okechukwu Ugwu J, Amoako JK, Simoes J, Zirikana J, Nzuwa Nsilu J, Adze JA, Enaholo JE, Obateru JA, Chinda JY, Akunyam J, Boakye-Yiadom J, Cook J, Quansah JIK, Chejfec Ciociano JM, Jiménez Tornero J, Herrera-Esquivel J, Flores Cardoza JA, Sánchez Martínez JA, Guzmán Barba JA, Pesquera JAA, Orozco Navarro JE, Sandoval Pulido JI, Pérez Navarro JV, Igiraneza J, Ejimogu J, Awindaogo JK, Ugboajah JO, Ashong J, Nsaful J, Arthur J, Yakubu J, Mutuyimana J, Umuhoza J, Thomas J, Ibarrola Peña JC, Tijerina Ávila JJ, Oladayo Kuku J, Gyamfi JE, Brown J, Appiah J, Attinon J, Jacob J, Gimba J, Seyi-Olajide JO, Ngaguene J, Jyoti J, Leshiini K, Boukari KA, Kumar K, Mumuni K, Quarchey KND, Sanni K, Bozada-Gutierrez K, Mandrelle K, Atobatele KM, Awodele K, Bawa KG, Duromola KM, Egbuchulem KI, Ngaaso K, Onyekachi K, Ugwuanyi K, Okoduwa KO, Ado KA, Rathod KK, Nunoo-Ghartey K, Rautela K, Kennedy KK, Ascencio Díaz KV, Boakye-Yiadom K, Onahi Iji L, Magill L, Martinez Perez Maldonado L, Pena Baolboa LG, Montano Angeles LO, Barau Abdullahi L, Ismail L, Awere-Kyere LKB, Uzikwambara L, Adam-Zakariah L, Larbi-Siaw LA, Chukwuemeka Anyanwu LJ, Etchisse L, Abdulrasheed L, Agbanda L, García González LA, Suárez Carreón LO, Cifuentes Andrade LR, Pacheco Vallejo LR, Ramirez Gonzalez LR, Aniakwo LA, Olajide Abdur-Rahman L, Abdur-Rahman LO, Namur LDCM, Mukamazera L, Airede LR, Nontonwanou MB, Amoako-Boateng MP, Rodha MS, Kawu Magashi M, Abubakar M, Yigah M, Dayie MSCJK, Victorin Agbangla M, Pathak M, Aggarwal M, Lokavarapu MJ, Talla Timo M, Isikhuemen ME, Gbassi M, Uwizeye M, Akpla M, Adjei MNM, Picciochi M, Chávez M, Fourtounas M, Quirarte Hernández MA, Zarate Casas MF, Gloriose Nabada M, Kouroumta MC, De Cristo Gonzalez Calvillo M, Trejo-Avila M, Guzmán Ruvalcaba MJ, Monahan M, Jesudason MR, Zume M, Totin M, Djeto M, Awe M, Islas Torres M, Morna MT, Oluwadamilola Adebisi M, Adams MA, Oluwatobi Busari M, Lazo Ramirez M, Taingson MC, Ruhosha M, Dery MK, Batangana M, Mellado Tellez MP, Vicencio Ramirez ML, Agyapong MM, Nortey M, Amao M, Bahrami-Hessari M, Calderón Llamas MA, Calderon Vanegas MA, Azanlerigu M, Becerra Moscoso MR, Sethoana ME, Oludara MA, Moussa Alidou M, Mohammad MA, Bashir M, Usman M, Adnan M, Alhassan MS, Aliyu MS, Singh M, Muhindo M, Dusabeyezu M, Kichu M, Castillo MN, Gureh M, Hans MA, Hollo M, Hodonou MA, Sivakumar MV, Edena ME, Abdulsalam MA, Adebisi Ogunjimi M, Dusabe M, Dokurugu MA, Galadima MC, Agbulu MV, Agbadebo M, Eunice ME, Nosipho Mathe M, Moreno-Portillo M, Awaisu M, Daniyan M, Duke George M, Malik MA, Amadu M, Pai MV, Adetola Tolani M, Abdullahi M, Moussa N, Guessou NO, Saqib N, Christian NA, Essel N, Tabuanu NO, Olagunju N, Sam NB, Akhtar N, Oyelowo N, Bisimwa Mitima N, Adewole ND, Sharma N, Anthea Nhlabathi N, Mbajiekwe N, Mishra N, Pundir N, Winkles N, Smart N, Agboadoh N, Ndukwe NO, Aperkor NT, Adu-Aryee NA, Chowdri NA, Singh N, Peters NJ, Sharma N, Agrawal N, Syam N, Duru NJ, Sentholang N, Okoi N, Anyanwu N, Rene Hounsou N, Aliyu NU, Abiola Adeleke N, Egwuonwu OA, Okoye OA, Hyginus Ekwunife O, Olanrewaju O, Osagie OO, Adeyemo OT, Oshodi OA, Olaolu Ogundoyin O, Ogundoyin OO, Babalola OF, Olasehinde O, Ajai OT, Balogun OS, Lawal OO, Olayioye O, Sayomi O, Samuel O, Mwenedata O, Oluwaseyi Bakare O, Sowande OA, Ojewuyi OO, Omisanjo OA, Akintunde OP, Abiola OP, Abiola OP, Akande O, Elebute OA, Adewara OE, Ayankunle OM, Odesanya OJ, Alatise OI, Ajenifuja OK, Ogunsua OO, Banjo OO, Ojediran O, Oladele OO, Fatudimu OS, Ajagbe OA, Idowu OC, Ladipo-Ajayi OA, Taiwo OA, Olaleye OH, Oluseye OO, Ige O, Odutola OR, Atoyebi OA, Omar O, Ayandipo OO, Omotola O, Faboya OM, Williams OM, Irowa OO, Salami OS, Onu OA, Asafa OQ, Akinajo OR, Osemwegie O, Osagie OT, Olvera Flores O, Iribhogbe OI, Aisuodionoe-Shadrach O, Gbehade O, Ojo OD, Olubayo OO, Prabhu PS, Flores Becerril P, Kumar P, Yanto P, Mukherjee P, Haque PD, Koggoh P, Igwe PO, Trinity P, Aderemi Adegoke P, Wondoh P, Domínguez Barradas P, Ogouyemi P, Boakye P, Brocklehurst P, Elemile P, Egharevba PA, Agbonrofo PI, Okoro PE, Kumassah PK, Mensah P, Munda P, Mshelbwala PM, Alexander PV, Nyirangeri P, Muroruhirwe P, Hardy P, Kwabena PW, Zechariah P, Nayak P, Dummala P, Singh P, Solanki P, Yeboah Owusu P, Mary P, Chowdhury P, Luri PT, Pareek P, Prakash P, Kumari P, Lillywhite R, Moore R, Tinuola Afolabi R, Williams R, Alpheus RA, Sharma R, Seenivasagam RK, Vakil R, Armah R, Samujh R, Chaudhary R, John RE, Gunny RJ, Wani RA, Verma R, Thind RS, Dar RA, Eghonghon RA, Acquah R, Rajappa R, Kpankpari R, Ofosu-Akromah R, Romaric