FOUR HEALTHY MODIFICATIONS FOR INFANT MEALS

a childInfant feeding can be a real daunting task. The struggle of finding the right healthy meal options for optimal growth coupled with fussy eating habits of children, mums of today are most likely to continuously stick to the one recipe or food brand their infant tolerates most and this act may result in certain unforeseen nutrient deficiencies in the child. Healthy eating should always adapt the principles of variety, balance and moderation.
Below are a few healthy modification, moms can try when cooking staples for their infants, to increase nutrient content of meals.

1. RICE
– Blend cooked vegetables (beet root, carrot, turkey berry, fresh Moringa leaves) and use as base for cooking rice.
– Cooked Vegetables can be diced or grated into rice (beet root, carrot).
– Coconut flesh and water can be blended and used as base.

2. PORRIDGES
– Coconut pulp and water can be blended and used as base for preparing porridges. Especially corn, oats & wheat based porridges.

3. YAM/POTATOES
– Boiled yam/potatoes can be mashed with grated carrot or beet roots.
– Vegetables can be steamed and mixed with mashed yam/potato.

4. FRUITS
– Fruits (washed and cleaned) can be mashed and mixed with milk. Fruits like pawpaw, banana, mango or soursop.
[Fruit – one portion, Milk – 3 teaspoons, or yoghurt – 240mls]

ARTICLE BY SALOMEY KOKORO
OFFICIAL DIETICIAN OF BISA
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Healthy Recipes: Whole Wheat Stir fry

stirFryTired of plain and boring white rice, let discover new ways to infuse some health into your daily meal choices. Whole wheat grains have been described to expose the body to a broader spectrum of nutrients. The bran and endosperm of the grain are packed with proteins, fiber, iron, B Vitamins       and antioxidants. Whole wheat has been linked with positive outcomes in the management of diabetes, blood cholesterol and weight control. This is just one of the reasons why you should include more wheat grains in your meals.

When we talk of wheat based meals, try thinking beyond wheat bread. There is a vast array of recipes which includes wheat as its main staple. Below is a simple wheat based recipe you can try

Ingredients

  • Whole wheat grains, 3/4 cup
  • Salt, 1/2 teaspoon
  • Vegetable oil ,1 tablespoon
  • Carrot , 3 small grated
  • Red/green bell pepper , 2 medium bulbs chopped
  • Onions, 2 medium bulbs chopped
  • Ginger, 2 teaspoons grated
  • Garlic, 1 clove minced
  • White pepper, ¼  teaspoon
  • Black pepper, ¼ teaspoon
  • Egg, 2 egg whites beaten
  • grilled chicken breast, 4 ounces shredded

Preparation

    1. Cook wheat in a small saucepan with 1 cup water and 1/4 teaspoon salt.
    2. Cover and cook, undisturbed, until wheat absorbs water, about 1 hour. Remove from heat, fluff with a fork and leave uncovered.
    3. Heat oil in a large skillet or wok over medium-high heat. Add black pepper and white and stir for 10seconds
    4. Add egg whites. Stir gently until egg is evenly distributed.
    5. Add onions, ginger, garlic, if desired; cook, stirring frequently for about 2 minutes.
    6. Add cooked quinoa and stir gently
    7. Sprinkle chopped pepper and grated carrots into mixture. Stir gently until it is evenly distributed.
    8. Allow to cook for 2 minutes and add shredded grilled chicken. Stir until it is evenly distributed.
    9.  Serve with some side salad (optional) and enjoy.

ARTICLE BY SALOMEY KOKORO
OFFICIAL DIETICIAN OF BISA
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Healthy Recipes: Banana Pancake

pancakeThis recipe is for pancake lovers who are cutting back on a few calories. A typical pancake recipe comprises of some ounces of calorie; dense flour, milk, eggs and butter totaling 160kcal for one six inches (6’) pancake without toppings. With a few healthy modifications you can enjoy this low calorie banana pancake (90kcal) which does not include FLOUR. This delicious recipe is also loaded with nutrients; potassium, vitamin B6, magnesium, fiber to mention a few.

I must also add, this a great meal or snack for children, especially fussy eaters. It is delicious and very easy to make.

