Secondary Level Hospital Research Articles

Etiology of Pulmonary Infections in Human Immunodeficiency Virus-infected Inpatients Using Sputum Multiplex Real-time Polymerase Chain Reaction.

BackgroundThere are limited data on the etiology of respiratory infections in human immunodeficiency virus (HIV)–infected patients in resource-limited settings.MethodsWe performed quantitative multiplex real-time polymerase chain reaction (PCR) for Pneumocystis jirovecii and common bacterial and viral respiratory pathogens on sputum samples (spontaneous or induced) from a prospective cohort study of HIV-infected inpatients with World Health Organization danger signs and cough. Mycobacterial culture was done on 2 sputum samples, blood cultures, and relevant extrapulmonary samples.ResultsWe enrolled 284 participants from 2 secondary-level hospitals in Cape Town, South Africa: median CD4 count was 97 cells/μL, 64% were women, and 38% were on antiretroviral therapy. One hundred forty-eight had culture-positive tuberculosis, 100 had community-acquired pneumonia (CAP), 26 had P. jirovecii pneumonia (PJP), and 64 had other diagnoses. Probable bacterial infection (>105 copies/mL) was detected in 133 participants; the prevalence was highest in those with CAP (52%). Haemophilus influenzae and Streptococcus pneumoniae were the commonest bacterial pathogens detected; atypical bacteria were uncommon. Viruses were detected in 203 participants; the prevalence was highest in those with PJP (85%). Human metapneumovirus was the commonest virus detected. Multiple coinfections were commonly detected.ConclusionsSputum multiplex PCR could become a useful diagnostic tool for bacterial respiratory infections in HIV-infected inpatients, but its value is limited as quantitative cutoffs have only been established for a few bacterial pathogens and validation has not been done in this patient population. We found a high prevalence of respiratory viruses, but it is unclear whether these viruses were causing infection as there are no accepted quantitative PCR cutoffs for diagnosing respiratory viral infections.

Identifying some factors affecting medical service quality (Case of secondary level hospital)

In recent years public concern over health care services has been growing which signals the need for health organisations to improve the quality of their service. The Resolution 13 of the Health Minister issued on 13 January 2014 “On approving guidelines for conducting customer satisfaction surveys” endorsed a questionnaire and a sample form aimed at identifying the quality of medical service and client satisfaction. Every year, state-owned clinics carry out survey among their customers using these documents and accordingly improve on their work and performance. However, customers’ assessment of the quality of services being provided by health organisations has not been able to find any improvement in health services.Since health organisations are service providers, customers’ assessment measures their quality and performance. On the other hand, researchers have identified a number of factors that affect the quality of medical care and customer satisfaction. Therefore, it is significant to optimally identify factors affecting customer satisfaction with regard to health care. Examining the perceptions of and expectations from health care service providers, including practitioners and health organisations, management has been identified as the most important need of the day.Management will make it possible to pinpoint factors that cause poor quality of health care. Most researchers employ the SERVQUAL quality model of Parasuraman, Zeithaml and Berry (1988) Parasuraman (1985), and Zeithaml, Berry (1988) and Gronroos’ (2000) indicators of service quality. The current study investigates the impact of factors that affect the quality of health services, and contains additional indicators related to measuring levels of significance of each dimension oriented to individuals that receive health care from the second tier hospitals of 6 districts in UB and health care providers respectively, plus some measurement items related to organisational issues of improving health care quality and health care system issues that have been identified by the customers themselves.

Retrospective analysis of HF detection in city hospitals of Bishkek in three-year study (2016-2018)

In this article, we analyzed prevalence of heart failure in patients visited cardiology departments of secondary level hospitals of Bishkek city, Kyrgyz Republic.

