Health Sciences Investigations Journal

Welcome message from the Editor-in-chief 2025

2025-12-23T14:56:48+00:00

It gives me great pleasure to welcome readers to Volume 7, Issue 2 of the Health Sciences Investigations (HSI) Journal. Over the past five years, the Journal has matured into a vibrant platform for evidence generation and scholarly work exchange across multiple disciplines in the health sciences. Each new issue reflects our commitment to rigorous inquiry, editorial integrity, and regional leadership in health science research publishing.
This edition showcases 17 peer-reviewed contributions—including 15 original research papers, two case reports, and one clinical image—that span methodological innovations, system-level assessments, and clinical-epidemiological studies. The contribution “Progress and challenges in implementation of the WHO Special Initiative on Mental Health in Ghana (2019–2023): a narrative review” is highlighted as the Editor’s Choice for this issue. The paper provides assessments of Ghana’s progress toward integrating mental-health services into routine care and underscores both the achievements made and the persistent challenges in governance, financing, and service delivery issues central to national and regional mental-health reform.

About the cover

2025-12-13T13:40:07+00:00

"Perception"
The painting invites viewers to reflect on the subjectivity of perception and the potential for unity and understanding despite apparent differences.
Artist's perspective
This painting shows a calm moment in a coastal community. The women in motion, one with a tray on her head and another fading into the background, reflect strength, work, and transition. Their unhurried movements suggest the end of a day’s hawking or the quiet walk home.
Soft blues and warm browns set a peaceful but grounded mood. The blues hint at the sea and calm, while the browns and oranges suggest sun, dust, and daily life. Together, they show both tiredness and endurance, the close of day and the will to keep going.
The figures are painted in a loose, semi-abstract style. Their shapes blend into one another, showing connection and shared experience.
In the background, the huts and coconut trees place the scene in a coastal Ghanaian village, yet the feeling is universal.

Strengthening diagnostic stewardship for antimicrobial resistance in Africa

2025-12-23T14:58:33+00:00

Antimicrobial resistance (AMR) has emerged as one of the defining public health challenges of our time, threatening progress in modern medicine and undermining decades of gains in infectious-disease control [1]. Often described as a “silent pandemic,” AMR now inflicts the highest mortality burden globally on the African continent — eclipsing the combined toll of HIV and malaria in several regions [2,3]. Despite this immense burden, Africa’s response to AMR has largely focused on antimicrobial stewardship and surveillance, while a critical but underdeveloped pillar — diagnostic stewardship — has received far less attention [4].
Diagnostic stewardship refers to the coordinated effort to promote the appropriate use of microbiological tests to guide patient management, antimicrobial therapy, and infection-prevention decisions [5]. It is the essential bridge that allows clinicians to move away from guesswork and toward targeted, pathogen-specific antibiotic therapy, enabling the critical practice of de-escalation to narrow antibiotic coverage once a diagnosis is confirmed. In many African settings, empirical treatment remains the default approach because of limited laboratory infrastructure, delayed test results, and lack of clinician confidence in diagnostic services [6].

Prevalence and Patterns of Medication Use in Central Nervous System Disorders at a Tertiary Hospital in Ghana: A Descriptive Study.

2025-12-23T14:58:34+00:00

Background: Central nervous system (CNS) disorders contribute significantly to global morbidity and mortality, with a disproportionate burden observed in low- and middle-income countries. In sub-Saharan Africa, the impact of these conditions is amplified by limited diagnostic capacity, inadequate pharmacological management, and systemic healthcare constraints.
Objective: This study aimed to determine the prevalence and patterns of medication use for CNS disorders at a tertiary hospital in Ghana.
Methods: A retrospective descriptive study was conducted using secondary data from patient records at the Cape Coast Teaching Hospital between June 2021 and November 2022. Medical records were reviewed to identify cases diagnosed with CNS disorders and pharmacological agents prescribed for their management. Data on CNS disorders and medication use prevalence were analysed and reported as counts and percentages.
Results: Out of 15,894 patient records reviewed, 1,128 cases (7.1%) involved CNS disorders. The majority of patients were male (52.8%) and above 45 years of age. Vascular disorders were the most prevalent (54.9%), with stroke accounting for 88.9% of cases. Structural and seizure disorders followed, accounting for 19.6% and 17.4%, respectively. Unspecified seizure disorders (62.5%) and epilepsy (32.5%) were the most common seizure types. Pharmacological treatment was limited, with only 13.1% of patients receiving medications. Frequently used drug classes included antibiotics (3.8%), antihypertensives (2.9%), analgesics (2.4%), antipsychotics (1.5%), and statins (0.9%).
Conclusion: The predominance of stroke and the underutilisation of pharmacotherapy underscore critical gaps in the prevention, diagnosis, and management of CNS disorders. These findings highlight the need for improved access to diagnostic tools and essential medications, as well as for policy reforms to enhance the National Health Insurance Scheme coverage for CNS therapies.