Ingredients

  • 1 medium ripe banana
  • 2 egg whites
  • 1/8 teaspoon baking powder, for fluffier pancakes
  • 1/8 teaspoon salt
  • 1/4 teaspoon vanilla or ½ teaspoon of cinnamon
  • 1/2 teaspoon coconut oil, for the pan.

Toppings

  • Maple syrup or jam.
  • 1 cup fresh fruit, like mango, pawpaw or apples.

Utensils

  • Small mixing bowls
  • Fork
  • Nonstick griddle or frying pan.
  • Spatula

Instructions

  1. Mash the banana: Peel the banana and break it up and mash until the banana has a pudding-like consistency and no large lumps remain.
  2. Add any extra ingredients: Add 1/8 teaspoon of baking powder for fluffier, lighter pancakes, and whisk in salt, cinnamon or vanilla to add flavor to the pancakes.
  3. Stir in the eggs: Whisk the eggs together until the yolk and whites are completely combined. Pour the eggs over the banana and stir until the eggs are completely combined.
  4. Heat a pan over medium heat: Melt a little butter or warm a little vegetable oil in the pan to prevent sticking, if you like.
  5. Drop the batter on hot pan: Drop roughly 2 tablespoons of batter onto the hot pan. It should sizzle immediately — if not, turn up the heat slightly.
  6. Cook for about 1 minute: Cook the pancakes until the bottoms look browned and golden when you lift a corner.
  7. Sprinkle with toppings: Sprinkle any loose toppings, like nuts or fruits, over the top of the pancakes. Serve and enjoy.

Macronutrient Comparison

Regular pancake (white flour, egg, milk, oil)

 Calorie: 323kcal, carbohydrate: 41g protein: 12g fat: 11g fiber: 1.3g

Banana pancake (banana, egg, oil)

 Calorie: 147kcal, carbohydrate: 23g protein: 4.7g fat: 0.39g fiber: 2.6g

Banana has a relatively low calorie as compared to regular pancake thus it is highly recommended for weight management. Not only is it a low calorie meal option, it is also loaded with nutrients namely potassium, B vitamins and vitamin C which are beneficial in warding off many diseases.

ARTICLE BY SALOMEY KOKORO
OFFICIAL DIETICIAN OF BISA
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NUTRITION SPOTLIGHT: Guava

guavaGuava is a tropical fruit with a unique flavor and rich nutritional profile. Its outer skin is usually light green, yellow or maroon when ripe. The soft sweet pulp of guava is either white or maroon with small hard seeds encased within it.

Considering its health promoting benefits, guavas can be considered as a “super fruit”. Originally believed to have originated from the warm tropics of south America and commonly cultivated in Asian countries , this super fruit is now cultivated in Ghana as a cash crop.

Significant Nutrients

  • Vitamin A – The guava fruit is a very good source of vitamin A and carotenoids. Guava provides 12% of our daily vitamin A needs whereas an apple provides only 1% of our daily needs.
  • Vitamin C – Again in comparison with apple which provides only 8% of daily needs whiles guavas provide a whopping 328% of daily vitamin C needs. The pulp right underneath the peel of the fruit contains the highest amount of the nutrient.
  • Potassium- Fresh guava fruit is a very rich source of potassium. It contains more potassium than other fruits like banana per 100g. Potassium is an important component of cell and body fluids that helps controlling heart rate and blood pressure.
  • Lycopene – Many studies suggest that eating lycopene-rich foods may be linked to reduced risk of cancer, prostate enlargement, heart disease, and age-related eye disorders. 100 g of pink guava fruit provides 5204 µg of lycopene, nearly twice the amount in tomato. (Tomatoes have been promoted as an excellent source of lycopene).
  • Fiber – significant source of soluble fibers; pectin and mucilage. Soluble fibers are known to greatly regulate blood sugar levels and also ward off many disease conditions. Individuals with high blood cholesterol levels have recorded significantly improved lipid profiles after 3 months intake of high soluble fiber foods.

