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Osman AA, Omar NMS, Osman MM, Ali AM, Bashir AM. Pattern and outcome of renal diseases in hospitalized patients at a tertiary hospital in Mogadishu, Somalia. Ren Fail 2024; 46:2363588. [PMID: 38856305 PMCID: PMC11168211 DOI: 10.1080/0886022x.2024.2363588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Abdirahman Abdikadir Osman
- Department of Internal Medicine, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
| | | | - Marian Muse Osman
- Department of Research, National Institute of Health, Mogadishu, Somalia
| | - Ali Mohamed Ali
- Department of Internal Medicine, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Muhammad Bashir
- Department of Internal Medicine, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
- Center for Postgraduate Studies, Horseed International University, Mogadishu, Somalia
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Gulamhussein MA, Sawe HR, Kilindimo S, Mfinanga JA, Mussa R, Hyuha GM, Rwegoshora S, Shayo F, Mdundo W, Sadiq AM, Weber EJ. Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study. BMJ Open 2023; 13:e063297. [PMID: 36720574 PMCID: PMC9890776 DOI: 10.1136/bmjopen-2022-063297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs. DESIGN Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania. PARTICIPANTS Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020. METHODS During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills. PRIMARY OUTCOME MEASURE The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income. RESULTS We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25-40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33-311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71-369.33) and 277.71 (191.02-874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills. CONCLUSION OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.
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Affiliation(s)
- Masuma A Gulamhussein
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Hendry Robert Sawe
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Said Kilindimo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Juma A Mfinanga
- Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of
| | - Raya Mussa
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Gimbo M Hyuha
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Shamila Rwegoshora
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Frida Shayo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Winnie Mdundo
- Emegency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Abid M Sadiq
- Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania, United Republic of
| | - Ellen J Weber
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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Kasongo N, Siziya S, Banda J. Clinical profile and predictors of renal failure in emergency department patients at a tertiary level hospital, a cross sectional study. Afr J Emerg Med 2022; 12:456-460. [PMID: 36397992 PMCID: PMC9664393 DOI: 10.1016/j.afjem.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Our study was able to highlight the profile of patients at risk of renal failure who were likely older, hypertensive, oliguric and with low hemoglobin compared to those without. This Knowledge can help care givers and policy makers to pay particular attention and institute interventions targeted at treating non communicable diseases (that lead to renal failure) and infections there by reducing progressing to renal failure and end stage renal disease with need for renal replacement therapy. In addition, it also showed that simple bedside tests like dip stick urinalysis and urine output monitoring are key in surveillance of renal failure.
Background Since establishment of the emergency departments (ED) in the country, there is lack of information on clinical profile of patients admitted to the ED and predictors of renal failure in these patients. Renal failure is prevalent in critical patients and a cause of significant mortality and morbidity. The aim of this study was to assess the clinical profile and predictors of renal failure in admissions to the ED. Methods This was a cross-sectional study that was conducted at a tertiary level hospital in Zambia from January to December, 2019 among admissions to the ED after ethical approval. The primary outcome of the study was to describe the clinical profile of admissions to the ED and proportion of renal failure defined as estimated glomerular filtration rate (eGFR) < 60 mls/1.72 m2 Results The final analysis includes 152 patients, 7 excluded for missing key data. The median age was 43.5 years (IQR 32.5-59.5) and 94.7% of patients were medical. Nearly 70.0% of the patients were triaged as emergency (red) or very urgent (orange). The reason for admission to the ED were sepsis and/or sepsis shock in 25.0%, diabetic hyperglycaemia emergencies in 20.0%, hypertensive crisis in 10.5%, respiratory failure (9.9%), severe malaria (7.9%) and poisoning (5.0%). The prevalence of renal failure was 36.1% and proteinuria was observed in 23.0%. Oliguria and hypertension were 5.9-fold and 1.7-fold independent predictors of renal failure in the ED. Patients with renal failure were likely older, hypertensive, oliguric and anaemic compared to those without. During admission to the ED, 19.1% died. Conclusion Sepsis and diabetic and hypertensive emergencies accounted for nearly half of ED admissions. Hypertension and oliguria were key predictors of renal failure. Early diagnosis, management and follow-up of hypertension including urine output monitoring for high-risk patients is key in surveillance and prevention of renal failure.
