Background: Although cancer pain is well documented, efficient management is largely inadequate in most patients especially in developing countries. This study evaluated the adequacy of pain management as well as potential social factors that may be associated with inadequate pain management.Methods: 204 ambulatory oncology patients (82% female; mean age 53.5) attending clinic at the Oncology Directorate, of a tertiary hospital in Ghana from January to December, 2015 were recruited and their pain severity and functional interference assessed with the Brief Pain Inventory (BPI). The adequacy of pain management was computed as the pain management index (PMI) using the BPI.Results: Although 62% of respondents were prescribed high potency opioids, 56.9% of them exhibited significant pain while 34.9% required a stronger analgesic to manage their pain. Majority of patients (56%) were over-managed for their pain (had PMI score >0). Only 26.4% had optimal cancer pain management. Pain interfered mostly with patients’ sleep (46.2%) and general activity (42.5%). Patients with high pain intensity were more likely to have it affect their daily activity (P<0.0001). Men were more likely to have inadequate pain management than females.Conclusions: This study has shown that whereas pain management may be adequate, there is the tendency for opioid tolerance and abuse as over 50% of patients receive more analgesics than required. The tenets of the WHO 3-step analgesic ladder should be strictly adhered to achieve optimum cancer pain relief.

Background: Adequate cancer pain assessment using valid and reliable pain assessment tools is essential for effective cancer pain management. This study evaluated the common types, effectiveness as well as adherence to prescribed analgesics in oncology outpatients in a tertiary oncology centre in Ghana.Methods: This descriptive cross-sectional study involved 204 oncology outpatients with different confirmed cancer diagnosis attending clinic at the Oncology Directorate of a Tertiary Hospital in Ghana. The research instruments used were the medical folders of patients, a hospital-based electronic drug database system; hospital administration management systems (HAMS) and the Brief Pain Inventory Long-Form (BPI-LF).Results: More than half (63.7%) of the participants reported moderate pain, 37.8% received opioid analgesics: 31.4% strong opioids and 6.4% weak opioids. Less than one-fourth (21.6%) had complete pain relief and 18.1% felt they needed a stronger pain medication. A little more than one-fourth (28.4%) of participants took their pain medications 1-2 times per day. Almost half (45.6%) of participants did not experience side effects from taking pain medications and 27.9% needed more information about their pain medications.Conclusions: Enhancing effective cancer symptom management approaches in healthcare practitioners and incorporating existing knowledge and guidelines on cancer pain management into routine clinical practice should be done to enhance efficient pain relief.

To assess the patronage, and the perceived efficacy of herbal preparations in the treatment of typhoid fever, and to ascertain the anti-salmonella activity of a herbal preparation used as an antityphoid in Ghana. Materials and Methods: Purposively and conveniently from 700, 65 individuals who had had typhoid fever (clinically confirmed) were sampled. Well-structured questionnaires on the subject were administered to sampled individuals. Experimentally, the Minimum Inhibitory Concentration (MIC) of a herbal antityphoid preparation on Salmonella typhi was determined using the broth dilution method. Results: 46/65 (70.8%) used herbal preparations (19 used pre-packaged products; 27 used extemporaneous preparations) while 19/65 (29.2%) used orthodox drugs to treat their infection. Some of the herbs commonly used were Nauclea latifolia, Morinda lucida, Paullinia pinnata, Vernonia amygdalina, Cassia alata, Phyllantus fraternus, Azadirachta indica, Mangifera indica, and Carica papaya. Majority, 42/45 (91.3%), recovered after the use of the herbal antityphoid products (laboratory confirmation), 7/42 (15.2%) had relapse within three months, 9/45 (19.6%) experienced mild side effects. Experimentally, both the prepared herbal mixture and ciprofloxacin had MICs of 4 and 2 µg/µl respectively. Conclusion: Herbal anti-typhoid preparations are highly patronized and have been found to be efficacious. Experimentally the herbal mixture prepared showed interesting anti-salmonella activity.

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Objective:Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management.Methods:In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated.Findings:While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43.Conclusion:Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation.

