Secondary Level Hospital Research Articles

Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India

Background:Calcium requirement increases during pregnancy, thereby increasing the chances of developing hypocalcaemia. Hypocalcaemia may be associated with pregnancy-related complications. Therefore, we planned this study to estimate the prevalence of hypocalcaemia among pregnant women attending secondary care hospital, and to study the association between hypocalcaemia and pregnancy outcomes.Materials and Methods:This study was conducted in a secondary level hospital at Ballabgarh, district Faridabad, Haryana, India. Consecutive pregnant women with gestation period more than 28 weeks were enrolled. Dietary calcium intake was ascertained using 24-hour dietary recall method. Serum calcium estimation was done by Biolis 24i auto analyser. Outcome of pregnancy (preterm delivery, low birth weight (LBW) babies, and neonatal mortality) was assessed telephonically 3 months after the enrolment.Results:A total of 696 pregnant women were enrolled in the study. Mean (SD) dietary calcium intake and serum calcium level was 796.4 (360.4) mg/day and 9.56 (0.94) mg/dl respectively. Prevalence (95% CI) of hypocalcaemia was 23.9% (20.8 – 27.2%). Serum total calcium level was not associated with dietary calcium intake (p-value = 0.36). Mean serum calcium level was significantly lower in mothers who had LBW babies. Pre-eclampsia, preterm delivery, and neonatal mortality were not associated with serum calcium level.Conclusion:Serum calcium level may not be related to dietary calcium level. Hence, the current recommendation of calcium supplementation during antenatal period appears to be inconclusive among our study population.

Diabetes registry and service in Nigerian suburban areas: experience at a secondary healthcare facility

Background: Disease registries help to provide quality healthcare, including chronic care. As part of ongoing bringing research in diabetes to global environments and systems 2 project in Delta State, Nigeria; a preliminary concern is completeness of clinical assessments and data collection that would enable patients’ follow-up. The aim of this piece of work is to investigate if data collected for local diabetes registry is complete and sufficient to provide better understanding of the disease epidemiology and treatment follow-up.Methods: This was a purposive medical records audit at public secondary level hospital that followed initial development of diabetes register at the Catholic Hospital, Abbi with 44 pieces of clinical and demographic information. At the public hospitals, 93 patients’ medical records were audited and the data were entered into the register and evaluated, descriptively.Results: The results show that about 52% of the 44 itemized information were collected, of which completeness of data/documentation was as low as 3% in some items. Blood pressure assessment was done on 70% of patients and 16% of patients had diabetes complications. Lifestyle regimen monitoring was not documented. Neither incidence nor morbidity and mortality rate could be definitively ascertained.Conclusions: Quality of clinical data documentation was poor. This study contributes a measure of community needs assessment for professional development training on diabetes.

Trend and determinants of tuberculosis treatment outcome in a tertiary hospital in Southeast Nigeria

IntroductionNigeria ranked 7th among the high TB burden nations globally and second most endemic in Africa. There are several highly effective interventions available for tuberculosis control. Operational challenges have been reported to interfere with the success of these interventions. This review was conducted to ascertain the treatment outcome using the Directly Observed Short Course Strategy implemented in the hospital. MethodsA retrospective review of the Tuberculosis treatment was conducted in former Ebonyi State Teaching Hospital and Federal Teaching Hospital from 2008 to 2014 as part of the departmental critique of patients’ clinical care and tuberculosis control activities. Using the facility’s TB treatment register, information on the patient’s demography, clinical characteristics and treatment outcome was extracted. The data were analyzed using Epi Info version 7.2. Frequencies and proportions were calculated. ResultsA total of 1070 cases were reviewed with majority 491 (45.9%) belonging to 25–44 years age group. There were 585 (54.7%) males and 68 (11.6%) paediatrics. Pulmonary tuberculosis (667, 62.3%) was the most common presentation. Among those that did sputum smear AFB, 53.2% were smear negative. In all, 91.2% of the cases were treatment naïve, 59.1% were HIV negative at beginning of their treatment while 8% had unknown HIV status. Of the treatment outcome, 40.5% were classified as treatment completed, 16.0% cured, 17.4% of the cases defaulted while 14.1% of the cases died on treatment. These patients were often referred from primary and secondary level hospitals. ConclusionsThe cure rate was very poor and treatment default rate high. The high default rate could be due to the referral nature of the hospital. The treatment success rate of 56.5% is still far below the national target of 85% treatment success rate for effective tuberculosis control. An operational research is recommended to elicit the root causes of low treatment success rate and high patient default rate.

