Health Sciences Investigations Journal

Welcome message from the Editor-in-chief Volume 6 Issue 1

Andrew Anthony Adjei — 2024-07-30

We gladly welcome readers to Volume 6, Issue 1 of the Health Sciences Investigations (HSI) Journal. Launched in 2020, the HSI Journal has rapidly gained international recognition, attracting global submissions across diverse scientific fields. Notably, our recent Special Edition (Volume 5 Issue 2, 2024) explored
the health implications of “galamsey” — a term referring to illegal smallscale gold mining in Ghana. This critically acclaimed issue is a mustread. The HSI Journal is indexed in Elsevier and affiliated journal repositories, including SCOPUS®, and is listed in the African Journals OnLine (AJOL) citation database. The HSI Journal is also pursuing inclusion in other major repositories. Consider the HSI Journal for your next publication. Volume 6 Issue 1 features ten Original Research
Articles on diverse topics, each providing valuable insights. The articles cover a range of subjects, including the presence of SARS-CoV-2 in wastewater from hand wash stations, substance use among high school-going adolescents in Ghana, and a rare but significant cause of chest pain in young adult females.

About the cover

Tabi Crentstil — 2024-07-30

Artist's perspective
The woman's posture and the way she holds the umbrella suggest a sense of protection and self-reliance, while the bold colours and abstract forms add a sense of mystery and intrigue to the scene. The extent to which one may go to shield themselves from impending interference has no limits. Yet those very things
shielded otherwise contribute to the endless opportunities that can be derived from such circumstances. Overall, this painting is a beautiful example of art that invites the viewer to appreciate the beauty of colour, form, and composition while also sparking contemplation and interpretation. It is a captivating piece that
engages the viewer's senses and emotions, making it a truly valuable work of art.

Developing and Growing the ‘Ebibiduro’ (Natural Medicine) Industry in Ghana: What about Cocoa?

Neils B Quashie — 2024-07-30

Ghana is endowed with a wide range of natural products which are high in therapeutic values. From the shrubs behind our various homes to the bark of the big trees in the deep green forest lies natural compounds with great therapeutic values.

Adequacy of Dietary Fibre Intake among Hypertensives in a University Hospital in Accra, Ghana: A Cross-sectional Study

Ediman Numadzi — 2024-07-12

Background: Dietary fibre, as a component of a healthy diet, has been shown to lower blood pressure and blood lipids and regulate body weight.
Objective: The study aimed to assess dietary fibre intake among people living with hypertension and its association with the sociodemographic characteristics of respondents.
Methods: A cross-sectional study was conducted among 186 participants (82 males, 104 females) attending the University of Ghana Hospital at Legon, Ghana. Dietary fibre intake was assessed using a quantitative food frequency questionnaire that measured food intake over a month.Blood pressure and anthropometric measurements were taken following standard World Health Organisation (WHO) guidelines. Lipid profile values were obtained from each participant’s folder.
Results: Participants’ median (IQR) dietary fibre intake per day was 14.8 g (2.4 to 38.1). The majority of the participants (88%, n = 165) had low intakes compared to the recommended daily intakes. The analysis revealed no association between either systolic (β = -0.114; p = 0.315) or diastolic blood pressure (β = -0.007; p = 0.947) and dietary fibre intake. The individual predictors indicated that BMI significantly predicted diastolic blood pressure (p = 0.033), and total energy intake significantly predicted systolic blood pressure (p = 0.019). The major source of dietary fibre was a cereal legume mix (tom brown), which contributed 24.5% of fibre to the daily fibre intake.
Conclusion: Reported dietary fibre intake among the study population was below the recommendation for fibre intake according to the United States Food and Drugs Administration Daily Reference Value. Dietary fibre intake was not associated with either systolic or diastolic blood pressure. Nutrition education strategies such as promoting whole meals and consuming plant-based foods should be intensified among people living with hypertension to encourage the consumption of meals rich in fibre.

