No abstract

Breast cancer is the number one cause of cancer death in women globally. According to the Global cancer registry, there were 2.3 million new cases of breast cancer diagnosed in 2020 worldwide, accounting for 25% of all cancer cases in women. The data on the cost burden of breast cancer on households is limited in Ghana, it is therefore imperative that it is estimated to ensure effective planning and provision of adequate resources for breast cancer treatment. This cost-of-illness study estimates the household treatment cost of breast cancer and the cost coping strategies used by patients. This cost-of-illness study was conducted at the surgical unit (Surgical unit 2) of the Korle Bu Teaching Hospital (KBTH), with 74 randomly selected patients and their accompanying caregiver(s). Data was collected using structured questionnaire on direct, indirect and intangible costs incurred and coping strategies used by patients and their households. The results are presented in descriptive and analytic cost statistics. Most of the patients were aged 40–69 years and were married with moderate education levels. Nearly 57% of patients earn an income of USD 370 or less per month. The average household expenditure was USD 990.40 (medical cost: USD 789.78; non-medical cost: USD 150.73; and indirect cost: USD 50). The publicly provided mechanism was the most utilized cost coping strategy. The direct, indirect and intangible costs associated with breast cancer treatment had significant financial and psychological implications on patients and their households. Moreover, poorer families are more likely to use the publicly provided strategies to cope with the increasing cost of breast cancer treatment.

Despite the established positive benefits, LMICs’ adoption of the WHO Surgical Safety Checklist (SSC) is inadequate, with as little as 20% use. This study assessed the utilization and beliefs that drive the non-utilization of the WHO SSC among surgical providers at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. A cross-sectional study was conducted among 186 surgical providers at the KBTH in Ghana. Data collected included the category of personnel, awareness of the SSC, training received, previously identified barriers, and staff perceptions. Utilization and drivers associated with non-utilization of the SSC were assessed using bivariate log-binomial regression. Out of 190 surgical professionals invited, 186 gave their consent and participated in the survey, giving a response rate of 97.9%. Respondents comprised 69 (37%) surgeons, 66 (36%) anesthetists, and 51 (27%) nurses. Only 30.4% of surgical professionals always use the SSC, as advised by WHO. The majority (67.7%) of surgical professionals had received no formal training on using the WHO SSC. The proportion was highest among surgeons (81.2%) compared to anesthetists (66.7%) and nurses (51%). Surgeons were perceived by other professionals to be the least supportive of checklist use (87.6%), in contrast to nurses (96.1%) and anesthetists (93.9%). Significant drivers associated with checklist usage among surgical professionals included the SSC taking too long to complete, poor communication between anesthetist and surgeon, checklist not covering all perioperative risks, difficulty finding a coordinator, poor attitude of team members toward questions, surgical specialty/unit and training status of professionals. The checklist was always used by only a small (30%) proportion of surgical professionals at the KBTH. Improving checklist use will necessitate its careful application to all surgical operations and a cycle of periodic training that includes context-specific adjustments, checklist auditing, and feedback from local coordinators.

Background Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. Objective The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. Patients and methods This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015–2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients’ demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. Results Twelve patients aged between 24–54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. Conclusion Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

Introduction: Medical lubricants are indispensable in the care process. Several products are used as lubricants in the medical industry including lidocaine gel. However in Ghana, procurement delays and high cost means the product is not always available. Physicians therefore resort to the usage of inappropriate materials with attendant complications. Shea butter which is locally produced and widely available, when adequately processed may serve as a non-inferior substitute. However data on its use as a medical lubricant is lacking Objective: To compare the effectiveness, complications and ease of use of shea butter to 2lidocaine gel as a surgical lubricant for digital rectal examination. Outcomes: Primary outcome: the primary end point is mean difference in pain perception with a non-inferiority limit set at − 0.72. Secondary outcome: differences in complication rates including discomfort, urinary urgency, bowel urgency and perianal pruritus. The ease of use and lubricating associated with the use of the lubricant will also be assessed. Methods: This is a randomized controlled non-inferiority trial comparing the effectiveness of shea lubricant to lidocaine gel for digital rectal examination. A total of 152 patients will be randomized. The data will be collected at the Surgical, Urology and Emergency units of the Ho Teaching Hospital. The study will estimate the differences in pain perception using the Visual Analogue Scale (VAS) with a non-inferiority limit set at − 0.72. The ease of use of the lubricants will be assessed using a Likert scale. Similarly, associated complications such as discomfort, urinary urgency, bowel urgency and perianal pruritus will be ascertained using Likert scales. Discussion: Lidocaine gels are essential but expensive lubricants. The cost of 2% Lidocaine gel has been estimated to be at least three times that of plain gel in some jurisdictions. Significant cost savings could be made if the Shea lubricant can be substituted for the 2% Lidocaine gel in Ghana since the main raw material can be locally sourced. A non-inferiority testing is best suited for this comparative study since the 2% Lidocaine gel is a standardized lubricant which has been used frequently in trials. Despite limitations, we believe the SHEA-LIDO trial is well designed and will yield important results