Hospital In Namibia Research Articles

Nursing students’ perceptions and experiences of utilising the nursing process at a university teaching hospital in Namibia

BackgroundThe appropriate utilisation of the nursing process, which is the scientific basis for the practice of nursing, can result in the provision of comprehensive and quality nursing care to patients. However, there is a major problem with utilisation of the nursing process. Utilisation of the nursing process depends on many factors, including knowledge and skills, which should ideally develop in nursing students during their nursing education. Few studies have assessed the utilisation of the nursing process among nursing students, thus the objective of this study was to explore and describe nursing students’ perceptions and experiences of utilising the nursing process. MethodsA qualitative exploratory descriptive research design was employed. Thirteen participants were purposefully sampled. Data were collected through in-depth interviews and data analysis was done thematically. FindingsSix themes emerged: understanding the nursing process; utilisation of the nursing process; theory-practice gap and practice-theory gap; learning experience; barriers to use of the nursing process; and benefits of the nursing process. The students understood the nursing process from a theoretical perspective, but experienced poor utilisation creating a negative learning experience. However, the students still believed there were some positive outcomes in the learning and use of the nursing process. ConclusionThe experiences and perceptions of nursing students regarding the utilisation of the nursing process showed that students have more theoretical than practical knowledge of the process. Their clinical experience is dominated by a theory/practice gap, leading to poor utilisation of the nursing process which negatively affects their learning experience. Despite these negative experiences, students perceived the nursing process as beneficial.

Midwives’ Perceptions Regarding the Use of the Cardiotocograph Machine as an Intrapartum Monitoring Tool in Namibia: A Qualitative Research Study

Although, at the time of this study, the cardiotocograph machine was the acceptable monitoring tool to be used intrapartum, its appropriate use was a matter of concern for midwives globally. This article reports the findings of a qualitative study which investigated the perceptions of midwives, who were working in a labor ward in a public referral hospital in Namibia, regarding the use of the cardiotocograph machine. The objectives of the study included: to explore and describe the perceptions of midwives working in a labor ward in Namibia regarding the use of the cardiotocograph machine as a labor monitoring tool; and to explore and describe how midwives working in a labor ward in Namibia perceived informing women who were in labor about the use of the cardiotocograph machine as a labor monitoring tool. 
 
 The study site was a public referral hospital which offered services to the five northern regions of Namibia. The requisite data was collected using semi-structured, one-on-one interviews which were conducted with seventeen (17) purposively selected participants. The interviews were recorded on an audio device. The spiral method of data analysis was adopted. The study findings revealed that the participants had varying perceptions on the use of the cardiotocograph machine intrapartum and, as such, perceived its use as a challenge. It was concluded that midwives need to be empowered via refresher courses with regard to the use of cardiotocograph machine to ensure optimum results.

Antibiotics’ susceptibility patterns of bacterial isolates causing lower respiratory tract infections in ICU patients at referral hospitals in Namibia

ABSTRACT Background Lower respiratory tract infections (LRTIs) are a particular public health concern especially among sub-Saharan African countries. This is especially the case in Namibia, where LRTIs are currently the third leading cause of death, 300 deaths in children under 5 years of age. To reduce the burden of LRTIs on health systems and ensure appropriate patient management, it is critical to know the most prevalent pathogens leading to LRTIs and their susceptibility patterns in the local setting. Consequently, the objective of this study was to formulate cumulative antibiograms for Intensive Care Units (ICUs) of referral hospitals in Namibia to guide future antibiotic use. Methods A retrospective analytical cross-sectional study was conducted over 2 years. The cumulative antibiograms were constructed in accordance with current guidelines. Results A total of 976 first isolate cultures were obtained from ICUs of the different referral hospitals. K. pneumoniae (8.8%, 8.1%) was a predominant pathogen in Windhoek Central hospital ICU in 2017 and 2018. In Oshakati intermediate hospital ICU, Enterobacter sp. (22.2%) and P. aeruginosa (37.5%) were the common pathogens in 2017 and 2018, respectively. A. baumannii isolates were >90% susceptibility to colistin, carbapenems, and tigecycline in 2017. In 2017, K. pneumoniae isolates were more susceptible to carbapenems (94% and 93.8% among isolates), amikacin (89.3%), and tigecycline (88.7%). In 2018, K. pneumoniae isolates were 100% susceptible amikacin, colistin, and carbapenems. S. maltophilia isolates were more than 80% susceptible to all the tested antibiotics. S. aureus isolates were 100% susceptible to linezolid, rifampicin, teicoplanin, and vancomycin in 2017 and in 2018. Its susceptibility to these antibiotics did not change. Conclusion The susceptibility patterns of the common isolated gram-negative pathogens were highly variable. Meropenem in combination with gentamicin is now the recommended antibiotic combination for empiric therapy for patients with LRTIs in Windhoek Central Hospital ICU.