Presence of SARS-CoV-2 in wastewater from handwash stations in selected facilities in Ghana

Mildred A. Adusei-Poku — 2024-07-29

Background: Following the COVID-19 pandemic, the occurrence of the causative agent, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), in water, has been reported as handwashing was recommended as a non-pharmaceutical tool to limit the spread of the virus. Wastewater from these handwash stations is discarded without proper guidelines and could end up in the environment, serving as a
dissemination route for SARS-CoV-2.
Objective: This study investigated the potential role of wastewater from handwash stations in the transmission of SARS-CoV-2 in Ghana.
Methods: A total of 390 water (195 reservoir water and 195 wastewater) samples from handwash stations were collected and analysed from selected schools, commercial banks, and hospitals in Accra, Ghana, between the 13th of June, 2022, and the 25th of August, 2022. Samples were first concentrated using the phase separation method before RNA extraction, and viral nucleic acid was amplified for SARS-CoV-2 detection using RT-PCR (N gene and ORF3a regions). Isolation of SARS-CoV-2 was performed for all 17 samples using VERO E6 cells.
Results: From the RT-PCR analysis, a total of 17 samples (4.4%) were positive for SARS-CoV-2 RNA. All 17 positive samples were wastewater samples. Propagation on Vero E6 cells yielded no cytopathic effect (CPE). Samples from schools had the highest positivity rate (15 out of 17), followed by the hospitals (2 out of 17) and the commercial banks (0 out of 17).
Conclusion: SARS-CoV-2 RNA detected in wastewater has a low likelihood of causing secondary infections in humans; however, the monitoring of SARS-CoV-2 in water matrixes could provide information on viral dynamics in the community.

Dermatological manifestations among patients with chronic kidney disease attending the renal clinic and dialysis unit of a tertiary hospital in Ghana

Mark-Young Seadey — 2024-07-29

Background: Cutaneous manifestations occurring in patients with chronic kidney disease (CKD) can indicate systemic problems such as metabolic abnormalities that have significant morbidity and mortality risks. Most studies on this subject have involved patients with end-stage kidney disease (ESKD) with skin manifestations.
Objective: The study aimed to determine the prevalence of dermatological manifestations amongst persons with CKD attending the KorleBu Teaching Hospital as compared with the prevalence in non-renal patients.
Methods: A cross-sectional study was used to determine the prevalence of skin diseases among chronic kidney disease (CKD) (renal) andnon-renal patients from January 2016 to June 2016. Each patient was assessed using a full medical history, physical examination and a full dermatological examination of skin, nails, and hair. Data was entered into Epi info and analysed with SPSS Version 18. Descriptive statistics was used in the analysis.
Results: The prevalence of dermatological disorders was 95.2% in the renal patients compared to only 5.6% in the non-renal patients. Themost common mucocutaneous disorder in renal patients was pallor (72.4%, n = 105), followed by xerosis (58.1%, n = 86), then pruritus (22.1%, n = 32). The most common nail disorder was half and half nails (66.3%, n = 55), followed by brown nails (10.8%, n = 32) and onycholysis (9.6%, n = 8). The most common hair abnormality was sparse scalp hair loss (44.4%, n = 16), sparse body hair loss (33.3%, n =12), and diffuse scalp hair loss (13.9%, n = 5).
Conclusion: The prevalence of skin disorders was higher in CKD patients than in patients without renal disease. Dermatological manifestations are an important component of CKD symptomatology, and healthcare providers should aim to recognise, diagnose, and managethem to improve patient outcomes.