User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico

BackgroundTo evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals.MethodsWe conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study’s independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals.ResultsThe study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction.ConclusionPatient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.

Hypoxaemia in hospitalised children and neonates: A prospective cohort study in Nigerian secondary-level hospitals

BackgroundHypoxaemia is a common complication of pneumonia and a major risk factor for death, but less is known about hypoxaemia in other common conditions. We evaluated the epidemiology of hypoxaemia and oxygen use in hospitalised neonates and children in Nigeria. MethodsWe conducted a prospective cohort study among neonates and children (<15 years of age) admitted to 12 secondary-level hospitals in southwest Nigeria (November 2015–November 2017) using data extracted from clinical records (documented during routine care). We report summary statistics on hypoxaemia prevalence, oxygen use, and clinical predictors of hypoxaemia. We used generalised linear mixed-models to calculate relative odds of death (hypoxaemia vs not). FindingsParticipating hospitals admitted 23,926 neonates and children during the study period. Pooled hypoxaemia prevalence was 22.2% (95%CI 21.2–23.2) for neonates and 10.2% (9.7–10.8) for children. Hypoxaemia was common among children with acute lower respiratory infection (28.0%), asthma (20.4%), meningitis/encephalitis (17.4%), malnutrition (16.3%), acute febrile encephalopathy (15.4%), sepsis (8.7%) and malaria (8.5%), and neonates with neonatal encephalopathy (33.4%), prematurity (26.6%), and sepsis (21.0%). Hypoxaemia increased the adjusted odds of death 6-fold in neonates and 7-fold in children. Clinical signs predicted hypoxaemia poorly, and their predictive ability varied across ages and conditions. Hypoxaemic children received oxygen for a median of 2–3 days, consuming ∼3500 L of oxygen per admission. InterpretationHypoxaemia is common in respiratory and non-respiratory acute childhood illness and increases the risk of death substantially. Given the limitations of clinical signs, pulse oximetry is an essential tool for detecting hypoxaemia, and should be part of the routine assessment of all hospitalised neonates and children.

Attrition from Care and Clinical Outcomes in a Cohort of Sickle Cell Disease Patients in a Tribal Area of Western India.

In a tribal area of western India, a non-governmental organization implemented a comprehensive sickle cell disease (SCD) program at a secondary level hospital. In a cohort of SCD patients registered during December 2015 to June 2017, we assessed rates of lost to follow-up (LTFU) during the follow-up period using routinely collected data. We compared the uptake of proven interventions and indicators of disease severity from one year prior to registration until the end of the study (June 2018). Of 404 patients, the total follow-up duration was 534 person-years (PY). The rate (95% CI) of LTFU was 21 (17.5–25.3) per 100 PY. The proportion of people who received the pneumococcal vaccine improved from 10% to 93%, and coverage of hydroxyurea improved from 3.5% to 88%. There was a statistically significant decrease in rates (per 100 PY) of pain crisis (277 vs 53.4), hospitalization (49.8 vs 42.2), and blood transfusion (27.4 vs 17.8) after enrollment in the SCD program. Although clinical intervention uptake was high, one quarter of the patients were LTFU. The study demonstrated significant reductions in disease severity in SCD patients.

The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum haemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomised trial.

ObjectiveTo assess the effectiveness of introducing condom-catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low- and middle-income settings.DesignStepped wedge, cluster-randomised trial.SettingEighteen secondary-level hospitals in Uganda, Egypt, and Senegal.PopulationWomen with vaginal delivery from October 2016 to March 2018.MethodsUse of condom-catheter UBT for PPH management was introduced using a half-day training and provision of pre-packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect).Main outcome measuresCombined IR of PPH-related invasive surgery and/or maternal death.ResultsThere were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH-related surgery or maternal death occurred in 19 women in the control period (IR = 6.7/10 000 deliveries) and 37 in the intervention period (IR = 11.6/10 000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval 1.07–15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods.ConclusionsIntroduction of condom-catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH-related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection on its role.Tweetable abstractStepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH-related surgery or death.Linked articleThis article is commented on by AD Weeks, p. 1622 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.15948.

A comprehensive validation of very early rule-out strategies for non-ST-segment elevation myocardial infarction in emergency departments: protocol for a multicentre prospective cohort study

IntroductionRecent advances in troponin sensitivity enabled early and accurate judgement of ruling-out myocardial infarction, especially non-ST elevation myocardial infarction (NSTEMI) in emergency departments (EDs) with development of various prediction-rules and...