Oculomycosis is a fungal infection of the eye which commonly manifests itself as exogenous or endogenous endophthalmitis, and keratomycosis. 1,2 The incidence of oculomycosis is higher; in tropical and semitropical areas of the world, and with warmer temperatures, rampant rainfall, windy seasons, and harvest periods. 3,4 It is more common among the agricultural population, and is responsible for 4-60% of cases of corneal ulcers in tropical areas. 5-7 In Ghana it accounts for 36.7% of corneal ulcers. 3 Reports on oculomycosis globally has increased in recent ABSTRACT Background: Effective treatment of oculomycosis involves the use of antifungal eye drops in addition to systemic antifungal medications. The aim of this study therefore was to ascertain the availability of antifungal eye drops in hospital and private retail pharmacies in Kumasi, in the Ashanti Region of Ghana. Methods: A cross-sectional survey using a structured questionnaire to obtain information on stocking of antifungal eye drops was administered to workers in 99 randomly selected pharmacies in Kumasi between January-June, 2015. Results: Respondents sampled from the pharmacies were: Pharmacists (37.4%), Medicine counter assistants (36.4%), and Pharmacy technicians (26.3%). Although none of the pharmacies visited had antifungal eye drops (AEDs) in stock, 25 (25.3%) had stocked these before; 18 (72%) stocked fluconazole while 7 (28%) stocked natamycin (17 (68%) indicated fluconazole to be the most patronised). The stocking pattern was not regular as 16 (64%) only stocked on demand. 51.5% the acquired AEDs from local importers of pharmaceutical medicines while 48.5% imported them by themselves. For the 74 (73.7%) pharmacies that did not stock, 60 (80.8%) indicated that AEDs were not NHIS-approved medicines, 51 (68.9%) indicated unavailability from wholesalers to stock, and another 27 (36.4%) indicated that prescriptions were rarely received at the pharmacies. Majority 71.7% of the respondents perceived AEDs to be scarce in Ghana. Conclusions: Antifungal eye drops are unavailable in hospital and private retail pharmacies in Kumasi, and is perceived to be scarce in Ghana.

AIDS is the late stage of infection with the Human Immunodeficiency Virus (HIV). Even though the Highly Active Antiretroviral Therapy (HAART) for the management of HIV/ AIDS has been in existence in Ghana since 2003, there is still limited data on their effectiveness. This study therefore sort to ascertain the effectiveness of HAART used at Anti-retroviral therapy (ART) Centres in the Ashanti region of Ghana by assessing its effects on immunological and haematological markers as well as some significant indicators such as body temperature and blood pressure changes. The study was a retrospective cross sectional study which reviewed medical record folders of 156 HIV infected patients who had attended the selected ART centres in the Ashanti region of Ghana between 2010 and 2014. About 49% of the study population had a significant rise in their CD4 counts after six months strict adherence to specific HAART regimen. HAART effectively reduced viral loads and increased CD4 counts in most of the patients whose medical record folders were reviewed. Socioeconomic factors, formal education and lack of health literacy had a significant effect on adherence to the HAART regimen, however; marital status of patients did not have any significant effect on adherence, CD4 counts and the haemoglobin concentration of patients. Based on results obtained from this study, HAART could be considered as effective in the adult population in the Ashanti region of Ghana provided there is a high level of adherence. Immunological and haematological markers for the assessment of effectiveness could also improve with high adherence recommended HAART regimen

The aim of the study was to assess the supply chain management of anti-malarials in the five district hospitals in the Kumasi Metropolitan Area (KMA) including the Regional Medical Store (RMS) and also to assess the level of knowledge of respondents on malaria in these facilities. Cross sectional study was conducted at the facilities and purposeful sampling technique was applied to select the clients and interviewed. All the hospitals sourced their anti-malarials from the regional medical store (RMS) with tablet artemether-lumefantrine, tablet artesunate-amodiaquine, injection artesunate and sulphadoxinepyrimethamine (SP) being dispensed by all the hospitals from January to December 2015. All health facilities transport their anti-malarials from RMS by vans. The commonly known anti-malarials by respondents were tablet artemether-lumefantrine (84.08%, n=169) and tablet artesunate-amodiaquine (81.09%, n =163), with 5.47% (n =11) of respondents not knowing any type of anti-malarial. Antimalarials used for the treatment of malaria was given to 65.67% (n=132) of the clients at the hospital. Most of these anti-malarials were available at the hospitals though some facilities encountered periodic shortages and also had stocks expiring within the studied period. Respondents had fair knowledge of the side effects of a few of the anti-malarials. There is a need to ensure proper and effective supply chain management of these anti-malarials in these hospitals to maintain adequate quantities of these medications in these hospitals and RMS.