Health benefits

  • Hypertension – The blood pressure lowering effect of guava can be associated to its significant amount of potassium and niacin.
  • High cholesterol – Guava has a cholesterol lowering effect due to its significant amounts of soluble fiber.
  • Eye health Macular degeneration and cataract development can be slowed or prevented by the frequent intake of the super fruit guava mainly due to its rich content of the antioxidant vitamin A.
  • Boost immune system – Guavas have been found to boost the body’s defenses against infections due to its outstandingly high antioxidant reserves. Vitamin C is known to boost the defenses of white blood cells; lycopene in the pink pulp of guava is also known to protect the skin from damage by the sun.
  • Nicotine addiction – High vitamin C levels in guava helps with neutralizing nicotine in the body.

ARTICLE BY SALOMEY KOKORO
OFFICIAL DIETICIAN OF BISA
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WE ARE BOTH CARRIERS. WE WILL HAVE 4 KIDS AND HOPEFULLY ONLY ONE WILL HAVE SICKLE CELL ANAEMIA

Before I go on let me explain some terminologies. Sickle Cell DISEASE is NOT the same as Sickle Cell Anaemia. The former, is a big, blanket term for all the abnormalities that are possible genetically, so technically, carriers who are “AS” can be described as having Sickle Cell Disease as well as those with “SS”. The latter refers specifically to those with the SS genotype.

This is the reality: in Ghana, 25% of us are CARRIERS for Sickle Cell Disease. Considering our population currently, that means 6million to 7million of us are carrying an abnormal Sickle Cell gene that together with the same or another abnormal Sickle Cell gene from a carrier (or even a partner with the disease) partner can cause the birth of a child with sickle cell anaemia.
It is not so uncommon in my practice for a couple, married or not, to make the assertion expressed in the title of this article. Mostly, they marry without knowing their status and when they find out by some other means, then the question of probability and chances come up: “So is it the first or fourth child that will have it?” “Can we try (that is, become pregnant) again?” “Surely, we cannot have more than two kids all having the problem?”

heya
Consider the above illustration: The scenario on the left is where a carrier and a “normal” person produce children and none of the kids will have Sickle Cell Anaemia. It is the scenario on the right that is the focus of this article; here both parents are carriers and thus there is a 25% (one-in-four) chance of having a child born with Sickle Cell Anaemia.
So does it mean that once two carriers copulate with a resultant pregnancy, the baby will definitely have Sickle Cell Anaemia, that is, SS?
The answer is NO. There is a one-in-four chance that every pregnancy will result in a child with SS genotype, that is, Sickle Cell Anaemia.
Wait a minute; what do I want to say? Does it mean that for the two carrier partners, when say they have 4 kids only one will have Sickle Cell Anaemia (that is, SS genotype)?
NO! Imagine you have 4 tomatoes in your bowl; 3 green (AS or AA) and the 4th red (SS). Each time there is a pregnancy it is as if you are dipping your hand into this bowl of 4 tomatoes to pick one at random (this is the one-in-four or 25%) with your eyes closed. You don’t know which one will come out (this is the chance).
Now, this is the confusion for most people. They assume that if for the first chance (likened to first pregnancy) say the “child is SS” (red tomato) as they say, then that is it. They further assume then that they can go ahead to have 3 more kids as they will all be “normal” (green tomatoes). This is because they think that once they dipped their hand into the bowl the first time and the red tomato came out, the bowl will now have only 3 green tomatoes for the subsequent “lucky dip”. Meaning, it is impossible to pick red tomato again because that particular one has already been taken out.
The fact is, in the event of two carrier parents, for each pregnancy the slate is wiped clean. The button is reset and there will always be 3 green tomatoes plus one red tomato in the bowl; meaning for each pregnancy, you start all over again. So a couple, both carriers can have 5 kids all “normal” or all SS; or one, two or more of either. It’s all a probability or chance and no one including Science can predict. (I should be careful, may be the Mathematicians can work something out!)
ON THIS WORLD SICKLE CELL DAY:
• Let’s screen our kids at birth so we know their status
• Tell your kids their statuses once they begin to comprehend and not later than 10 years of age
• Every adolescent in Senior High School MUST be tested to know his or her status
• Discuss your sickle cell status with the partner with whom you hope to have kids
• No one should decide for you who to marry or have kids with, but if you decide to do so as carriers, educate yourself on the implications of having a child with Sickle Cell Anaemia and where you can get help
• Finally, no one is a SICKLER; there are only persons with Sickle Cell Disease or Sickle Cell Anaemia. DO NOT STIGMATISE AGAINST THEM. LOVE THEM, EMPLOY THEM, HELP THEM.

