Informed Consent under the Ghana Health Service Patients Charter: Practice and Awareness

Background: Every human being of adult years and sound mind has a right to determine what shall be done with his/her own body. Patient autonomy and the practice of informed patient consent are now pivotal in medical practice. Aim: To assess patient’s knowledge of Patients’ Rights Charter and whether patients receive adequate information to enable them make an informed consent to a particular treatment. Methodology: Patients who were undergoing elective surgery from selected surgical departments of Komfo Anokye teaching hospital in Kumasi were randomly selected and assisted to answer structured questionnaire without the knowledge of their doctors. The study period was in June to December (2014). Descriptive analysis was done using SPSS (II) of the results. Results: 84.7% (144) had no idea about the Patients’ Rights Charter of the Ghana Health Service. 75% (128) did not know or had not heard of informed patient consent. Of those who knew of the charter, 85% (37) had ever stayed in a developed country. 60% (102) did not know of their diagnosis. 79% (134) said the doctor only asked them to either sign or thumb print the consent document without giving them treatment options or possible complications. Conclusion: Most of respondents undergoing various surgical procedures at the Komfo Anokye Teaching Hospital were not aware of the existence of the Patients’ Rights Charter of the Ghana Health Service. Again, practitioners did not provide sufficient information to patients for them to make an informed decision about their health.

Non-Random Distribution of Human Orofacial Clefts in Ghana: Gene-Environment Interactions

Human orofacial clefts (OFCs) are congenital anomalies that result from the breakdown of normal mechanisms that regulate the formation of the human face. They could be syndromic or non-syndromic, with a global incidence of 1:700 per live births. Environmental and genetic factors are thought to play various roles in the aetiology of OFCs. This study seeks to establish the diversity, distribution and pattern of inheritance of OFCs as well as environmental and other risk factors associated with OFCs in a Ghanaian population. A family-based, descriptive cross-sectional study that employed an interview-based survey questionnaire was used to obtain information from 467 families with history of OFCs. We employed chi-square statistics to analyse the data and used graphs to interpret the data. All previously reported subphenotypes of OFCs were observed by the present study. Clinically, about 12% of clefts in the study population were syndromic. The most common syndromic forms observed were Pierre Robin Sequence, cleft-with-club foot abnormalities and Van der Woude Syndrome. Only about 5% of clefts in the study cohort were familial. The study also established that lower level of education of parents, poverty, late antenatal care and dietary folate deficiency are major environmental factors associated with clefts in the Ghanaian population. In conclusion, OFCs are non-randomly distributed in Ghana and folate deficiency could likely be a source of genetic mutations and “epimutations” that cause OFCs, since folate is essential for DNA methylation, replication and repair as well as histone modification.

Carious Nasal Tooth: A Case Report from the Oral and Maxillofacial Unit of Komfo Anokye Teaching Hospital

Ectopic teeth erupting in the nasal cavity are a rare occurrence. This may present with varying degree of morbidity. We present a very rare occurrence case report of an ectopic carious tooth in a nasal cavity. The upper left central incisor was congenitally missing and patient thought it was a form of diastema. Her chief complaint was painful whitish growth in the floor of her left nose with foul smelling mucoid discharge. The learning experience in this case report is that, in conducting examination for a missing upper incisors, the floor of the nose must be included. A further research is needed to establish the actual pathogenesis involved in cariogenesis in the nasal cavity.

Salivary Gland Tumours at Komfo Anokye Teaching Hospital, Ghana

In African studies on salivary gland tumours, there are considerable epidemiological differences in different parts of the continent. There is no study of salivary gland tumours from the second largest hospital in Ghana, Komfo Anokye Teaching Hospital. Aim: This study was to look at the prevalence and demographic distribution of salivary gland tumours at the Komfo Anokye Teaching Hospital (KATH). Method: Histopathologically diagnosed salivary gland tumours of consecutive patients were evaluated. The study duration was from 1999 to 2010 October. Result: The total number of salivary gland tumours were 121. Male to female ratio was 1.75:1. Out of the total of 34 salivary malignancies seen, male to female ratio was 1.8:1. Malignant tumour was 28.1% while 71.9% were benign. Mean age for malignancy was 53.5 years (SD = 9.7) and that for benign was 35.5 years (SD = 8.2). Conclusion: The commonest benign tumour of the parotid was Pleomorphic adenoma (48.3%) which is consistent with most of the African and western reports. Warthin’s tumour prevalence was higher than most of the studies from Africa.