Characteristics and Management Outcome of Patients with Severe Odontogenic Infections

2025-12-23T14:58:35+00:00

Background: Severe odontogenic infections (SOI) continue to persist in varying forms with associated morbidity.
Objective: This study aimed to describe the sociodemographic and laboratory characteristics of patients with SOI following admission, and to determine the factors influencing their length of stay.
Methods: This was a cross-sectional study involving patients with SOI who required hospital admission. Variables for this study included age, sex, employment category, educational level, Health Insurance status, previous dental visit, offending tooth, diagnosis, random blood glucose, laboratory parameters, and length of stay (LOS) as a measure of management outcome.
Results: Forty-six patients were included in this study, consisting of 18 females. The mean age of patients was 43.2 years (SD 18.4). The median LOS for patients over the study period was 7 days (IQR 6,10). Length of stay varied significantly with age category (p = 0.018). Middle-aged adults (36 – 65 years) and older adults (over 65 years) were more likely to remain hospitalised for more than a week compared to patients aged 18 – 35 years (OR = 13.3 and 12.0, respectively). The most consistently abnormal parameters in patients with SOI were elevated white blood cell count, deranged Gamma-glutamyl Transferase (GGT) and albumin tests. Albumin showed the highest correlation with LOS (r = 0.623, p = 0.198), and serum total protein showed a significant difference between participants with LOS of up to one week and patients who stayed longer (p = 0.035).
Conclusion: With the high success rate of our current management regime for SOI, age, serum albumin, and total protein were the most suggestive predictors of the length-of-stay of patients with Severe Odontogenic Infections.

Evaluating pain reduction interventions during blood donation: A randomised controlled trial

2025-12-23T14:58:36+00:00

Background: Blood shortages for transfusions are often associated with potential donors’ fear of pain from large-bore needles, which may deter them from donating.
Objective: This study evaluated the effectiveness and satisfaction of topical anaesthetics, cooling sprays, and audiovisual distractions in reducing needle-induced pain during blood donation.
Methods: This randomised controlled study (August 2023 – January 2024) investigated methods to alleviate pain during blood donation and was registered with the Thai Clinical Trials Registry (TCTR20230324007). Forty-eight eligible participants were recruited via convenience sampling and randomly assigned to one of four groups: control, topical anaesthetic, cooling spray, or audiovisual distraction. All procedures involved 16-gauge needle insertion. Pain was assessed immediately after needle insertion and blood collection using a 10-point numeric rating scale, while satisfaction was measured using a 4-point Likert scale. Participants met standard blood donation eligibility criteria. Data were analysed using descriptive statistics, one-way ANOVA, and multivariate linear regression to determine intervention effects on pain scores.
Results: The final analysis incorporated all 48 subjects, with 12 individuals in each of the four groups. The mean age of participants was 30.73 years (SD = 11.83), and females comprised the majority of the sample (54.16%). Mean pain scores during needle insertion were 3.25 (SD = 1.21), 2.83 (SD = 1.11), 2.67 (SD = 1.61), and 3.00 (SD = 2.22) (p = 0.960) for Groups A through D, respectively. Compared with the control, regression analyses of audiovisual distraction showed small differences that were not statistically significant (e.g., audiovisual
distraction: β = 0.78, 95% CI 1.01 to 2.58). During blood withdrawal, mean pain scores were 1.67 (SD = 1.19), 1.67 (SD = 0.83), 1.58 (SD = 1.51), and 1.25 (SD = 0.62) (p = 0.892). Similarly, regression analyses showed no significant intervention effects (audiovisual distraction vs. control: β = 0.79, 95% CI 0.50 to 2.08). Multivariate analyses revealed no significant effects of the intervention methods, demographic factors, prior blood procedure experience, or body mass index on pain scores.
Conclusion: Although pain-reduction interventions showed a trend toward lowering pain, the differences were not statistically significant. Given the variability in pain perception, larger multicentre studies are needed to confirm these findings.