ARTICLE BY 
DR LAWRENCE OSEI-TUTU
OFFICIAL DOCTOR OF BISA AND SPECIALIST PAEDIATRICIAN AND HEALTH ADVOCATE; KOMFO ANOKYE TEACH HOSP-KATH-GHANA

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THE FREIGHT TRAIN- STDs: Herpes

I had a hard time picking which STD to write on considering that they are quite a lot to begin with. I however thought about the commonest STDs among the youth and settled on herpes.

Herpes is a common sexually transmitted disease that can affect the mouth (oral) or the genitals. It is caused by the simplex virus type 1 (HSV-1) or the simplex virus type 2 (HSV-2). Herpes is very common and sometimes have symptoms which we will discuss.

ORAL HERPES

Oral herpes leaves its victims with cold sores. Cold sores or fever blisters are small, painful, fluid filled blisters that appears on the mouth, throat, cheek, chin, nose or fingers. People with oral herpes may experience itching or pain at the affected area which will be preceded by blisters in a day or two. After the blister occurs, they break, leak infectious fluid and then crust in over a period of 2-24 days.

Oral herpes can be contracted during oral, vaginal or anal sex with an infected person. It can be spread though close contact with an infected person or through a kiss. An infected person can also spread the virus to other parts of his or her body upon touch. Avoid contact with infected person- sexual intercourse even with condom should be avoided till the sore is fully treated. People with herpes should regularly wash their hands to avoid spreading to others.

GENITAL HERPES

As the name implies, genital herpes occurs around the genitals. Genital herpes may sometimes be mistaken for some other skin condition like pimple. It is always good practice to report any skin condition that occurs after an unprotected sex. Genital herpes sores may leave blisters around the genitals which is sometimes accompanied by flu like symptoms such as fever, body aches, and swollen glands.

Both herpes can easily be treated although there is no cure. Herpes during pregnancy can cause a lot problems to the unborn baby. The baby may be delivered early or even worse there could be a miscarriage. Babies can also be born with a potentially deadly infection. It is therefore important not to get STD during one’s pregnancy. Pregnant women with herpes can protect their babies by reporting to their doctors early that they have herpes so that they are treated for it.

Oral/Genital Herpes
Oral/Genital Herpes

Sources: Centre for Disease Control and Prevention, Mayo Clinic, www.herpes.com

3 Quick and Healthy Eating Tips for People on A Busy Schedule.

In this day and era, with busy mornings, buzzing vehicular traffic, deadlines to meet, long hours at work, late nights at work, it is quite cumbersome to juggle all these with staying fit and eating healthy. Most people cannot afford to take some few minutes off their schedule to cook a well-balanced nutritious meal.

Below are few healthy eating tips to help someone who is always on the go to enhance overall health, boost immunity, gain or lose weight.

1.     Shop for healthy convenient foods – Having quick and convenient nutritious ingredients at home or workplace will ensure you eat healthy even with a tight work schedule.  Foods such as instant oats, tom brown, high fiber breakfast cereal, low fat milk, low fat                 yogurt,                   granola/muesli & fruits are all quick meal alternative you can make use of on a busy           day.

2.     Plan ahead – if there is a day (or days) when you’re always late home, make sure you have the ingredients for a meal that is quick to cook. This highlights the need for the earlier point, always have healthy ingredients available.    E.g. Spaghetti & Stew, Boiled rice & Soup, Quick porridge.

3.     Breakfast meals for supper – If there’s nothing else at hand, a quick bowl of a low sugar ,high fiber breakfast cereal with milk is a good nutritious ‘fast food’ – keep some at work too.

4.     Meal preps – this is nothing fancy. On your less busy nights or weekends, Cook in bulk.

Whether you cooking rice, stew, soup, steaming meat, fish or even porridges , cook extra          portions so you can freeze some for a later date – ensuring that you always have a                   nutritious meal in the house ready for those ‘I’m too tired to even think about cooking’ days.

