Serwah Bonsu Asafo-Agyei

Diabetes mellitus in children, adolescents and young adults presents major clinical, social, and psychological challenges, particularly in low- and middle-

Background and Aim: Pneumonia contributes substantially to the childhood mortality burden in low and middle‐income countries (LMICs). Reported predictors of mortality in childhood pneumonia in LMIC are varied. This study aimed to describe predictors of mortality among children with pneumonia in a tertiary hospital in Ghana. Methods: A retrospective cohort study that reviewed demographics, clinical features, admission outcomes, and predictors of in‐hospital mortality among Ghanaian children admitted with pneumonia. Outcome measures of interest were survival and death. Results: A total of 630 children were eligible for the study; 394 (62.5%) had medical records that were at least 85% complete. 56% ( n = 220) were males. Children who died had a median age of 8 months (IQR: 4–17) and 12 months (IQR: 6–24) for the survivors. Among children with pneumonia, 74% ( n = 290) were younger than 24 months, and 73.3% ( n = 239) were fully immunized. Mortality rate was 19% ( n = 75/394), 34 children died within 24 h of admission, and a cumulative 42 children died within 48 h of admission. Hypoxemia at presentation was more frequent, 38.6% ( n = 27), among those who died compared to the survivors, 17% ( n = 47). Lower chest wall indrawing (LCI) occurred in both groups (80% vs. 60%, respectively). Predictors of mortality included; presence of diarrhea (aHR = 2.19, 95% CI:1.02–4.71, p = 0.05), hypoxemia (aHR = 2.08, 95% CI:1.09–3.96, p = 0.03). Conclusion: We observed a high burden of pneumonia in very young children. The predictors of mortality were hypoxemia and diarrhea.

Background and Aims: Anemia remains a major contributor to pediatric morbidity and mortality in sub‐Saharan Africa, yet contemporary data from tertiary pediatric emergency settings are limited, particularly among children older than 5 years. This study assessed the prevalence, factors associated with anemia, hematological characteristics, and short‐term clinical outcomes among children admitted to a pediatric emergency unit (PEU) in Kumasi, Ghana. Methods: This prospective observational study enrolled children aged 2 months to 17 years admitted to the PEU of Komfo Anokye Teaching Hospital, Ghana, between November 2024 and January 2025. Sociodemographic, dietary, and clinical data were obtained through caregiver interviews and medical record review. Anemia was defined and graded using age‐ and sex‐specific World Health Organization hemoglobin thresholds. Red cell indices were used to describe anemia morphology. Logistic regression analysis was employed to identify factors independently associated with anemia. Results: Among 318 children enrolled, 66.7% had anemia. Mild, moderate, and severe anemia accounted for 14.8% (47/318), 34.6% (110/318), and 17.3% (55/318) of cases, respectively. Among children aged 6–59 months, 65.3% (113/173) were anemic. Moderate anemia predominated across age groups, while severe anemia was more frequent among older children. Microcytic anemia with elevated red cell distribution width was the most common morphological pattern, suggesting a high burden of iron deficiency. Anemia was independently associated with clinically presumed iron deficiency, sickle cell disease, and malaria rapid diagnostic test positivity. Nearly one‐quarter of participants required blood transfusion, reflecting the severity of presentations. Conclusion: Anemia was highly prevalent among children admitted to a tertiary pediatric emergency unit in Ghana and was frequently associated with severe disease requiring blood transfusion. Strengthened strategies focusing on early identification of hemoglobinopathies, prompt malaria control, and improved nutritional assessment and counseling are urgently needed within emergency and inpatient pediatric care.

Objective: This study described the spectrum of neural tube defects (NTDs) and identified factors associated with their occurrence among hospitalised infants admitted at Komfo Anokye Teaching Hospital (KATH), Ghana. Methods: We conducted an institution-based unmatched case-control study on 293 infants (97 cases, 196 controls) admitted to KATH between September 2024 and June 2025. Maternal sociodemographic, obstetric, behavioural and environmental characteristics were collected using a structured questionnaire. Bivariate and multivariable logistic regressions were used to identify factors independently associated with NTDs. Results: Of the 97 infants with NTDs, 81(83.5%) had spina bifida, 15(15.5%) had encephalocele and 1(1.0%) had anencephaly. Delayed folic acid supplementation (AOR: 1.16, 95%CI: 1.09 - 1.23 p<0.001), periconceptional herbal medicine use (AOR: 4.25, 95%CI: 1.89 - 9.84, p<0.001) and exposure to agrochemicals and/or pesticides (AOR: 3.66, 95%CI: 1.30 - 10.60 p=0.015) were independently associated with NTDs. Conclusion: Delayed folate supplementation, periconceptional herbal medicine use and exposure to agrochemicals or pesticides were independently associated with NTDs.