Orofacial Cysts at Komfo Anokye Teaching Hospital, Ghana

Background: Information about orofacial cysts from African populations is scarce and there are only a few studies available regarding the prevalence of these lesions in the West African sub-region. The purpose of the present study is to determine the distribution and prevalence of all histologically diagnosed orofacial cysts in Kumasi, Ghana. Aim: To determine prevalence, sex, age and anatomic distribution of orofacial cyst seen at the oral and maxillofacial unit in Komfo Anokye Teaching hospital (KATH). Method: This is a retrospective study, which examined histologically diagnosed lesions including orofacial cysts. The study duration was from 1999 to 2010 September inclusive. Results: There were 37 odontogenic cysts constuting 6.5%, of all orofacial lesions. There were 18 non-odontogenic cysts i.e. 3.1% of all lesions diagnosed during the study period. The odontogenic cysts comprised 19 (51.4%) developmental cysts and 18 (48.6%) inflammatory cysts. Male-to-female ratio for the orofacial cysts was 1:1 and the mean age was 36.7 years. Conclusion: There is low prevalence of the odontogenic cysts, which is consistent with findings from other African studies. Although radicular cysts accounted for the majority of orofacial cysts in this study, the prevalence of radicular cysts is low compared to reports from developed countries.

Concordance between Clinical and Histopathological Diagnoses at Komfo Anokye Teaching Hospital Oral and Maxillofacial Unit

Background: Accurate diagnosis of orofacial tumours is important as this determines the treatment options as well as the eventual treatment outcome. Agreement between clinical and histopathological diagnosis becomes important in this regard. Aims: The aim was to determine the level of agreement between clinical and histopathology diagnosis of orofacial lesions. Method: This is a retrospective study of all histopathology reports seen at KATH maxillofacial unit. Thedata collected included, clinical diagnosis and histological diagnosis. Results: A total of 567 histopathology reports were evaluated. The percentage of agreement between clinical and histopathological diagnosis was 62.8%. Conclusion: The agreement between clinical and histopathological diagnosis was high. However clinicians cannot rely on only the clinical diagnosis in managing patients.

Usage of Potential Teratogenic Chemical Preparations among Mothers of Children Attending the Multidisciplinary Cleft Clinic at the Komfo Anokye Teaching Hospital, Ghana

Objective: The purpose of this study is to determine the usage of potential teratogenic chemicals among cleft lip and palate mothers attending a multidisciplinary cleft clinic at Komfo Anokye Teaching Hospital (KATH). Method: This is a retrospective study based on records of consecutive patients attending the multidisciplinary cleft clinic at KATH. Mothers of children with cleft lip and palate formed the study sample. Information on the use of chemical agents by the mothers either before or during the first three months of pregnancy was collected on to a specially designed form. The study period was from January 2006 to December 2012. Setting: The study was carried out in a multidisciplinary cleft clinic at Komfo Anokye Teaching Hospital in Ghana. The clinic is the main referral centre for the northern sector of Ghana for cleft lip and palate care. Results: Chemical preparations usage ranged from 0.2% for tobacco to 25.3% for skin lightening creams. Other agents used include, enema, non-proprietary concoctions and prednisolone tablets. 2.1% of the mothers ingested alcohol during pregnancy. Conclusion: There is a high level of usage of potentially teratogenic chemicals among cleft mothers attending the multidisciplinary cleft lip and palate clinic at the Komfo Anokye Teaching Hospital in Ghana. Further studies are, however, required to clarify any relationship this may have with the development of orofacial clefts.