Comparative renoprotective and haematological effects of gallocathechin and Anona muricata in rats treated with 7,12-dimethylbenz[a]anthracene (DMBA)

2025-12-23T14:58:37+00:00

Background: Chemically induced carcinogenesis often leads to renal dysfunction and haematological abnormalities.
Objective: This study compared the effects of doxorubicin, gallocatechin, and Annona muricata leaf extract (AMLE) on renal function, oxidative stress, and haematological markers in rats treated with cancer-inducing DMBA.
Methods: Fifty female Sprague-Dawley rats were randomised into five groups (n = 10). Group A served as control; Group B received DMBA (80 mg/kg); Groups C – E received DMBA followed by doxorubicin (4 mg/kg weekly), gallocatechin (40 mg/kg daily), or AMLE (40 mg/kg daily) for 21 days, respectively. Renal function markers (urea, creatinine, electrolytes), oxidative stress indices (SOD, CAT, MDA, total protein), and haematological parameters (PCV, RBC, Hb, WBC, platelets) were measured. Kidney histology was also evaluated.
Results: DMBA-treated rats (Group B) showed increased kidney weight, elevated serum urea and creatinine, oxidative stress (↑MDA, ↓SOD, ↓CAT), electrolyte imbalance,↓PCV, ↓RBC, ↓Hb, and ↑WBC. Doxorubicin (Group C) reduced kidney weight and partially reversed electrolyte imbalance but exacerbated renal and haematological toxicity. In contrast, gallocatechin (Group D) and AMLE (Group E) significantly improved renal markers, restored antioxidant enzyme levels, corrected electrolyte and hematologic imbalances, and ameliorated kidney histopathology. AMLE showed the most pronounced histological recovery.
Conclusion: While doxorubicin retained antitumor effects, it contributed to renal and haematological damage. Gallocatechin and AMLE demonstrated superior nephroprotective and hematopoietic benefits, primarily via antioxidant and anti-inflammatory mechanisms, making them promising adjuncts in cancer therapy.

Otoacoustic emission assessment of hearing loss prevalence among Ghanaian preschoolers: A cross sectional study

2025-12-23T14:58:38+00:00

Background: Childhood hearing impairment is a health concern which can result in reduced ability to communicate, inability to interpret speech sounds, leading to poor language acquisition, educational disadvantage and social isolation. Early childhood screening for hearing lossenables the detection and management of the condition.
Objective: This study aimed to determine the prevalence of hearing loss among selected preschool children following screening with Distortion Product Otoacoustic Emission (DPOAE).
Methods: This study was a cross-sectional investigation of preschool children aged 3 to 5 years. Data collected included demographic information, outcome of otoscopy, and otoacoustic emission assessment (OAE). The data were analysed with IBM SPSS version 21. The ChiSquare test was used to determine the associations between outcomes of the OAE test and the demographic characteristics of participants. Pvalues less than 0.05 were considered statistically significant.
Results: Six hundred and eleven (611) preschool children from four schools were examined. The mean age was 3.8 ± 0.8 years. Out of the 1,222 ears examined, 89.9% passed the DPOAE test. Otoscopic exams showed 64.8% of right ears and 68.6% of left ears were normal, while 35.0% and 31.4% had impacted wax, respectively. One child had a foreign body in the right ear. For both ears, no significant sex differences were observed (p = 0.427 and 0.862). The prevalence of failed OAE tests in both ears was 4.4%. There was an association between age and
outcome of OAE assessment for both right and left ears (p = 0.001 and 0.014, respectively).
Conclusion: The Prevalence of failed OAE test bilaterally of the preschool children was 4.4%. Age was associated with the outcome of the OAE assessment.