An analysis of hospital pharmacy practice in Namibia, based on FIP's Basel Statements.

Sub-Saharan Africa, a region faced with a double challenge of infectious and non-communicable diseases requires strengthening of hospital pharmacy practice to improve treatment outcomes and patient safety. The objectives of this study were to assess the current state of pharmacy practice in hospitals in Namibia and to identify opportunities for expanding pharmacists' role in addressing public health challenges and improving medicines use outcomes. A survey utilized FIP's self-assessment tool to evaluate current hospital pharmacy practice in Namibia against best practices articulated in the Basel Statements. The study was conducted among hospital pharmacists across Namibia. Quantitative and qualitative data were analysed using descriptive statistics and thematic analysis. The study was conducted in 24 hospital pharmacies across Namibia, the majority of which were public facilities (67%). Overall, current hospital pharmacy practice activities are focused on medicine procurement, preparation and distribution. The main barriers to optimal hospital pharmacy services are associated with limited human resources and collaboration across healthcare providers, as well as policy gaps. There is a strong desire among hospital pharmacists to expand their contributions to improving medicines outcomes and solving public health problems. Namibia's pharmacy educational system is a strength and should be utilized to continue advancing hospital pharmacy practice and medicines use. Therapeutics committees are usually part of each hospital's structure and can be very effective for hospital-based policy change. The opportunity exists to optimize pharmacists' contributions by utilizing the local therapeutics committees in combination with the educational system to advance hospital pharmacy practice in Namibia.

Models for Setting up Medical Information Services in Namibia

This paper proposes conceptual models of information seeking for medical doctors. The models are based on a study entitled “Information Needs and Information-Seeking Behavior of Practicing Medical Doctors at Katutura and Windhoek Central State Hospitals in Namibia” conducted between 2015 and 2018. Using a mixed-methods research approach, the study aimed to establish the information required by practicing medical doctors to carry out their work, how they seek information, the information sources and resources they use, and the factors that affect them as they do so. The proposed models are based on the premise that information service providers need to analyze the medical doctors’ contexts, motivating factors, prevailing circumstances, information-seeking behaviors and information use.

Effort and reward imbalance factors motivating Namibian professional nurses to participate in continuous professional development: A confirmatory factor analysis.

BackgroundTo improve professional development, it is important to understand the motivational factors behind nurses’ participation in specific types of continuous professional development activities. Effort–rewards imbalance (ERI) posits an imbalance between high efforts spent at work and low rewards sometimes received in turn. However, professional nurses have various ERIs that can influence their reasons to participate in continuous professional development activities.AimThe purpose of this article was to propose a model for selected ERI factors, which motivate professional nurses to participate in continuous professional development activities.SettingTwo hundred and forty-one professional nurses working in a public national referral hospital in Namibia participated in the study.MethodsSurvey data on professional nurses’ reasons and motivations to participate in the professional development activities were analysed using a literature-based framework on ERI and reasons for participation in continuous professional development. The survey data were analysed for reflective relationships of ERI and reasons for participation in continuous professional development activities. A confirmatory factor analysis method using IBM SPSS AMOS version 23 was used to develop and validate the effort–reward motives for a continuous professional development model.ResultsFour effort-reward imbalance factors were derived from sixteen CPD motives. The reflective factors were (1) extrinsic efforts, (2) intrinsic efforts, (3) reward motives, and (4) over-commitment motives. The four conceptual factors made up a second-order effort-reward motives factor for the nurses’ reasons to take part in continuous professional development activities.ConclusionsThe results of this study show that professional nurses consider taking part in continuous professional development activities in order to carry out their work better but not as a way to increase chances of promotion. The study also concluded that the older professional nurses tend to have higher intrinsic effrot motivation than their younger counterparts. Thus, nurses could use these findings to understand the reasons which motivate them to develop professionally.

Effect of Interpregnancy Interval on Adverse Maternal and Perinatal Outcomes at Katutura Regional Referral Hospital in Namibia: A Retrospective Cohort Study, 2005 to 2015

Effect of Interpregnancy Interval on Adverse Maternal and Perinatal Outcomes at Katutura Regional Referral Hospital in Namibia: A Retrospective Cohort Study, 2005 to 2015

Tenofovir disoproxil fumarate associated nephrotoxicity: a retrospective cohort study at two referral hospitals in Namibia.

