Daniel N. A. Ankrah

Bio: Daniel N. A. Ankrah is an academic researcher from Korle Bu Teaching Hospital. The author has contributed to research in topics: Pharmacy & Medical prescription. The author has an hindex of 4, co-authored 6 publications receiving 27 citations. Previous affiliations of Daniel N. A. Ankrah include Utrecht University.

Incidence of adverse events among healthcare workers following H1N1 Mass immunization in Ghana: a prospective study

Abstract: Cases of the A(H1N1) 2009 influenza were first recorded in Ghana in July 2009. In June 2010 when prioritized vaccination against the novel A(H1N1) 2009 influenza virus started in the country, health workers were among the selected groups to receive the vaccination. The aim of this study was to determine the distribution and types of adverse events reported following immunization of healthcare workers at the Korle-Bu Teaching Hospital from the day vaccination started until 1 week after the end of vaccination. Safety data collected during the A(H1N1) 2009 influenza vaccination of health workers at the Korle-Bu Teaching Hospital (Accra, Ghana) were used for this study. All workers aged 18 years and over were eligible for vaccination. For uniformity, 0.5 mL of Pandemrix® (equivalent to 3.75 μg of hemagglutinin antigen) was administered intramuscularly into the deltoid muscle of the left arm. Each vaccinee was issued with a card and was advised to report any adverse events following immunization (AEFI) to designated health workers for follow-up. Incidence rates of adverse events were estimated and compared with the Pandemrix® Summary of Product Characteristics (SPC) A total of 5870 people (64.9 % females) with a mean age of 34.0 years were vaccinated. In total, 140 vaccinees reported adverse events. The mean age among vaccinees reporting adverse events was 36.1 years. The overall incidence of vaccinees reporting adverse events and the overall incidence of adverse events was 232 (95 % CI 199–320) per 10,000 people and 930 (95 % CI 820–1070) per 10,000 people, respectively. In particular, we found no difference in the way males reported AEFI compared with females (Chi-squared [χ2] = 0.59; p > 0.2), and we did not find any association between age as a categorical variable and vaccine adverse event reporting (χ2 = 5.24; p > 0.1). There were only three serious cases that led to hospitalization. All three cases occurred within 24 hours of receiving the vaccine. The incidence rates for the various reported events were all lower compared with those in the Pandemrix® SPC, but while injection-site pain was the most frequent in the SPC and other foreign studies, we recorded headache as the most frequent. Even fatigue, muscle/joint aches and fever had higher incidence rates compared with injection-site pain. Tachycardia (n = 6), tinnitus (n = 1) and decreased appetite (n = 4) were reported although were not included in the SPC. The most prominent adverse events reported were headaches, dizziness, muscle and joint aches, weakness, fever and injection-site pain. Although similar events were reported in other studies, the incidence was different and there were a few differences in the most frequently reported events. More studies of a similar nature should be encouraged in low- and medium-income countries to bridge the information gap with the developed world.

Patients' perception and expectations of services provided by pharmacists in Ghanaian hospitals

Abstract: A customer’s perceived value of service has been identified as one of the most important drivers of satisfaction. Using a cross-sectional survey among out-patients with a chronic disease in Ghana, this study assessed their perception on the role of the hospital pharmacist, their expectation of services provided by the hospital pharmacist and the factors encouraging them to speak to the hospital pharmacist. This was a cross-sectional survey of out-patients during visits to pharmacies at the Korle-Bu Teaching Hospital. Six pharmacies with a high patronage of patients with chronic diseases were purposively selected. A structured questionnaire was completed using a face-to-face approach and the results were presented in the form of descriptive and analytical (logistic regression) statistics. In all, 331 respondents made up of 56.8% women and 43.2% men were interviewed. The mean age of respondents was 42 years. Of those who responded, 87.3% (289/331) have had at least basic education and 63.7% of respondents were in some form of employment. In all, 77.2% at least agreed that the pharmacist is a health professional just like doctors and nurses, and only 3.8% of respondents strongly disagreed that their awareness of the role of the pharmacist has improved over the last five years. It was found that those who reported little difficulty identifying the pharmacy staff were about three times as likely (OR 3.19, 95% CI 1.78 to 5.80, p < 0.001) to request to speak with the pharmacist compared to those who found this difficult. Counseling services at the various pharmacies in the Korle-Bu Teaching Hospital need improvement. More work should be done by pharmacists to educate patients on the role of the pharmacist in providing pharmaceutical care. Key words: Patient’s perception, out-patient pharmacist, Korle-Bu Teaching Hospital.