Assistant computer program for adequate disposal of medical devices

In developing countries, up to 80% of medical equipment comes from donation. The World Health Organization (WHO) has made recommendations on desirable factors that should be taken into consideration when donating medical technology. We included these recommendations while building the Assistant Program for Adequate Disposal of Medical Devices (APAD) using the application generator App Building by MATLAB. We evaluated thirty units of medical equipment from different areas of a secondary health care level hospital. The Instrumentation Technician (IT) (expert) previously defined if the medical units were suitable to be donated, could be repaired, could be used as reservoir, or should be completely removed. APAD also made a proposal of the possible use of this technology. In 23 out of 30 medical units, the decision made by the APAD matched with that of the expert: seven for donation, eight to be repaired, two to serve as reservoir and six for disposal. Our results suggest that APAD could serve as a support tool for the IT and for the Biomedical Engineering Department in a hospital, to determine the possible use of medical equipment that has been discarded.

An overview of how on‐call consultant paediatricians can recognise and manage severe primary immunodeficiencies

Severe primary paediatric immunodeficiency syndromes are rare and potentially fatal unless suspected, diagnosed and treated early. We provide clinical guidance and support for on-call consultant paediatricians working in secondary level hospitals on how to recognise and manage children with these conditions. Our paper addresses four conditions that risk the most severe outcomes if they are not adequately cared for during on-call periods, such as weekends: severe combined immunodeficiency, haemophagocytic lymphohistiocytosis, severe congenital neutropaenia and chronic granulomatous disease. CONCLUSION: On-call paediatricians are provided with advice on handling the most severe primary immunodeficiencies.

Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

BackgroundRetaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State.MethodWe conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study.ResultWe found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence.ConclusionRetention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

Clinical Determinants of Diabetes Progression in Multiethnic Asians with Type 2 Diabetes – A 3-Year Prospective Cohort Study

The risk for diabetes progression varies greatly in individuals with type 2 diabetes mellitus (T2DM). We aimed to study the clinical determinants of diabetes progression in multiethnic Asians with T2DM. A total of 2057 outpatients with T2DM from a secondary-level Singapore hospital were recruited for the study. Diabetes progression was defined as transition from non-insulin use to requiring sustained insulin treatment or glycated haemoglobin (HbA1c) ≥8.5% when treated with 2 or more oral hypoglycaemic medications. Multivariable logistic regression (LR) was used to study the clinical and biochemical variables that were independently associated with diabetes progression. Forward LR was then used to select variables for a parsimonious model. A total of 940 participants with no insulin use or indication for insulin treatment were analysed. In 3.2 ± 0.4 (mean ± SD) years' follow-up, 163 (17%) participants experienced diabetes progression. Multivariable LR revealed that age at T2DM diagnosis (odds ratio [95% confidence interval], 0.96 [0.94-0.98]), Malay ethnicity (1.94 [1.19-3.19]), baseline HbA1c (2.22 [1.80-2.72]), body mass index (0.96 [0.92-1.00]) and number of oral glucose-lowering medications (1.87 [1.39-2.51]) were independently associated with diabetes progression. Area under receiver operating characteristic curve of the parsimonious model selected by forward LR (age at T2DM diagnosis, Malay ethnicity, HbA1c and number of glucose-lowering medication) was 0.76 (95% CI, 0.72-0.80). Young age at T2DM diagnosis, high baseline HbA1c and Malay ethnicity are independent determinants of diabetes progression in Asians with T2DM. Further mechanistic studies are needed to elucidate the pathophysiology underpinning progressive loss of glycaemic control in patients with T2DM.

Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo

Introduction and objectivesHospital care by a cardiologist has been shown to improve the prognosis of patients admitted with acute coronary syndrome (ACS), although on-call cardiologists are not common in second-level hospitals. MethodsRetrospective analysis of a cohort of patients admitted due to ACS using propensity-score matching to assess differences between both periods. ResultsThe study included 2257 patients, of which 33.2% were admitted during the cardiologist on-call period, with 734 pairs of patients being obtained using propensity score-matching. A shorter hospital stay was observed in patients admitted during the cardiologist on-call period (5.2 vs 6.3 days; P<.01) and this was one of the variables independently associated with the shorter hospital stay variable. Within the cardiologist on-call period there was a shorter stay in the intensive care unit (47.7% vs 54.5%; P=.03), mainly by the non-ST-elevation ACS patients (33.2% vs 19.1%; P<.01), and in weekdays. There were also higher rates of angiography and revascularisation within the first 24h of admission (76.2% vs 66.0%; P<.01). There were no differences in-hospital mortality or within the first 12 months after discharge between both periods. ConclusionsImplementation of on-call cardiology shortened the time to revascularization and hospital stay, as well as reducing the length of intensive care unit stay. These results support the usefulness of an on-call cardiologist in non-tertiary hospitals, at least for the benefit of ACS patients.

