Adam Gyedu

• MD, MPH FWACS FICS FGCS
• Associate Professor at Kwame Nkrumah University of Science and Technology

[This corrects the article DOI: 10.1371/journal.pone.0300458.].

Introduction Hawthorne effect refers to changes in clinician behavior in response to being observed. It has been minimally evaluated in trauma and surgical research, especially in low‐ and middle‐income countries (LMICs). Methods We used data from the first (control) phase of a randomized clinical trial in Ghana (2020‐21). Trained observers were s...

Snapshot of trauma and anesthesia care capacity and preparedness in resource-limited setup in the face of war: the case of northern Ethiopia. Hussien Endris Assen, KalabTesfaye, Kassaye Demeke Altaye, Aklilu Yiheyis, Khalid Jemal, Demeke Yilkal, Ashenafi Amsalu, Lema Derseh, Yophtahe W/Gerima, Tadesse Belayneh, Mekuanint Tiruneh, Almaw Bitew, Sew...

Background In low- and middle-income countries (LMICs), most road traffic injury victims are vulnerable road users. Injuries and deaths are frequent, as walking, cycling, and traveling on motorized two and three-wheelers are the most common modes of transportation in LMICs, emphasizing the intersection of mobility and equity in transportation plann...

Background Globally, injuries are a leading cause of death, especially in low- and middle-income countries. Although trauma care improvements have reduced mortality rates, efforts in these countries mainly target tertiary centers rather than smaller hospitals closer to the scene of injuries. Enhancing initial assessment and care provision at the pr...

Background Road safety authorities in high-income countries use geospatial motor vehicle collision data for planning hazard reduction and intervention targeting. However, low-income and middle-income countries (LMICs) rarely conduct such geospatial analyses due to a lack of data. Since 1991, Ghana has maintained a database of all collisions and is...

Background Although road traffic injuries and deaths have decreased globally, there is substantial national and sub-national heterogeneity, particularly in low- and middle-income countries (LMICs). Ghana is one of few countries in Africa collecting comprehensive, spatially detailed data on motor vehicle collisions (MVCs). This data is a critical st...

Road traffic collisions disproportionately impact Ghana and other low- and middle-income countries. This study explored road user perspectives regarding the magnitude, contributing factors, and potential solutions to road traffic collisions, injuries, and deaths. We designed a qualitative study of 24 in-depth interviews with 14 vulnerable road user...

Background Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia...

Introduction Frequent reassessment of injured patients is an important component of trauma and emergency care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve assessment and reassess...

Background The experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes. Methods This study is a follow-up surve...

Background We sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at district (first‐level) and regional (second‐level) hospitals in Ghana and to assess the effectiveness of a standardized trauma intake form (TIF) to improve care. Methods A stepped‐wedge cluster randomized trial was performed with direct...

Background: The WHO Trauma Care Checklist improved key performance indicators (KPIs) of trauma care at tertiary hospitals. A standardized trauma intake form (TIF) with real-time clinical decision support prompts was developed by adapting the WHO Trauma Care Checklist for use in smaller low- and middle-income country hospitals, where care is delive...

Background: Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions...

Background: A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma...

The Trauma Intake Form was designed to function as a checklist that is built into the patient's clinical chart and provides prompts on the critical components of assessment and care of the injured.

Background Ghana has a large and growing burden of injury morbidity and mortality. There is a substantial unmet need for trauma surgery, highlighting a need to understand gaps in care.Methods We conducted 8 in-depth interviews with trauma care providers (surgeons, nurses, and specialists) at a large teaching hospital to understand factors that cont...

Background: Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delive...

Background Enterally based resuscitation for major burn injuries has been suggested as a simple, operationally superior, and effective resuscitation strategy for use in austere contexts. However, key information to support its implementation is lacking, including palatability and acceptability of widely available rehydration drinks. Methods We per...

Inguinal hernia repair aims to improve patients’ quality of life (QoL). Mesh repair of inguinal hernia is the standard of care. The high cost of a commercial mesh precludes its extensive use in most rural and urban parts of West Africa. We compared patients’ QoL after nylon darn repair of inguinal hernias to that after polypropylene mesh repair of...

Introduction: We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. Methods: Trained observers were stationed at emergency units of six district (first level) and two region...

Background Existing emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems. Methods A systematic review and thematic an...

Purpose To determine the population-based rate of emergency surgery performed in Ghana, categorized by hospital level. Methods Data on operations performed from June 2014 to May 2015 were obtained from a nationally representative sample of hospitals and scaled up to nationwide estimates. Operations were categorized as to: “emergency” or “elective”...

