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Biomedical subjects

J O Commey

Publications and source records attributed to J O Commey.

17 recordsLinked to original sources
PubMed1997

Reversible suppression of bone marrow response to erythropoietin in Plasmodium falciparum malaria.

To study the importance of bone marrow inhibition in the pathogenesis of malarial anaemia, haematological and parasitological parameters were followed in patients with acute malaria. Three patient categories were studied, severe malarial anaemia (SA), cerebral malaria (CM) and uncomplicated malaria (UM). Red cell distribution width (RDW) was used as a surrogate marker of release of young erythrocytes and reticulocytes. Initially RDW was low in all patients in spite of markedly increased concentrations of erythropoietin (EPO). 3 d after institution of treatment and coinciding with parasite clearance RDW increased dramatically, reaching the highest levels 1-2 weeks later. Although severe anaemia was corrected by blood transfusion during the first 3 d of treatment, the peak RDW correlated significantly with the initial EPO levels. This suggests that Plasmodium falciparum infection causes a rapidly reversible suppression of the bone marrow response to EPO. Furthermore, the inhibition of bone marrow response was a general finding irrespective of initial haemoglobin levels suggesting that the severity of anaemia depends upon the degree of peripheral erythrocyte destruction in patients with suppressed bone marrow response to EPO.

Antimalarials↗
PubMed1996

The gamma/delta T-cell response to Plasmodium falciparum malaria in a population in which malaria is endemic.

Frequencies and absolute numbers of peripheral gamma/delta T cells have been reported to increase after episodes of Plasmodium falciparum malaria in adults with limited or no previous malaria exposure. In contrast, little is known about the gamma/delta T-cell response to malaria in children from areas where malaria is endemic, who bear the burden of malaria-related morbidity and mortality. We investigated the gamma/delta T-cell response in 19 Ghanaian children from an area of hyperendemic, seasonal malaria transmission. The children presented with cerebral malaria (n = 7), severe malarial anemia (n = 5), or uncomplicated malaria (n = 7) and were monitored from admission until 4 weeks later. We found no evidence of increased frequencies of gamma/delta T cells in any of the patient groups, whereas one adult expatriate studied in Ghana and three adults admitted to the hospital in Copenhagen, Denmark, all with uncomplicated, primary P. falciparum malaria, showed increased gamma/delta T-cell frequencies similar to those previously reported. All patients had lowered absolute numbers of peripheral gamma/delta T cells at admission, changing to increased numbers by days 7 to 14 and then returning to normal levels. The study raises questions regarding age and degree of previous exposure as determinants of malaria-induced gamma/delta T-cell responses.

Adult↗
PubMed1994

Drug compliance among parents and guardians of children in Accra, Ghana.

Through a structured questionnaire, 523 parents and guardians who received prescription to collect medicine for their wards at the pharmacy of the Department of Child Health, Korle Bu Teaching Hospital were interviewed during the months of March and April, 1993. The objectives were to determine to what extent they remembered prescription instructions for their wards and to find out any other factors that contributed to drug non-compliance. A large percentage (about 80%) were able to recount instructions given correctly. It was however worrying, that quite a sizeable number could not recount instructions given. This obviously contributed to non-compliance. Other factors that were found and which could have contributed to non-compliance were: poor economic standing, non-availability of drugs at the hospital pharmacy, availability of similar drugs at home and patients getting well before the scheduled period of treatment is over. Of particular concern was the response by some parents/guardians that they would double the dosage to their wards to make up for a missed one should they forget any of the scheduled doses. Workers at pharmacy shops need to use simple practical means of giving prescription instructions, especially to illiterate patients.

Adolescent↗
PubMed1994

Bacterial meningitis in children in southern Ghana.

One hundred and three children (1% of seriously ill children referred to the Korle Bu Teaching Hospital in Accra) were admitted with bacterial meningitis over a 17 month period. 43 of these children had been ill for more than 4 days before arrival at our centre. The main causative organisms were S. pneumoniae (47.9%), Neisseria meningitides (38.4%) and Haemophilus influenzae (9.6%). All bacterial isolates were highly sensitive to ceftriaxone. Resistance to penicillin and chloramphenicol was however present in 5-17% of isolates. All cerebrospinal fluid samples were sterilised within 48 hours of antibiotic treatment. Case fatality rate was 22% with the majority of deaths occurring within hours of admission and closely related to S. pneumoniae infection. Neurological complications occurred in 22%; mild diarrhoea in 33% and secondary fever in 14.8% of survivors. No significant difference was noted among the three treatment regimens of ceftriaxone alone, penicillin plus chloramphenicol, and ceftriaxone alone for 48 hours followed by penicillin/chloramphenicol combination. Our overall outcome would have been better if patients had been started on appropriate antibiotic treatment within the earlier hours of the infection. Furthermore, the latter generation cephalosporins, including ceftriaxone, must be given consideration as antibiotics of first choice world wide.

