1
|
Giriteka T, Bulakali DP, Wendler CB. Essential human and material resources for emergency care in the district hospitals of Burundi. Afr J Emerg Med 2023; 13:300-305. [PMID: 37859728 PMCID: PMC10582767 DOI: 10.1016/j.afjem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Burundi, like many African nations, faces challenges in providing accessible emergency care. The aim of this study was to assess the type of staff training, accessibility to imaging, and availability of essential equipment in the district hospitals of Burundi in order to inform strategic planning for healthcare delivery. Methods In June 2022 an online survey was sent to each district hospital of the country. Complete responses were analysed and, where appropriate, significance determined by chi-square analysis, with p<0.05 considered significant. Results Forty of 45 district hospitals completed the survey, of which 35 were rural (matching national demographics). The majority of district hospitals (21/40) had ready access to ≥4/5 critical drugs while few (5/40) were equipped with ≥4/5 key material. One quarter had 24/7 physician coverage and X-ray available. Only 3 had continuous access to ultrasound studies despite most district hospitals having ultrasound machines. Trained emergency room staff were almost totally absent from the field, with only 6 nurses, 4 generalists, and 1 specialist reported across 9 sites. Even a single EM-trained staff member was significantly correlated with being better equipped for emergencies (p<0.01). Conclusion Burundi needs a strategic investment in emergency preparedness and care. Policy initiatives and technology purchases have demonstrated reasonable penetration down to the district hospital level, however, trained personnel are essential to develop sustainable emergency capacity.
Collapse
Affiliation(s)
| | | | - Carlan Bruce Wendler
- Kibuye Hope Hospital, Kibuye, Bukirasazi, Gitega, Burundi
- Hope Africa University, Ngagara II, Bujumbura, Burundi
| |
Collapse
|
2
|
Marme G, Kuzma J, Zimmerman PA, Harris N, Rutherford S. Tuberculosis infection prevention and control in rural Papua New Guinea: an evaluation using the infection prevention and control assessment framework. Antimicrob Resist Infect Control 2023; 12:31. [PMID: 37046339 PMCID: PMC10092912 DOI: 10.1186/s13756-023-01237-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Papua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. METHODS The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO's IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. RESULTS Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. CONCLUSIONS The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines' operationalisation in health settings to reduce TB prevalence in PNG.
Collapse
Affiliation(s)
- Gigil Marme
- Faculty of Medicine and Health Sciences, Department of Public Health and Leadership, Divine Word University, P O Box 483, Madang Province, Papua New Guinea.
| | - Jerzy Kuzma
- Faculty of Medicine and Health Sciences, Department of Medicine, Divine Word University, P O Box 483, Madang Province, Papua New Guinea
| | - Peta-Anne Zimmerman
- School of Nursing and Midwifery, Graduate Infection Prevention and Control Program, Griffith University, Parklands Drive, Southport, QLD, 4215, Australia
| | - Neil Harris
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD, 4215, Australia
| | - Shannon Rutherford
- School of Medicine & Dentistry (Public Health), Griffith University, Gold Coast, QLD, 4215, Australia
| |
Collapse
|
3
|
Mnguni AT, Schietekat D, Ebrahim N, Sonday N, Boliter N, Schrueder N, Gabriels S, Sigwadhi LN, Zemlin AE, Chapanduka ZC, Ngah V, Yalew A, Jalavu T, Abdullah I, Tamuzi JL, Tembo Y, Davies MA, English R, Nyasulu PS. The clinical and epidemiological characteristics of a series of patients living with HIV admitted for COVID-19 in a district hospital. BMC Infect Dis 2023; 23:123. [PMID: 36855103 PMCID: PMC9972337 DOI: 10.1186/s12879-023-08004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature describing the effects of the COVID-19 in a high human immunodeficiency virus (HIV)/tuberculosis (TB) burden district-level hospital setting. We found scanty literature. METHODS A retrospective observational study was conducted at Khayelitsha District Hospital in Cape Town, South Africa (SA) over the period March 2020-December 2021. We included confirmed COVID-19 cases with HIV infection aged from 18 years and above. Analysis was performed to identify predictors of mortality or hospital discharge among people living with HIV (PLWH). Predictors investigated include CD4 count, antiretroviral therapy (ART), TB, non-communicable diseases, haematological, and biochemical parameters. FINDINGS This cohort of PLWH with SARS-CoV-2 infection