Introduction of an undergraduate interprofessional simulation based skills training program in obstetrics and gynaecology in India

Interprofessional simulation based education (SBE) improves core clinical skills and team training in obstetrics and gynaecology. In this innovative study, the introduction of an undergraduate interprofessional SBE program for teaching obstetrics and gynaecology skills in India was evaluated. The study attempted to evaluate the feasibility and benefit of the interprofessional skills training workshop in obstetrics and gynaecology, which was introduced for medical and midwifery students in a secondary level hospital in India. The program focuses on improving “hands-on” clinical skills and can be explained by the “skills acquisition theory”. Using a survey, participants rated relevance, pitch and confidence (on a 5-point Likert scale) and described the contextualisation and teaching of core clinical skills through the workshop using free-text. Descriptive analysis of quantitative Likert scale responses and thematic analysis of the free-text data was conducted and themes identified. Ninety-five medical and midwifery students attended the inaugural workshop, in a low-resource setting. The clinical experience in obstetrics and gynaecology across both groups was minimal, neither were they exposed to any prior SBE. Both health professional groups found the workshop useful, relevant and improved their confidence in performing vaginal examination and births. The key theme, which emerged from qualitative analysis, was “getting hands-on” experience. Other themes included learning by simulation without clinical time constraints, retaining the ability to make mistakes, bridging theory to practice, valuing interprofessional experience and ensuring equal learning opportunities for all participating professional groups. The advantages of interprofessional SBE, for medical and midwifery students, are reproducible in a low-resource setting, and may be be helpful for learning intimate clinical examination, obstetric procedures and team training.

Providing oxygen to children and newborns: a multi-faceted technical and clinical assessment of oxygen access and oxygen use in secondary-level hospitals in southwest Nigeria.

BackgroundOxygen is an essential medical therapy that is poorly available globally. We evaluated the quality of oxygen therapy in 12 secondary-level Nigerian hospitals, including access to oxygen equipment, equipment functionality, healthcare worker knowledge and appropriateness of use.MethodsWe conducted a three-part evaluation of oxygen access and use involving: (1) facility assessment (including technical evaluation of oxygen equipment), (2) clinical audit (children and neonates admitted January 2014–December 2015) and (3) survey of healthcare worker training and experience on the clinical use of oxygen (November 2015).ResultsOxygen access for children and newborns is compromised by faulty equipment, lack of pulse oximetry and inadequate care practices. One hospital used pulse oximetry for paediatric care. Eleven hospitals had some access to oxygen supplies. Testing of 57 oxygen concentrators revealed two (3.5%) that were ‘fit for use’. Overall, 14.4% (3708/25 677) of children and neonates received oxygen some time during their admission; 19.4% (1944/10 000) of hypoxaemic children received oxygen; 38.5% (1217/3161) of children who received oxygen therapy were not hypoxaemic.ConclusionsOxygen access for children in Nigerian hospitals is poor, and likely results in substantial excess mortality. To improve oxygen access for children globally we must focus on actual provision of oxygen to patients—not simply the presence of oxygen equipment at the facility level. This requires a systematic approach to improve both oxygen (access [including equipment, maintenance and affordability]) and oxygen use (including pulse oximetry, guidelines and continuing education).

Diabetes Health Services in Sri Lanka: Development of a Quality Index

BACKGROUND: Diabetes mellitus is a major public health issue in Sri Lanka and across the globe. Patients with diabetes mellitus (DM) need long term comprehensive care. Quality of care for DM varies in different settings. Service quality assessment leads to identifying service areas that may benefit from appropriate intervention in order to achieve better health outcomes. The aim of this study was to develop and validate an instrument to measure the quality of services provided for patients with DM attending medical and diabetic clinics in state hospitals of Sri Lanka.
 
 METHODS: A ‘Care for DM Quality of services’ (CD QS) instrument comprised of 8 subscales: routine services, glycaemic control, Blood Pressure and lipid control, weight control, annual screening, patient empowerment, recording of information and functional aspects was developed and validated. Trained research assistants collected data from 100 volunteer patients attending four diabetic clinics two each at secondary and tertiary level hospitals. Construct validity was established by multi-trait scaling analysis and known group comparisons. Internal consistency was assessed by item-total correlations and Cronbach’s alpha. Cut off levels to classify the hospital clinic as ‘good’, ‘moderate’ or ‘poor’ performance were determined by the average score in each subscale being above mean + SD (good), between mean + SD (moderate), and below the mean –SD (poor) respectively.
 
 RESULTS: Multi-trait scaling analysis of items showed highest correlation with its own subscale compared to the other subscales. Significantly higher mean scores (p<0.05) for all the subscales were observed in tertiary level clinics compared to the secondary level. Internal consistency of ‘CD QS’ was good with Cronbach’s alpha of 0.9. Intra Class Correlation Coefficients were over 0.9 for all subscales with confidence intervals ranging from 0.8 to 2.9 suggestive of good inter-rater reliability.
 