Incomplete childhood immunisation remains a global concern, especially following disruptions caused by the COVID-19 pandemic. This study assessed the immunisation status and clinical outcomes of children admitted to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH), Ghana, from November 2024 to January 2025. Differences in vaccination coverage before and after the pandemic were also explored by comparing immunisation status between children under five and those aged five years and above. This prospective cohort study collected data on demographic characteristics, clinical diagnoses, outcomes, and immunisation status through caregiver interviews and medical record review using a structured questionnaire. Immunisation status was evaluated against the Ghana Expanded Programme on Immunisation (EPI) schedule. Reasons for incomplete immunisation were also explored. Logistic regression was used to identify factors associated with vaccination default and their outcomes. Out of 401 children admitted, 95 were excluded (13 readmissions, 77 inadequate immunisation records, five refusals), leaving 306 enrolled. Median age was 3.2 years (IQR 1.2, 7.6), and 55.9% were male. Overall, 74.5% were fully vaccinated for age, 24.5% under-vaccinated, and 1.0% unvaccinated. Vaccination default was significantly more common in children under five years (AOR: 7.86, 95% CI: 3.66–19.2). Mortality was higher among un- and under-vaccinated children (16.7%) compared to fully vaccinated (7.0%) children. While univariate analysis demonstrated a significant association between vaccination default and mortality (p = 0.017), this association did not remain significant in multivariate analysis. Instead, vaccination default was independently associated with younger age, the presence of respiratory distress at presentation, and a shorter duration of hospital stay. Caregiver hesitancy (48.7%), vaccine unavailability (20.5%), and child-related health issues (19.2%) were the leading reasons for vaccination default. Immunisation coverage in children admitted to the PEU was suboptimal, with younger children, especially those vaccinated during or after the COVID-19 pandemic, being disproportionately affected. Strengthening routine immunisation services, addressing caregiver concerns, and institutionalising catch-up vaccination protocols in hospitals are critical. The online version contains supplementary material available at 10.1186/s12887-025-06365-2.

This study sought to determine the prevalence and types of ocular pathologies in Ghanaian children and young adults with type 1 diabetes mellitus (T1DM). This cross-sectional study was conducted during a 4-day annual T1DM camp in December 2024. An ophthalmologic examination was performed, including visual acuity assessment, slit-lamp examination, and dilated fundoscopy. The visual acuity of participants with established refractive errors was evaluated after refractive correction. Visual impairment was classified as mild, moderate, or severe based on the International Classification of Diseases 11 definitions of visual impairment and blindness. Sociodemographics, HbA1c, and information about diabetes onset and duration were also documented. Univariate and multivariate analyses were used to evaluate for potential associations between ocular abnormalities and diabetes-related factors such as HbA1c, diabetes duration and patient age. A total of 110 children, adolescents and young adults (mean age 18.8 years, SD 5.0) were examined. The study cohort comprised 71 females (64.5%) and 39 males (35.5%). The mean duration of diabetes was 6.3 years (SD 3.9). The mean HbA1c was 10% (SD 1.8). No cases of diabetic retinopathy were observed. However, 43.6% of the participants had some degree of visual impairment. Other ocular findings, including iris atrophy (0.9%), cataracts (3.6%), intraocular lens posterior capsule opacification (1.8%) and a posterior chamber intraocular lens (0.9%), were also documented. Univariate analysis demonstrated a significant association between the duration of diabetes and the presence of right lens abnormalities. In multivariate analysis, increasing patient age emerged as an independent predictor of lens abnormalities. Additionally, higher HbA1c levels and longer duration of diabetes were positively correlated with the presence of visual impairment. While no cases of diabetic retinopathy were detected in this population, a significant proportion of youth with T1DM had visual impairment and lens abnormalities. Not applicable.