ARTICLE BY SALOMEY KOKORO
OFFICIAL DIETICIAN OF BISA
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THE FREIGHT TRAIN: Facts of STDs

Civilization hit the world like a freight train and soon everything was changing so fast; slavery stopped and technology took over, medicine evolved and man ventured into space. Man always celebrated his victories and as the years flew by, man found more reasons to celebrate and with more celebration came more carelessness and let’s just say we all get the picture.

If you however did not get the picture then all I am driving at is “let’s talk about sex”, specifically STD’s. There really isn’t any nice or easy way to talk about sex. Although, how it feels may be different from how we talk about it. Sex is very pleasurable but just like all things pleasurable, it can lead to unwanted situations. Pregnancy is your least worry when it comes to sex, STDs is more problematic.

STD stands for sexually transmitted diseases, for a start you only increase your chances of getting it when you have sex. STDs are infections passed from one person to another during sexual contacts. For a fact all forms of sex can get you STDs- oral, anal, vaginal, name it, as long as it is sexually related, you might be on the freight train to STDs. The symptoms of STDs are usually not visible for a long time but the effect they have on your health is drastic. There are very few ways of ensuring that you are STD free

  • Abstain from sex
  • Practice safe sex; use condom -although not hundred percent proof, many will testify to the number of times it has saved them 😉
  • Get tested – trust in one’s sexual partner is not enough. The best way to ensure safety is a medical confirmation from a professional.

Let’s face it, abstaining from sex can be difficult but you can always make sure you are clean and good for years to come by getting tested and getting treatment as soon as possible.

There are a lot of sexually transmitted diseases and over the course of this month, we will be going through them one after the other. We will learn about their symptoms and their effect. We will also learn how to protect ourselves and our sexual partners.

Sources: mayoclinic.org, Centers for Disease Control and Prevention

Typhoid intestinal perforations in Ghana

In many developing countries, typhoid fever; a severe febrile illness primarily caused by Salmonella typhi, is still a disease of enormous public health concern, even though it is almost eliminated in developed countries. Typhoid fever is generally transmitted by faecal-oral route and may occasionally lead to an epidemic, particularly in areas with poor waste disposal system, and limited availability of clean drinking water. It has been estimated that 22 million cases of typhoid fever and 216 000 deaths occur annually worldwide. In Africa, population based incidence of typhoid fever is reported to range from 13 to 845 cases per 100000 population annually.

Effective public health measures such as the provision of clean, potable water and good waste disposal systems have led to a dramatic decrease of the disease in developed countries. Developing countries on the other hand still bear the burden of the disease, due to the fact that most communities still fall short of standards for good drinking water, hygiene and sanitation.

Clinical signs and symptoms of typhoid fever include malaise–a general feeling of discomfort, headache, sustained fever, constipation and/or diarrhea, abdominal pain, and other gastrointestinal symptoms, cough and loss of appetite. Confirmatory laboratory findings are conducted by the isolation of Salmonella Typhi from bone marrow, blood, or other site in a patient with compatible illness.

With a case mortality rate approaching 30% – 40%, typhoid intestinal perforations (TIPs) and intestinal bleeding arising from necrosis of Peyer’s patches in the terminal ileum is the most lethal complications of typhoid fever. Just like typhoid fever, TIP is the most common surgical problem in developing countries, where it is associated with high mortality and morbidity, due to lack of clean drinking water, poor sanitation and lack of medical facilities in remote areas and delay in hospitalization. The high incidence of TIP has also been attributed to the emergence of multi-drug resistant and virulent strains of Salmonella typhi.

TIP affects mostly children and young adults who are the future leaders and would contribute greatly to the economy of developing countries in the future. This results in devastating effects (socially and economically) on resource poor countries due to loss of productive hours as due to hospitalization of patients with acute disease and the complications and loss of income attributable to the duration of the clinical illness. In resource-poor countries like Ghana, the management of the TIP which requires surgery has peculiar challenges relating to diagnostic and therapeutic measures. Some of these unique challenges include late presentation of the disease coupled with lack of clean drinking water, poor sanitation, and lack of diagnostic facilities and emergence of multi-drug resistant (MDR) strains of S. typhi. This may result in poor treatment outcomes. Many factors such as late presentation, inadequate pre-operative resuscitation, delayed operation, the number of perforations, and the extent of faecal peritonitis, have been found to have a significant effect on the prognosis.