Substance use among high school-going adolescents, Northern Region, Ghana

Abdul Gafaru Mohammed — 2024-07-29

Background: Substance use among adolescents in Ghana remains underreported despite its consequences. There is limited information on the prevalence of alcohol, cigarette, and other drug use among adolescents in the northern region of Ghana.
Objective: This study assessed adolescent substance use in nine senior high schools in the Northern Region of Ghana to inform evidencebased decision-making.
Methods: We conducted a school-based cross-sectional study to assess the prevalence of substance use and the factors that influence its occurrence among randomly sampled adolescents in the Northern region of Ghana. A semi-structured questionnaire was used to collect data on their background characteristics and use of substances. Binary logistic regression was used to determine the association between substance use and adolescents’ characteristics at the 5% significance level.
Results: Of the 403 adolescents studied from nine senior high schools, the average age was 17.7 years (SD = 1.01), with 52.9% (n = 213) being male. The lifetime use of any substance was 62.3% [95% CI: 57.35 - 67.03]. Smoking status, alcohol intake, and illicit drug use were 6.2% (n = 25/403), 5.0% (n = 20/403), and 62.3% (n = 251/403), respectively. Substance use by peers (aOR = 2.07, 95% CI: 1.16 - 3.68), sexual activity (aOR = 1.81, 95% CI: 1.08 - 3.03), sexual relationships (aOR = 1.66, 95% CI: 1.03-2.69), social media use (aOR = 2.13, 95% CI: 1.36 - 3.36), and smartphone use (aOR = 2.89, 95% CI: 1.65 - 5.07) were significantly associated with substance use.
Conclusion: This study revealed an alarming rate of substance use among adolescents in the Northern Region. Peer use of drugs, sexual activity, sexual relationships, and use of smartphones and social media were factors identified to influence substance use. The research team organised educational and sensitisation programmes for the selected high schools. The findings could influence the development or enhancement of school policies related to substance use prevention, detection, and disciplinary actions by the Ghana Education Service (GES).

HIV in Sunyani and peri-urban areas is associated with previous history of syphilis infection and multiple sexual partners- A cross-sectional study

Kingsley Arhin-Wiredu — 2024-07-29

Background: The Bono Region of Ghana has consistently recorded increase in HIV prevalence over the years with an average prevalence of 3.4% in the recent HIV survey. Sunyani, the capital Region of Bono recorded an HIV prevalence of 3.8% higher than the National average. Against this background, this study assessed the factors associated with the high HIV prevalence in the Sunyani municipality in the Bono Region of Ghana.

Method: Participants (445) accessing HIV counselling and testing services were enrolled from three hospital in the Sunyani Municipality using cross-sectional design, from March to August 2018 and were interviewed using a structured questionnaire. Descriptive and logistic regressions analyses were used to identify factors associated with HIV prevalence at p < 0.05 with 95% confidence interval.

Results: The mean age of respondents was 30.8±8.5 years. The prevalence of HIV among participants was 10.3% (95% CI: 7.82-13.54). HIV prevalence per sub districts ranged from 0 to 11.9% with New Dormaa recording the highest of 11.9% (CI: 5.7-23.1). 28% (13/56) of the HIV positive participants reside in districts outside the Sunyani Municipality. Participants with previous history of syphilis were 6 times more likely to be HIV positive compared with those with vaginal or urethral discharges (aOR=6.39, 95% CI: 4.14-9.78), and those with multiple sex partners have 3 times increased odds of getting HIV than those with single partner (aOR=3.33, 95% CI: 1.16-9.55).

Conclusion: There was high prevalence of HIV in Sunyani municipality and surrounding districts. HIV prevalence was significantly associated with multiple partners and previous history of syphilis infection.

Early Phase Bioprospecting and Phenotypic Characterization of Streptomycetes in Greater Accra

Reuben Essel Arhin — 2024-07-30

Introduction: Microbial life forms including streptomycetes are an important source of natural products obtained from bioprospecting. The aim of this study was to provide baseline data on the phenotypic diversity of streptomycetes from soils in Greater Accra and to determine the suitability of the selected areas for bioprospecting of potentially novel antimicrobial-producing strains.