had a median (IQR) age of 46 (37-54) years, male sex distribution of 29.1%, and a median (IQR) CD4 count of 267 (141-457) cells/mm3. Of 255 patients, 195 (76%) patients were discharged, 60 (24%) patients died. One hundred and sixty-nine patients (88%) were on ART with 73(28%) patients having acquired immunodeficiency syndrome (AIDS). After multivariable analysis, smoking (risk ratio [RR]: 2.86 (1.75-4.69)), neutrophilia [RR]: 1.024 (1.01-1.03), and glycated haemoglobin A1 (HbA1c) [RR]: 1.01 (1.007-1.01) were associated with mortality. CONCLUSION The district hospital had a high COVID-19 mortality rate among PLWH. Easy-to-access biomarkers such as CRP, neutrophilia, and HbA1c may play a significant role in informing clinical management to prevent high mortality due to COVID-19 in PLWH at the district-level hospitals.
Collapse
Affiliation(s)
- Ayanda Trevor Mnguni
- grid.11956.3a0000 0001 2214 904XDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa ,Khayelitsha District Hospital, Cape Town, South Africa
| | | | | | | | | | - Neshaad Schrueder
- grid.11956.3a0000 0001 2214 904XDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiraaz Gabriels
- grid.11956.3a0000 0001 2214 904XDepartment of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lovemore N. Sigwadhi
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E. Zemlin
- grid.11956.3a0000 0001 2214 904XDivision of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Zivanai C. Chapanduka
- grid.11956.3a0000 0001 2214 904XDivision of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Veranyuy Ngah
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anteneh Yalew
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Thumeka Jalavu
- grid.11956.3a0000 0001 2214 904XDivision of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Ibtisam Abdullah
- grid.11956.3a0000 0001 2214 904XDivision of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa ,grid.507908.30000 0000 8750 5335Division of Haematological Pathology, Department of Pathology, Northland District Health Board, Northland, New Zealand
| | - Jacques L. Tamuzi
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yamanya Tembo
- grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa ,grid.7836.a0000 0004 1937 1151Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa ,grid.7836.a0000 0004 1937 1151School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rene English
- grid.11956.3a0000 0001 2214 904XDivision of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S. Nyasulu
- grid.11956.3a0000 0001 2214 904XDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa ,grid.11951.3d0000 0004 1937 1135Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
Aghahowa ME, Bassey OS, Esomonu SN, Salu IK, Olofin EK, Aigbovo RO. Presentation and Management Outcomes of Cholecystectomies at a District Hospital in Abuja, North Central Nigeria: A 20-Year Review. West Afr J Med 2022; 39:916-921. [PMID: 36126114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although laparoscopic cholecystectomy has become the gold standard for removing the Gall Bladder (GB) for operable benign diseases, many open cholecystectomies are still performed in developing countries. We present our experiences with all cholecystectomies done in a secondary health care hospital, in north-central Nigeria. PATIENTS AND METHODS All patients who had open and laparoscopic cholecystectomies over a 20year period between January 2000 and December 2019 at the general surgery unit of Asokoro District Hospital, Abuja, Nigeria were reviewed with a focus on demography, indications for surgery, type of operation, complications, and outcomes. The diagnosis of benign gall bladder diseases was by findings on patients' presentation, clinical examination, trans-abdominal ultrasound scan, and histological examination of all specimens. All open cholecystectomies were via the Kocher's incision approach while the laparoscopic cholecystectomies were via the 4-port incisions approach. RESULTS A total of 120 cholecystectomies comprising 74 open cholecystectomies and 46 laparoscopic cholecystectomies were performed. There were 27(22.5%) males and 93(77.5%) females giving a male to female ratio of 1:3.4. The age range was 19 to 80years and the peak age was in the 41-50years range. The commonest indication for surgery was calculous cholecystitis in 107(89.2%) patients while the commonest post-operative complication was surgical site infection in 4(3.33%) patients. Majority (80%) were cholesterol stones. All the gall bladders were benign and there was no mortality recorded. CONCLUSION Open and laparoscopic cholecystectomies are safe in Asokoro District Hospital, Abuja Nigeria and the outcomes are comparable to results from other centres in the region.