Soton R, Jain R, Guinnou R, Munyaneza R, Mares País R, Delano-Alonso R, Miranda Ackerman RC, Bello R, Kour R, Guadalupe Cano Arias RG, Uwayezu R, Nájar Hinojosa R, Mittal R, Ranjan R, Goudou R, Cethorth Fonseca RK, Hussey R, Tubasiime R, Dukuzimana R, Varghese R, Boateng RA, Pswarayi R, Ojewola RW, Abdus-Salam RA, Abdus-Salam RA, Sarfo Kantanka R, Manu R, Abdul-Hafiz S, Oyewale S, Yussif S, Abolade Lawal S, Kanyarukiko S, Abeku Yusuf S, Suleiman S, Tabara S, Mbonimpaye S, Kanyesigye S, Joshua S, Tamou SB, Gupta S, Muhammad SS, Abdulai S, Olori S, Mensah S, Asirifi SA, Sani SA, Ajekwu SC, Nwokocha SU, Quaicoo S, Tsatsu SE, Philips S, Gupta S, Misra S, Kaur S, Omorogbe SO, Eniola SB, Kwarteng SM, Tobome SR, Emmanuel Hedefoun S, Adams SM, Singh S, Duniya SAN, Yahaya S, Mohammed S, Rajan S, Adekola Adebayo S, Ibarra Camargo SA, Cousens S, Hinvo S, Kapoor S, Singh S, Nindopa S, Jacob SE, Laurberg S, Chakrabortee S, Chowdhury S, Mathai S, Prasad S, Tchati SV, Habumuremyi S, Habumuremyi S, Hamadou S, Lawani S, Veetil SK, D S, D S, Sharma S, Doe S, Mathew S, Emeka Nwabuoku S, Ideh SN, Laurent Loupeda S, Tabiri S, Olutola S, Kache SA, Bature SB, Garba SE, Gana SG, Soni SC, Raul S, Kanchodu S, Daneji SM, Sallau SB, P T S, Saluja SS, Goyal S, Surendran S, Joseph S, John S, Obiechina SO, Hounsa S, Lawal TA, Badmus TA, Bakare TIB, Mohammed TO, Cueto Valadez TA, Dhar T, Agida TE, Arkorful TE, Atim T, Orewole TO, Wordui T, Okonoboh TO, Mavoha T, Hessou TK, Agyen T, Pinkney T, Olajide TO, Odunafolabi TA, Sholadoye TT, Kumar U, Kingsley Oriji V, Varsheney VK, Samuel VM, Agyekum-Gyimah VO, Ifeanyichukwu Modekwe V, Ojo V, Abhulimen V, Pérez Bocanegra VH, Avalos Herrera VJ, Etwire VK, Ibukunoluwa Adeyeye V, Kumar V, Ismavel VA, John V, Sehrawat V, Kudoh V, Kanna V, Mukanyange V, Michael V, Adobea V, Sam VD, Ghansah WW, Asman WK, Bhatti W, Kagomi WY, Mehounou Y, Mustapha Y, Oyewole Y, Edwin Y, Oshodi YA, Adofo-Asamoah Y, Ally Z, Imam ZO, Shah ZA, Lara Pérez ZM, Robertson Z. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400:1767-1776. [PMID: 36328045 DOI: 10.1016/s0140-6736(22)01884-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI. METHODS ChEETAh was a multicentre, cluster randomised trial in seven low-income and middle-income countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, South Africa). Any hospitals (clusters) doing abdominal surgery in participating countries were eligible. Clusters were randomly assigned to current practice (42) versus intervention (39; routine change of gloves and instruments before wound closure for the whole scrub team). Consecutive adults and children undergoing emergency or elective abdominal surgery (excluding caesarean section) for a clean-contaminated, contaminated, or dirty operation within each cluster were identified and included. It was not possible to mask the site investigators, nor the outcome assessors, but patients were masked to the treatment allocation. The primary outcome was SSI within 30 days after surgery (participant-level), assessed by US Centers for Disease Control and Prevention criteria and on the basis of the intention-to-treat principle. The trial has 90% power to detect a minimum reduction in the primary outcome from 16% to 12%, requiring 12 800 participants from at least 64 clusters. The trial was registered with ClinicalTrials.gov, NCT03700749. FINDINGS Between June 24, 2020 and March 31, 2022, 81 clusters were randomly assigned, which included a total of 13 301 consecutive patients (7157 to current practice and 6144 to intervention group). Overall, 11 825 (88·9%) of 13 301 patients were adults, 6125 (46·0%) of 13 301 underwent elective surgery, and 8086 (60·8%) of 13 301 underwent surgery that was clean-contaminated or 5215 (39·2%) of 13 301 underwent surgery that was contaminated-dirty. Glove and instrument change took place in 58 (0·8%) of 7157 patients in the current practice group and 6044 (98·3%) of 6144 patients in the intervention group. The SSI rate was 1280 (18·9%) of 6768 in the current practice group versus 931 (16·0%) of 5789 in the intervention group (adjusted risk ratio: 0·87, 95% CI 0·79-0·95; p=0·0032). There was no evidence to suggest heterogeneity of effect across any of the prespecified subgroup analyses. We did not anticipate or collect any specific data on serious adverse events. INTERPRETATION This trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world. FUNDING National Institute for Health Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, Mölnlycke Healthcare.