 CONCLUSIONS: ‘CD QS’ is a valid and reliable tool to assess both functional and technical quality of follow up care provided for patients with DM. This facilitates regular quality assessment of DM care thus identifying the gaps and improving the service quality. Further implementation and testing for clinical usefulness and acceptability will determine the tools application in the healthcare setting.

English

The objective of this work is to elaborate good practice guidance, aimed at preparing and administering drugs through feeding tube. This study was performed at a secondary level hospital in the interior of Sao Paulo state, Southeast Region of Brazil. For the first phase, a literature review was carried out in the following databases: LILACS, MEDLINE, Web of Science, and MICROMEDEX® Solutions. A manual search was also carried on other sources. In a second phase, the guide was refined for the hospital through meetings. Out of 104 references found, seven were read in full. The most employed technique for drug preparation was a simultaneous crushing of solid formulations. Participants identified a need to standardize techniques for drug preparation and administration through feeding tube, and the importance of using best practice guidance for patient safety was acknowledged. Key words: Feeding tube, medication errors, hospital, good practice.

Recording Vital and Laboratory Parameters and the Risk of Death in Children Admitted to First- and Second-Level Hospitals for Emergency Medical Care: A Case-Control Study

Background. Diagnostic mistakes due to incomplete examination of patients are the leading cause of death. The prevalence of such mistakes and their association with treatment outcomes in our country remain uninvestigated.Objective. Our aim was to study the frequency of recording vital and laboratory parameters and its relationship with death in children admitted to a hospital for emergency medical care.Methods. In our case-control study we analysed the data of medical records of an inpatient (Form 003/u) — patients for intensive care at the age of 0–17 years who were admitted to first-level (n = 13) and second-level (n = 5) hospitals of the Rostov Region (except for Rostov-on-Don) in 2006–2017. We considered the frequency of recording vital (heart rate, respiration rate; blood pressure; oxygen saturation of arterial blood; body temperature) and laboratory (blood count, haemoglobin, hematocrit, total protein, glucose, urea, creatinine, pH, pCO2, pO2, BE, sodium and potassium levels) parameters upon admission to in-patient hospital and when transferred to the intensive care unit (ICU). The association of the frequency of recording these parameters with hospital outcome was assessed using multivariate logistic regression analysis adjusted for the effect of confounders (consultation by a resuscitationist of the resuscitation and consultation centre; the level of healthcare facility; admission time; the presence of infectious diseases and diseases that occurred in the perinatal period; the level of consciousness; the duration of the underlying disease before admission; the method of admission to a healthcare facility).Results. We studied the data of 61 children with a favourable (discharged from healthcare facilities) and 90 children with a fatal outcome in the in-patient hospital (76 — in the ICU). A fatal outcome in the in-patient hospital was associated with records of BE [odds ratio (OR) 3.25; 95% confidence interval (CI) 1.25–8.46)], total protein level (OR 0.19; 95% CI 0.05–0.79), urea (OR 0.24; 95% CI 0.06–0.87) and creatinine (OR 0.23; 95% CI 0.08–0.67) upon admission. A fatal outcome in the ICU was associated with records of systolic (OR 0.36; 95% CI 0.14–0.94) and diastolic (OR 0.30; 95% CI 0.12–0.80) blood pressure, SpO2 (OR 0.38; 95% CI 0.15–0.93) and body temperature (OR 0.32; 95% CI 0.11–0.90) upon admission to the unit.Conclusion. The association of the outcome with recording of vital (blood pressure, SpO2 and body temperature upon admission to the ICU) and laboratory (BE, total protein, urea, creatinine upon admission to a healthcare facility) parameters in children admitted to a hospital for emergency medical care indicates the need to control their clinical and paraclinic examination. A more complete examination of these children may be a reserve for reducing hospital mortality.