Collapse
Affiliation(s)
- M E Aghahowa
- Department of Surgery, Asokoro District Hospital, Abuja, Nigeria
- Department of Surgery, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - O S Bassey
- Department of Radiology, Asokoro District Hospital, Abuja, Nigeria
| | - S N Esomonu
- Federal Capital Territory Primary Healthcare Board, Area 3, Garki, Abuja, Nigeria
| | - I K Salu
- Department of Surgery, Asokoro District Hospital, Abuja, Nigeria
- Department of Surgery, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - E K Olofin
- Department of Surgery, Asokoro District Hospital, Abuja, Nigeria
| | - R O Aigbovo
- Department of Surgery, Asokoro District Hospital, Abuja, Nigeria
| |
Collapse
|
5
|
Khuwa ZK, Matlala SF, Ntuli TS. Outpatients' satisfaction with healthcare services received at a district hospital in Botswana. Ghana Med J 2022; 56:215-220. [PMID: 37448988 PMCID: PMC10336639 DOI: 10.4314/gmj.v56i3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objectives To investigate patient satisfaction regarding healthcare services at a district hospital. The research question was: what is the level of patient satisfaction regarding service delivery? Design An observational cross-sectional descriptive study conducted in September 2019. Settings A district hospital in Botswana serving a population of 90 000. Outpatients from the Eye clinic, Casualty and Outpatient Department, Sexual Reproductive Health clinic and Infectious Diseases Control Centre were selected for the study. Participants 240 stable outpatients over 17 years selected through consecutive sampling participated voluntarily after giving informed consent. Main outcome measures The level of satisfaction was measured using 19 questions on five-point Likert scales ranging from strongly disagree 1, disagree 2, unsure 3, agree 4 to strongly agree 5. A binary outcome was created into satisfied and unsatisfied using the mean score as the cut-off point. Age, gender, employment, education and departments were independent variables. Results 65% (95% CI: 58-71%) were satisfied but unsatisfied with: doctor's politeness (66.9%; 95% CI: 60-73%), explaining (67.8%; 95% CI: 61-73%), privacy (65.6%; 95% CI: 59-72%), skills (67.4%; 95% CI: 61-73%), confidence (67.4% 95% CI: 61-73%), compassion (66.5%; 95% CI: 60-72%) and waiting time (49.2%; 95% CI: 42-57%). Department visited predicted satisfaction (p=0.002); those from the Eye clinic and Sexual Reproductive Health clinic were satisfied compared to others. Conclusion Satisfaction was generally high but lower regarding specified services and departments visited. There is a need for targeted interventions. Studies are needed to explore reasons for lower satisfaction in Casualty, Outpatient Department and Infectious Diseases Control Centre. Funding None declared.
Collapse
Affiliation(s)
- Zibo K Khuwa
- Department of Public Health, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa
| | - Sogo F Matlala
- Department of Public Health, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa
| | - Thembelihle S Ntuli
- Department of Statistical Sciences, Sefako Makgatho Health Sciences University, P.O Box 60, Medunsa, 0204, South Africa
| |
Collapse
|
6
|
Ifeanyichi M, Broekhuizen H, Cheelo M, Juma A, Mwapasa G, Borgstein E, Kachimba J, Gajewski J, Brugha R, Pittalis C, Bijlmakers L. Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia. BMC Health Serv Res 2021; 21:728. [PMID: 34301242 PMCID: PMC8299644 DOI: 10.1186/s12913-021-06709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. METHODS We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. RESULTS At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. CONCLUSION Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.