The incidence and risk factors of tenofovir disoproxil fumarate (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV. A retrospective cohort study among HIV-infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR <50 mL/min/1.73m2 . 10 387 patients were included: 11.4% (n = 1182) experienced the decline in eGFR. Of these, 0.6% (n = 62) migrated to eGFR stages IV and V. The incidence was 4.5 (95% CI: 4.3-4.8) per 100 patient years. RI developed in 400 patients for an incidence rate of 2.4 (95% CI: 2.2-2.6) cases per 100 patient years. Risk factors with effect sizes >2.0, for decline-in-eGFR were baseline eGFR >60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29). The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI.

Factors Associated with Increased Neonatal Deaths at a Regional Hospital in Namibia

The increased neonatal mortality rate in a regional hospital in Namibia is a concern. According to the 2013 records of the hospital, there were 333 neonatal deaths from 1 January to 31 December 2013. The aim of the study was to investigate the causes of the increased neonatal deaths at this regional hospital in Namibia. A retrospective descriptive survey design was employed to conduct the study. Data were collected from 231 record files of neonates that died from 1 January to 31 December 2013 while admitted at the regional hospital before 28 completed days of life. The results shows that 67.1 per cent (n = 155) neonates that died in the regional hospital were during the first 7 days of life, and 32.9 per cent (n = 76) died after 7 days of life but before 28 completed days of life. Five causes accounted for the early neonatal deaths: respiratory distress syndrome, congenital abnormalities, neonatal sepsis, birth asphyxia, and haemorrhagic diseases of newborns. The late neonatal deaths were mainly caused by neonatal sepsis, followed by respiratory distress syndrome, congenital abnormalities, and birth asphyxia. The results also indicated poor record-keeping as an associated factor in this regional hospital. The study finally concluded that the majority of neonatal deaths that occurred in 2013 at the regional hospital were associated with multiple factors such as respiratory distress syndrome, neonatal sepsis, asphyxia, and congenital abnormalities. However, the majority of these factors could have been avoided.

Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study.

Introduction:Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy.Aim:To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia.Methods:A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL.Results:Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages.Conclusion:Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence.

Effect of TDF-containing regimens on creatinine clearance in HIV patients in Namibia with a baseline CrCl

ABSTRACTBackground and aims: The advent of antiretroviral therapy (ART) and early diagnosis of the human immunodeficiency virus (HIV) has resulted in an appreciable reduction in morbidity and mortality among people infected with HIV. However, tenofovir disoproxil fumarate (TDF)–containing ART regimens are associated with a reduction in creatinine clearance (CrCl). No evaluation has been conducted in Namibia to date on the relationship between TDF-containing ART and CrCl among patients with moderate to severe reductions in CrCl to guide future practice. We aimed to address this.Methodology: Retrospective longitudinal study between January 2008 to December 2016 evaluating CrCl in patients with a baseline CrCl <60ml/min who were receiving TDF-containing ART in a leading hospital in Namibia. We identified patients who had experienced an improvement in CrCl and compared their characteristics with those whose CrCl did not improve. We assessed factors for an association with improvement in CrCl using binary logistic regression.Results: 389 patients were included, the majority were female (n = 294). Female vs. male assessments showed no difference in age (p = 0.340), weight (p = 0.920), number who experienced an improvement (105 vs 39, p = 0.349), or absence of improvement (189 vs. 56, p = 0.349). The improvement group (male and female) had a lower baseline CrCl (45.9 vs. 55.0, p < 0.001). The follow-up CrCl for the improvement and no improvement groups were 72.6 and 55.9 respectively. Multivariate analysis showed that the odds of improvement were: 0.905 (0.871–0.940, p < 0.001) for each unit rise in the baseline CrCl, and 0.904(0.880–0.923) for each year of follow-up.Conclusion: More improvement than decline in CrCl was observed. Improvement occurred more in patients with lower baseline CrCl, and occurred in the early period of ART with reduced odds of experiencing this with time. Our findings indicate that TDF may be used in patients with a low baseline CrCl.

How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: quality improvement study

BackgroundPostpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia.MethodsA criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10-month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients’ care meeting the predetermined criteria.ResultsIn the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p < 0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning.ConclusionThe study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies.

