Lower Health Facilities Research Articles

BARRIERS TO THE DETECTION, MANAGEMENT and PREVENTION OF PREECLAMPSIA/ECLAMPSIA IN ETHIOPIA: FORMATIVE REVIEW

Abstract Background: Preeclampsia is the third leading cause of maternal mortality in Ethiopia accounting for 11% of maternal deaths. Barriers to the diagnosis, management and prevention of Preeclampsia are not well studied in Ethiopia. Objectives: To explore barriers to the detection, management, and prevention of preeclampsia/ Eclampsia in Ethiopia Methods: Desk review of Scientific papers, Health surveys, and national documents were done after employing a search strategy and browsing through databases (PubMed, Google Scholar,). Eight in-depth interviews with relevant stakeholders were also done for supplementation. Framework for analysis of barriers was devised and thematic synthesis of findings done Results: Eight primary studies; three demographic surveys (DHS) and 11 national documents (2 policy papers; 2 legislations; 4 guidelines; 1 protocol and 2 training materials were included for data synthesis from the desk review. There is no national policy exclusively on preeclampsia. All drugs used in the management of preeclampsia/eclampsia are included in the essential medicine list but are not registered. In the standard guidelines, which health professionals could administer Magnesium is not specified. Moreover, elements of referral are not detailed and pre-referral care is substandard. None of the documents have recommended Aspirin for the prevention of preeclampsia. There is no national protocol on Preeclampsia care. But the national emergency Obstetric care training material has included updated information on Magnesium, anti-hypertensives, and Aspirin. Administration of loading dose magnesium at lower health facilities is not approved in any of the documents. There was a significant gap in drug procurement, distribution, and availability. At health facility level inadequate training; perceived inability to provide Magnesium; lack of local guidelines; substandard quality care and Poor knowledge on preeclampsia by health providers were barriers whereas delayed care-seeking; alternative cultural remedies and poor awareness on preeclampsia were barriers at the community level. Conclusion: There are substantial barriers to the detection, management, and prevention of Preeclampsia at all levels of health care provision which should be addressed with a concerted effort from all responsible stakeholders. Key Words: Preeclampsia, Eclampsia, Barriers, Diagnosis, Management, Prevention

Predictors of in-hospital mortality among under-five children with severe acute malnutrition in South-Western Uganda.

BackgroundSevere acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM.MethodsThis was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0.ResultsWe enrolled 122 children, median age of 15 months [IQR:11–24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14–24.08, p = 0.001).ConclusionThe in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines.

UNMET NEED OF HEALTH FACILITIES IN BOGOR REGENCY

The existence of health facilities (fasilitas kesehatan/faskes) especially at the district level is considered very appropriate to reduce the number of people whose health is impaired. For this reason, a targeted program needed to reduce this number. The program is by reducing the number of unmet needs in areas that have high population, high rate of increase and high density. This is very in accordance with the characteristics of Bogor regency as a research locus. The method used in this research is a combination method, which is a combination of tabular analysis (statistics) with spatial data. The combination of the two will produce locations with low unmet need health facilities resulting from a causality of 2 (two) variables, both of these variables are the number of residents with the number of health facilities, so that the precise and accurate results will be obtained. The conclusion from the spatial analysis is that there are 19 from 40 sub-districts in Bogor regency whose indicators of unmet need for low health facilities. Although this research is considered very simple, the results of this study are very important because it can be used as a guideline for the development of health facilities, especially community health centers (Puskesmas) in Bogor regency.

Risk factors for obstructed labour in Eastern Uganda: A case control study.