Correlates of self-rated health among BIMA telemedicine customers in Ghana: A cross-sectional survey

2025-12-23T14:58:39+00:00

Background: Self-rated health (SRH) is a subjective predictor of morbidity and mortality. Nevertheless, little is known about its correlates among telemedicine users in low-resource settings, a population that may face unique health and access challenges.
Objective: The study examined demographic and lifestyle factors associated with SRH among customers of BIMA’s telemedicine service in Ghana.
Methods: We analysed cross-sectional secondary data from a telephone survey of BIMA customers (January 2022 – June 2023). Variables included SRH, age, gender, medication use, tobacco use, physical activity (PA), and diet. A composite Healthy Life Score (HLS) combined PA and diet frequency. Multivariable logistic regression was used to examine the association between SRH and its correlates.
Results: Females who formed majority of the 9,547 participants (61.4%) had a mean age of 35.1 (SD 11.6) years, Among them, higher HLS showed a dose–response association with good SRH (Average: aOR = 1.32, 95% CI: 1.06 -1.64; Good: aOR = 1.61, 95% CI: 1.29 – 2.01; Excellent: aOR 2.17, 95% CI: 1.69 – 2.78). Age had a small per-year effect (aOR = 0.99, 95% CI: 0.98 – 0.99), which is meaningful cumulatively, resulting in approximately 10% lower odds over a decade. Men had higher odds than women (aOR = 1.14, 95% CI: 1.05 – 1.24). Medication use (aOR = 0.58, 95% CI: 0.52 – 0.65) and smoking (aOR = 0.70, 95% CI: 0.50 – 0.98) were associated with lower odds
of good SRH.
Conclusion: Among BIMA telemedicine users in Ghana, SRH is closely linked to lifestyle and demographic factors. Integrating physical activity promotion, dietary counselling, and smoking cessation support into telemedicine consultations may enhance perceived health. However, findings should be interpreted with caution, given the reliance on self-reported data, non-validated HLS items, and the crosssectional design of this study.

Eighty-one years of Research on Congenital Toxoplasmosis: A comprehensive Bibliometric Analyses

2025-12-23T14:58:40+00:00

Background: Congenital toxoplasmosis poses significant health and socioeconomic challenges, necessitating effective research and control strategies.
Objective: The study evaluated global research output on congenital toxoplasmosis based on articles indexed in Scopus, assessed collaborations, and identified research gaps through co-authorship and author keyword co-occurrence data, with implications for research and improved disease control.
Methods: The review used the search term “congenital toxoplasmosis*” and “humans” to retrieve 1,382 research articles from Scopus (1942–June 2023). Co-authorship and author keywords co-occurrence analyses were performed on these articles based on author-affiliated countries that fulfilled the minimum thresholds of five documents, regardless of citations, and five keyword occurrences, respectively. The bibliometric maps were created using VOSviewer.
Results: The findings indicate that research output on the subject has increased steadily since 1966, with the most prolific authors and institutions based in France, the USA, and Brazil. Collaborative research networks were strongest among authors from the USA, France, the UK, Denmark, Italy, Austria, Sweden, and Brazil, with high total link strengths of 161, 137, 127, 103, 83, 73, 63, and 53, respectively. Frequently used keywords and their respective high occurrences and strong total link strengths included Toxoplasma gondii (209; 382),
congenital toxoplasmosis (251; 370), toxoplasmosis (172; 331), and pregnancy (75; 185). In contrast, terms such as abortion, microcephaly, prenatal diagnosis, risk factors, prevention, and knowledge appeared less frequently (5 – 33), with weak link strengths ranging from 6 to 87.
Conclusion: The findings highlight critical gaps in congenital toxoplasmosis research and emphasise the need for greater focus on risk factors, prevention, diagnosis, and stakeholder collaboration to enhance control efforts. Future research and policy should prioritise early detection strategies, maternal education, and preventive interventions to reduce the disease burden and improve neonatal outcomes.

