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Background We report a case of an elderly woman who developed an Ischemic stroke. Thrombolytic therapy was successful as evidenced by functional and neurological improvement. This is the first well-documented case of such intervention in Korle-Bu Teaching Hospital (KBTH), Stroke unit. Case Information: Our patient is a 64-year-old woman who is known to have hypertension and diabetes. She had been relatively well until she developed an ischemic stroke. Five days prior to this, she had experienced two episodes of Transient Ischemic Attacks (TIA). Thrombolytic therapy was successful with Tenecteplase given at 4.5 hours post-episode. MRS (Modified Ranking Scale) and NHISS (National Health Institute of Stroke Scale) pre thrombolysis were 4 and 10 respectively. NHISS 2hrs post thrombolysis was 4. MRS and NHISS 24hrs post thrombolysis were 0 and 1 respectively. We sought to identify why only a few cases of thrombolytic therapies are carried out in developing countries, and we found that the strict eligibility for the initiation of therapy was the main barrier. Conclusion In acute infarctive stroke management, intervention is time-dependent, as thrombolysis has been shown to prevent permanent disability if instituted early enough. We believe that many more individuals may benefit from thrombolytic therapy if more studies are carried out with systematic reviews of case reports and research, factoring in key challenges met in middle to low-income countries.

Introduction:The coronavirus disease 2019 (COVID-19) pandemic began at the end of 2019 in Wuhan, the capital of Hubei Province, China. This novel coronavirus is classified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurological manifestations are commonly associated with moderate to severe COVID-19 infection. Guillain-Barré syndrome (GBS) is a rare immune-mediated postinfectious neuropathy but there has been an increase in the number of cases of GBS associated with COVID-19, supporting the present body of global evidence of the notable association between the 2 conditions. We present the first proven case of GBS and pulmonary embolism associated with COVID-19 infection in Ghana, West Africa.Case Presentation: A 60-year-old apparently healthy female presented in August 2020 to the COVID-19 treatment center of the Korle-Bu Teaching Hospital in Accra, Ghana from a referral facility following a week's history of low-grade fever, chills, rhinorrhoea, and generalized flaccid limb weakness. A positive SARS-CoV-2 test result was recorded 3 days after the onset of symptoms and the patient had no known chronic medical condition. Following cerebrospinal fluid analysis, neurophysiological studies and a chest computed tomography pulmonary angiogram, Guillain-Barre syndrome and pulmonary embolism were confirmed. The patient was however managed supportively and then discharged after 12 days on admission, as he made mild improvement in muscular power and function. Conclusion:This case report adds to the body of evidence of the association between GBS and SARS-CoV-2 infection, particularly from West Africa. It further highlights the need to anticipate potential neurological complications of SARS-CoV-2, particularly GBS even in mild respiratory symptoms for prompt diagnosis and initiation of appropriate therapy to improve outcomes and avert long-term deficits.Abbreviations: COVID-19 = coronavirus disease 2019, CSF = cerebrospinal fluid, GBS = Guillain-Barre syndrome, RT-PCR = reverse transcriptase polymerase chain reaction, SARS-CoV-2 = severe acute respiratory syndrome coronavirus -2.

Objectives: This study sought to assess the current impact of health insurance coverage on medication adherence and blood pressure control of patients being managed for hypertension in Ghana and Nigeria. Methods: The study was a prospective study among 109 patients with hypertension in two health facilities with similar population dynamics in Ghana and Nigeria. Patients were systematically selected, categorized as having health insurance coverage or not, and followed up monthly for 6 months. The outcome variables (medication adherence and blood pressure control) were then measured and compared at 6 months. Analysis was done using Stata with level of significance set at p ⩽ 0.05. Results: There was a 90% insurance coverage among participants from Ghana compared to 15% from Nigeria. National Health Insurance Authority enrolees in both countries had better blood pressure control and medication adherence compared to non-enrolees (adjusted odds ratio = 2.6 and 4.5, respectively). Conclusion: National Health Insurance Authority enrolment was found to be poor among respondents in Nigeria compared to Ghana. Enrolment into the National health financing schemes in both countries led to better blood pressure control and medication adherence among patients with hypertension at primary health facilities. There is therefore the need for system strengthening to improve their sustainability.