Methodology: Twenty-one soil samples were collected from 7 areas in Greater Accra. Streptomycetes were cultured on Oatmeal Agar for sporulation. Spores were subcultured onto a variety of media to ascertain the colony morphology of the strains. Extracts of pure isolates were obtained via submerged cultures. The antimicrobial activity of the extracts was determined against clinical bacteria using the agar well diffusion method and categorized by their antimicrobial inhibition halo diameter.

Results: A total of 15 phenotypically proven diverse strains of streptomycetes were recovered from the soil samples. Two of the isolates were antimicrobial producers. Tryptone Soya Broth extract of Streptomyces sp. V1 showed good efficacy (++) against Pseudomonas aeruginosa (22 ± 2 mm) whereas Streptomyces sp. W2 showed good efficacy (++) against Escherichia coli (20 ± 8 mm) and moderate efficacy (+) against Pseudomonas aeruginosa (13 ± 2 mm).

Conclusions: Soils from different areas in Ghana may be potential sources of the next novel antimicrobial producing streptomycetes.

Uptake and correlates of long-acting reversible contraceptive use among postpartum women in Ledzokuku-Krowor municipality in Ghana: a facility-based cross-sectional study

Leticia Adelaide Appiah — 2024-07-30

Background: The unmet need for post-partum family planning globally is around 65%, but in sub-Saharan Africa (SSA), it ranges between 25 and 96%, and 84.5% in Ghana. Long-acting reversible contraceptive (LARC) methods can optimally space births and markedly reduce the high levels of unwanted and or risky pregnancies as well as maternal and child mortality and morbidity. Although they are the most effective, easy, and safe to use after delivery, reports from the Ledzokuku-Krowor Municipality Assembly (LEKMA) show the prevalence of LARC methods is very low among post-partum women.
Objective: This study aimed to determine the prevalence of LARC uptake and assess factors associated with the use of LARC methods in the LEKMA of Ghana.
Methods: A facility-based cross-sectional study using a probability proportionate to size sampling approach was employed to recruit postpartum women within 12 months of delivering a live baby and accessing child welfare clinics in the Government-run health facilities in LEKMA. Secondly, a semi-structured interview guide was administered to sexual and reproductive health workers. The multivariable binary logistic regression model with a robust standard error was used to determine correlates of LARC use.
Results: A total of 406 post-partum women were enrolled in the study. Only 4.1% (n = 16) used LARC, although 59.7% (n = 242) of postpartum mothers had access to LARC methods. The results from the multivariable binary logistic regression model showed adequate knowledge of LARC (adjusted odds ratio = 4.88, 95% CI: 2.64, 26.79, p < 0.05), and age was associated with the odds of uptake of LARC. Interviews with facility managers and other health workers revealed that barriers to uptake of LARC methods include fear of side effects, lack of spousal support, misconceptions about LARC, and lack of adequate knowledge of providers.
Conclusion: There is a high unmet need for contraception among post-partum women. Even though uptake of LARC in the post-partum period in LEKMA is low, it is relatively high among women with adequate knowledge of LARC and in unions (presumably in stable relationships or marriages). Ghana Health Service and the Ministry of Health should make LARC affordable and easily assessable through efficient distribution at the community health post and adequately build the capacity of providers through institutionalised training. There is
a need for stakeholders to intensify community-level education geared towards mitigating the barriers to uptake, including myths and misconceptions, and promoting the possible benefits of the use of LARC services.