An Analysis of Cause-, Age- and Sex-Specific Schedule of Cancer Mortality in an Urban Complex: Evidence from Routine Records in Ghana

2025-12-23T14:58:41+00:00

Background: In countries without functioning cancer registries, population-based cancer estimates are problematic, and the burden of allsites and site-specific cancer mortality is hard to gauge.
Objective: The study aimed to estimate cause-specific, age- and sex-specific cancer mortality burden using data from the Vital Registration System (VRS) in an urban complex with no cancer registry.
Methods: The Ghana Vital Registration System (GVRS) is designed to be coterminous with the national political-administrative units, allowing for mortality reporting at the household level. Death records are stored centrally at the National Office in Accra, the capital of Ghana.
We collected and analysed, using Binomial/Poisson, Hazard and Cox regression models, mortality records from Ghana’s VRS over a 14-year (1998-2011) period in order to estimate and study the relationship among sex, age, and the risk of dying of cancer.
Results: Overall, the results showed an increase in cause-specific hazard rates with increasing age. The results also showed strong evidence of a difference in all-cause relative hazard rate between males and females (1.12, 95% CI 1.07 - 1.19, p < 0.001). Finally, further causespecific analyses showed that, while stomach cancers and lymphomas were more prevalent in males than females, the converse was true for bladder and pancreatic cancers (11.4% and 12.5%, respectively).
Conclusion: The consistency of the findings reported here with results from similar analyses using data from standard cancer registries supports the view that routine data from vital registration systems can be used validly to estimate the burden of cancer mortality in resourcepoor settings where cancer registries are unavailable.

Traumatic amputations in a Ghanaian tertiary hospital over a 6-year period: A retrospective study

2025-12-23T14:58:43+00:00

Background: Traumatic amputation refers to an injury to a limb that results in its immediate separation from the body or may ultimately lead to loss of the limb. The most common causes include falls, road traffic accidents, explosions, and armed conflicts. These could result in complications such as haemorrhage, infection, shock, and psychological trauma. Out of 160 traumatic amputations over a 6-year period, traumatic amputations were found to be more common in the groups of people aged 20 years or less (43.1%), self-employed groups or artisans (50.9%), groups with some level of education (59.7%), and with a male preponderance (85%). Road traffic accidents were associated with the female group (54.2%) and the unemployed (53.4%). The use of prosthetics among amputees is not a common practice, though they are the common remedy for traumatic injuries (45.6%). Upper limbs (54.4%) were the most common site of traumatic amputations, with 62.1% below the elbow. There was a significant relationship between the mechanism and the site of injury. While primary trauma (59.4%) was the immediate cause of traumatic amputation, it is essential to educate the public about the dangers associated with injury management by bonesetters, as well as to promote road safety education to reduce the incidence of traumatic amputations.

Preparedness of health facilities and their midwives for emergency obstetric and neonatal care services in Accra, Ghana: A multicenter cross-sectional study

2025-12-23T14:58:43+00:00

Background: Emergency Obstetric and Neonatal Care (EmONC) provides comprehensive medical care to women and their newborns during pregnancy, childbirth, and the immediate postnatal period. The timely provision of EmONC can prevent most maternal and early neonatal deaths. In sub-Saharan Africa, including Ghana, maternal and neonatal mortality rates remain unacceptably high, largely because of a lack of access to quality healthcare and poorly prepared health systems. A recent EmONC assessment of public and private health facilities in Ghana revealed capacity gaps in basic pre-referral procedures at the referring health facilities, resulting in maternal deaths.
Objective: The study sought to determine the preparedness of health facilities and their midwives for EmONC services in Accra, Ghana.
Methods: A multicenter analytic cross-sectional study was conducted in Accra, Ghana, from 1st June to 31st July 2020. A total of 194 randomly selected midwives answered a self-administered questionnaire to assess their knowledge and preparedness for EmONC. The factors associated with the preparedness of the midwives for EmONC procedures were determined using chi-square analysis and logistic regression. P-value of <0.05 at 95% confidence interval was considered statistically significant. Availability of EmONC signal functions in health facilities was scored.
Results: Eighty-seven (45%) of midwives had adequate knowledge of EmONC, while only 19% (n = 36) were adequately prepared for EmONC. The factors associated with being prepared for EmONC services were currently working at the labour ward (aOR, 3.43; 95% CI, 1.49 – 7.91) and being a senior midwifery officer or higher (aOR, 6.00; 95% CI, 1.01 – 35.75). Both facilities A and B had a high availability of essential medicines, protocols, and equipment of 90.7%, while facility C had a significantly lower availability of 69.8%.
Conclusion: Despite well-equipped facilities for EmONC, midwives' limited knowledge and preparedness for EmONC can compromise maternal and neonatal outcomes. A thorough review of the midwifery curriculum, clinical training, and the implementation of regular, mandatory training are crucial to ensure their skills align with best practices.