Collapse
Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands. .,EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands.
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Adinan Juma
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Gerald Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Klopper J, Moola H, Venter J, Cheddie D, Luzulane S, Muchenje T, van Zyl J, Chambers J. Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa. Afr J Emerg Med 2021; 11:60-64. [PMID: 33489735 PMCID: PMC7808920 DOI: 10.1016/j.afjem.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Trauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital. METHOD In this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality. RESULTS Sixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors. DISCUSSION The in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12-18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively. CONCLUSION Management of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.
Collapse
Affiliation(s)
- Juan Klopper
- Department of Health, Western cape, Cape Town, South Africa
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Husna Moola
- Department of Health, Western cape, Cape Town, South Africa
| | - Jeremy Venter
- Department of Health, Western cape, Cape Town, South Africa
| | - Dylan Cheddie
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Samukele Luzulane
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinashe Muchenje
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joshua van Zyl
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Chambers
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
8
|
Sagahutu JB, Kagwiza J, Cilliers F, Jelsma J. The impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on knowledge and attitudes regarding interprofessional practice in Rwandan health professionals: a cluster randomized control trial. BMC Med Educ 2021; 21:139. [PMID: 33648496 PMCID: PMC7923455 DOI: 10.1186/s12909-021-02537-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The first step in improving interprofessional teamwork entails training health professionals (HP) to acknowledge the role and value the contribution of each member of the team. The International Classification of Functioning, Disability and Health (ICF) has been developed by WHO to provide a common language to facilitate communication between HPs. OBJECTIVE To determine whether ICF training programme would result in improved knowledge and attitudes regarding interprofessional practice within Rwandan district hospitals. DESIGN, SETTING AND PARTICIPANTS A cluster randomised, single blinded, control trial design was used to select four district hospitals. Participants included physicians, social workers, physiotherapists, nutritionists, clinical psychologists/mental health nurses. INTERVENTION Health professionals either received one day's training in interprofessional practice (IPP) based on the ICF (experimental group) as a collaborative framework or a short talk on the topic (control group). OUTCOME MEASURES Validated questionnaires were used to explore changes in knowledge and attitudes. Ethical approval was obtained from the relevant authorities. RESULTS There were 103 participants in the experimental and 100 in the control group. There was no significant difference between Knowledge and Attitude scales at baseline. Post-intervention the experimental group (mean = 41.3, SD = 9.5) scored significantly higher on the knowledge scale than the control group (mean = 17.7, SD = 4.7 (t = 22.5; p < .001)). The median scores on the Attitude Scale improved in the Experimental group from 77.8 to 91.1%, whereas the median scores of the control remained approximately 80% (Adjusted Z = 10.72p < .001). CONCLUSION The ICF proved to be a useful framework for structuring the training of all HPs in IPP and the training resulted in a significant improvement in knowledge and attitudes regarding IPP. As suggested by the HPs, more training and refresher courses were needed for sustainability and the training should be extended to other hospitals in Rwanda. It is thus recommended that the framework can be used in interprofessional education and practice in Rwanda and possibly in other similar countries. TRIAL REGISTRATION Name of the registry: Pan African Clinical Trial Registry. TRIAL REGISTRATION NUMBER PACTR201604001185358 . Date of registration: 22/04/2016. URL of trial registry record: www.pactr.org.