P1.07-19 Palliative Care Social Workers Multi-Dimensional Roles: A Namibian Perspective

This article provides insight on multi-dimensional roles of twenty social workers providing palliative to patients with life-limiting illnesses (e.g. cancer, cardiovascular diseases, diabetes, etc.) in six hospitals in primary care in Namibia. Constructive grounded theory as a qualitative research approach was utilized and an ethnographic study was carried out through in-depth interviews with twenty practicing social workers at six public hospitals in Namibia using an audio-tape recorder to explore how social workers perceive their role in providing palliative care to patients with life-limiting illnesses. Purposive, non-probability sampling through qualitative in-depth face-to-face and open-ended interviews. Data were gathered using a narrative approach. Memoranda through field notes, memos assisted in data analysis, applying traditional grounded theory coding techniques applied. Data collection and analysis were conducted interchangeably. Social workers perform multi-dimensional roles in the provision of palliative care such as advocate, assessor, broker, counsellor, educator, facilitator, patient liaison, mediator, discharge planner and manager of in-country referrals. Understanding the importance of the multi-dimensional roles of social workers in the provision of palliative care to patients with life-limiting illnesses is critical. National palliative care policy guidelines and further research are needed in strengthening social workers’ role in the provision of the field of palliative care. This can be achieved through effective training and capacity building of social workers through continuous education in palliative care.

HIV Status Disclosure to Sexual Partner(s) and Associated Factors Among Young Adults, A Mixed Methods Study

With a documented HIV prevalence among adults of 12.6% with disparities by sex; 15.7% and 9.3% among women and men respectively, Namibia is one of the first countries reported to be nearing epidemic control for HIV. Namibia has been very successful in ensuring universal treatment access for people living with HIV. For prevention interventions, the importance of HIV status disclosure among HIV-infected individuals, particularly to their sexual partners cannot be over emphasized. We used a mixed methods approach on a combined sample of 185 HIV positive young adults attending comprehensive care departments at selected referral hospitals in Namibia. For quantitative data, the chi-square test and multiple regression analysis were employed for data analysis. Qualitative data was transcribed, coded and analysed to build themes in line with study objectives. Of the 185 participants; only 35 were included in the qualitative component of the study with stratification by gender and age. Multiple logistic regression found HIV post-test counselling plus age were the only factors associated with disclosure status whilst adjusting for other study variables. Three major themes were built from the qualitative data. Theme one showed fear to be an important barrier to disclosure (fear of being rejected and violence). Theme two showed revealed lack of knowledge on importance of disclosure to sexual partner if not married or cohabitating. Theme three showed one main motivation for disclosure was having been tested together or discussed with sexual partner prior to testing. The importance of HIV post-test counselling remains an important factor affecting HIV status disclosure. In the advent of new HIV interventions such as HIV self-testing, findings from our study may be used to guide policies for these new interventions and strengthen post-test counselling to ensure HIV status disclosure to sexual partner(s). Health education on importance of testing as couples or with sexual partner needs to be strengthened.

Validity of World Health Organisation prescribing indicators in Namibia’s primary healthcare: findings and implications

World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia's primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this. An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator. Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs. WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.

Monitoring of gentamicin serum concentrations in obstetrics and gynaecology patients in Namibia.

Background Therapeutic drug monitoring is frequently used to optimize the gentamicin dose. Objective The study investigated whether a 240mg once daily standard dose achieves the recommended target serum gentamicin concentrations. Setting The prospective, observational study took place in the 2 major public hospitals in Namibia. Method Twenty-nine female patients receiving a standard dose (240mg gentamicin once daily) participated in the study. Two blood samples were withdrawn to estimate gentamicin pharmacokinetic parameters. Serum creatinine was used to calculate creatinine clearance with the Cockcroft-Gault formula (CLcr), and estimate glomerular filtration rate (eGFR) by the Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Main outcome measure The outcome measure was the proportion of patients receiving 240mg gentamicin once daily having Cmax values above 15mg/L. Results Total body weight (TBW) and body mass index were highly variable: 43-115kg, and 17.3-41.3kg/m2, respectively. The gentamicin dose normalized for TBW (adjusted body weight for obese patients) was relatively low, i.e. 4.2 ± 0.8mg/kg (mean SD). Gentamicin Cmax was 14.4 ± 4.7mg/L; only 9 patients (31%) had a Cmax > 15g/mL. eGFR (MDRD-4) correlated well with CLcr, but eGFR (EPI-CKD) formula showed systematic deviations from CLcr. Conclusions (1) a standard 240mg dose results in gentamicin Cmax values below 15mg/L in the majority of the patients, (2) eGFR formulas to estimate kidney function will have to be evaluated for their usefulness in the Namibian patient population.

Prospective Observational Study of Intraoperative Anesthetic Events in District Hospitals in Namibia.