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Wu Z, Byrd DA, Wan Y, Ansong D, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Dagnall CL, Jones K, Hutchinson A, Hicks BD, Ahearn TU, Shi J, Knight R, Biritwum R, Yarney J, Seth Wiafe, Awuah B, Nyarko K, Figueroa JD, Sinha R, Garcia-Closas M, Brinton LA, Vogtmann E. The oral microbiome and breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in the Ghana Breast Health Study. Int J Cancer 2022; 151:1248-1260. [PMID: 35657343 PMCID: PMC9420782 DOI: 10.1002/ijc.34145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/24/2022]
Abstract
The oral microbiome, like the fecal microbiome, may be related to breast cancer risk. Therefore, we investigated whether the oral microbiome was associated with breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in a case-control study in Ghana. A total of 881 women were included (369 breast cancers, 93 nonmalignant cases and 419 population-based controls). The V4 region of the 16S rRNA gene was sequenced from oral and fecal samples. Alpha-diversity (observed amplicon sequence variants [ASVs], Shannon index and Faith's Phylogenetic Diversity) and beta-diversity (Bray-Curtis, Jaccard and weighted and unweighted UniFrac) metrics were computed. MiRKAT and logistic regression models were used to investigate the case-control associations. Oral sample alpha-diversity was inversely associated with breast cancer and nonmalignant breast disease with odds ratios (95% CIs) per every 10 observed ASVs of 0.86 (0.83-0.89) and 0.79 (0.73-0.85), respectively, compared to controls. Beta-diversity was also associated with breast cancer and nonmalignant breast disease compared to controls (P ≤ .001). The relative abundances of Porphyromonas and Fusobacterium were lower for breast cancer cases compared to controls. Alpha-diversity and presence/relative abundance of specific genera from the oral and fecal microbiome were strongly correlated among breast cancer cases, but weakly correlated among controls. Particularly, the relative abundance of oral Porphyromonas was strongly, inversely correlated with fecal Bacteroides among breast cancer cases (r = -.37, P ≤ .001). Many oral microbial metrics were strongly associated with breast cancer and nonmalignant breast disease, and strongly correlated with fecal microbiome among breast cancer cases, but not controls.
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Affiliation(s)
- Zeni Wu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Doratha A Byrd
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Yunhu Wan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey L. Dagnall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Belynda D. Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Thomas U. Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | | | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Nsaful J, Dedey F, Nartey E, Labi J, Adu-Aryee NA, Clegg-Lamptey JN. The impact of a breast cancer educational intervention in Ghanaian high schools. BMC Cancer 2022; 22:893. [PMID: 35971095 PMCID: PMC9380352 DOI: 10.1186/s12885-022-09991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
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 test to assess the impact of the educational intervention. The total score for each domain was categorised into adequate knowledge > 50% and inadequate knowledge < 50%. Results The number of participants in the pre-test and post-test were 1043 and 1274; the median ages [IQR] were 16.0 [15.0–17.0] for both the pre and post-test students. General knowledge on breast cancer at pre-education (29.1%) improved to 72.5% (p < 0.001). Knowledge on signs and symptoms improved from 33.1 to 55% (p < 0.001); knowledge on risk factors improved from 55.3 to 79.2% (p < 0.001), and knowledge on breast self-examination and screening improved from 9.8 to 22.2% (p < 0.001). The overall performance of the students improved from 17.2 to 59.4% (p < 0.001). Conclusion There is inadequate knowledge about breast cancer and self-examination among senior high school girls in Ghana. Our breast cancer educational intervention was effective in improving general knowledge of breast cancer, risk factors, signs and symptoms and breast self-examination. The overall knowledge base improved from 17.2 to 59.4% 3 months post intervention, accompanied by an increase in the reported practice of breast self-examination and a greater belief that breast cancer is curable. This study has demonstrated the need for a school breast cancer educational program and that breast cancer education in high schools is effective.
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Affiliation(s)
- Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana. .,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana.