Obstructed labour (OL) is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality. Risk factors for OL and its associated obstetric squeal are usually context specific. No epidemiological study has documented the risk factors for OL in Eastern Uganda. This study was conducted to identify the risk factors for OL in Mbale Hospital. To identify the risk factors for OL in Mbale Regional Referral and Teaching Hospital, Eastern Uganda. We conducted a case control study with 270 cases of women with OL and 270 controls of women without OL. We consecutively enrolled eligible cases between July 2018 and February 2019. For each case, we randomly selected one eligible control admitted in the same 24-hour period. Data was collected using face-to-face interviews and a review of patient notes. Logistic regression was used to identify the risk factors for OL. The risk factors for OL were, being a referral from a lower health facility (AOR 6.80, 95% CI: 4.20-11.00), prime parity (AOR 2.15 95% CI: 1.26-3.66) and use of herbal medicines in active labour (AOR 2.72 95% CI: 1.49-4.96). Married participants (AOR 0.59 95% CI: 0.35-0.97) with a delivery plan (AOR 0.56 95% CI: 0.35-0.90) and educated partners (AOR 0.57 95% CI: 0.33-0.98) were less likely to have OL. In the adjusted analysis, there was no association between four or more ANC visits and OL, adjusted odds ratio [(AOR) 0.96 95% CI: 0.57-1.63)]. Prime parity, use of herbal medicines in labour and being a referral from a lower health facility were identified as risk factors. Being married with a delivery plan and an educated partner were protective of OL. Increased frequency of ANC attendance was not protective against obstructed labour.

Increasing retention of HIV positive pregnant and breastfeeding mothers on option-b plus by upgrading and providing full time HIV services at a lower health facility in rural Uganda

BackgroundDespite advancement in Prevention of Mother to Child Transmission (PMTCT) services, the rate of MTCT of HIV in sub-Saharan Africa is still high. This is partly due to low retention of HIV positive mothers in HIV care. We sought to determine the level of retention and the factors associated with retention among HIV positive pregnant and breastfeeding mothers following accreditation of an antiretroviral therapy (ART) clinic to offer full time ART services in one of the lower health facilities in rural Western Uganda.MethodsThis study was a mixed methods study conducted in 5 health centres in rural Western Uganda from 10th April to 10th May 2017. A total of 132 retained and non-retained HIV positive pregnant and breastfeeding mothers were recruited. A Mother was categorized as retained if she had not missed her ART appointments at antenatal or postnatal clinic for ≥3 consecutive months. Questionnaires were administered and four focus group discussions were held. We used descriptive statistics to understand characteristics of mothers and their levels of retention. Thematic analysis was used to analyze qualitative data.ResultsAbout a third (35.6%) of the mothers were aged 18–24 with a median age of 26 (IQR 23, minimum age of 16 and maximum age of 39). More than half, 73 (55.3%) of all mothers were in HIV care for 3–24 months and about 116(87.9%) of all mothers were retained in HIV care. This was an improvement from 53% reported in 2015. We found lack of formal education, lack of disclosure of HIV status to the spouse, perceived lack of confidentiality and self stigmatization as factors hindering retention. The desire to have an HIV free baby, fear of death and opportunistic infections, support from significant others and community groups were factors associated with retention.ConclusionsWe observed improved retention in lower health centres and to achieve 100% retention, we recommend interventions such as sensitizing HIV positive mothers on disclosure of HIV status to spouse, maintaining confidentiality of client information at the clinic, support to girl child education and formation of community support groups.Trial registrationThis study was retrospectively registered with the Uganda National Council for Science and Technology (UNCST), registration receipt number 10961 on the 9th March, 2018.

Pre-referral stabilization and compliance with WHO guidelines for trauma care among adult patients referred to an urban emergency department of a tertiary referral hospital in Tanzania

BackgroundThe outcomes of trauma are considered to be time dependent. Efficient and timely pre-referral stabilization of trauma patients has been shown to impact survival. Tanzania has no formal pre-hospital or trauma system. World Health Organisation has provided a set of standards for initial stabilization of trauma patients according to the level of the hospitals. We aimed to describe pre-referral stabilization provided to adult trauma patient referred to the national referral hospital and compliance with World Health Organisation guidelines.MethodsThis prospective observational cross-sectional study was conducted at the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH), between July 2017 and December 2017. Eligible patients were adults with head injury and extremity injury ≥18 years who were referred from a peripheral hospital and had a referral note. Research assistant enrolled patients using structured case report form clinical information, and initial stabilization received at the referring hospital. Primary outcome was the proportion of patients who had initial stabilization performed according to World Health Organisation recommendation.ResultsWe enrolled 368 (29% of eligible patients), the median age was 34 years (Interquartile range 26–44 years), and 281 (76%) were male. Overall 69% of referred patients arrived at the EMD more than 24 h after injury. Of those enrolled, 50 (13.6%) patients had received at least one stabilization intervention prior to transfer to MNH. Among 206 patients with extremity injuries, splinting was inadequate or missing in all cases; No patients with head injury received cervical spine protection. Among patients referred from a health center, 26.9% received an initial stabilization, while stabilization procedures were administered to 13.2% of those from district hospitals, and 10% of those from regional hospitals.ConclusionsIn this urban public emergency department in Tanzania, majority of trauma patients were referred from lower health facilities after 24-h of injury. Most did not receive initial trauma stabilization as recommended by the World Health Organisation guidelines. Future studies should identify barriers to pre-referral stabilization of adult trauma patients.