Africa\u2019s challenged ENT services: highlighting challenges in Zambia

BackgroundDiseases of the ear, nose and throat (ENT) are common and are a major cause of morbidity and mortality. In many low income countries like Zambia, the high ENT disease burden has not received the required resources for treatment. We investigated ENT service provision in hospitals in Zambia by documenting the profile of hospitals offering ENT services and examining the country’s ENT services with regards to human resource, infrastructure and availability of equipment based on the levels of care of various hospitals.MethodsThe study was a cross-sectional descriptive survey conducted using a structured and piloted questionnaire which was administered to the 109 Ministry of Health (MoH) registered hospitals across the country. Ethical clearance was granted by University of KwaZulu-Natal and the Zambia National Health Research Authority. Participation in the study was voluntary and all respondents signed informed consent. Descriptive statistics were used to analyse the data.ResultsOf the 109 hospitals approached to participate in the study, 61 (55.9%) hospitals responded. This represented 83.3% (n = 5) of Third Level Hospitals (TLH), 89.5% (n = 17) of Second Level Hospitals (SLH) and 41.7% (n = 35) of First Level Hospitals (FLH) countrywide. Of the participating hospitals, 6.6% (n = 4) were unclassified. Within this sample, 8.6% (n = 3) FLH, 11.8% (n = 2) SLH and 60.0% (n = 3) TLH had an ENT examination room. Only 2.9% (n = 4) hospitals had an audiology booth and 1.6% (n = 1) had a speech therapy room. Of the second and third level hospitals, 9.1% (n = 2) had flexible rhinolaryngoscopes, 18.2% (n = 4) had operating microscopes and 68.2% (n = 15) adenotonsillectomy sets. The data revealed that there were 4 ENT surgeons, 1 Audiologist and no Speech Therapists across the country.ConclusionZambia’s ENT services were deficient at all levels of hospital care. There were deficiencies in infrastructure, human resource and equipment in hospitals. With the current burden of disease, critical intervention is required. These findings should be used to direct national policy on the improvement of ENT service provision in Zambia.

Evaluation of Clinical Laboratory Performance as a Procuring Agency

Primary and Secondary Healthcare Department of Punjab, Pakistan has outsourced its clinical laboratory services at various secondary level hospitals in the province. Methodology adapted to outsource these facilities was based on phasing out the process. While methodology adapted to selection of service provider was on the basis of bidding. Two service providers contracted the procuring agency to deliver services to general public. In the first phase, clinical laboratory services of DHQ Hospital Chakwal were outsourced to a private laboratory service of the country. This communication aims on the methods adopted by Pathology Department of the hospital to evaluate the technical efficiency of the service.

The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial

ObjectiveTo investigate whether graded motor imagery (GMI) is effective for reducing phantom limb pain (PLP) in people who have undergone limb amputations. DesignA single-blinded randomised, controlled trial. SettingPhysiotherapy out-patient departments in three secondary level hospitals in Cape Town, South Africa. ParticipantsTwenty-one adults (≥18 years) who had undergone unilateral upper or lower limb amputations and had self-reported PLP persisting beyond three months. InterventionsA 6-week GMI programme was compared to routine physiotherapy. The study outcomes were evaluated at baseline, 6 weeks, 3 months and 6 months. Outcome measuresThe pain severity scale of the Brief Pain Inventory (BPI) was used to assess the primary outcome — PLP. The pain interference scale of the BPI and the EuroQol EQ-5D-5L were used to assess the secondary outcomes — pain interference with function and health-related quality of life (HRQoL) respectively. ResultsThe participants in the experimental group had significantly greater improvements in pain than the control group at 6 weeks and 6 months. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all follow-up points. There was no between-group difference in HRQoL. ConclusionThe results of the current study suggest that GMI is better than routine physiotherapy for reducing PLP. Based on the significant reduction in PLP and pain interference within the participants who received GMI, and the ease of application, GMI may be a viable treatment for treating PLP in people who have undergone limb amputations. Clinical trial registration number(PACTR201701001979279).