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Edmund Nartey
- Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Juliana Labi
- Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Joe Nat Clegg-Lamptey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
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Ahearn TU, Choudhury PP, Derkach A, Wiafe-Addai B, Awuah B, Yarney J, Edusei L, Titiloye N, Adjei E, Vanderpuye V, Aitpillah F, Dedey F, Oppong J, Osei-Bonsu EB, Duggan MA, Brinton LA, Allen J, Luccarini C, Baynes C, Carvalho S, Dunning AM, Davis Lynn BC, Chanock SJ, Hicks BD, Yeager M, Chatterjee N, Biritwum R, Clegg-Lamptey JN, Nyarko K, Wiafe S, Ansong D, Easton DF, Figueroa JD, Garcia-Closas M. Breast Cancer Risk in Women from Ghana Carrying Rare Germline Pathogenic Mutations. Cancer Epidemiol Biomarkers Prev 2022; 31:1593-1601. [PMID: 35654374 DOI: 10.1158/1055-9965.epi-21-1397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Risk estimates for women carrying germline mutations in breast cancer susceptibility genes are mainly based on studies of European ancestry women. METHODS We investigated associations between pathogenic variants (PV) in 34 genes with breast cancer risk in 871 cases [307 estrogen receptor (ER)-positive, 321 ER-negative, and 243 ER-unknown] and 1,563 controls in the Ghana Breast Health Study (GBHS), and estimated lifetime risk for carriers. We compared results with those for European, Asian, and African American ancestry women. RESULTS The frequency of PV in GBHS for nine breast cancer genes was 8.38% in cases and 1.22% in controls. Relative risk estimates for overall breast cancer were: (OR, 13.70; 95% confidence interval (CI), 4.03-46.51) for BRCA1, (OR, 7.02; 95% CI, 3.17-15.54) for BRCA2, (OR, 17.25; 95% CI, 2.15-138.13) for PALB2, 5 cases and no controls carried TP53 PVs, and 2.10, (0.72-6.14) for moderate-risk genes combined (ATM, BARD1, CHEK2, RAD51C, RAD52D). These estimates were similar to those previously reported in other populations and were modified by ER status. No other genes evaluated had mutations associated at P < 0.05 with overall risk. The estimated lifetime risks for mutation carriers in BRCA1, BRCA2, and PALB2 and moderate-risk genes were 18.4%, 9.8%, 22.4%, and 3.1%, respectively, markedly lower than in Western populations with higher baseline risks. CONCLUSIONS We confirmed associations between PV and breast cancer risk in Ghanaian women and provide absolute risk estimates that could inform counseling in Ghana and other West African countries. IMPACT These findings have direct relevance for breast cancer genetic counseling for women in West Africa.
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Affiliation(s)
- Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Parichoy Pal Choudhury
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | | | | | | | | | | | | | | | - Máire A Duggan
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Jamie Allen
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Sara Carvalho
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Brittny C Davis Lynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Belynda D Hicks
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Nilanjan Chatterjee
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, California
| | | | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Jonine D Figueroa
- Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
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16
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Bonful HA, Addo-Lartey AA, Sefenu RS, Nwameme A, Abagre TA, Awua AK, Adu-Aryee NA, Dedey F, Adanu RMK, Okuyemi KS. Developing a culturally tailored short message service (SMS) intervention for improving the uptake of cervical cancer screening among Ghanaian women in urban communities. BMC Womens Health 2022; 22:154. [PMID: 35538476 PMCID: PMC9092690 DOI: 10.1186/s12905-022-01719-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background There has been extensive research across the globe to understand the barriers and facilitators of cervical cancer (CC) screening. However, few studies have focused on how such information has been used to develop text messages for mHealth screening programs, especially in resource-poor countries. This study elicited information on barriers and facilitators, the preferences of women regarding the modalities for delivery of health SMS messages on screening for cervical cancer, and demonstrates how this information was used to create a health screening program among women in the Greater Accra Region of Ghana. Methods Four main activities were carried out, including (1) a total of five focus group discussions, (2) a baseline survey involving 62 female bankers and 68 women from the communities, (3) a stakeholder meeting involving experts in cervical cancer research and clinical care, and (4) pilot testing of the text messages. Focus group discussions and the baseline survey data were collected concurrently between February and May 2017 and the results were used to develop 5 specific communication objectives during the stakeholder engagements held in June 2017. Results In all, 32 text messages were developed and pretested in July 2017(13 addressed knowledge on CC; 6 highlighted the importance of early detection; 5 allayed fear as a barrier to CC screening; 5 encouraged women to have time for their health, and 3 messages contained information on where to go for screening and the cost involved). Although awareness about the disease was high, knowledge of CC screening was low. For two-thirds of respondents (22/33), perceived lack of time, high cost, and fear (of cc, screening procedure, and potential for negative outcome) accounted for the reasons why respondents will not go for screening, while education on CC, especially from health workers and the mass media enabled uptake of CC screening. Conclusion Several factors prevent women from accessing screening services for CC, however, barriers such as low levels of education on CC, lack of time, and fear can be targeted in SMS messaging programs.
Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01719-9.