Background: Pregnancy in patients with diabetes is known to be associated with complications. Improving glycaemic control can improve pregnancy outcomes. Aims: This study assessed pregnancy outcomes among adolescents and young women with diabetes at Paediatric and Adolescent Diabetes Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods: A clinical review involving eighteen children and young women with diabetes who became pregnant during follow-up care at Paediatric and Adolescent Diabetes Clinic in Ghana. Girls and young women suspected to be pregnant were referred to antenatal clinic for confirmation. Multidisciplinary care including comprehensive antenatal care was given to each participant throughout the pregnancy. Questionnaire was used to gather demographic and clinical information of participants including pregnancy outcomes. Results: A total of eighteen adolescents and young women got pregnant and were included in the study. They were attending school when they got pregnant, 55.6% were in Senior High School, 33.3% were in Junior High School and 11.1% were in Teacher Training College. The mean age at pregnancy was 18.39 years (SD 2.97). Two pregnancies ended in abortion while 16 resulted in 18 live births (14 singleton and 2 twin deliveries). All deliveries were supervised, 56.3% delivered via cesarean section. Two births were preterm, occurring at 30 and 32 weeks of gestation. Neonatal outcomes were generally favorable: all babies were clinically well, 55.6% had 5-minute APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score between 8 and 10, while 44.4% had 5-minute APGAR score between 6 and 7. Only one infant (5.6%) had a congenital malformation. One baby died at one month due to septicemia. Conclusion: Structured multidisciplinary interventions led to positive pregnancy outcomes among young females with diabetes in Ghana.

Background and Aims: Sickle cell disease (SCD) is the most common clinically significant genetic disorder affecting about 300,000 newborns globally each year. In Ghana, a prevalence of 1.8% exists among newborns. With increasing life expectancy, assessment of the effect of progressive organ damage on quality of life becomes essential. Organs involved could be the lungs, heart, brain, kidney, and bones. This study aims to describe major organ dysfunction and its associated factors in children aged 6–16 years with SCD in the Kumasi Centre for Sickle Cell Disease (KC‐SCD) patient cohort in Kumasi, Ghana. Methods: It will be a cross‐sectional study conducted over a 1‐year 8‐month period at the pediatric sickle cell clinic of the Komfo Anokye Teaching Hospital (KATH). All patients, except those coming for acute care or emergency visits, will be eligible for enrollment. Data on sociodemographic details, medical history, and previous complications, anthropometry, and pubertal stage will be collected. Full blood count, reticulocyte counts, lactate dehydrogenase counts, lung function tests, electrocardiogram, echocardiogram, mental health status assessment and pubertal staging will be conducted to assess end organ dysfunctions. Data will be entered into a REDCap database, cleaned, and exported to the STATA statistical software for analysis. The prevalence of specific end‐organ dysfunction will be determined based on predefined criteria. Subsequently, the relationship between the various end‐organ dysfunctions and clinical and laboratory covariates will be determined using inferential analysis. Conclusion: These results will help to know the burden of end organ damage in our pediatric population and subsequently feed into the recommendations and hospital policies for screening for end organ dysfunction.

Differences in sex development (DSD) are congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical. Ovotesticular DSD is the rarest variant of DSD where both ovarian and testicular tissues co-exist in an individual. Ambiguous genitalia may be a glaring indicator of DSD, but multiple genital anomalies should also raise a suspicion of DSD. This is a case report of a 15-year-6-month-old boy who presented during infancy with multiple genital anomalies requiring surgery. The diagnosis of ovotesticular DSD was missed until later in adolescence when he presented with progressive bilateral breast enlargement. Work-up revealed a 46, XX karyotype and dysgenetic testes, but functional ovarian tissue. The patient wanted to consider switching to a female gender but was constrained by psychosocial factors. Maintenance of a masculine phenotype was done using testosterone injections due to the relatively high cost of testosterone patches. Conclusion. Multiple genital anomalies should raise the suspicion of DSD, and prompt referral to an endocrinologist should be done before urogenital surgery and gender assignment are carried out.

Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences have also been reported. This study was performed to establish norms for clitoral size in term Ghanaian female newborns. This was a cross-sectional study of all apparently well full-term newborns of postnatal age < 48 h and birth weight between 2.5 and 4.0 kg delivered at Komfo Anokye Teaching Hospital between May and September, 2014. Anthropometric and genital parameters were documented for study subjects as well as parental socio-demographic indices. In 612 newborn females studied, the mean (±SD) clitoral length (MCL) and the mean (±SD) clitoral width (MCW) were 4.13 ± 1.6 mm and 4.21 ± 1.1 mm, respectively. MCL was inversely related to birth weight (r = −0.62; p < 0.001) while MCW was inversely related to both gestational age (r = −0.1; p = 0.02) and birth weight (r = −0.54; p < 0.001). Babies with a clitoris that was completely covered by the labia majora had relatively lower clitoral sizes (p < 0.001) than those who had a partially covered or prominent clitoris. Neither MCL nor MCW differed significantly by birth length or maternal tribe. Clitoral size varies with birth weight and gestational age. Babies with a completely covered clitoris are unlikely to warrant detailed clitoral measurements for clitoromegaly.