Collapse
Affiliation(s)
| | - Jeanne Kagwiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | |
Collapse
|
9
|
Zitti T, Fillol A, Lohmann J, Coulibaly A, Ridde V. Does the gap between health workers' expectations and the realities of implementing a performance-based financing project in Mali create frustration? Glob Health Res Policy 2021; 6:5. [PMID: 33526079 PMCID: PMC7852126 DOI: 10.1186/s41256-021-00189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Performance-Based Financing (PBF), an innovative health financing initiative, was recently implemented in Mali. PBF aims to improve quality of care by motivating health workers. The purpose of this research was to identify and understand how health workers’ expectations related to their experiences of the first cycle of payment of PBF subsidies, and how this experience affected their motivation and sentiments towards the intervention. We pose the research question, “how does the process of PBF subsidies impact the motivation of health workers in Mali?” Methods We adopted a qualitative approach using multiple case studies. We chose three district hospitals (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation; we used 53 semi-directive interviews conducted with health workers (to follow the principle of saturuation), field notes, and documents relating to the distribution grids of subsidies for each DH. We analyzed data in a mixed deductive and inductive manner. Results The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work more efficiently. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention. Conclusion The PBF implementation in Mali left health workers frustrated. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive nor negative. This underlines how short-term interventions might not just lack impact, but instil negative sentiments likely to carry on into the future.
Collapse
Affiliation(s)
- Tony Zitti
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France. .,École doctorale Pierre Louis de santé publique, Université de Paris, Paris, France. .,ONG Miseli, Bamako, Mali.
| | - Amandine Fillol
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France.,Ecole de santé publique de l'Université de Montréal, Montréal, Canada
| | - Julia Lohmann
- London School of Hygiene & Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Abdourahmane Coulibaly
- ONG Miseli, Bamako, Mali.,Faculté de Médicine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies, Bamako, Mali
| | - Valéry Ridde
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) et Université de Paris, Inserm ERL 1244, 45 rue des Saints-Pères, 75006, Paris, France
| |
Collapse
|
10
|
Chu KM, Dell AJ, Moultrie H, Day C, Naidoo M, van Straten S, Rayne S. A geospatial analysis of two-hour surgical access to district hospitals in South Africa. BMC Health Serv Res 2020; 20:744. [PMID: 32791995 PMCID: PMC7425023 DOI: 10.1186/s12913-020-05637-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.
Collapse
Affiliation(s)
- Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa. .,Department of Surgery, University of Cape Town, Cape Town, South Africa. .,Department of Global Health, University of Stellenbosch, Francie Van Zijl Dr Tygerberg Hospital, Cape Town, 7505, South Africa.
| | - Angela J Dell
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Harry Moultrie
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, Cape Town, South Africa
| | - Candy Day
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
11
|
Nkwanyana NM, Voce AS. Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature. BMC Health Serv Res 2019; 19:731. [PMID: 31640655 PMCID: PMC6805543 DOI: 10.1186/s12913-019-4583-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background South Africa has a high burden of perinatal deaths in spite of the availability of evidence-based interventions. The majority of preventable perinatal deaths occur in district hospitals and are mainly related to the functioning of the health system. Particularly, leadership in district hospitals needs to be strengthened in order to decrease the burden of perinatal mortality. Decision-making is a key function of leaders, however leaders in district hospitals are not supported to make evidence-based decisions. The aim of this research was to identify health system decision support tools that can be applied at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Methods A structured approach, the systematic quantitative literature review method, was conducted to find published articles that reported on decision support tools to strengthen decision-making in a health system for perinatal, maternal, neonatal and child health. Articles published in English between 2003 and 2017 were sought through the following search engines: Google Scholar, EBSCOhost and Science Direct. Furthermore, the electronic databases searched were: Academic Search Complete, Health Source – Consumer Edition, Health Source – Nursing/Academic Edition and MEDLINE. Results The search yielded 6366 articles of which 43 met the inclusion criteria for review. Four decision support tools identified in the articles that met the inclusion criteria were the Lives Saved Tool, Maternal and Neonatal Directed Assessment of Technology model, OneHealth Tool, and Discrete Event Simulation. The analysis reflected that none of the identified decision support tools could be adopted at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Conclusion There is a need to either adapt an existing decision support tool or to develop a tool that will support decision-making at district hospital level towards strengthening the health system for perinatal care in South Africa.