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Affiliation(s)
- Nancy Kasongo
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
- Copperbelt University School of Medicine, Ndola, Zambia
- Corresponding author.
| | - Seta Siziya
- Copperbelt University School of Medicine, Ndola, Zambia
| | - Justor Banda
- Department of Internal Medicine, Ndola Teaching Hospital, Ndola, Zambia
- Department of Medical Sciences, University of Namibia, Namibia
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Kazibwe J, Shah HA, Kuwawenaruwa A, Schell CO, Khalid K, Tran PB, Ghosh S, Baker T, Guinness L. Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review. BMJ Open 2022; 12:e060422. [PMID: 36414306 PMCID: PMC9684998 DOI: 10.1136/bmjopen-2021-060422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/21/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Critical care is essential in saving lives of critically ill patients, however, provision of critical care across lower resource settings can be costly, fragmented and heterogenous. Despite the urgent need to scale up the provision of critical care, little is known about its availability and cost. Here, we aim to systematically review and identify reported resource use, availability and costs for the provision of critical care and the nature of critical care provision in Tanzania. DESIGN This is a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Medline, Embase and Global Health databases were searched covering the period 2010 to 17 November 2020. ELIGIBILITY CRITERIA We included studies that reported on forms of critical care offered, critical care services offered and/or costs and resources used in the provision of care in Tanzania published from 2010. DATA EXTRACTION AND SYNTHESIS Quality assessment of the articles and data extraction was done by two independent researchers. The Reference Case for Estimating the Costs of Global Health Services and Interventions was used to assess quality of included studies. A narrative synthesis of extracted data was conducted. Costs were adjusted and reported in 2019 US$ and TZS using the World Bank GDP deflators. RESULTS A total 31 studies were found to fulfil the inclusion and exclusion criteria. Critical care identified in Tanzania was categorised into: intensive care unit (ICU) delivered critical care and non-ICU critical care. The availability of ICU delivered critical care was limited to urban settings whereas non-ICU critical care was found in rural and urban settings. Paediatric critical care equipment was more scarce than equipment for adults. 15 studies reported on the costs of services related to critical care yet no study reported an average or unit cost of critical care. Costs of medication, equipment (eg, oxygen, personal protective equipment), services and human resources were identified as inputs to specific critical care services in Tanzania. CONCLUSION There is limited evidence on the resource use, availability and costs of critical care in Tanzania. There is a strong need for further empirical research on critical care resources availability, utilisation and costs across specialties and hospitals of different level in low/middle-income countries like Tanzania to inform planning, priority setting and budgeting for critical care services. PROSPERO REGISTRATION NUMBER CRD42020221923.
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Affiliation(s)
- Joseph Kazibwe
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiral A Shah
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Center for Global Development, Washington, DC, USA
| | - August Kuwawenaruwa
- Health System Impact Evaluation and Policy Unit, Ifakara Health Institute, Ifakara, United Republic of Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Karima Khalid
- Department of Anaesthesia and Critical Care, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Srobana Ghosh
- Global Health Department, Center for Global Development, Washington, DC, USA
| | - Tim Baker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Department of Emergency Medicine, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lorna Guinness
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Center for Global Development, Washington, DC, USA
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Masina J, Moolla M, Motara F, Kalla IS, Laher AE. Clinical Profile of Adult Patients Presenting With Renal Dysfunction to a Tertiary Hospital Emergency Department. Cureus 2022; 14:e21873. [PMID: 35265412 PMCID: PMC8898047 DOI: 10.7759/cureus.21873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Abstract
Background Renal dysfunction is a potentially life-threatening condition that is commonly encountered in the emergency department (ED). This study aimed to describe the clinical profile of patients presenting with renal dysfunction to a tertiary-level hospital ED. Methods Medical records of patients presenting to the ED with renal dysfunction over a six-month period (July-December 2017) were reviewed. A descriptive analysis of the data was performed. Results Serum creatinine levels were measured in 7,442 (69.9%) of the 10,642 patients that were triaged into the ED. Of these, 208 (2.8%) were identified with renal dysfunction, of which 192 consented to study participation. The median age of study subjects was 49.5 (IQR 38.8-63.0) years; 108 (56.3%) were male; proteinuria on urine dipsticks was demonstrated in 108 (56.3%); 72 (37.5%) were HIV-positive; 66 (39.6%) required dialysis; 11 (5.7%) were admitted to the ICU; and 59 (30.7%) died prior to hospital discharge. More patients presented with acute kidney injury (AKI) (46.9%) compared to chronic kidney disease (CKD) (27.6%) and acute on chronic kidney disease (AoCKD) (25.5%). Sepsis was the most common precipitant of AKI (42.2%) and AoCKD (30.6%), while chronic hypertension (35.8%) and diabetes mellitus (34.0%) were the most common comorbidities in subjects with CKD. Conclusion Patients presenting to the ED with various risk factors and comorbidities, including HIV, sepsis, hypertension, and diabetes mellitus, may have underlying renal dysfunction. ED clinicians should therefore adopt a low threshold to screen for renal dysfunction in these patients.