Alcohol consumption and subjective well-being in Ghana: Evidence from the World Health Organisation’s study on global ageing and adult health

2025-12-23T14:58:45+00:00

Background: Adverse outcomes of unhealthy alcohol use are highest in Africa. The prevalence of heavy episodic drinking, defined as 60 or more grams of pure alcohol on at least one occasion at least once per month, remains high among drinkers, particularly in some sub-Saharan African countries.
Objective: This study evaluates sociodemographic factors associated with lifetime alcohol consumption and characterises the relationship between alcohol consumption and subjective well-being across regions of Ghana.
Methods: The dataset of the WHO Study on Global Ageing and Adult Health (SAGE) wave 2 for Ghana was used for analysis. Subjective well-being was measured using the WHO-8 Quality of Life tool. Predictors of the outcome variables were determined using logistic regression in Stata 14.
Results: Overall, 4090 participant entries comprising 1692 males were evaluated. The prevalence of lifetime alcohol use was 20.7%. Lifetime alcohol drinkers were more likely to be male (p < 0.001), aged 40-49 years (p < 0.001) and having a smoking history (p < 0.001) or residence in Southern Ghana (p < 0.001). Participants aged 50 years of older (PR 0.67, CI 0.48 - 0.92)who were separated, divorced (PR 0.70, CI 0.48 - 0.99)or widowed (PR 0.51, CI 0.39-0.67) had significantly lower levels of subjective well-being.
Conclusion: Sociodemographic determinants of lifetime alcohol consumption define the at-risk population, and thus, provide a framework for targeted health policies against the harmful physical and psychological effects of unhealthy alcohol intake in Ghana.

Prognostic value of immuno-expression of Epidermal Growth Factor Receptor (EGFR) & B-Cell Lymphoma (BCL-2) as apoptotic biomarkers in oral squamous cell carcinoma: A systematic review and meta-analysis

2025-12-23T14:58:46+00:00

Background: Apoptosis, or programmed cell death, plays a crucial role in cancer development and progression. Biomarkers like EGFR and BCL-2 are known to regulate apoptosis and have been studied in various cancers, including oral squamous cell carcinoma (OSCC). The expression patterns and prognostic implications of these biomarkers could help in predicting patient outcomes. To address this research question, we conducted a systematic review and meta-analysis of studies examining the prognostic significance of two apoptotic biomarkers, EGFR (Epidermal Growth Factor Receptor) and BCL-2 (B-cell lymphoma 2), in OSCC.
Objective: By elucidating the prognostic value of EGFR and BCL-2 immunoexpression in OSCC, this systematic review aimed to contribute to predicting the immunoexpression value of EGFR and BCL-2.
Methods: This systematic review and meta-analysis investigated the prognostic significance of immunostaining of EGFR and BCL-2 in patients with OSCC. The PICO criteria were applied to OSCC patients, defining the population, intervention (immunoexpression of EGFR and BCL-2), and outcome (prognostic significance). This systematic review was registered with PROSPERO to ensure transparency and avoid duplication. A comprehensive search strategy was developed using relevant keywords and Medical Subject Headings (MeSH) terms related to OSCC, EGFR, BCL-2, immunohistochemistry, and prognosis. Electronic databases such as PubMed and SCOPUS were searched, along with reference lists from relevant articles. Data extraction included author, publication year, patient characteristics (sample size, age, gender), and outcomes related to overall survival.
Results: EGFR is frequently overexpressed in OSCC, and its expression has been associated with aggressive tumour behaviour and poor prognosis. High EGFR expression is often correlated with reduced survival rates in OSCC patients. High BCL-2 expression has been associated with tumour progression and poor prognosis in OSCC patients.
Conclusion: Overall, the immunohistochemical expression of EGFR in Oral Squamous Cell Carcinoma (OSCC) appears to hold significant prognostic value. However, further research is needed to validate these findings and to optimise the clinical utility of EGFR as a prognostic biomarker in OSCC management. Likewise, evidence suggests a prognostic role for BCL-2 immunohistochemical expression in OSCC.Additional studies are required to fully elucidate its significance and potential implications for patient management and treatment decision making.