A Seven-Year retrospective review of stroke admissions in Benin-City, Southern Nigeria

Background: Stroke is a significant cause of hospital admissions, disability and mortality, but there is a lack of information on stroke in parts of the southern region of Nigeria. Objective: To analyze the frequency of stroke admissions, clinical presentations, risk factors, stroke types and outcomes over seven years, in a secondary level hospital in southern Nigeria. Methods: This was a retrospective study. The hospital record of patients hospitalized between January 2006 and December 2012 at the Central Hospital, Benin-City with the diagnosis of stroke based on the World Health Organization (WHO)-clinical criteria, were studied. Results: Four hundred and nineteen patients with stroke were hospitalized during the study period; this accounted for 3.1% of all the medical admissions. The mean age was 62.4 ± 13.6 years. There were 222 (53%) males and 197(47.0%) females. Ischaemic stroke occurred among 71% of cases; others included intra-cerebral haemorrhage (26%) and subarachnoid haemorrhage (3.1%). The main presenting features included hemiparesis (69%) and sudden loss of consciousness (27.2%). The risk factors included hypertension (84%) and diabetes mellitus (12.2%). The 7, 14 and 30 days case fatality rates were 21.2%, 25.5% and 30.8% respectively. A higher case fatality rate was recorded in haemorrhagic stroke compared to ischaemic stroke (68.8% vs 24%, p = 0.0001). Conclusion: Stroke was a significant cause of mortality amongst medical admissions and hypertension was the most common risk factor. Closer attention to the risk factors for stroke may likely help to reduce the burden of stroke.

Clinical features and endocrine evaluation of non-functioning pituitary adenomas at a secondary level hospital

Clinical features and endocrine evaluation of non-functioning pituitary adenomas at a secondary level hospital

ABC-VEN Matrix Analysis of the Pharmacy Store in a Secondary Level Health Care Facility in Arbaminch Town, Southern Ethiopia

: Objective: This study was aimed to analyze Arbaminch Secondary level Hospital inventories by using ABC-VED matrix analysis and to identify the medicines requiring strict management control. Method: The ABC, VEN and ABC-VEN matrix analysis of the medicines used by Arbaminch Hospital, Arbaminch, Ethiopia for the year 2015-2017. Results: The medicine store inventory of Arbaminch Secondary Level Hospital consisted of a total of 218 products. The total annual drug expenditure of the store on products issued in 2013-2015 was found to be 259049.4 USD. In the year 2015-2017, 15.14%, 22.47% and 62.39% items were placed into A, B and C category medicines respectively, costing to 70.08 %, 19.87% and 10.05 % of drug expenditure. On VED analysis, 31.19%, 67.43% and 1.38% products were placed into the vital, essential and non-essential categories and the hospital had spent 45.05%, 52.62% and 2.33% of drug expenditure respectively. On ABC-VEN reconciliation analysis, 39.91%, 59.17% and 0.92% medicines were in group I, II and III respectively and amounting for 80.86%, 18.79% and 0.35% of drug expenditure respectively. Conclusion: The study showed that medicines belonging to category I need strict inventory control, also medicines belonging to categories II and III which need control by middle and lower managerial level respectively. ABC-VEN techniques should be applied for efficient use of resources and taking away of wastage and out-of-stock in the secondary level health care facility.Key words: ABC analysis, ABC-VEN analysis, Pharmacy store, Secondary Level, VED analysis.

The continuous audit of events and outcomes of labour and birth using the Ten Group Classification System and its role in quality improvement

ObjectiveThe knowledge of a labour and birth unit’s rates of events and outcomes is essential to design any quality improvement initiative. It is in the same way important to have a system to analyse results of the ongoing changes within the unit. The Ten Group Classification System is the framework for doing this in a systematic and clinically relevant way. We aimed to use this classification system as a quality improvement tool. Study designAll labours and births during four years at a secondary level Hospital were included in a continuous analysis and of events and outcomes based on the Ten Group Classification System. From the results of the audit, policies and guidelines were designed and updated to improve outcomes. ResultsThe normal vaginal birth rate in Group 1 increased during the four-year-period and the Caesarean Section rate in Group 2 A dropped after the introduction of a new induction method. The overall Caesarean Section rate decreased. The experience of giving birth improved in Groups 1, 2 A and 3. ConclusionThe use of a continuous audit of events and outcomes based on a clinically significant classification for all women makes it possible to improve quality. Other labour and birth units are encouraged to collect and present data in a way that allows comparisons between units and over time.