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Affiliation(s)
- Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Ransford Selasi Sefenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Timothy Agandah Abagre
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Adolf Kofi Awua
- Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Kwabenya, Accra, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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17
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Geczik AM, Falk RT, Xu X, Ansong D, Yarney J, Wiafe-Addai B, Edusei L, Dedey F, Vanderpuye V, Titiloye N, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Biritwum R, Nyarko K, Wiafe S, Awuah B, Clegg-Lamptey JN, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Measured body size and serum estrogen metabolism in postmenopausal women: the Ghana Breast Health Study. Breast Cancer Res 2022; 24:9. [PMID: 35081987 PMCID: PMC8793253 DOI: 10.1186/s13058-022-01500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several anthropometric measures have been associated with hormone-related cancers, and it has been shown that estrogen metabolism in postmenopausal women plays an important role in these relationships. However, little is known about circulating estrogen levels in African women, and the relevance to breast cancer or breast cancer risk factors. To shed further light on the relationship of anthropometric factors and estrogen levels in African women, we examined whether measured body mass index (BMI), waist-to-hip ratio (WHR), height, and self-reported body size were associated with serum estrogens/estrogen metabolites in a cross-sectional analysis among postmenopausal population-based controls of the Ghana Breast Health Study.
Methods
Fifteen estrogens/estrogen metabolites were quantified using liquid chromatography-tandem mass spectrometry in serum samples collected from postmenopausal female controls enrolled in the Ghana Breast Health Study, a population-based case–control study conducted in Accra and Kumasi. Geometric means (GMs) of estrogens/estrogen metabolites were estimated using linear regression, adjusting for potential confounders.
Results
Measured BMI (≥ 30 vs. 18.5–24.9 kg/m2) was positively associated with parent estrogens (multivariable adjusted GM for unconjugated estrone: 78.90 (66.57–93.53) vs. 50.89 (43.47–59.59), p-value < 0.0001; and unconjugated estradiol: 27.83 (21.47–36.07) vs. 13.26 (10.37–16.95), p-value < 0.0001). Independent of unconjugated estradiol, measured BMI was associated with lower levels of 2-pathway metabolites and higher levels of 16-ketoestradriol. Similar patterns of association were found with WHR; however, the associations were not entirely independent of BMI. Height was not associated with postmenopausal estrogens/estrogen metabolite levels in African women.
Conclusions
We observed strong associations between measured BMI and parent estrogens and estrogen metabolite patterns that largely mirrored relations that have previously been associated with higher breast cancer risk in postmenopausal White women. The consistency of the BMI-estrogen metabolism associations in our study with those previously noted among White women suggests that estrogens likely explain part of the BMI-postmenopausal breast cancer risk in both groups. These findings merit evaluation in Black women, including prospective studies.
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18
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Ali MA, Hagbevor I, Maalman RSE, Donkor YO, Dedey F, Abedi E. HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome. Int J Surg Case Rep 2022; 90:106726. [PMID: 34979426 PMCID: PMC8732747 DOI: 10.1016/j.ijscr.2021.106726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection. Case presentation A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years. Clinical discussion The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection. Conclusion Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection. Surgical site infection is a challenge in hernias with perforated viscus after repair. Current standard modalities of hernia repairs are used in such patient's infection are not anticipated. Patient with retroviral infection and wound contamination requires a different approach to ensure the intact repair. Nylon darn, one of the methods was used with success. Our patient with a prolonged infection after surgery and a 5-year post-repair success are a first of the kind reported.
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Affiliation(s)
- Mahamudu Ayamba Ali
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana.
| | - Israel Hagbevor
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
| | - Raymond Saa-Eru Maalman
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Yaw Otchere Donkor
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Korle-Bu - Accra, Ghana
| | - Emmanuel Abedi
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
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19
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Abstract
Warfarin induced skin necrosis is a rare debilitating and, in some cases, life-threatening complication. A 47-year-old male on life-long anticoagulation omits his medication and develops extensive skin necrosis of the left leg complicated by acute renal failure three days after restarting warfarin. Investigations reveal possible Protein S deficiency which is known to be a predisposing condition. Various mechanisms have been proposed as the underlying cause. He was managed on heparin, wound debridement and skin grafting. Warfarin was restarted concurrently with heparin. Knowledge of this complication will enable timely diagnosis and treatment.
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Affiliation(s)
- Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Yaw Ofori Adjei
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Nelson Agboadoh
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Edem Anyigba
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Warigbani Pieterson
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
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20
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Nsaful J, Vanderpuye V, Scott AA, Dedey F, Oppong SA, Appiah-Danquah R, Damale N, Fenu B, Wordui T, Yarney J, Clegg-Lamptey JN. Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases. Ecancermedicalscience 2020; 14:1140. [PMID: 33281932 PMCID: PMC7685764 DOI: 10.3332/ecancer.2020.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the commonest female cancer worldwide and the most common malignancy during pregnancy. The current management of breast cancer is based on patient and tumour characteristics, preferences and disease stage. In pregnancy-associated breast cancer, the gestational age influences treatment options. Sequencing of therapies is guided by safe imaging options, timing of delivery and prognosis. Systemic therapy options in the neoadjuvant, adjuvant and palliative settings are limited due to safety concerns of the unborn foetus. In resource-constrained regions, the application of safe options may be challenging. This paper reports four of such cases managed in Ghana using a multidisciplinary approach and local resource-appropriate evidence-based practices. Maternal and foetal outcomes were acceptable with none resulting in termination of pregnancy.