Way forward

There should be access to clean portable water, people must make it a point to keep their surroundings clean at all times and health facilities and equipment must be made available to help detect this disease at the early stage.

Source: US National Library of Medicine enlisted journal

 

What is haemophilia ? Part 2

lawrenceI have three male kids myself. It’s a joy watching them go through their rather hectic and hearts in mouth play activities daily. They become even more daring as the years role by. No day passes without a fall, separating a fighting pair, consoling the one at the receiving end of a smack from the other and so on and so forth.

But imagine for a moment that each of these happenings I have described actually did result in an injury; one resulting from a seemingly harmless and natural thing such as adventurous male siblings shoving and pushing each other harmlessly. And this injury each time it happens results in abnormally PROLONGED BLEEDING episode way out of proportion to the apparent provocation – indeed, a harmless and almost flimsy one at that.

For some families, male children come along with ‘bloody’ gloomy days of anguish and uncertainty. This is due to a genetic defect they suffer the result of which is the inability of their bodies to manufacture certain soluble FACTORS in blood called CLOTTING factors. These clotting factors are responsible for an otherwise commonly overlooked daily phenomenon like the spontaneous seizure of blood flow when we get a small cut or scratch or say even our bodies inherent ability to stop excessive bleeding resulting from squeezing a pimple on our noses.

We do not bleed out in all of the above instances because we possess these clotting factors among other things, which enable our blood to clot when the need arises.
Two examples of such clotting factors are FACTOR VIII (factor 8) or the ANTI-HAEMOPHILIA FACTOR and FACTOR IX (factor 9) or the CHRISTMAS FACTOR. The absence of these factors is due to the inheritance of a defective gene passed on from carrier mothers to their sons resulting in the disease called HAEMOPHILIA.

There are two main types of Haemophilia – A and B. Haemophilia A results from the lack or absence of factor VIII while Haemophilia B occurs as a result of the absence of factor IX.
A third type called Haemophilia C disease resulting from the absence of another clotting factor called factor XI exist but is extremely rare!

Haemophilia A is by far the commoner comprising about 85 per cent of sufferers while Haemophilia B accounts for about 15 per cent. Globally, it is estimated that the disease occurs in 1 in every 10,000 people. So, for Ghana with an estimated population of about 27, 000, 000 people then potentially, there are about 2,700 people with Haemophilia locally. However, official records from the Ghana Haemophilia Society’s Register indicates a total registered number about 120 children with Haemophilia; about 90 of who are persons leaving with Haemophilia.

THE HISTORY OF THE DISEASE

Haemophilia is mostly spoken of as a ‘European’ disease. No surprise in that as perhaps very little if any was recorded in our medical literature in Ghana.

Haemophilia was recognized, though not named, in ancient times. The Talmud, a collection of Jewish Rabbinical writings from the second century AD, stated that male babies did not have to be circumcised if two brothers had already died from the procedure. The Arab physician Albucasis, who lived in the twelfth century, wrote of a family whose males died of bleeding after minor injuries.

Then, in 1803, a Philadelphia physician named Dr. John Conrad Otto wrote an account of ‘a hemorrhagic disposition existing in certain families’. He recognized that the condition was hereditary and affected males. He traced the disease back through three generations to a woman who had settled near Plymouth, New Hampshire, in 1720.

The word haemophilia first appears in a description of the condition written by Hopff at the University of Zurich in 1828.

IS HAEMOPHILIA REALLY A ROYAL DISEASE?

Haemophilia has often been called The Royal Disease. This is because Queen Victoria, Queen of England from 1837 to 1901, was a carrier. Her eighth child, Leopold, had haemophilia and suffered from frequent haemorrhages (abnormal bleeding). These were reported in the British Medical Journal in 1868. Leopold died of a brain hemorrhage at the age of 31, but not before he had children. His daughter, Alice, was a carrier and her son, Viscount Trematon, also died of a brain hemorrhage in 1928.

A somewhat similar account is told of the Royal family in Russia. Two of Queen Victoria’s daughters, Alice and Beatrice, were also carriers of hemophilia. They passed the disease on to the Spanish, German and Russian Royal Families.