An epidemiological study of varicella outbreak in a military training establishment

Context: Though incidence of the Varicella has decreased in recent years due to introduction of vaccine; outbreaks continue to occur in closed environments such as those of militaries. The present study describes one such outbreak in a military training establishment. Setting and Design: This cross sectional study was conducted at a Secondary level hospital. Aims: To describe the distribution and characteristics of Varicella infections and to make suitable recommendations for prevention and control. Materials and Methods: All admitted cases of Varicella from a military training establishment during the outbreak were included in the study. Epidemiological data was collected by face to face interview. Statistical Analysis Used: Statistical analysis was performed using Epinfo software version 3.5.3. Results: Total 332 recruits were admitted in the local military hospital in said outbreak. Eight administrative staffs of recruiting center and two medical staffs attending the patient at hospital were also affected. The age of the patients ranged from 18 to 34 years with a mean of 20.3 ± 3.5 years. None of the cases admitted had developed any complication and their hospital stay remained uneventful. Maximum cases (59%) were presented with rash as a first clinical manifestation and 94.3 % of them had history of contact with a case of Varicella. None of them gave a history of vaccination. Conclusions: Though policy to offer vaccination against Varicella to all recruits on entry level exists, it should be implemented on ground to ensure unnecessary interruption in training activities.

Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes.

To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4-91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3-3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000-751/1000). No neonate from lower socioeconomic families was admitted. SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Health workforce availability and competency to manage noncommunicable diseases at secondary care level hospitals of Delhi

Context: Health system strengthening is a major component of the national strategy to address noncommunicable diseases (NCDs). Human resource (HR) is an important building block of health system, and its capacity to address NCDs needs to be assessed. Aims: We assessed the availability, training, and self-rated competencies of available staff in secondary-level health facilities under the Government of Delhi for NCD services. Settings and Design: This study was conducted in a secondary care hospital in Delhi; this was a cross-sectional study. Subjects and Methods: Fifteen hospitals listed by the Directorate of Health Services, Delhi, were assessed through personal visits. Medical superintendents provided information regarding the availability of workforce and their training. Self-rated competency was assessed among doctors, nurses, and laboratory workers using a self-administered questionnaire. Results: A total of 85 doctors, 66 nurses and 52 laboratory technicians were interviewed. Shortage of staff ranged from 7.2% for staff nurse to 42.5% for medicine specialist. None of the staff had undergone special training for providing NCD-related services. 96.5% of doctors and 83.3% of nurses reported being aware of standard treatment guidelines for diabetes and hypertension. Key reported deficiencies were seen in doctors and nurses in managing diabetes complications. Cancer was not being managed in any hospital. Proficiency in cardiovascular disease management was reported by 24.7% and COPD management by 83.5% of doctors. There was major gap in competencies related to stroke management. Conclusions: Availability of trained and competent workforce was a limiting step in delivering NCD care in secondary-level public health facilities of Delhi, indicating the need for strengthening the HR capacity.

Parents’ and caregivers’ attitudes towards malaria, and health care seeking practices for their febrile children in a hospital in north-eastern Nigeria

Despite the very high burden of malaria among children in Borno state, the proportion of those who receive standard treatment has been very low. This study aimed to determine malaria knowledge, attitude towards prevention, and health care seeking behaviours of parents or caregivers of children presenting with fever at the paediatric clinic of a secondary-level hospital in Maiduguri, Borno state, Nigeria. A cross-sectional study design was used to obtain information from the respondents. Data were collected using a structured questionnaire, from the parents or caregivers of children presented to the Paediatric clinic with history of fever, and analysed in SPSS. A total of 331 respondents were finally recruited into the study. The ages of the children ranged from one to fourteen years. Some of them (15.3%) were internally displaced persons (IDPs). As many as 90.7% and 91.9% of the respondents believed that malaria is a life-threatening illness, and ITNs could prevent malaria, respectively. Less than a half of them (42.3%) had immediately brought their children to the hospital once they detected the fever. At the hospital, only 202 (60.7%) of the children had had malaria parasite test done on them, of which 89.1% tested positive. Permanent residents were more likely to promptly take their children to the hospital, one they detected fever, compared to IDPs (Χ2=12.401, df =1, p=0.002). There is the need for promoting early presentation of febrile children to health centres, and also promoting routine malaria tests for febrile persons.

Universal newborn hearing screening in public healthcare in South Africa: Challenges to implementation

Background. The implementation of early hearing detection and intervention (EHDI) remains a challenge in developing countries, despite the known benefits. Objectives. To investigate challenges encountered during implementation of universal newborn hearing screening (UNHS) at a secondary-level public hospital in Johannesburg, South Africa. Methods. A prospective cohort study design that assessed the feasibility of conducting UNHS was adopted. This feasibility assessment was conducted during a 3-month period, and all challenges encountered were identified and documented. Screening time was also recorded for each neonate. Data were entered into Excel, and later analysed using Stata version 11. Results. Of 2 740 neonates born during the study period, 490 (17.9%) were identified for screening, and distortion product otoacoustic emissions screening was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat screening was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The most important challenges to the feasibility of UNHS implementation were the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the unacceptably high rates of loss to follow-up. Two modifiable factors, namely the presence of vernix caseosa in the external ear canal and high ambient noise levels, were found to have significantly influenced the screening process. Conclusion. The identified challenges are important considerations for any successful implementation of universal screening protocols. Careful planning to mitigate the challenges will have a positive impact on EHDI initiatives in these contexts.