Collapse
Affiliation(s)
- Ntombifikile Maureen Nkwanyana
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, George Campbell Building Room 215, Howard Campus, Durban, KwaZulu-Natal Province, South Africa.
| | - Anna Silvia Voce
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, George Campbell Building Room 215, Howard Campus, Durban, KwaZulu-Natal Province, South Africa
| |
Collapse
|
12
|
Biswas TK, Begum AA, Akther S, Rahman MH, Perry HB, Jones HE, Chowdhury ME. A newly developed tool for measuring the availability of human resources for emergency obstetric and newborn care services: prospective analytic study in two district-level public facilities in Bangladesh. BMC Health Serv Res 2018; 18:688. [PMID: 30180827 PMCID: PMC6124004 DOI: 10.1186/s12913-018-3511-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bangladesh, while the infrastructure of public health facilities to provide maternal and newborn care services is adequate, services are not always available due to insufficient staffing. A human resource availability index for health facilities is needed for monitoring and advocacy. This study aimed to develop indices for measuring the availability of different types of human resources to provide round-the-clock emergency obstetric and newborn care (EmONC) service at district-level public facilities. METHODS As part of a larger intervention study, 30 days of prospective observation of providers was done at a district hospital (DH) and a mother and child welfare centre (MCWC) in one district of Bangladesh using checklists. A scoring system was developed to create an index to quantify the availability of providers for maternal and newborn care. RESULTS Based on the newly developed index, medical doctors in the emergency department of the DH were 100% available, but ranged from 27 to 41% availability in the obstetrics/gynecology (ob/gyn) and pediatric wards. In MCWC, the corresponding indices ranged from 32 to 36%. In the DH, the availability of nurses in the ob/gyn ward (96%) was relatively better than in the pediatric ward (65%) but that in operation theatre was only 31%. In the MCWC, the index for the presence of a paramedic or nursing aid was 82% in the ob/gyn ward and 63% in the operation theatre. However, the availability scores of facility support staff for maintenance and security were generally high (over 90%) in both facilities. CONCLUSIONS Our newly developed index on availability of providers demonstrated huge gaps in availability of providers in evening and night shifts in most of the disciplines in the study facilities. This provider availability index is easy to create and can be used as a meaningful tool to quantify gaps in human resources by type in various types of district-level health facilities. Further studies are needed for adaptation of this tool in different types of health facilities and to assess its implication as an advocacy tool.
Collapse
Affiliation(s)
- Taposh Kumar Biswas
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Anjuman Ara Begum
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shamima Akther
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Hafizur Rahman
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry B Perry
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi E Jones
- CUNY Graduate School of Public Health & Health Policy, New York, USA
| | - Mahbub Elahi Chowdhury
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| |
Collapse
|
13
|
Moyimane MB, Matlala SF, Kekana MP. Experiences of nurses on the critical shortage of medical equipment at a rural district hospital in South Africa: a qualitative study. Pan Afr Med J 2017. [PMID: 29515718 PMCID: PMC5837176 DOI: 10.11604/pamj.2017.28.100.11641] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Medical equipment is an essential health intervention tool used by nurses for prevention, diagnosis and treatment of disease and for rehabilitation of patients. However, access to functioning medical equipment is a challenge in low- and middle-income countries. The World Health Organization estimated that 50 to 80 percent of medical equipment in developing countries is not working, creating a barrier to the ability of the health system to deliver health services to patients. This study explored and described the lived experiences of nurses working at a district hospital with a critical shortage of medical equipment. Methods A qualitative, exploratory, phenomenological and descriptive study design was used. A purposive sampling was used to select participants and due to saturation of data 14 nurses participated in the study. Research ethics were observed. Data was collected through semi-structured interviews using an interview guide. Interviews were audio-taped and field notes were taken. Voice recordings were transcribed verbatim and Tesch's open coding method was used for data analysis. Findings were confirmed by an independent coder. Results Critical shortage of medical equipment at the hospital occurred in the form of unavailability of equipment, low quality and poor maintenance of the few that were available. Shortage impacted negatively on nursing care, nursing profession and the hospital. Conclusion Nurses should be provided with functional medical equipment in order to provide quality nursing care. Management, leadership and governance structures should be strengthened to ensure that procurement and maintenance plans for medical equipment are developed and implemented.