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Affiliation(s)
- Josephine Nsaful
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Aba Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Florence Dedey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Rita Appiah-Danquah
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Nelson Damale
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Benjamin Fenu
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Theodore Wordui
- Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
| | - Joe Nat Clegg-Lamptey
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, GA-379-5258, Ghana.,Department of Surgery, Korle Bu Teaching Hospital, Accra, GA-379-5258, Ghana
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21
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Iddrisu M, Aziato L, Dedey F. Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study. BMC Psychiatry 2020; 20:353. [PMID: 32631279 PMCID: PMC7336427 DOI: 10.1186/s12888-020-02760-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Young women diagnosed with breast cancer face challenges that interfere with their entire life with psychological and physical effects. METHOD We employed a qualitative exploratory descriptive design, and recruited twelve participants through purposive and snowball sampling methods to conduct 12 face to face individual interviews. A reputable review board in Ghana; Noguchi Memorial Institute for Medical Research, gave ethical clearance for data collection. Data were transcribed verbatim and analysed using thematic content analysis. RESULTS Three themes emerged from the data; physical effects of breast cancer, effects of treatment on body image, and emotional effects of breast cancer diagnosis and treatment. The negative effects of treatment incapacitated most of the women and limited their activities of daily living. Some experienced severe bodily weakness and stayed indoors for days. Most participants felt they looked unattractive because they have had a mastectomy done, and used pieces of rags and handkerchiefs as breast prostheses. Those who had hair loss through chemotherapy used different kinds of wigs to cover their baldness. Almost all the participants cried, felt depressed, and became emotionally unstable when they were told their diagnosis. Some denied their diagnoses and displaced their anger on healthcare personnel. A few of them felt they had brought disgrace to their families because breast cancer is perceived, a disgraceful disease. CONCLUSION Young women diagnosed with breast cancer require psychological interventions and physical support from healthcare personnel and their families.
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Affiliation(s)
- Merri Iddrisu
- grid.8652.90000 0004 1937 1485Department of Adult Health, School of Nursing and Midwifery, University of Ghana, P. O. Box LG43, Legon, Accra, Ghana
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, P. O. Box LG43, Legon, Accra, Ghana.
| | - Florence Dedey
- grid.8652.90000 0004 1937 1485School of Medicine and Dentistry, University of Ghana Medical School, Accra, Ghana
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22
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Nilsson E, Olsson S, Regner S, Polistena A, Ali A, Dedey F, Avenia N, Wu L, Banka Johnson L. Surgical intervention for intestinal typhoid perforation. G Chir 2019; 40:105-111. [PMID: 31131808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Typhoid perforation is the most fatal complication of typhoid fever in developing countries and is most often caused by the bacteria Salmonella Typhi. There are conflicting views as to which type of surgical intervention gives the best outcome. The aim of this study was to determine the mortality associated with the different types of surgical interventions employed in patients with typhoid perforation. METHOD This was a retrospective review of the medical records of adult and paediatric surgical patients treated in the general and paediatric surgical units of the Korle Bu Teaching Hospital. Information was obtained from medical records at the Korle Bu Teaching Hospital in Accra, Ghana, between January 2009 and April 2012. The data was analysed using IBM SPSS Statistics version 20 and 22. RESULTS 133 patients (median age of 21 years, 72.2% males) with typhoid perforation were included in the study. The typhoid perforation specific mortality rate was 12.8%. Males had a significantly lower mortality rate (7.3%) compared to females (27%). Simple bowel closure (85.7% of total) was the most common surgical intervention performed and patients operated upon with this method had a significantly lower mortality rate (9.6%) compared to patients with bowel resection (31.6%). CONCLUSIONS In this study, patients treated with intestinal resection were more likely to die from typhoid perforation and female gender was a risk factor for death. Simple bowel closure was the predominant surgical procedure.
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23
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Sanuade OA, Ayettey H, Hewlett S, Dedey F, Wu L, Akingbola T, Ogedegbe G, de-Graft Aikins A. Understanding the causes of breast cancer treatment delays at a teaching hospital in Ghana. J Health Psychol 2018; 26:357-366. [PMID: 30497300 DOI: 10.1177/1359105318814152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Poor outcomes for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with 20 women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g. misinterpretation of symptoms, fear), (2) healthcare provider (e.g. negative attitudes) and (3) health systems (e.g. shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support and strengthening health systems.