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

BackgroundHand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems.MethodsWe conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization’s concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate.ResultsWe included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility.ConclusionObserved compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units.Trial registrationRetrospectively registered with Clinical Trials Registry- India (CTRI/2018/04/013014).

Child Migrant Health: The Role of Pediatric Surgery in the Migrants' Route across Balkan Countries to North-West Europe.

Child migrants are the most vulnerable population, prone to various health conditions due to trauma and the bad living conditions that they experience during their migration. The objective of this study was to determine the pediatric surgical conditions of migrant children treated in our hospital on their way toward North-West Europe. A retrospective analysis was performed on all admitted migrants in one tertiary and one secondary level hospital from 2016 to 2018. Only migrant children with surgical issues who had been hospitalized or treated in outpatient clinics were included in the study. There were 47 migrants admitted to hospitals and outpatient clinics; 32 from Afghanistan, 11 from Iraq, 1 from Syria, 2 from Iran, and 1 from Algeria. There were 27 boys and 20 girls, average age 7.96 years (range: 3 months-17 years). The average length of hospitalization was 14.1 days (range: 1-48), and average stay in the intensive care unit (ICU) was 7.4 days (range: 1-15). There were 29 migrants treated in outpatient clinics, and 18 were hospitalized. The cause of seeking surgical treatment was trauma in 33 and non-traumatic surgical problems in 14. The most common types of trauma were isolated fractures which occurred in one, followed by isolated head injury in eight. Polytrauma occurred in five. A lethal outcome occurred in one 9-year-old boy from Afghanistan due to severe polytrauma. Trauma, predominantly fractures and head injuries, was the leading cause of morbidity in migrant children treated in these two hospitals.

Audiological follow-up in a risk-based newborn hearing screening programme: An exploratory study of the influencing factors.

BackgroundFollow-up return rate in Early Hearing Detection and Intervention (EHDI) programmes is of specific importance as it ensures that benchmarks are met and that no child with suspected hearing loss is left unidentified.ObjectivesThe aim of this study was to determine the factors influencing audiological follow-up of high-risk infants in a risk-based newborn hearing screening programme.MethodA non-experimental, exploratory, qualitative research design was employed. Purposive sampling was used. The study was conducted at a secondary level hospital in the public health care sector in South Africa. Participants comprised 10 caregivers (age range 26–40 years) of infants who had been enrolled in a risk-based newborn hearing screening programme, and returned for follow-up appointments. Data were collected using semi-structured interviews. Responses were recorded by the researcher and a colleague to ensure rigour and trustworthiness of findings. Data were analysed using thematic analysis for open-ended questions and descriptive statistics for the closed-ended questions.ResultsThe most common positive contributors that facilitated participants’ attendance at follow-up appointments were: having friendly audiologists; a clear line of communication between caregiver and audiologist and a reminder of the appointment. The most significant perceived challenge that participants described in returning for the follow-up appointment was living in far proximity from the hospital.ConclusionFindings of the study revealed that influencing factors on follow-up return rate are demographic, socio-economic, and interpersonal in nature and further suggested the need for an all-inclusive appointment day. It may be of importance to not only look at what is being done to improve the follow-up return rate but also how it should be done in terms of professional-to-patient communication and interactions.