Five-year trends in treatment changes in an adult cohort of HIV/AIDS patients in Ghana: a retrospective cohort study.

Abstract: There is limited information on patterns of treatment change among new initiators of highly active antiretroviral therapy (HAART) in the regions most affected by HIV/AIDS. This makes it difficult to identify the determinants of treatment change. In this retrospective cohort study, we examined treatment change patterns over a five-year period among initiators of HAART. De-identified data were obtained from the Fevers’ Unit Database at the Korle-Bu Teaching Hospital. All adult treatment-naive patients who started treatment with first line HAART between 1st January, 2008 and 31st December, 2012 were followed over a minimum period of three months. The main outcome was the first treatment change, defined as the first substitution/switch in accordance with the standard treatment guidelines. Data were analyzed stratified by year of treatment initiation. Crude and adjusted hazard ratios were calculated. A total of 3933 patients were followed with almost equal numbers of initiators per year. The mean age (standard deviation) at treatment initiation was 39 (10.3) years. The most prescribed HAART combination was AZT/3TC/EFV and overall for initiators zidovudine combination therapy was about 60%. Utilization of stavudine containing HAART increased gradually until 2010 and then dropped to zero. Over the study period, 44.9% of recorded deaths were from those initiated with a stavudine backbone, 41.1% from a zidovudine backbone, and 11.5% from a tenofovir backbone. Females had a significantly higher rate of treatment change compared to males (p-value = 0.0002), and d4T/3TC/EFV and d4T/3TC/NVP recorded independent treatment change hazard ratios of 12.05 (CI 9.58 to 15.16) and 12.03 (CI 9.27 to 15.61) respectively.. Kaplan-Meier curves showed that treatment change was higher among those who started treatment later in the study period compared with those who started earlier. A major treatment change in the utilization of antiretroviral medicines in Ghana occurred during the study period which was associated with type of treatment, year of treatment, gender and disease stage. The influence of a policy change during the period may have made a significant impact.. For diseases involving life-long treatment in particular, it is important to monitor and periodically evaluation treatment utilization patterns.

Insufficient access to oral paediatric medicines in Ghana: A descriptive study.

Abstract: Among the most vulnerable people in society are children and this is especially so in their access to health care Off-label prescription of paediatric medicines is known to be associated with safety outcomes some of which may be serious. This study identifies frequently prescribed children’s medicines that are not readily available in Ghana and are prepared extemporaneously. All prescriptions for extemporaneous oral preparations for children presented to the local production unit of the Korle-Bu Teaching Hospital from November, 2013 were eligible for the study. Information from such prescriptions was recorded in a systematic format. Presence of the prescribed medicine on the World Health Organization Children’s Medicine List was ascertained in addition to the anatomical and therapeutic classification code. The registration of the prescribed medicine for paediatric use by the Food and Drugs Authority, Ghana was also checked. Descriptive statistics of the data was presented. In all 622 prescriptions for 35 different paediatric formulations were served. Prescriptions from several health facilities including government hospitals (6.6 %, N = 622), private hospitals (2.4 %, N = 622) and the University of Ghana hospital (1.1 %, N = 622) were all honoured. Some of the prescribed medicines (Baclofen, Clonazepam, Hydroxyurea and Lamotrigine) were neither on the World Health Organization Children’s Medicine list nor registered with the Food and Drugs Authority, Ghana. Most prescribed medicines (88.6 %, N = 35) were for non-communicable diseases. Paediatric prescriptions including off-label medicines are prescribed and formulated extemporaneously in this setting. Steps should be taken to improve access and monitor benefit-risk profiles of paediatric medicines in order to improve treatment outcomes among children.

Adherence and Treatment Change among HIV/AIDS Patients in Ghana A Nested Case Control Study

Abstract: Objective: A level of 95% adherence to antiretroviral therapy (ART) has been found to benefit HIV/AIDS patients. Low adherence may lead to treatment failure, and may subsequently result in treatment change. The main objective of this study was to evaluate the effect of ART adherence on treatment change Methods: Data were extracted from available written clinical and pharmacy records, and the electronic database at the Korle-Bu Teaching Hospital. Cases comprised all those (≥15 years) who experienced a first treatment change after starting first-line ART between 1/1/2004 and 31/12/2009. Controls (who did not change treatment) were sampled from the same cohort of ART starters and matched to cases on date ART was started. Adherence was determined using the proportion of days covered (PDC) approach and poor adherence was defined as PDC levels below 95%. Measures of effect were calculated using conditional logistic regression. Results: The 298 cases and 298 matched controls were similar in most baseline characteristics. Among cases 20.1% (60/298) switched to second-line therapy and the rest had treatment substitutions. Overall, 88.9% of controls compared with 79.9% of cases had adherence levels greater than or equal to 95% (p=0.003). After adjusting for possible confounders, an adherence level below 95% was associated with almost four times (ORadj=3.56 (95% CI 1.60 to 7.88)) the likelihood of having a treatment change. Conclusion: This study showed that insufficient ART adherence was associated with about four times the likelihood of treatment change. Policy makers must partner researchers to engage patients more often, to unravel the causes of non-adherence, and make the necessary interventions for patients to achieve maximum benefits from dispensed medicines.

Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies.

Abstract: We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%-93.1%) and specificity of 96.1% (95% CI, 94.2%-97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.

Innovations in Pediatric Drug Formulations and Administration Technologies for Low Resource Settings.

Abstract: Despite advances in regulations and initiatives to increase pediatric medicine development, there is still an unmet need for age-appropriate medicines for children. The availability of pediatric formulations is particularly lacking in resource poor areas, due to, for example, area-specific disease burden and financial constraints, as well as disconnected supply chains and fragmented healthcare systems. The paucity of authorized pediatric medicines often results in the manipulation and administration of products intended for adults, with an increased risk of mis-dosing and adverse reactions. This article provides an overview of the some of the key difficulties associated with the development of pediatric medicines in both high and low resource areas, and highlights shared and location specific challenges and opportunities. The utilization of dispersible oral dosage forms and suppositories for low and middle-income countries (LMICs) are described in addition to other platform technologies that may in the future offer opportunities for future pediatric medicine development for low resource settings.

Adverse events following immunization with oral poliovirus in Kinshasa, Democratic Republic of Congo: preliminary results

Abstract: Aim: We investigated the nature and frequency of adverse events following immunization (AEFI) associated with oral polio vaccines (OPV) in the general population in Kinshasa, Democratic Republic of Congo (DR Congo).Methods: The DR Congo National Pharmacovigilance Centre organized active AEFI surveillance during mass immunization campaigns for the general population from March to June 2011. A patient individual case safety report was used as a questionnaire and addressed to pupils and students from high schools and universities who had any adverse events after OPV administration. We used the preferred term from the WHO Adverse Reaction Terminology for AEFI designation. Here is presented the results of the second step of the mass immunization campaign.Results: A total of 767 patients reported AEFI during the second step. Sex distribution shows that 512 (66·8%) students were females, while 255 (33·2%) were males, giving a female/male ratio 2∶1. The average age was 16·8±5·19 years (ranged: 6–35·5 year...

Pharmacy drive‐thru service in Jordan: assessing customers' awareness, perceptions and factors affecting the use of this service

Abstract: In Jordan, drive‐thru pharmacy service has recently been introduced representing a new trend in community pharmacy services. This study aimed to evaluate pharmacy customers' awareness and perceptions towards the drive‐thru service to unveil important information regarding such service.

DRIVE-THRU PHARMACY SERVICE: ASSESSMENT OF PERCEPTION AMONG PATIENTS OR CAREGIVERS IN HOSPITAL RAJA PEREMPUAN ZAINAB II Original Article

Abstract: Objective: The aim of this study was to evaluate the perception of patients or caregivers on drive-thru pharmacy in Raja Perempuan Zainab II Hospital (HRPZ II), Kelantan. Methods: A cross-sectional study was conducted from July to September 2014 on 387 patients or caregivers recruited from outpatient pharmacy, HRPZ II using a constructed survey form. The questionnaire was validated through a pilot study which yielded a Cronbach’s alpha score of 0.897. It comprised common socio-demographic characteristics as well as 3 domains which described subject’s experience in outpatient pharmacy, subject’s perception of drive-thru pharmacy and subject’s willingness to participate in the service. Results: More than half of respondents (n=231, 59.7 %) were aware of the existence of drive-thru pharmacy service. Almost all patients and caregivers (n=349, 90.2 %) perceived the service as useful to the public. Only a handful of them were reluctant to sign up, mainly due to the perception that it would cause lack of interaction between patients and pharmacists (n=16, 4.1%). Nearly three-quarters of participants (n=288; 74.4%) informed that they had never been asked to register as drive-thru pharmacy clients. They claimed that they were willing to use the service should it was offered to them (n=301; 77.8 %). Conclusion: This survey managed to garner positive feedbacks on drive-thru pharmacy. Most of the subjects perceived it as beneficial and were willing to use the service.