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Affiliation(s)
| | | | - Sandra Hewlett
- University of Ghana, Ghana.,Korle-Bu Teaching Hospital, Ghana
| | - Florence Dedey
- University of Ghana, Ghana.,Korle-Bu Teaching Hospital, Ghana
| | - Lily Wu
- Korle-Bu Teaching Hospital, Ghana
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24
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Brinton LA, Figueroa JD, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Thistle JE, Adjei E, Aitpillah F, Dedey F, Edusei L, Titiloye N, Awuah B, Clegg-Lamptey JN, Wiafe-Addai B, Vanderpuye V. Skin lighteners and hair relaxers as risk factors for breast cancer: results from the Ghana breast health study. Carcinogenesis 2018; 39:571-579. [PMID: 29324997 DOI: 10.1093/carcin/bgy002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/05/2018] [Indexed: 01/14/2023] Open
Abstract
Skin lighteners and hair relaxers, both common among women of African descent, have been suggested as possibly affecting breast cancer risk. In Accra and Kumasi, Ghana, we collected detailed information on usage patterns of both exposures among 1131 invasive breast cancer cases and 2106 population controls. Multivariate analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for breast cancer risk factors. Control usage was 25.8% for ever use of skin lighteners and 90.0% for use of hair relaxers for >1 year. The OR for skin lighteners was 1.10 (95% CI 0.93-1.32), with higher risks for former (1.21, 0.98-1.50) than current (0.96, 0.74-1.24) users. No significant dose-response relations were seen by duration, age at first use or frequency of use. In contrast, an OR of 1.58 (95% CI 1.15-2.18) was associated with use of hair relaxers, with higher risks for former (2.22, 1.56-3.16) than current (1.39, 1.00-1.93) users. Although numbers of burns were inconsistently related to risk, associations increased with duration of use, restricted to women who predominately used non-lye products (P for trend < 0.01). This was most pronounced among women with few children and those with smaller tumors, suggesting a possible role for other unmeasured lifestyle factors. This study does not implicate a substantial role for skin lighteners as breast cancer risk factors, but the findings regarding hair relaxers were less reassuring. The effects of skin lighteners and hair relaxers on breast cancer should continue to be monitored, especially given some biologic plausibility for their affecting risk.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.,Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland
| | | | | | | | | | | | | | - Jake E Thistle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, 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Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Brinton LA, Awuah B, Nat Clegg-Lamptey J, Wiafe-Addai B, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Adjei AA, Adjei E, Aitpillah F, Edusei L, Dedey F, Nyante SJ, Oppong J, Osei-Bonsu E, Titiloye N, Vanderpuye V, Brew Abaidoo E, Arhin B, Boakye I, Frempong M, Ohene Oti N, Okyne V, Figueroa JD. Design considerations for identifying breast cancer risk factors in a population-based study in Africa. Int J Cancer 2017; 140:2667-2677. [PMID: 28295287 DOI: 10.1002/ijc.30688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 02/04/2023]
Abstract
Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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- Korle Bu Teaching Hospital, Accra, Ghana.,University of Ghana, Accra, Ghana
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland
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Adugbire BA, Aziato L, Dedey F. Patients’ experiences of pre and intra operative nursing care in Ghana: A qualitative study. International Journal of Africa Nursing Sciences 2017. [DOI: 10.1016/j.ijans.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Adu-Aryee NA, Aabakken L, Dedey F, Nsaful J, Kudzi W. Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection. BMC Res Notes 2016; 9:421. [PMID: 27576901 PMCID: PMC5004304 DOI: 10.1186/s13104-016-2237-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/23/2016] [Indexed: 01/27/2023] Open
Abstract
Background Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients. Methods Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared. Results Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373). Conclusion Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.
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Affiliation(s)
- N A Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - L Aabakken
- Division of Gastroenterology, University of Oslo, Oslo, Norway
| | - F Dedey
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - J Nsaful
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana
| | - W Kudzi
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, P.O. Box GP 4236, Accra, Ghana.
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Dedey F, Wu L, Ayettey H, Sanuade OA, Akingbola TS, Hewlett SA, Tayo BO, Cole HV, de-Graft Aikins A, Ogedegbe G, Adanu R. Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana. Health Educ Behav 2016; 43:420-7. [PMID: 27091222 DOI: 10.1177/1090198115620417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study evaluated duration and factors that influenced waiting time from first presentation to start of definitive treatment. Method We conducted a hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013. We used descriptive statistics to summarize patient characteristics. Mann-Whitney U and Kruskal-Wallis tests and Spearman rank correlation were performed to examine the patients, health system, and health worker factors associated with median waiting time. Poisson regression was used to examine the determinants of waiting time. Results The mean age of the patients was 51.1 ± 11.8 years. The median waiting time was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. Conclusion A prolonged waiting time to treatment occurs for breast cancer patients in Ghana, particularly for older patients, those with minimal or no education, with lower income, single patients, those with late disease, those who are insured, and who did not receive adequate information from the health workers. Time to obtain biopsy reports should be shortened. Patients and providers need education on timely treatment to improve prognosis.
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Affiliation(s)
| | - Lily Wu
- University of Ghana, Accra, Ghana
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Aziato L, Dedey F, Marfo K, Asamani JA, Clegg-Lamptey JNA. Validation of three pain scales among adult postoperative patients in Ghana. BMC Nurs 2015; 14:42. [PMID: 26265901 PMCID: PMC4531519 DOI: 10.1186/s12912-015-0094-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain assessment is an important component of pain management and health professionals require valid tools to assess pain to guide their pain management decisions. The study sought to select, develop, and validate context-appropriate unidimensional pain scales for pain assessment among adult post-operative patients. METHODS A mixed methods design was adopted. The study was conducted at two hospitals in Accra, Ghana. The qualitative phase involved 17 patients and 25 nurses, and the quantitative phase involved 150 post-operative patients. Qualitative data was collected iteratively through individual interviews and focus groups. RESULTS Two existing pain scales (0-10 Numeric Rating Scale [NRS] and Wong-Baker FACES [FPS] scales) and one new pain scale (Colour-Circle Pain Scale-[CCPS]) were validated. The psychometric properties of the three scales were assessed when patients had fully recovered from anesthesia. The CCPS had higher scale preference than NRS and FPS. Convergent validity was very good and significant (0.70-0.75). Inter-rater reliability was high (0.923-0.928) and all the scales were sensitive to change in the intensity or level of pain experienced before and after analgesia such as paracetamol and diclofenac suppositories, injectable pethidine, and oral tramadol had been administered. CONCLUSION Using a valid tool for pain assessment gives the clinician an objective criterion for pain management. Due to the subjective nature of pain, consideration of socio-cultural factors for the particular context ensures that the appropriate tool is used.
