Faculty Bibliography

Background: Many district hospitals and medical centers in Ghana are limited with regard to the number of employed medical staff, hospital resources, and services available. Our team went to Kumawu Polyclinic to learn about the detailed operations of the hospital, resources, and to determine the challenges faced by the facility. A needs assessment was developed that can be used as a model for how to briefly and efficiently evaluate a district facility in Sub Saharan Africa. Methods: A team consisting of an emergency physician working at a tertiary referral hospital in Ghana and medical students from the United States developed a needs assessment and conducted a visit to Kumawu Polyclinic (Sekyere Afram Plains District, Ashanti Region, Ghana) over three consecutive days in July 2015. The team surveyed the facility, observed rounds with the medical staff, and conducted informal interviews with the polyclinic director and staff. Findings: Kumawu Polyclinic is a district health facility with 23 inpatient beds, split between three wards. There is only one medical officer (physician) at the hospital, along with one physician's assistant and a physician assistant in training. 25 nurses work at the hospital but only 8 are formally trained. The most common patient presentations are fever in children under five, pregnancy and delivery, and complications of noncommunicable diseases such as stroke and hypertensive crisis. The clinic faces several challenges, one being an unreliable supply of essential consumables from the Ghana Health Service. The polyclinic also has limited capability to run laboratory tests and has to send patients 45 minutes away to a larger facility for any imaging. Electric supply is intermittent and requires the use of a backup generator during periods of electrical failure. Interpretation: Our team recommended establishing a triage system for patient intake to increase the efficiency of the clinic. In addition, the needs assessment addressed the clinic's limited range of drugs it can prescribe, moving forward on a 25-bed extension, and the challenges of intermittent electricity. This method of assessing the needs of a district facility can be employed at other polyclinics in Ghana and in developing countries in Africa

OBJECTIVES: We sought to evaluate the impact of New York City's (NYC's) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates. METHODS: We compared CO poisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey. RESULTS: Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related CO poisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law's effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries. CONCLUSIONS: Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e7. doi:10.2105/AJPH.2015.302577).

BACKGROUND: The current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt. DISCUSSION: Participants' personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers' fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government's ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, "all-hazards" outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control. The EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity.

Introduction: The World Health Organization (WHO) has published lists of essential equipment and supplies for delivering emergency care in resource-limited settings. The objective of this study was to assess material resources available for adult emergency care at a major academic tertiary care referral centre in Accra, Ghana, to determine quality improvement needs.
Method(s): A spot inventory of emergency centre equipment and supplies was conducted in Korle-Bu Teaching Hospital (KBTH) and compared to the WHO essential emergency equipment list released in 2006.
Result(s): Most items considered essential were available at the time of inventory. Notable exceptions included: equipment and supplies for healthcare provider safety and infection control, advanced airway management, and ophthalmologic or gynaecological examinations. Several additional items, such as glucometers and pulse oximeters, were available and often used for patient care.
Conclusion(s): Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME) centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and 'ready-to-hand'. Consequently, key factors in determining readiness to provide quality emergency care include supplychain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.
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Mobile phone penetration rates have reached 63% in sub-Saharan Africa (SSA) and are projected to pass 70% by 2013. In SSA, millions of people who never used traditional landlines now use mobile phones on a regular basis. Mobile health, or mHealth, is the utilization of short messaging service (SMS), wireless data transmission, voice calling, and smartphone applications to transmit health-related information or direct care. This systematic review analyzes and summarizes key articles from the current body of peer-reviewed literature on PubMed on the topic of mHealth in SSA. Studies included in the review demonstrate that mHealth can improve and reduce the cost of patient monitoring, medication adherence, and healthcare worker communication, especially in rural areas. mHealth has also shown initial promise in emergency and disaster response, helping standardize, store, analyze, and share patient information. Challenges for mHealth implementation in SSA include operating costs, knowledge, infrastructure, and policy among many others. Further studies of the effectiveness of mHealth interventions are being hindered by similar factors as well as a lack of standardization in study design. Overall, the current evidence is not strong enough to warrant large-scale implementation of existing mHealth interventions in SSA, but rapid progress of both infrastructure and mHealth-related research in the region could justify scale-up of the most promising programs in the near future.