Ultrastructural hepatic damage in murine malaria with and without prandial natural cocoa powder and artemether-lumefantrine treatment

Eric Aidoo — 2024-08-01

Background: There is paucity of data on the potential benefit of cocoa in reducing oxidative stress and inflammation in the pathophysiology of plasmodial infection and its associated damage to liver tissues
Objective: This study compared hepatocyte ultrastructural integrity in rodent malaria treated with aqueous natural cocoa powder (NCP) ingestion with and without artemether-lumefantrine (AL).
Methods: Twenty-four Sprague-Dawley rats were randomly assigned to groups. Every rat was inoculated with 0.2 ml of parasitised blood containing 1 x 105 P. berghei (NK 65) parasites per microlitre to induce malaria infection. Subsequently, group 1 rats were given 2% (weight/volume) aqueous NCP; group 2 rats were given 2% NCP and 0.6 ml of 4.0 mg/kg AL. Group 3 rats received only the same dose of AL as group 2, whilst group 4 rats were given neither NCP nor AL. NCP and AL were administered by oral gavage once daily. Liver tissue
harvested from euthanised and perfusion-fixed rats was processed for transmission electron microscopic examination. Hepatic tissue damage was quantitatively assessed using design-based stereology. Ultrastructural variables assessed were sinusoidal diameters, sinusoidal endothelial wall thickness, volume density of Kupffer cells, and perisinusoidal microvilli.
Results: As per the study variables, liver damage in group 1 rats was significantly extenuated compared with rats in group 2, group 3, and group 4. Serum biochemical markers assayed indicated statistically lower levels of aspartate transaminase (AST) and alanine transaminase (ALT) in groups 1,2 and 3 rats compared to group 4 rats. Inferably, mitigation of liver ultrastructural damage in P. berghei-infected rats given NCP was better than treatment with AL and putatively attributable to the anti-inflammatory activity of cocoa evidenced by significantly lower serum transaminases.
Conclusion: The evidence shows that damage to the ultrastructural liver morphology in murine malaria was significantly mitigated by daily ingestion of NCP compared with AL treatment with respect to hepatic sinusoidal endothelial thickness and density of hepatic microvilli despite parasitaemia being comparable to untreated control rats.

Assessing gastric viability of probiotics: real testing in real human gastric fluid

Mansa Fredua-Agyeman — 2024-08-01

Background: It is believed that the harsh conditions of the upper gastrointestinal tract, such as gastric fluid acidity, may affect the viability of ingested probiotics. Thus far, this notion has been verified in vitro by viability testing in simulated gastric fluid.
Objective: In this study, the survival of 8 probiotic bacteria was investigated in real human gastric fluid to determine the response of the bacteria in the actual biological medium.
Methods: Gastric tolerance of the different probiotic bacteria was determined by inoculation of the bacteria in human gastric fluid, sampling at 30 min, 60 min, 120 min, 180 min, serial dilution and spread plating. Tolerance was also determined in traditionally simulated fluids at pH of 2.2 ± 0.1 and 2.8 ± 0.1, mimicking the pH of the human gastric fluid.
Results: All the probiotic bacteria tested except for one strain, which showed less than 1 log CFU/mL loss in viability in the two fluids, were susceptible to the gastric fluids. The results showed significant (p < 0.05) strain-specific differences in the sensitivities of the bacteria in the gastric fluids. Some species were more sensitive to the real human gastric fluid than the simulated fluid. However, overall, the simulated gastric fluid did not significantly differ (p > 0.05) and hence provided a comparable environment to the actual human fluid at a similar pH.
Conclusion: More than 80% of the tested probiotic strains were susceptible to real human gastric fluids. The results demonstrated strain differences in the susceptibility of different probiotic bacteria to gastric fluid. Also noteworthy are the differences in the behaviour of some of the probiotic bacteria in the real fluid against the simulated fluid. The result highlights the importance of using biorelevant test systems in viability assays.

