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Objectives: To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting., Design: Prospective study., Setting: Obstetrics and Gynaecology department in a tertiary hospital in Ghana., Population: Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD., Methods: Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements., Main Outcome Measures: Lower uterine segment findings at laparotomy, successful vaginal birth., Results: A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI -0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80-1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03-1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5-99.8%) and specificity of 81.8% (95% CI 75.8-86.8%)., Conclusion: Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: Malnutrition is a significant public health problem and is a major cause of morbidity and mortality in children., Aims: To assess knowledge and socioeconomic status of caregivers of children under 5 years with malnutrition at a district hospital in Ghana., Methods: Case Report forms were used to gather data in a cross-sectional study which was carried out among 189 caregivers and their children aged from zero to fifty-nine months at the Out-Patient Department clinic., Results: Most (80.95%) children had marasmus. Sixty-two point four-two percent had severe wasting, while 35.45% had mild stunting. The rest, 21.69% had moderate stunting; while only 2.12% severe stunting. Almost all caregivers (94.71%) had heard of exclusive breast feeding as a good feeding practice but only 58.20% practiced it. Most caregivers (68.26%) had no education or only up to basic level, p=0.035. The average number of children per family was 4.8 per household (SD: 1.69) with majority of them (64.55%) having 4-6 children per family and 13.23% of them had more than 7 children per family, p=0.009. More than a third (37.04%) of the caregivers earned less than a hundred Ghana cedis (GhC 100 [US$ 19] per month and 50.26% of them earned between GhC 101 (US$ 19) and GhC 500 (US$ 96) per month., Conclusion: Lower level of caregivers' education and large family size were risk factors for developing malnutrition among children., Competing Interests: The authors declare that there is no conflict of interest., (© 2023 Ameyaw R et al.)

Background: Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana., Methods: Data were collected from children <5 years of age presenting at the 2 major teaching hospitals with clinical signs of meningitis. Cerebrospinal fluid specimens were collected and tested first at the sentinel site laboratory with conventional microbiology methods and subsequently with molecular analysis, at the World Health Organization Regional Reference Laboratory housed at the Medical Research Council Unit The Gambia, for identification of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, the 3 most common bacteria causing meningitis., Results: There were 4008 suspected cases of meningitis during the surveillance period, of which 31 (0.8%) were laboratory confirmed. Suspected meningitis cases decreased from 923 in 2010 to 219 in 2016. Of 3817 patients with available outcome data, 226 (5.9%) died. S. pneumoniae was the most common bacterial pathogen, accounting for 68.5% of confirmed cases (50 of 73). H. influenzae and N. meningitidis accounted for 6.8% (5 of 73) and 21.9% (16 of 73), respectively. The proportion of pneumococcal vaccine serotypes causing meningitis decreased from 81.3% (13 of 16) before the introduction of 13-valent PCV (2010-2012) to 40.0% (8 of 20) after its introduction (2013-2016)., Conclusions: Cases of suspected meningitis decreased among children <5 years of age between 2010 and 2016, with declines in the proportion of vaccine-type pneumococcal meningitis after the introduction of 13-valent PCV in Ghana., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.)

Objectives: To identify behavior theory-based strategies to improve compliance with daily multiple micronutrient supplementation (MMS) among rural Ghanaian women., Methods: Components of a multi-theoretical framework were investigated in focus groups of reproductive-aged women in 6 communities., Results: Participants were generally unaware of MMS' purpose. Perceived benefits included better health and stimulated appetite, which some believe escalates food purchases and financial constraints. Cost, forgetfulness, and unsustainability were also perceived barriers. Facilitators for compliance incorporated initial visual reminders and daily announcements with reinforcement using the 'keeper' system., Conclusions: Application of a tailored health behavioral model can effectively guide the design, implementation and evaluation of community-based MMS interventions.

Aim: Cardiovascular diseases (CVDs), of which hypertension is a major risk factor, are predicted to account for four times as many deaths as from communicable diseases by the year 2020. Hypertension, once rare, is rapidly becoming a major public health burden in sub-Saharan Africa (SSA). However, data on its prevalence, awareness, treatment and control are paltry, especially for rural communities. This study was done to determine the burden and correlates of adult hypertension in the rural Barekese sub-district of Ghana., Methods: A cross-sectional survey was conducted on 425 adults aged ≥ 35 in the Barekese sub district (estimated population 18,510). Socio-demographic characteristics, modifiable and non-modifiable risk factors, blood pressure (BP) and anthropometric measurements were collected using standardized protocols., Results: Overall, the proportion of hypertension and isolated systolic hypertension is 44.7% and 32.7% respectively in the study population. However, 64.9% of these were on treatment, with only 8.9% having controlled blood pressure (<140/90 mmHg). The mean systolic and diastolic BP were 134.38 mmHg (standard deviation, SD: 21.46) and 84.32 mmHg (SD: 12.44). Obesity (Body Mass Index, BMI>30 kg/m²) was found in 37 (10.4% of the population), out of whom 7 (15.9%) were extremely obese (BMI> 40 kg/m²). Increasing age and level of education were positively correlated with increasing blood pressure., Conclusion: The high burden of hypertension in this population along with the considerable less detection, treatment and control is of great concern. There is the need to promote health education measures that will foster prevention and early detection of hypertension., (Copyright © 2013 Diabetes India. All rights reserved.)