HOW HAEMOPHILIA REVEALS ITSELF

One can only imagine the conclusions that may be drawn here in Ghana where superstition and religion are rife amidst low levels of education, high levels of “miseducation” and scarce resources for adequate healthcare advocacy and delivery. Unexplained and unprovoked prolonged bleeding episodes that may likely result in deaths of male infants when not promptly attended to are best addressed as the result of the work of evil spirits, curses and for the more adventurous, could be due to some vampire tendencies as portrayed in the movies. This is even made more believable as the disorder happens to be genetic and hereditary, hence, seen among particularly males of a particular lineage.

How else can the rural Ghanaian folk without formal classroom education and scientific knowledge explain the prolonged bleeding of possibly all his/her male sons resulting practically from the cut of their umbilical cords at delivery through circumcision and vaccinations to their adult lives? And what’s worse, that their mothers transferred the abnormal gene to these sons? Well, your guess is as good as mine.

There are three main categories of persons with haemophilia: A first group who have the disorder but have quite a substantial quantity of the clotting factor though not as much as the non-sufferer. They only get bleeding episodes following major trauma and major surgeries. This group is described as having MILD disease. The second group are described as having MODERATE disease and consists of a group of sufferers who lack more than say, two-thirds of the usual quantity needed to be normal who tend to bleed following even minor trauma and occasionally spontaneously and unprovoked.

The third category comprise individuals with SEVERE disease who practically have no clotting factor at all and tend to have more life threatening bleeds even without any provocation or with the slightest of provocations such as a pat on the shoulder or biting on a fried meat or bone for instance. For such individuals, even activities of natural daily living such as injections from vaccinations, crawling and tumbling over as regular toddlers, brushing the teeth and natural teeth eruptions become risky and hazardous.

When bleeding is obvious it signals danger and usually urgent attention is sought by care givers. However, in certain cases severe bleeders may bleed into areas that are inconspicuous such as into internal organs, the abdominal cavity and into the brain. These bleeds are usually slow and happen over long periods.

So, typically the bleeds resulting from haemophilia and other clotting factor deficiencies tend to result in bleeding into big joints such as the knee, ankle and elbow joints as well as bleeding into muscles. When these events happen repeatedly over time, the result is a persistently swollen, stiff and painful joint(s) which reduces the quality of life of the affected individual. This long term effect on the joints without appropriate intervention and rehabilitation leads to physical disability of the affected individual.

From the foregoing, it can be deduced that haemophilia can lead to life threatening bleeds resulting in even death and also to long term complications mainly of joints resulting in permanent physical disabilities.

CAN HAEMOPHILIA BE CURED?

The simple answer is no, it cannot be cured but it can be managed. Once born with it, the individual leaves with the disorder for his entire life. The only solution is the replacement of the clotting factors (VIII or IX) periodically in a bid to prevent bleeding episodes from occurring. The main goals of treatment are to ensure deaths do not happen from episodes of bleeding should they happen and that, persons with haemophilia get improved quality of life. The overall aim is therefore to prevent the occurrence of physical disabilities from persistent joint bleeds and deaths from other life threatening bleeds.

In order to achieve this, the World Federation of Haemophilia, WFH, recommends the setting up of Haemophilia Treatment Centers, HTC at several locations (hospitals) across the country with Haemophilia Comprehensive Care Teams staffed with all the key health care providers and parent support groups who can provide focused point of care needs for the person with haemophilia.

For the appropriate and best overall treatment of persons with suspected haemophilia, it is vital that they are diagnosed promptly; classified as either suffering from either Haemophilia A or B; grouped as either mild, moderate or severe; and tested following treatment with clotting factor to determine whether they are out of danger or otherwise. All these are done in a well-resourced laboratory following strict internal and external quality assurance standards.

Another important aspect of care is the provision of continuous parental or care-giver and patient education on prevention of unintentional injuries, home treatment of some of the complications and access to resources available for their use.

ARTICLE BY 
DR LAWRENCE OSEI-TUTU
OFFICIAL DOCTOR OF BISA AND SPECIALIST PAEDIATRICIAN AND HEALTH ADVOCATE; KOMFO ANOKYE TEACH HOSP-KATH-GHANA

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