Sustainable Development Goal 3.8 Universal Health Coverage from global perspectives: An analysis of the health insurance policies in Rwanda, Tanzania, South Africa, and Ghana

Daniel Dramani Kipo-Sunyehzi — 2024-08-01

Background: The paper reviewed the policy strategies of four African states (Rwanda, Tanzania, South Africa, and Ghana) towards achieving Universal Health Coverage (UHC). It found that these four countries used national or community-based health insurance schemes as vehicles or the means to achieve UHC by 2030 in the context of the global agenda (the United Nations Sustainable Development Goals (UN SDGs).
Objective: The study aimed to specifically contribute to an interrogation of health insurance policy strategies in Africa.
Methods: It reviewed relevant literature on universal health coverage in selected regions like Europe, America, the Pacific, and Asia. It then added the materials to Sub-Saharan Africa. Data was obtained from secondary sources. Included criteria were the use of words such as United Nations Sustainable Development Goals SDGs), Universal Health Coverage (UHC), health, health insurance, health insurance scheme, and World Health Organization (WHO).
Results: The findings suggest that most African states have national or community-based health insurance schemes, and most of the health insurance schemes cover a good percentage of their population. However, most health insurance schemes cover less than half of the population. For the four cases, Rwanda and Ghana are excluded from the coverage of less than 50 percent of the population. Also, the four African states spent less than 10% of their GDP on health. These indicators suggest that the pathway towards achieving UHC in Africa by 2030 may still take some more years to be realised.
Conclusion: The study concludes that funding various health insurance schemes remains a challenge. Therefore, adequate funding by the African government for health and a positive attitude towards publicly funded health services are necessary to sustain African health insurance schemes or policies

High-Performance Liquid Chromatography applications and challenges in developing countries: A short communication

Ebenezer Ofori-Attah — 2024-08-01

Over the years, developing countries have utilized High-Performance Liquid Chromatography (HPLC) to conduct extensive research on local and global health-related issues. However, challenges such as scarce service engineers, lengthy shipment procedures for spare parts, and other factors hinder HPLC from working at full capacity. This brief communication discussed HPLC research in developing countries, identified challenges, and proposed beneficial strategies for users and potential buyers.

Minimally invasive resin infiltration with DMG Icon for white spot lesions: A case report

Akshada Mungee — 2024-07-29

White spot lesions (WSLs) which are frequent occurrences in dental orthopaedics and pediatric dental patients, often result from demineralisation of enamel due to poor oral hygiene and excessive sugar consumption. Patients with early-stage dental caries usually present with WSLs, which occur as a result of the deionisation of the outer covering of the teeth. The management of these early-stage carious lesions can be challenging, as the traditional approach involves invasive restorative procedures. Over the years, many treatment methods have been proposed, but none of them have shown good clinical results. However, the application of the DMG Icon, a minimally invasive treatment, resulted in the reversal and arrest of the progression of WSLs. This case report presents an 18-year-old female patient with the chief complaint of visible white spots on the upper anterior teeth for two months. Based on the clinical examination and history, the patient was diagnosed with WSLs on bilateral labial surfaces of the maxillary incisors and canines. The treatment plan involved using DMG Icon resin infiltration to prevent the WSLs and improve the structure of the anterior teeth. This case report presents a successful application of the DMG Icon in the treatment of WSLs in a young patient with WSLs on the anterior teeth. The report highlights the potential of DMG Icon as an effective alternative to conventional restorative methods.

Catamenial Pneumothorax: A rare but important cause of chest pain in young adult females in the Ghanaian population

Eadbert Nortey — 2024-07-29

Catamenial Pneumothorax refers to a spontaneous pneumothorax due to thoracic endometriosis, often associated with menstruation in young women. It forms part of the spectrum of thoracic endometriosis syndrome, a term used to describe the occurrence of pneumothorax, hemothorax, haemoptysis, or chest pain associated with menstruation. We present three females between the ages of 30 and 40 years who sought medical attention at the Emergency Department of the University of Ghana Medical Centre with complaints of chest pain and difficulty breathing associated with their menstrual cycle. In all three cases, chest X-rays revealed right-sided pneumothoraxes. The diagnosis of Catamenial Pneumothorax was made in all three cases based on clinical findings. This write-up aims to underscore the importance of maintaining a high index of suspicion for diagnosing catamenial pneumothorax in young women presenting to the Emergency Department with cyclical chest pain associated with menstruation.