Collapse
Affiliation(s)
- Merriam Bautile Moyimane
- Department of Public Health, University of Limpopo, Private bag X1106, Sovenga, 0727, South Africa
| | - Sogo France Matlala
- Department of Public Health, University of Limpopo, Private bag X1106, Sovenga, 0727, South Africa
| | - Mokoko Percy Kekana
- Department of Public Health, University of Limpopo, Private bag X1106, Sovenga, 0727, South Africa
| |
Collapse
|
14
|
Hategeka C, Mwai L, Tuyisenge L. Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers' perspectives on relevance and challenges. BMC Health Serv Res 2017; 17:256. [PMID: 28388951 PMCID: PMC5385061 DOI: 10.1186/s12913-017-2193-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/28/2017] [Indexed: 02/01/2023] Open
Abstract
Background An emergency triage, assessment and treatment plus admission care (ETAT+) intervention was implemented in Rwandan district hospitals to improve hospital care for severely ill infants and children. Many interventions are rarely implemented with perfect fidelity under real-world conditions. Thus, evaluations of the real-world experiences of implementing ETAT+ are important in terms of identifying potential barriers to successful implementation. This study explored the perspectives of Rwandan healthcare workers (HCWs) on the relevance of ETAT+ and documented potential barriers to its successful implementation. Methods HCWs enrolled in the ETAT+ training were asked, immediately after the training, their perspective regarding (i) relevance of the ETAT+ training to Rwandan district hospitals; (ii) if attending the training would bring about change in their work; and (iii) challenges that they encountered during the training, as well as those they anticipated to hamper their ability to translate the knowledge and skills learned in the ETAT+ training into practice in order to improve care for severely ill infants and children in their hospitals. They wrote their perspectives in French, Kinyarwanda, or English and sometimes a mixture of all these languages that are official in the post-genocide Rwanda. Their notes were translated to (if not already in) English and transcribed, and transcripts were analyzed using thematic content analysis. Results One hundred seventy-one HCWs were included in our analysis. Nearly all these HCWs stated that the training was highly relevant to the district hospitals and that it aligned with their work expectation. However, some midwives believed that the “neonatal resuscitation and feeding” components of the training were more relevant to them than other components. Many HCWs anticipated to change practice by initiating a triage system in their hospital and by using job aids including guidelines for prescription and feeding. Most of the challenges stemmed from the mode of the ETAT+ training delivery (e.g., language barriers, intense training schedule); while others were more related to uptake of guidelines in the district hospitals (e.g., staff turnover, reluctance to change, limited resources, conflicting protocols). Conclusion This study highlights potential challenges to successful implementation of the ETAT+ clinical practice guidelines in order to improve quality of hospital care in Rwandan district hospitals. Understanding these challenges, especially from HCWs perspective, can guide efforts to improve uptake of clinical practice guidelines including ETAT+ in Rwanda. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2193-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Celestin Hategeka
- ETAT+ Program, Rwanda Paediatric Association, Kigali, Rwanda. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Leah Mwai
- Maternal and Child Health Program, International Development Research Centre, Ottawa, ON, Canada.,Afya Research Africa, Nairobi, Kenya
| | - Lisine Tuyisenge
- ETAT+ Program, Rwanda Paediatric Association, Kigali, Rwanda.,Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| |
Collapse
|
15
|
Kwok CS, Gordon AC. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital. Ann R Coll Surg Engl 2016; 98:479-82. [PMID: 27269243 PMCID: PMC5210001 DOI: 10.1308/rcsann.2016.0175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.