Access to safe surgery and anesthesia care is grossly inadequate in low- and middle-income countries, with a shortage of anesthesia providers contributing to this crisis. In Namibia, medical officers typically receive no >3 months of informal training in anesthesia. This study sought to determine the prevalence, currently unknown, of intraoperative adverse anesthetic events in this setting. Further, we assessed surgical volume, complications, and mortality outcomes at the district hospital level. This was a prospective observational study over 7 months involving 4 district hospitals from geographically separate and diverse areas of Namibia. A standardized protocol was used to record adverse anesthetic events during surgery, surgical volume, and complications including mortality. A total of 737 surgical procedures were performed during the study period. There was a 10% prevalence of adverse anesthetic events intraoperatively. Of these, 70% were related to hypotension and 17% due to hypoxia and/or difficult/failed intubation. Ninety-eight percent of patients were classed as low risk (American Society of Anesthesiologists I or II). Seventy-two percent of the surgical workload was in obstetrics and gynecology, with over half being for urgent obstetrics. Perioperative mortality rate was 1.4/1000, with an overall surgical complication rate of 1.6% and a surgical infection rate of 0.8%. We found a 10% prevalence of adverse anesthetic events intraoperatively when anesthesia was administered by medical officers with no >3 months of informal training in this low-resource environment. The patients were considered low risk by the medical officers responsible for the anesthesia, yet these events had the potential to lead to patient harm.

Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

Compliance to guidelines for the prescribing of antibiotics in acute infections at Namibia’s national referral hospital: a pilot study and the implications

ABSTRACTBackground: Sub-optimal antibiotic prescribing remains a public health concern in Namibia. The objective was to determine the level and predictors of compliance to guidelines in the prescribing of antibiotics in acute infections at a national referral hospital in Namibia to improve future prescribing.Methods: An analytical cross-sectional survey design. The clinical records of patients receiving care were reviewed. Prescribing practices were assessed using a self- administered questionnaire with reference to Namibia Standard Treatment Guidelines (NSTG).Results: The majority of prescriptions (62%) complied with the NSTGs; however, lower than national targets (95%). Most prescriptions were empiric and prescribers typically made reference to the NSTG (58%). Diagnosed infections were principally respiratory infections (58%) and penicillins were the most used antibiotics. Good concurrence between signs and symptoms with the diagnosis indicated on the prescription - OR=5.2 (95% CI: 1.4, 19.2), a diagnosis of upper respiratory tract (p=0.001), oral-dental OR=0.1(95% CI: 0.03,0.3) and urogenital infections OR=0.3(95% CI: 0.1,0.95) and the prescribing of penicillins (p=0.001) or combination antibiotics and amphenicols were independent predictors of compliance to the NSTGs. The main behaviours associated with antibiotic prescribing were patient influences, clinical state, and access to guidelines.Conclusions: Compliance with NSTGs is suboptimal. Prescribing of combination antibiotics, penicillins and diagnosis of oral dental, genitourinary and ear, nose and throat infections were important predictors for NSTG compliance. There is a need to implement antibiotic indicators and stewardship programmes, and ensure access to NSTGs, to improve future antibiotic prescribing in Namibia.

Liver enzyme elevations in a cohort of HIV/AIDS patients on first-line antiretroviral therapy in Namibia: Findings and implications

IntroductionAll antiretroviral therapies (ARTs) are potentially toxic to the liver. In sub-Saharan Africa, the rising incidence of ART induced adverse events has complicated treatment leading to recent revisions of Namibian ART guidelines. Unfortunately there have been limited studies to date evaluating ART induced liver injury in Namibia to guide further revisions if needed. ObjectiveDetermine the current patterns and grades of ALT elevation in Namibia’s HIV/AIDS. MethodsRetrospective cohort analysis. Patterns of alanine amino transferase (ALT) liver enzyme elevation were determined in a cohort of ART naïve HIV patients on firstline ART regimen in a referral hospital in Namibia over a 1year treatment period. Patterns of ALT changes at baseline, 3months and 6months were analyzed using ANOVA and Bonferroni test for pairwise comparisons. ResultsOf 79 eligible patients, 72 developed significant ALT elevation within 3months of ART initiation (F (3, 76)=6.4, p=0.002, η2=0.193). Four 4 (5.6%) and 1 (1.38%) patient respectively developed grade 2 and grade 3 ALT elevation by month 3. There was no significant difference between mean ALT levels at baseline and month 6. A CD4 count of <350cells/mm3; female gender and age over 40years were the main factors associated with moderate or severe ALT elevation. ConclusionsFirst line ART commonly induces mild self-limiting liver enzyme elevation in Namibian HIV patients especially in the first 3months. Consequently, there is a need to monitor ALT levels for at least 3months after initiation mainly in high risk patients to reduce side-effect concerns. This is already happening.