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Affiliation(s)
- John Masina
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Muhammed Moolla
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Feroza Motara
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Ismail S Kalla
- Internal Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
| | - Abdullah E Laher
- Emergency Medicine, University of the Witwatersrand, Johannesburg, Johannesburg, ZAF
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Moretti K, Uwamahoro DL, Naganathan S, Uwamahoro C, Karim N, Nkeshimana M, Aluisio AR. Emergency medicine matters: epidemiology of medical pathology and changes in patient outcomes after implementation of a post-graduate training program at a Tertiary Teaching Hospital in Kigali, Rwanda. Int J Emerg Med 2021; 14:9. [PMID: 33478387 PMCID: PMC7819192 DOI: 10.1186/s12245-021-00331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Emergency care is a new but growing specialty across Africa where medical conditions have been estimated to account for 92% of all disability-adjusted life years. This study describes the epidemiology of medical emergencies and the impact of formalized emergency care training on patient outcomes for medical conditions in Rwanda. Methods A retrospective cohort study was performed using a database of randomly sampled patients presenting to the emergency center (EC) at the University Teaching Hospital of Kigali. All patients, > 15 years of age treated for medical emergencies pre- and post-implementation of an Emergency Medicine (EM) residency training program were eligible for inclusion. Patient characteristics and final diagnosis were described by time period (January 2013–September 2013 versus September 2015–June 2016). Univariate chi-squared analysis was performed for diagnoses, EC interventions, and all cause EC and inpatient mortality stratified by time period. Results A random sample of 1704 met inclusion with 929 patients in the pre-residency time period and 775 patients in the post-implementation period. Demographics, triage vital signs, and shock index were not different between time periods. Most frequent diagnoses included gastrointestinal, infectious disease, and neurologic pathology. Differences by time period in EC management included antibiotic use (37.2% vs. 42.2%, p = 0.04), vasopressor use (1.9% vs. 0.5%, p = 0.01), IV crystalloid fluid (IVF) use (55.5% vs. 47.6%, p = 0.001) and mean IVF administration (2057 ml vs. 2526 ml, p < 0.001). EC specific mortality fell from 10.0 to 1.4% (p < 0.0001) across time periods. Conclusions Mortality rates fell across top medical diagnoses after implementation of an EM residency program. Changes in resuscitation care may explain, in part, this mortality decrease. This study demonstrates that committing to emergency care can potentially have large effects on reducing mortality.
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Affiliation(s)
- Katelyn Moretti
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA.
| | - Doris Lorette Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Sonya Naganathan
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Naz Karim
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
| | - Menales Nkeshimana
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Adam R Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, USA
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Furia FF, Shoo J, Ruggajo PJ, Kilonzo K, Basu G, Yeates K, Varughese S, Svarstad E, Kisanga O. Developing nephrology services in low income countries: a case of Tanzania. BMC Nephrol 2019; 20:378. [PMID: 31623570 PMCID: PMC6798480 DOI: 10.1186/s12882-019-1568-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. METHODS This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. RESULTS Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. CONCLUSION Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.
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Affiliation(s)
- Francis F. Furia
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Jacqueline Shoo
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Paschal J. Ruggajo
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Gopal Basu
- Department of Renal Medicine, The Alfred Hospital, Melbourne, Australia
- Previously Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu India
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queen’s University, Kingston, Ontario Canada
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College-Vellore, Vellore, Tamil Nadu India
| | - Einar Svarstad
- Department of Medicine, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Onesmo Kisanga
- School of Medicine, Muhimbili University of Health Sciences (MUHAS), P. O. Box 65001, Dar es Salaam, Tanzania
- Renal Unit, Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
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