Progress and challenges in implementation of the WHO special initiative on mental health in Ghana (2019 - 2023): A narrative review

2025-12-23T14:58:47+00:00

Background: The WHO Special Initiative for Universal Mental Health (2019 - 2023) seeks to expand access to affordable, high-quality mental health services for 100 million people across 12 priority countries, including Ghana. Despite the ongoing efforts, Ghana continues to face a substantial treatment gap of approximately 98%, with limited service coverage.
Objective: This review article aims to synthesise the literature on the implementation of the WHO Special Initiative in Ghana, evaluating its progress, highlighting challenges, and offering recommendations to strengthen the country’s mental health system.
Methods: This review analysed peer-reviewed and grey literature, policy documents, and reports on the WHO’s Special Initiative for Universal Mental Health. Sources published in English up to 2023 were retrieved from major databases and key institutional websites. Data were synthesised thematically, guided by the WHO Health System Building Blocks Framework.
Results: Ghana has made notable progress under the WHO’s Special Initiative for Universal Mental Health. Key achievements include the Ministry of Health approval of a comprehensive essential health services package which includes mental health, the establishment of the Mental Health Board for service delivery, and the inclusion of selected mental health conditions in the National Health Insurance Scheme (NHIS) benefits. Despite these significant gains, critical challenges remain, including a limited workforce, low accessibility and treatment coverage, persistent stigma and discrimination, limited funding, shortages and non-adherence to psychotropic medications, limited availability
of psychosocial therapies, and ongoing human rights violations.
Conclusion: Despite Ghana’s notable advancements in strengthening its mental health system, the targets of the WHO’s Special Initiative remain unmet due to complex systemic and structural challenges. Achievement of these remaining targets requires multifaceted interventions, including expanding the workforce, improving access and coverage, addressing stigma and discrimination, securing sustainable funding, ensuring availability and adherence to psychotropic medications, scaling up psychosocial services, and addressing sociocultural, religious, and human rights concerns. These findings outline actionable steps toward universal mental health coverage.

Effect of Antiretroviral Treatment (ART) on Cardiovascular Risk Factors among People Living with HIV in LMIC: A systematic review

2026-01-08T14:38:42+00:00

Background: Effective use of antiretroviral treatment (ART) is known to reduce HIV/AIDS-related morbidity and mortality significantly. However, as life expectancy increases, the risk factors for cardiovascular disease become more prevalent. Data on the risk of cardiovascular diseases in relation to antiretroviral therapy in low- and middle-income countries (LMIC) remain limited.
Objective: In this review, we examined the association between antiretroviral therapy and cardiovascular disease (CVD) risk factors (hypertension, diabetes, dyslipidaemia) among people living with HIV (PLHIV) in LMIC.
Methods: We conducted a systematic review and meta-analysis of studies on LMIC published between 2007 and 2018. Studies published in English and indexed in PubMed, Scopus, Cochrane, and Google Scholar were critically reviewed, and the effect of estimates were pooled for hypertension, diabetes, and high lipid profiles using a random-effects meta-analysis. In all, twenty-one studies were included involving 12,229 participants after screening.
Results: There was no link found between ART use and diabetes (RR = 0.88, 95% CI: 0.58 - 1.33). ART use was, however, associated with hypertension (RR = 1.74, 95% CI: 1.21 - 2.50), increased total cholesterol (RR = 2.72, 95% CI: 1.75 - 4.23), high triglycerides concentration (RR = 1.64, 95% CI: 1.50 - 1.80), elevated LDL-cholesterol (RR = 2.72, 95% CI: 1.75 - 4.23)., and decreased HDL-cholesterol (RR=0.65, 95% CI: 0.58 - 0.77).
Conclusion: There is an association between antiretroviral therapy and raised LDL, triglycerides, total cholesterol, and hypertension in LMIC, hence the need to provide tailored education on CVD risk factors among PLHIV. Moreover, there is a need to formulate policies and programmes aimed at addressing CVDs among PLHIV in LMIC.