Multicentre evaluation of significant bacteriuria among pregnant women in the cascade of referral healthcare system in North-western Tanzania: Bacterial pathogens, antimicrobial resistance profiles and predictors.

The aim of this multicentre study was to evaluate the magnitude of significant bacteriuria (SB) as well as the implicated bacterial pathogens, antimicrobial resistance (AMR) profiles and risk factors for SB among pregnant women attending different levels of healthcare facilities (HCFs) in Tanzania in order to guide antimicrobial therapy and preventive measures. Information on sociodemographic and clinical characteristics, midstream urine culture and antimicrobial susceptibility testing was collected from 1828 pregnant women between March 2016 and May 2017. Data were analysed using STATA v.13.0 software. The prevalence of SB among pregnant women was 17.7% (323/1828; 95% CI 16.0-19.5%), with a predominance of Escherichia coli (164/323; 50.8%), Klebsiella spp. (55/323; 17.0%) and Staphylococcus aureus (28/323; 8.7%). Moreover, 37.5% (121/323) of bacteria were multidrug-resistant [84.3% (102/121) Gram-negative bacteria and 15.7% (19/121) in Gram-positive bacteria; P<0.001]. Third-generation cephalosporin resistance in E. coli, Klebsiella spp. and other Enterobacteriaceae was 13.4%, 21.8% and 27.5%, respectively, and was higher in strains from a tertiary hospital (OR=3.27, 95% CI 1.02-10.49; P=0.046) compared with lower HCFs. Predictors of SB among pregnant women were lack of formal occupation, current hospital admission and presence of co-morbidities. The prevalence of SB among pregnant women in this study was high (17.7%) and was within the same range reported 10 years ago in a single-centre baseline study. However, there is an increase in AMR in the cascade of referral healthcare system, underscoring the need for health facility level-specific antimicrobial stewardship.

Long term trends and spatial distribution of animal bite injuries and deaths due to human rabies infection in Uganda, 2001-2015.

BackgroundIn the absence of accurate data on trends and the burden of human rabies infection in developing countries, animal bite injuries provide useful information to bridge that gap. Rabies is one of the most deadly infectious diseases, with a case fatality rate approaching 100%. Despite availability of effective prevention and control strategies, rabies still kills 50,000 to 60,000 people worldwide annually, the majority of whom are in the developing world. We describe trends and geographical distribution of animal bite injuries (a proxy of potential exposure to rabies) and deaths due to suspected human rabies in Uganda from 2001 to 2015.MethodsWe used 2001–2015 surveillance data on suspected animal bite injuries, collected from health facilities in Uganda. To describe annual trends, line graphs were used and linear regression tested significance of observed trends at P<0.05. We used maps to describe geographical distribution of animal bites by district.ResultsA total of 208,720 cases of animal bite injuries were reported. Of these, 27% were in Central, 22% in Eastern, 27% in Northern and 23% in Western regions. Out of 48,720 animal bites between 2013 and 2015, 59% were suffered by males and 81% were persons aged above 5 years. Between 2001 and 2015, the overall incidence (per 100,000 population) of animal bites was 58 in Uganda, 76 in Northern, 58 in Central, 53 in Western and 50 in Eastern region. From 2001 to 2015, the annual incidence (per 100,000 population) increased from 21 to 47 (P = 0.02) in Central, 27 to 34 (P = 0.04) in Eastern, 23 to 70 (P = 0.01) in Northern and 16 to 46 (P = 0.001) in Western region. A total of 486 suspected human rabies deaths were reported, of which 29% were reported from Eastern, 28% from Central, 27% from Northern and 17% from Western region.ConclusionAnimal bite injuries, a potential exposure to rabies infection, and mortality attributed to rabies infection are public health challenges affecting all regions of Uganda. Eliminating rabies requires strengthening of rabies prevention and control strategies at all levels of the health sector. These strategies should utilize the “One Health” approach with strategic focus on strengthening rabies surveillance, controlling rabies in dogs and ensuring availability of post exposure prophylaxis at lower health facilities.