Objective We aimed to describe the incidence of childhood household injuries and prevalence of modifiable household risk factors in rural Ghana to inform prevention initiatives. Setting 357 randomly selected households in rural Ghana. Participants Caregivers of children aged <5 years. Primary and secondary outcome measures Childhood injuries tha...

Background The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet...

Introduction: falls contribute to almost one-fifth of injury-related deaths. The majority of these occur in low- and middle-income countries. The impact of fall injury in low- and middle-income countries is greater in younger individuals. We aimed to determine the epidemiology of falls among rural Ghanaian children. Methods: from March to May, 2...

Background Childhood household injuries incur a major proportion of the global disease burden, particularly in low- and middle-income countries (LMICs). However, household injury hazards are differentially distributed across developed environments. Therefore, we aimed to compare incidence of childhood household injuries and prevalence of risk facto...

Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on...

p>Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications...

Introduction : Hemorrhage is an important cause of preventable injury-related death. Many low- and middle-income country (LMIC) patients do not have timely access to safe blood. We sought to determine the degree of appropriateness of blood transfusion among patients with injuries requiring surgical intervention at presentation to a tertiary hospita...

Background Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aim...

Objective: To determine the association between having government health insurance and the timeliness and outcome of care, and catastrophic health expenditure in injured patients requiring surgery at a tertiary hospital in Ghana. Methods: We reviewed the medical records of injured patients who required surgery at Komfo Anokye Teaching Hospital i...

Introduction The majority of injury deaths occur outside health facilities. However, many low- and middle-income countries (LMICs) continue to lack efficient Emergency Medical Services (EMS). Understanding current first aid practices and perceptions among members of the community is vital to strengthening non-EMS, community-based prehospital care....

Introduction Ghana implemented a National Health Insurance Scheme (NHIS) in 2003 as a step toward universal health coverage. We aimed to determine the effect of the NHIS on timeliness of care, mortality, and catastrophic health expenditure (CHE) among children with serious injuries at a trauma center in Ghana. Methods We performed a retrospective...

Background We aimed to determine the incidence of childhood burn injuries in rural Ghana and describe modifiable household risk factors to inform prevention initiatives. Methods We performed a cluster-randomized, population-based survey of caregivers of children in a rural district in Ghana, representing 2713 households and 14,032 children. Caregi...

A sensitivity analysis of multivariable regression on association of NHIS with time to surgery, mortality and experience of catastrophic health expenditure among injured patients presenting to Komfo Anokye Teaching Hospital, Ghana, who needed surgery at time of admission, 2015 - 2016

Purpose To estimate the population-based annual rate of hernia surgery in Ghana, so as to better define the met and unmet need and to identify opportunities to decrease the unmet need. Methods Data on operations performed from June 2014 to May 2015 were obtained from representative samples of 48 of 124 district (first-level) hospitals, 9 of 11 reg...

Introduction Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs. Materials and Methods Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were catego...

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, we study aime...

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study ai...

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, we study aime...

Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study ai...

IMPORTANCE Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood. OBJECTIVE To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemiol...

Introduction Childhood burns are a leading cause of injury in low- and middle-income countries. Many childhood burns can be prevented by modifications in the household environment and targeted education. Therefore, we aimed to determine the incidence of childhood burn injuries and describe the prevalence of potentially modifiable household risk fac...

Background Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to study the safety and effectiveness of the ApriDec Medical Outreach Group (AMOG). Methods Data fr...

Objective To estimate the annual rate of obstetric and gynecologic (ObGyn) operations performed in Ghana and establish a baseline for tracking the expansion of Ghana's surgical capacity. Methods Data were obtained for ObGyn operations performed in Ghana between 2014 and 2015 from a nationally representative sample of hospitals and scaled up for na...

Background: The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma operations/100,000 persons, providing a benchmark for trauma surgery needs. We sought to determine G...

Introduction The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high-...

Backgroud: Groin hernia repairs (GHR), though classified as clean surgeries, are associated with varying rates of surgical site infections. We assessed the practices of surgeons in Ghana regarding antibiotic use for GHR in comparison to evidence-based international guidelines (EBIG). Methods: We interviewed surgeons trained by the Ghana College...

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who ha...

Background Prior to 2003, production of new surgeons in Ghana was limited. In 2003, the Ghana College of Physicians and Surgeons (GCPS) initiated the first wholly in-country training and credentialing of surgeons. The purpose of this study was to assess the impact of in-country training of surgeons in Ghana. Methods We interviewed 117 (80%) of the...

Background: Ghana passed a law in 2012 banning the use of mobile phones while driving. However, data on compliance to the law has been lacking. Objective: To examine factors associated with mobile phone use while driving among Ghanaian commercial drivers. Methods: A survey was conducted among 627 commercial drivers (98.0% response rate). Bivar...