Anti-Bacterial Agents↗
PubMed1992

Pediatric cerebral malaria in Accra, Ghana.

Characteristics of pediatric cerebral malaria, including specificity of clinical diagnosis, efficacy of antimalarial regimens, and the influence of drug resistance remain poorly defined in many parts of the world. The utility of the Glasgow coma scale and quantitative assessment of parasitaemia levels as diagnostic and prognostic indices in cerebral malaria were determined in this study. Thirty-one pediatric patients with admission diagnoses of cerebral malaria in the emergency ward at Korle Bu Hospital, Accra, Ghana were evaluated. Mean age was 4.8 years. The initial diagnosis of malaria was confirmed in 65 per cent of patients; 16 per cent ultimately received another diagnosis including pneumonia, meningitis or encephalitis. In 19 per cent the diagnoses were inconclusive. Mean initial blood parasitaemia level was 10(4.6) parasites per mm3, and mean initial Glasgow coma score was 10.4. The initial Glasgow score was a better predictor of length of stay (Pearson correlation coefficient r = 0.66) than initial parasitaemia level (r = 0.17). For most treated patients parasitaemia levels decreased a mean of 1.3 logs per day of therapy; however, in 33 per cent parasitaemia continued to rise or fluctuate. High parasitaemia levels were associated with deep levels of coma, but only when both parameters were assessed throughout the hospital stay. Both deaths in this series occurred in patients who had persistently negative blood smears for malaria parasites, but showed autopsy findings consistent with cerebral malaria.

Child↗
PubMed1985

The nutritional status and feeding practices among sick urban pre-school children admitted to a major hospital in Accra, Ghana.

In a prospective study of 652 sick pre-school children only 33% were found to be adequately nourished. Among the malnourished, 54.3% had first degree malnutrition while 32.3% and 13.4% had second and third degree malnutrition respectively. The majority of malnourished children (72.4%) had undernutrition: kwashiorkor (14.2%), marasmus 7.3%) and marasmic kwashiorkor (6.1%) was relatively less common. Furthermore, 58% of the underweight children were stunted, indicating malnutrition of some considerable duration. Malnutrition was essentially of postnatal origin and closely related to a high incidence of malnutrition-associated illnesses: diarrhoea (74%), measles (51%) and intestinal parasites (54%). Though breast feeding was universal and of adequate duration, milk production was mostly inadequate because of too early supplementation with low-energy cereal gruels with little or no protein-enrichment. The majority of children came from low socio-economic homes (61%) with mostly illiterate or semi-literate mothers. It is essential that newer methods of teaching be employed in the health education of these unfortunate mothers. Health institutions other than well-baby clinics need to have integrated units for nutritional and immunization surveillance and also for serving as avenues for the supply of free supplementary food items to children with poor weight gain, especially those from poor homes. Clinical Nutrition Units are needed to ensure that inpatients receive nutrients sufficient for continuing and catch-up growth.

Adult↗
PubMed1984

Measles in Ghana--1973-1982.

Admissions of children with measles constituted 8.8% of all admissions to the paediatric medical service of the Korle Bu Teaching Hospital, Accra, over the ten-year-period 1973-1982. Measles remains endemic in urban Accra as in the towns of other developing nations. The peak of admissions occurred in the age range seven to 12 months. Complications were frequent, with a high mortality (16.86%). Bronchopneumonia, the commonest complication (63.9%) was also the commonest cause of death in 51.5% of cases. Comparative national case-mortality rates were, however, surprisingly low and should be accepted with caution. There is an urgent need for intensification of immunization efforts through amalgamation of the preventive and curative services of Ghana, especially for children attending health centres for medical care. Vaccination should be administered before the peak age of admission, preferably at six months of age, with a second dose administered as soon after one year of age as possible.

Age Factors↗
PubMed1976

Physical signs in childhood asthma.

In 62 children with bronchial asthma, the presence of subjective dyspnea and wheeze, and some physical signs commonly associated with chronic obstructive airway disease in older patients, were compared with results of routine pulmonary function tests. Overall, airway resistance and the relationships of residual volume and functiona residual capacity to total lung capacity were increased and other measurements of pulmonary function were moderately decreased. The time-honored subjective dyspnea, wheeze, rhonchi, and prolonged expiration were least useful as indices of severity of disease. Most of the patients, particularly those in whom laboratory testing revealed marked impairment, had notable rhonchi, prolonged expiration, scalene muscle and sternocleidomastoid contraction, and supraclavicular indrawing. Only sternocleidomastoid contraction and supraclavicular indrawing clearly correlated with the severity of airway obstruction. A call is made for a search for these useful signs, whose presence may be the only clue to moderately severe disease; however, their absence does not guarantee absence of severe airway obstruction.