Does quality influence utilization of primary health care? Evidence from Haiti

BackgroundExpanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti.MethodsWe constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery.ResultsFacilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure.ConclusionsPoor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa.

BackgroundSyphilis in pregnancy is an under-recognized public health problem, especially in sub-Saharan Africa which accounts for over 60% of the global burden of syphilis. If left untreated, more than half of maternal syphilis cases will result in adverse pregnancy outcomes including stillbirth and fetal loss, neonatal death, prematurity or low birth weight, and neonatal infections. Achieving universal coverage of antenatal syphilis screening and treatment has been the focus of the global campaign for the elimination of mother-to-child transmission of syphilis. However, little is known about the availability of antenatal syphilis screening and treatment across sub-Saharan Africa. The objective of this study was to estimate the ‘likelihood of appropriate care’ for antenatal syphilis screening and treatment by analyzing health facility surveys and household surveys conducted from 2010 to 2015 in 12 sub-Saharan African countries.MethodsIn this secondary data analysis, we linked indicators of health facility readiness to provide antenatal syphilis detection and treatment from Service Provision Assessments (SPAs) and Service Availability and Readiness Assessments (SARAs) to indicators of ANC use from the Demographic and Health Surveys (DHS) to compute estimates of the ‘likelihood of appropriate care’.ResultsBased on data from 5,593 health facilities that reported offering antenatal care (ANC) services, the availability of syphilis detection and treatment in ANC facilities ranged from 2% to 83%. The availability of syphilis detection and treatment was substantially lower in ANC facilities in West Africa compared to the other sub-regions. Levels of ANC attendance were high (median 94.9%), but only 27% of ANC attendees initiated care at less than 4 months gestation. We estimated that about one in twelve pregnant women received ANC early (<4 months) at a facility ready to provide syphilis detection and treatment (median 8%, range 7–32%). The largest implementation bottleneck identified was low health facility readiness, followed by timeliness of the first ANC visit.ConclusionsWhile access was fairly high, the low levels of likelihood of antenatal syphilis detection and treatment identified reinforce the need to improve the availability of syphilis rapid diagnostic tests and treatment and the timeliness of antenatal care-seeking across sub-Saharan Africa.

Accessibility of Point-of-Care Diagnostic Services for Maternal Health in Lower Healthcare Facilities in Northern Ghana: A Cross-Sectional Survey

Background: Improving access to maternal healthcare in resource limited settings plays a critical role in improving maternal health outcomes and reducing maternal deaths. However, barriers and challenges may exist in rural clinics and could affect successful implementation. This study assessed the current accessibility of point-of-care (POC) diagnostic services for maternal healthcare in rural primary healthcare (PHC) clinics in Northern Ghana. Method: We randomly selected 100 PHC clinics providing maternal healthcare from a total list of 356 PHCs obtained from the regional health directorate. Selected clinics were surveyed from 15th February to 31st March, 2018 using an adopted survey tool. We obtained data for clinic-level staffing, availability, usage, and desired POC diagnostic tests. One antenatal clinic in-charge or a Physician Assistant from each facility was interviewed to assess their knowledge on POC diagnostic tests. Stata 14 was used for data analysis. Findings: Majority (64%) of the respondents were midwives. Average years of work experience and working hours per week were estimated at 5.6 (CI: 4.8-6.3) and 122 (CI: 111.9-132.6) respectively. Average antenatal clinic attendance per month was 65±67 (range 3-360). Mean POC tests available and use was 4.9 (CI: 4.5-5.4) out of 15 tests. Respondents' knowledge on POC test was 99.2 (CI: 99.7-100.5). The study found a positive correlation between availability and use though regression analysis showed no significance. POC test for malaria; HIV; urine pregnancy; and blood pressure were available in most clinics. Desired POC tests included: Glucose-6-phosphate dehydrogenase (95%); hepatitis c (94%); sickling (91%); tuberculosis, blood glucose and blood type (89%) each; urinary tract infection (87%), urine protein (81%); hepatitis b (78%); haemoglobin (76%); and syphilis (76%). Interpretation: There is poor accessibility of POC diagnostic services for maternal healthcare as results of low availability of POC tests in rural primary healthcare clinics in Northern Ghana. Funding: College of Health Sciences Scholarship. Declaration of interests: None declared. Ethics approval and consent to participate: This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to conducting the study. All study participants signed an informed consent prior to participating in this study.