Background and Objectives Outcome data after surgery for cancer in Sub‐Saharan Africa are insufficient. We aimed to describe the presentation and outcomes of patients with solid cancers managed at a tertiary hospital in Ghana. Methods Records of cancer patients admitted to Komfo Anokye Teaching Hospital general surgery wards from 2013 to 2016 were...

Objective: Translation of evidence to practice is a public health priority. Worldwide, injury is a leading cause of morbidity and mortality. Case study publications are common and provide potentially reproducible examples of successful interventions in healthcare from the patient to systems level. However, data on how well case study publications...

Objective: Capacity assessments serve as surrogates for surgical output in low- and middle-income countries where detailed registers do not exist. The relationship between surgical capacity and output was evaluated in Ghana to determine whether a more critical interpretation of capacity assessment data is needed on which to base health systems str...

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort stu...

In the original article some funding information was inadvertently omitted. The complete funding information is as follows.

Purpose: The burden of breast cancer continues to increase in low- and middle-income countries (LMICs), where women present with more advanced disease and have worse outcomes compared with women from high-income countries. In the absence of breast cancer screening in LMICs, patients must rely on self-detection for early breast cancer detection, fo...

Background: We aimed to assess surgeons' access to and use of medical information, as well as their training and perceptions about evidence-based medicine (EBM), in order to identify priority areas for improvement. Study design: An anonymous survey conducted among surgeons from the USA, Ghana, Peru, and Thailand examined access to, and use and p...

Objective: To evaluate the operation rate in Ghana and characterize it by types of procedures and hospital level. Background: The Lancet Commission on Global Surgery recommended an annual rate of 5000 operations/100,000 people as a benchmark at which low- and middle-income countries could achieve most of the population-wide benefits of surgery,...

Introduction: Many low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to assess the cost-effectiveness of surgical outreach missions provided by a wholly local organiza...

Systematic assessments of individual-and community-level barriers to surgical care (BSC) in low-and middle-income countries that might inform potential interventions are lacking. We used a novel tool to assess BSC systematically during a surgical outreach in two communities in Upper West region, Ghana. Results were scored in three dimensions of bar...

Background: Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of patients with...

Background: Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify ho...

There are major differences in etiology, tumor characteristics, treatment, and survival of HCC patients between Egypt and other African countries. In the absence of early diangosis or treatment, outcomes of HCC in most African countries were extremely poor. No HCC treatment, HBV etiology, large tumor extent, serum AFP, poor performance status, and...

Background Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need. Methods Using geospatial methods, this study e...

Introduction The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained...

Objective: Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. Methods: The normative Delphi method was...

Background Women in developing countries might experience certain barriers to care more frequently than men. We aimed to describe barriers to essential surgical care that women face in five communities in Ghana. Methods Questions regarding potential barriers were asked during surgical outreaches to five communities in the northernmost regions of Gh...

Importance Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood. Objective To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemi...

Introduction: We aimed to describe the burden of fires in displaced persons settlements and identify interventions/innovations that might address gaps in current humanitarian guidelines. Methods: We performed a systematic review of: (i) academic and non-academic literature databases; and (ii) guidelines from leading humanitarian agencies/initiat...

Objective: Childhood burns are a leading cause of injury in low- and middle-income countries; most of which are preventable. We aimed to describe the prevalence of household risk factors for childhood burn injury (CBI) in semi-urban Ghana to inform prevention strategies for this growing population. Methods: We conducted a population-based survey...

Background: This study aimed to describe national peripheral vascular disease (PVD) risk and health burden, and vascular care capacity in Ghana. The gap between PVD burden and vascular care capacity in low- and middle-income countries was defined, and capacity improvement priorities were identified. Methods: Data to estimate PVD risk factor burd...

To the Editor: Hepatocellular carcinoma (HCC) is highly endemic in Africa (1). There is a general anecdotal consensus that persons with HCC induced by viral hepatitis or other causes in Africa present at younger ages than in other regions of the World. This has resulted in recommended guidelines that surveillance of African-born persons at risk for...

Importance Trauma care capacity assessments in developing countries have generated evidence to support advocacy, detailed baseline capabilities, and informed targeted interventions. However, serial assessments to determine the effect of capacity improvements or changes over time have rarely been performed.Objective To compare the availability of...

This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of...

Introduction: Laparoscopy has become the gold standard for many surgical cases in the developed world. It however, remains a rarity in developing countries for several reasons, a major one being cost. This study aimed to determine the knowledge and attitude of patients attending Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana toward laparos...

Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income co...