Adolescent↗
PubMedDate not supplied

Childhood deaths from anaemia in Accra, Ghana.

Severe anaemia has remained a major cause of morbidity and mortality in children of Southern Ghana since the early 1960s. 71.1% of 15450 children attending the Korle Bu Teaching Hospital, Accra referred to the laboratory for haematological studies had haemoglobin (HB) levels below 11.0 Gm/dl while 27.7% of anaemic patients had Hb levels below 7.0 gm/dl. Indeed, 71.1% of children with severe anaemia had Hb levels below 5.0 gm/dl, thus requiring urgent blood transfusion. Though the Department of Child Health alone utilised 32.2% of total blood processed by the National Blood Transfusion Service at Korle Bu, as many as 259 (58.1%) of the 554 deaths in the emergency rooms per annum in children beyond the neonatal period were related to severe anaemia. Iron deficiency was the commonest cause of anaemia and contributed further to the anaemias of sickle cell disease and protein--energy malnutrition. In the light of the significant decline in the prevalence of childhood anaemia in the developed world following improved counseling in nutrition, fortification of foods with iron, and iron supplementation to infants and school children, and the documented attendant improvement in growth velocity and intellectual performance we support the planned national anaemia survey and recommend for early consideration iron supplementation to older infants and pre-school children at risk.

Anemia↗
PubMedDate not supplied

Measles in southern Ghana: 1985-1993.

Measles continues to be a significant cause of morbidity and mortality among children in Southern Ghana although at a much lower level than a decade earlier. The major indications for measles admissions and the mortality associated factors of pneumonia, malnutrition, and diarrhea complicated by dehydration, however remain the same. The majority of measles admissions were in children without primary immunization resident in the more densely populated inner city of Accra and the peri-urban areas inhabited by lower-income recent immigrants. Our data show uncomfortable increases in the number of children aged 3-8 months as well as school age children (> or = 60 months), thus reopening the perennial discussion on the measles immunization programme i.e. what to do with younger infants with doubtful maternally-derived protection as well as the children who have missed their primary immunization at 9 months or those with immunization failure. The advantages of the 2-dose measles immunization programme need urgent consideration by national programme directors in African countries. The second dose is especially advocated to address the attendant problems of the cold chain system, vaccine efficacy, vaccine failure and diagnostic errors as older school-going age children.

Child↗
PubMedDate not supplied

Neurodevelopmental problems in Ghanaian children: Part I. Convulsive disorder.

Children with convulsive disorder made up 3% of new patients seen in the paediatric department over a ten year period and 51.5% of children subsequently enrolled in the paediatric neuro-developmental clinic of the Korle Bu Teaching Hospital in Accra, Ghana. Generalised tonic-clonic seizures were the commonest type of seizure (76.5%), followed by complex seizures (14.8%) and temporal lobe seizures (3.4%). Majority of patients had no definable cause and normal neurological examination. 47.7% of electroencephalographs had diagnostic abnormalities. Most patients responded well to conventional antiepileptic drugs (AEDs) leading to discontinuation of drug therapy in 48 (7.1%) patients who remained seizure-free for two or more years. Adverse drug reactions and laboratory test abnormalities were rather uncommon. Discontinuation of antiepileptic therapy after effective long-term control is discussed.

Anticonvulsants↗
PubMedDate not supplied

Acute respiratory infections in young children comparative findings in emergency rooms in Accra, (Ghana) and Harare (Zimbabwe).

A descriptive study of the emergency room outcome of Acute Respiratory Infections (ARI) in children aged 0-3 years in the department of Child health of the Korle Bu Teaching Hospital (KBTH), Ghana and Parirenyatwa Hospital (PH), Zimbabwe was undertaken in June-July 1993. Each hospital's emergency room received over one thousand patients during the period with ARI contributing 22.4% to 45.5% of all admissions. KBTH had the lower incidence of ARI; probably as a result of the general lack of knowledge of ARI, resulting in late case of identification and referral for treatment. In PH, the colder environmental temperatures in June/July, the comprehensive ARI control programme and the HIV/AIDS and Tuberculosis epidemic could in part explain the relatively high attendance of patients with ARI to the emergency room. Our study shows an appreciable decline in the severer forms of ARI from the first to the third year of life, confirming the noted importance of younger age as a universal risk factor in ARI outcome. Lower respiratory infections, mainly pneumonia and bronchiolitis were more prevalent in both countries, while the chance of a child dying from ARI was higher in KBTH. Ghana urgently needs a comprehensive national ARI control programme based on the WHO case control programme guidelines with antibiotics permissible at all levels of the health service.

Acute Disease↗