Culture and Birthing: Experiences from a Rural Community in Western Kenya

Despite numerous campaigns to increase uptake of hospital delivery services in Kenya, skilled birth attendance is still low. The situation is particularly worse for marginalized rural communities, including the Marakwet of western Kenya. Marakwet County ranks far below the national health survey indicators, with only 28% of the women delivering in hospitals compared to the average national index, which is at 62% [1]. Different reasons are cited for the low health facility use by women during delivery. Drawing from a study on determinants of birthing sites conducted among the Marakwet of western Kenya, this paper discusses the socio-cultural factors that influence women's choice of the site of birthing. The study employed both qualitative and quantitative methods of data collection and analysis and it reports the qualitative findings. A total of 186 mothers, selected using multistage cluster sampling, were interviewed. Three focus group discussions with participants ranging from 8-12 were conducted, one with mothers below 20 years of age, another with mothers above 45 years of age and the third one with married men. A total of 29 participants participated in the FGDs. The FGDs participants were separately selected and were outside the 186 sampled informants. The study found that traditional birth attendants, rituals performed in the birthing process, and disposal of the placenta were the critical socio-cultural factors influencing the Marakwet women choice of birthing site. The paper concludes that understanding and addressing these factors is the key to any intervention programs designed to improve the reproductive health of women through the utilization of hospital as a birthing site.

High sero-prevalence of hepatitis B virus and human immunodeficiency virus infections among pregnant women attending antenatal clinic at Temeke municipal health facilities, Dar es Salaam, Tanzania: a cross sectional study

BackgroundHepatitis B virus (HBV) and Human immunodeficiency virus (HIV) infection in pregnancy is associated with direct effect of pregnancy and potential viral transmission from mother to newborn. In Tanzania very little in known on prevalence of HBV infection and their associated factors among pregnant women in lower health facilities. The main objective of the study was to determine the prevalence of HBsAg, HIV and HBV-HIV co-infection among pregnant women attending antenatal clinics in Dar es Salaam.MethodsThis cross sectional study was conducted in three Temeke municipal health-care facilities between May 2014 and June 2014. A total of 249 pregnant women attending antenatal clinic (ANC) were consecutively enrolled in the study. A data collection tool was used to extract socio-demographic characteristics from ANC card. Commercial ARCHITECT® ci4100™ was used to assess HBsAg status and liver function (Alanine amino-transferase (ALAT). HIV status was determined by anti-HIV antibody test.ResultsOf 249 pregnant women enrolled the median age was 25 years (IQR 22–30) and most of them were married (72.4%). The overall prevalence of HBsAg and HIV were 8.03% (95% CI: 5.0–12.1%) and 17.2% (95% CI: 12.8–22.5%), respectively. HBV/HIV co-infection rate was 2.8% (95% CI; 1.3–5.4%). HBsAg positive rate was significantly high in women who were HIV positive (p < 0.05). Being employed /student were less associated with HBV infection (aOR 0.35, 95% CI 0.13–0.95). Only 3 (15%) of pregnant women with HBsAg positive had abnormal ALAT.ConclusionsHigh prevalence of HBV and HIV infections among pregnant women were reported in this setting thus calls for the national expansion of the integration of prevention of mother-to-child transmission (PMTCT) services for HBV infection.

The Socio-cultural Behaviours of Women’s Health Facilities Utilisation in Northern Nigeria

This study looks at the influence of socio-cultural behaviours and women’s health facilities utilisations in northern Nigeria. A Pearson’s correlation statistical analysis was employed using a questionnaire administered to 315 women between the ages of 15 and 45 years. The findings indicate husband’s permission had strong significant relationships to antenatal care services (ANC). In addition, there were strong significant relationships between women limited freedom and female genital mutilation in terms of skilled delivery (DC) as well as husband’s permission and limited freedom of women among others. Also, a strong significant relationship exists between the postnatal care services (PNC) and limited women freedom as well as with home delivery and hot-bathing practices among others. To improve women health care utilisation and maternal health in northern Nigeria, this study provides useful planning information drawn from the women sociocultural behaviours leading to the consequent low modern health facilities utilisations. DOI: 10.5901/mjss.2015.v6n4s3p517

