Introduction Ghana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines. Methods We conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening. Results Almost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level). Conclusion Despite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.

Purpose The incidence of colorectal cancer (CRC) in Ghana has increased eightfold since the 1960s. In 2011, national guidelines were set forth recommending all patients aged 50–70 years old undergo annual CRC screening with fecal occult blood testing (FOBT), but adherence to these guidelines is poor and screening rates remain low for unclear reasons. Methods We performed semi-structured interviews with 28 Ghanaians including physicians ( n = 14) and patients ( n = 14) from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, to better understand the factors driving screening adherence and perceived barriers identified in an earlier quantitative study. Results Participants reported sociocultural factors such as reliance on alternative medicine or religion, lack of education, and financial burden as community-level barriers to CRC screening. At the system level, screening was limited by insufficient access to FOBT as well as a perceived lack of national prioritization. This was described as inadequate efforts from the Ministry of Health regarding national education as well as lack of incorporation of CRC screening into the National Health Insurance Scheme. Conclusion Several community- and system-level barriers exist to widespread screening of CRC in Ghana. A multi-level approach will be required to improve rates of CRC screening and ultimately reduce the burden of CRC in Ghana.

Gastric infarction is a rare condition often associated with high mortality due to a delay in diagnosis. The stomach which has a rich supply of blood is a rare site for such a condition. Gastric infarction has a long list of etiological factors. We report a case of a patient who was managed successfully following gastric infarction from gastric dilatation. An 18-year-old female student presented with a three-day history of abdominal pain associated with abdominal distension of two days. The abdomen was distended with generalized tenderness, rebound tenderness, and guarding. Bowel sounds were absent. Digital rectal examination was unremarkable, and a pregnancy test was negative. Biochemical tests were all normal. Intraoperatively, two litres of serosanguinous fluid was suctioned from the abdomen. About 300 mL of pus was suctioned from the pelvis. The gangrenous portion was resected, and repair was done in two layers using Conell and Lambert suture techniques. Acute gastric necrosis is a rare surgical condition that requires a high index of suspicion and prompts aggressive resuscitation and surgical intervention to obviate the high mortality rate associated with the condition.

Systematic assessments of individual-and community-level barriers to surgical care (BSC) in low-and middle-income countries that might inform potential interventions are lacking. We used a novel tool to assess BSC systematically during a surgical outreach in two communities in Upper West region, Ghana. Results were scored in three dimensions of barriers to care (acceptability, affordability, and accessibility); higher dimension scores signified less salient barriers. A total index out of 10 was derived. In total, 169 individuals participated in Nadowli (68, 40%) and in Nandom (101, 60%). Nadowli had fewer BSC than Nandom (median index 7.8 vs 7.2; p < .001). Dimension scores ranged from 10.8 to 14.5 out of 18 points. Fear or mistrust of surgical care and stigma were reported more frequently in Nandom (p < .001). Reported barriers were not always the same in each community. Systematically defining barriers to essential surgical care provides an opportunity for planning targeted interventions at the community-level.

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Background Not much is known about the information preferences of individuals at risk for cancer in sub-Saharan Africa. Clinicians exercise great autonomy in how, when, and to whom they disclose patients’ medical diagnosis and prognostic status. We sought to investigate the information preferences with regards to cancer diagnosis and prognosis of a cross-section of Ghanaians living in and outside of Ghana. Methods We surveyed a general population of Ghanaians aged ≥ 18 years old, living in and outside of Ghana about their cancer information preferences. Survey questions were developed using Qualtrics software and deployed via WhatsApp mobile app. After initial pilot to assess for feasibility and cultural relevance, initial links were distributed through social and medical contacts who were then asked to share widely with their social contacts. Participant characteristics were reviewed and their association with cancer information needs evaluated with logistic regression analysis. Results Of the four hundred and twenty-six participants who responded to the survey, 33.1% were female. Majority of respondents (81.9%) were living in Ghana at time of survey. Four hundred and twelve (96.7%) patients would like to know from their provider if they were diagnosed with cancer. The most common information need of participants was treatability/curability (92%) of the cancer. A worry about impact of cancer on family was the most common reason for not wanting any information. Univariate analysis did not identify any factors associated with reduced cancer information needs. Conclusions The overwhelming majority of Ghanaians surveyed would like to know if they were diagnosed with cancer. It is imperative that clinicians tell Ghanaians about their cancer diagnosis and share all pertinent information with them.