Collapse
Affiliation(s)
- C-S Kwok
- Wexham Park Hospital, Frimley Health NHS Foundation Trust , UK
| | - A C Gordon
- Wexham Park Hospital, Frimley Health NHS Foundation Trust , UK
| |
Collapse
|
16
|
Dixit S, Sahu P, Kar SK, Negi S. Identification of the hot-spot areas for sickle cell disease using cord blood screening at a district hospital: an Indian perspective. J Community Genet 2015; 6:383-7. [PMID: 25860337 DOI: 10.1007/s12687-015-0223-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022] Open
Abstract
Sickle cell disease (SCD), a genetic disorder often reported late, can be identified early in life, and hot-spot areas may be identified to conduct genetic epidemiology studies. This study was undertaken to estimate prevalence and to identify hot spot area for SCD in Kalahandi district, by screening cord blood of neonates delivered at the district hospital as first-hand information. Kalahandi District Hospital selected for the study is predominated by tribal population with higher prevalence of SCD as compared to other parts of Odisha. Cord blood screening of SCD was carried out on 761 newborn samples of which 13 were screened to be homozygous for SCD. Information on area of parent's residence was also collected. Madanpur Rampur area was found to be with the highest prevalence of SCD (10.52 %) and the gene distribution did not follow Hardy-Weinberg Equation indicating un-natural selection. The approach of conducting neonatal screening in a district hospital for identification of SCD is feasible and appropriate for prioritizing area for the implementation of large-scale screening and planning control measures thereof.
Collapse
|
17
|
Sani R, Sanoussi S, Didier JL, Salifou GM, Abarchi H. Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals. Indian J Surg 2015; 77:822-6. [PMID: 27011464 DOI: 10.1007/s12262-013-1015-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022] Open
Abstract
The purpose of the study was to evaluate the qualitative aspect and global impact of surgery in a district hospital (DH) since the launching of the surgery at the district level. Surgical care was provided by general practitioners (GP) who received 12-month training in surgery, certified by a "Capacity of District Surgery" (CDS) diploma. It was a prospective study during 4 years from 2007 to 2010. Of the 34 DHs, only 21 were functional and included in this study. Most of the DHs had two or more CDS (n = 15). The majority of the DHs had one nurse surgical aid (n = 16) and one nurse anesthetist (n = 17). The total number of surgical operations was 18,441 cases; emergency cases represented 51.8 % and elective surgery 48.2 %. Regarding emergency surgery, cesarean sections revealed the most common surgical procedure (37.21 %), followed by wound debridement (19.42 %). In elective surgery, hernia repair and hydrocelectomy were the most common surgical procedures (69.60 %), followed by gynecologic procedures in 12.74 % of the cases. The global complication rate was 4.34 %. The global mortality rate was 1.04 % (n = 192), 102 deaths following cesarean section (2.87 %). No death was encountered in elective surgery. Nine hundred and fifty-five patients (5.17 %) were transferred to a higher-level facility of whom 598 patients (62.61 %) were admitted for fracture treatment. The concept of district surgery has proven to be an effective tool to counter skilled medical manpower shortage to perform emergency and elective basic surgery at the rural level and could be adopted by developing countries facing similar health challenges.
Collapse
|
18
|
Torzewski J, Zimmermann O, Paula J, Fiedermutz M, Li K, Ito W, Karch M, Liu Z, Ruland A, Hüttner I, Osberghaus M, Doll N. In-hospital results of transcatheter aortic valve implantation (TAVI) in a district hospital--an approach to treat TAVI patients in rural areas. Int J Cardiol 2013; 168:4845-6. [PMID: 23932047 DOI: 10.1016/j.ijcard.2013.07.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
|