Feasibility Analysis and Simulation of Integrated Renewable Energy System for Power Generation: A Hypothetical Study of Rural Health Clinic

This paper presents the feasibility analysis and study of integrated renewable energy (IRE) using solar photovoltaic (PV) and wind turbine (WT) system in a hypothetical study of rural health clinic in Borno State, Nigeria. Electrical power consumption and metrology data (such as solar radiation and wind speed) were used for designing and analyzing the integrated renewable energy system. The health clinic facility energy consumption is 19 kWh/day with a 3.4 kW peak demand load. The metrological data was collected from National Aeronautics and Space Administration (NASA) website and used to analyze the performance of electrical generation system using HOMER program. The simulation and optimization results show that the optimal integrated renewable energy system configuration consists of 5 kW PV array, BWC Excel-R 7.5 kW DC wind turbine, 24 unit Surrette 6CS25P battery cycle charging, and a 19 kW AC/DC converter and that the PV power can generate electricity at 9,138 kWh/year while the wind turbine system can generate electricity at 7,490 kWh/year, giving the total electrical generation of the system as 16,628 kWh/year. This would be suitable for deployment of 100% clean energy for uninterruptable power performance in the health clinic. The economics analysis result found that the integrated renewable system has total NPC of 137,139 US Dollar. The results of this research show that, with a low energy health facility, it is possible to meet the entire annual energy demand of a health clinic solely through a stand-alone integrated renewable PV/wind energy supply.

Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria.

BackgroundUpper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility.MethodsThis was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013.ResultsDuring the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients).ConclusionEndoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality, and is cost effective. Efforts should be made to improve the accessibility of these therapeutic procedure for patients with UGIB in Nigeria.

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.

English

BACKGROUND: Due to active involvement of fetal system in regulation of amniotic fluid volume, AFI has been identified as indicator of intrauterine fetal status. USG has revolutionized the process of assessment of amniotic fluid thus becoming an integral part of fetal surveillance. Polyhydramnios is an obstetrical condition associated with significant perinatal and maternal morbidity and mortality. In a low resource health facility as India with poor coverage of antenatal care and malnutrition it still becomes more important to screen pregnancies for such high risk factors. AIMS: 1. To study incidence of polyhydramnios. 2. To identify major etiological factors of polyhydramnios. 3. To study perinatal outcome. SETTINGS AND DESIGN: A hospital based cross section study for duration from 1 st May 2009 to 31 st October 2010. MATERIAL & METHOD: All the cases identified as polyhydramnios according to AFI in four pocket were included in the study. The cases identified as having polyhydramnios but not delivered at the facility were excluded. OBSERVATION: Incidence of polyhydramnios is 0.72% of the total antenatal cases, multiparous ie, 52% more than primiparous cases. Majority were unbooked (77.3%) 63% were from rural set up. 76% belonged to low socio economic status. Majority 66% of the cases had their 1 st antenatal visit at term. Increased incidence of operative delivery was seen in the study. Associated maternal factors found with polyhydramnios were gestation hypertension (8.4%), preeclampsia (2.9%), eclampsia (2.9%), anaemia (11%), twins (8.4%), malpresentation (5%), RH negative factor (3.7%), and diabetes (1.9%). Fetal complication include prematurity 21.6%, IUFT 20.7%, congenital malformation 21.6%, cord prolapse 3.7%, birth asphyxia 1.9%. Most common congenital anomaly was anencephaly i.e., 11%. CONCLUSION: The study gives us the understanding of the impact of polyhydramnios on the maternal and fetal outcome. Our study demonstrates that careful fetal examination has to be performed when polyhydramnios is diagnosed as congenital malformations are often associated with this condition. These anomalies if detected early timely termination of pregnancy can be done hence less physical and psychological trauma to mother. Also antenatal visits play important role in early diagnosis of high risk pregnancy like polyhydramnios.

An epidemiologic profile of trauma patients admitted to maputo central hospital, maputo-mozambique

BackgroundIn Mozambique, the magnitude of trauma and violence has increased in recent years with traffic crashes as the leading cause of traumatic death.ObjectiveIs to describe the epidemiological profile of trauma...

The Effect of Distance to Health-Care Facilities on Childhood Mortality in Rural Burkina Faso

This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.