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Affiliation(s)
- Lydia Aziato
- />Department of Adult Health, School of Nursing, University of Ghana, Legon, Accra, Ghana
- />School of Nursing, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Florence Dedey
- />Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Kissinger Marfo
- />Public Health Unit (Biostatistics), Korle-Bu Teaching Hospital, Accra, Ghana
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Seshie B, Adu-Aryee NA, Dedey F, Calys-Tagoe B, Clegg-Lamptey JN. A retrospective analysis of breast cancer subtype based on ER/PR and HER2 status in Ghanaian patients at the Korle Bu Teaching Hospital, Ghana. BMC Clin Pathol 2015; 15:14. [PMID: 26161039 PMCID: PMC4496863 DOI: 10.1186/s12907-015-0014-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/29/2015] [Indexed: 01/05/2023] Open
Abstract
Background Breast cancer is a heterogeneous disease composed of multiple subgroups with different molecular alterations, cellular composition, clinical behaviour, and response to treatment. This study evaluates the occurrence of the various subtypes and their clinical and pathological behaviour in the Ghanaian breast cancer population at the Korle Bu Teaching Hospital (KBTH). Methods Retrospective review of case notes of patients who had completed treatment for breast cancer at the KBTH within the last 5 years was conducted between April 2011 and March 2012. Subtypes were determined by immunohistochemistry classification based on expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2). Result A total of 165 cases contributed to this study. The mean age at diagnosis was 52.5 ± 12.1 years. Tumour size ranged from 0.8 cm to 15 cm with a mean of 4.9 ± 2.8 cm and median of 4 cm. Tumour grade was Grade I 8.3 %, Grade II 60.8 % and Grade III 30.8 %. ER, PR and HER2/neu receptor positivity was 32.1, 25.6 and 25.5 % respectively. Almost half (49.4 %) of the study population had triple negative tumours. Luminal A, luminal B and non-luminal HER2 were 25.6, 12.2, and 12.8 % respectively. No statistically significant association was seen between subtype and tumour size, tumour grade, lymph node status and age at diagnosis. Conclusion Triple negative tumour is the most occurring subtype in the Ghanaian breast cancer population treated at the Korle Bu Teaching Hospital. Lack of association seen between subtypes and their clinical and pathological behaviour could be due to small sample size.
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Affiliation(s)
- Bernard Seshie
- Department of Surgery, Tema General Hospital, Tema, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Benedict Calys-Tagoe
- Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Joe-Nat Clegg-Lamptey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Aziato L, Dedey F, Clegg-Lamptey JNA. Dysmenorrhea Management and Coping among Students in Ghana: A Qualitative Exploration. J Pediatr Adolesc Gynecol 2015; 28:163-9. [PMID: 25823719 DOI: 10.1016/j.jpag.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/29/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE The study sought to gain an in-depth understanding of primary dysmenorrhea management and coping strategies for dysmenorrhea among adolescents and young adults who were in school. DESIGN The study adopted a qualitative exploratory approach using a descriptive phenomenology to explore the phenomenon of interest. SETTING The study was conducted in two educational institutions in Accra, Ghana: a Senior High School (SHS) and a University. PARTICIPANTS AND DATA COLLECTION Sixteen participants were purposively recruited (8 SHS and 8 University students) through snowball sampling. Individual interviews were conducted in English, audio-taped, transcribed and analysed using content analysis procedures. Informed consent was obtained from all participants and rigor was ensured through prolonged engagement and member checking. RESULTS Participants employed both pharmacologic (orthodox and herbal) and nonpharmacologic approaches such as warm compress, exercise, and water and diet therapy for their dysmenorrhea. Students' dysmenorrhea was managed at the school clinic and the hospital. Health professionals demonstrated negative attitudes towards dysmenorrhea management. Students coped with dysmenorrhea by planning activities before the onset of pain, receiving social and spiritual support, and developing a mind-set to bear pain. CONCLUSIONS Individualized approaches should be employed to enhance dysmenorrhea management. Health professionals should be educated on dysmenorrhea to improve their attitude and skills for dysmenorrhea management.
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Affiliation(s)
- Lydia Aziato
- Department of Adult Health, School of Nursing, University of Ghana, Accra, Ghana.
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
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Aziato L, Dedey F, Clegg-Lamptey JNA. The experience of dysmenorrhoea among Ghanaian senior high and university students: pain characteristics and effects. Reprod Health 2014; 11:58. [PMID: 25064081 PMCID: PMC4113597 DOI: 10.1186/1742-4755-11-58] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysmenorrhoea is a common problem of women at the reproductive age and may have negative effect on the education of females at various stages on the educational ladder. CONTEXT AND PURPOSE This study sought to gain an in-depth understanding of the experience of dysmenorrhoea and its effect on female students in a secondary and a tertiary institution in Accra, Ghana. METHODS The study employed a descriptive phenomenology design and was conducted at a University and a Senior High School (SHS) in Accra. Purposive and snowball sampling techniques were used to recruit participants and data was saturated with 16 participants. Concurrent analysis was done by applying the processes of content analysis and the NVivo software was used to manage the data. RESULTS It was realized that dysmenorrhoea is associated with symptoms such as diarrhoea, headache and vomiting. Pain may start one week to the day of menstruation and the severity differed across the days of menstruation. The effect of dysmenorrhoea included activity intolerance, altered emotion and interaction, altered sleep pattern, absenteeism and inattentiveness, wishes and regrets, and misconceptions. CONCLUSIONS It was concluded that severe dysmenorrhoea has a debilitating effect on female students and is associated with misconceptions that could result in drastic action with fatal consequences. Thus, there is the need to enhance education on dysmenorrhoea, and an aggressive step should be taken to effectively manage dysmenorrhoea.
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Affiliation(s)
- Lydia Aziato
- Department of Adult Health, School of Nursing, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
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