Pattern of surgical admissions to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A five-year retrospective study

Background: Tikur Anbessa specialized hospital (TASH) is Ethiopia’s largest tertiary teaching and referral hospital admitting and treating surgical patients under various specialties. This study aims to analyze the magnitude and pattern of surgical admissions to this facility. Methods: A five-year Cross sectional retrospective analysis was done on all adult surgical admissions to TASH from Sept. 2010 to Sept. 2015. Results: There were a total of 8,698 surgical admissions of which, 4471 (51.4%) were male and 4227 (48.5%) were female with male to female ratio of 1.06:1. Their age ranged from 13 to 95, with mean age being 38.8 ± 16.2 years. Three thousand two hundred twenty two (46.5%) patients were from Addis Ababa. Of all admissions, 4706 (54.1%) were elective ones of which obstructive uropathy, 997(21.1%), esophageal diseases, 716(15.2%) and Urolithiasis, 573(12.2%) respectively are the top three. The rest, 3992 (44.9%), were emergency admissions, the top three ones being trauma, 1435(35.9%), appendicitis 281(7%) and Intestinal obstruction, 190(4.7%) respectively. General surgical (gastrointestinal, endocrine and vascular) cases account for 3414 (39.25%) of all admissions followed by urosurgical cases, 2114 (25.31%), cardiothoracic surgical cases, 1942 (22.33%), and neurosurgical cases, 1139 (13.1%). There were a total of 280 deaths with an overall mortality rate of 4% of which, 3.2% were from elective admissions and 5.2% from emergency ones. Mortality rate was the highest among neurosurgical patients being 6.3% followed by 4.3%, 3.8% and 3.5% in cardiothoracic, general surgical and urosurgical cases respectively. Conclusions: The admission pattern indicates quite a big number and diversity of cases though the bed capacity is limited. There are significant number of cases that could be treated at other secondary level hospitals. Trauma is the leading cause of emergency admissions and significant cause of mortality. We recommend increasing the number of beds, organizing separate trauma center and admitting only cases requiring tertiary level care. Keywords: pattern of surgical diseases; surgical admissions; Tikur Anbessa Specialized Hospital

Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study

ObjectivesThis study aimed to identify the epidemiology, clinical characteristics, aetiology and seasonality of sporadic infectious diarrhoea in adults in Shanghai.SettingThis study was based on a city-wide, active continuous hospital-based diarrhoea...

Survey of hospitalization for respiratory syncytial virus in Nagano, Japan.

Respiratory syncytial virus (RSV) infection is one of the major causes of hospitalization of children during the winter months in Nagano, Japan. This investigation was conducted to understand the details of hospitalized patients infected with RSV in Nagano. The study used a questionnaire to survey hospitals who treated children for RSV infection in the pediatric wards of 11 major hospitals in Nagano. Between April 2016 and March 2017, 438 patients were hospitalized with RSV infection in the 11 participating hospitals. The mean gestational age at birth was 38 weeks 2 days. Average birthweight was 2,834 g. The ratio of hospitalized patients with RSV infection to the total number of hospitalized patients was, on average, 7.0% in the second-level hospitals. Despite the use of prophylactic palivizumab, six patients were hospitalized. The rate of hospitalization for RSV was similar across each of the second-level hospitals in Nagano. Patients hospitalized after prophylactic palivizumab had received palivizumab only a few times during the season when infection rates were highest. Palivizumab is therefore advised prior to the outbreak initiation season.

Implementation of a diabetic retinopathy referral network, Peru

ObjectiveTo describe the implementation of a diabetic retinopathy referral network incorporating all levels of health care in La Libertad region, Peru.MethodThe nongovernmental organization Orbis International and the Regional Institute of Ophthalmology established a network of primary, secondary and tertiary health-care facilities for diabetic retinopathy screening and treatment. The programme included the provision of three non-mydriatic retinal cameras for patient examination, the development of a flowchart to guide patient referrals, training of health personnel, investment in laser technology for treatment and the delivery of public awareness activities for blindness prevention and the need for timely screening.FindingsFrom 2014–2017, 11 849 patients with diabetes were screened within the diabetic retinopathy referral network. In primary-care centres, 6012 patients with diabetes mellitus were identified and 5632 patients were referred for diabetic retinopathy screening. A further 4036 patients directly attended two secondary-level hospitals and 2181 attended the tertiary-level hospital for screening. This represented a 138.1% increase in diabetic retinopathy screenings from a baseline of 4977 patients screened at the regional institute of ophthalmology over 2010–2013. A total of 2922 patients (24.7%) were found to have diabetic retinopathy and 923 (31.6%) were treated: 508 with laser photocoagulation, 345 with intravitreal bevacizumab and 70 with vitreoretinal surgery.ConclusionEffective and timely treatment for diabetic retinopathy is possible when patient education, screening and care are fully integrated into the general health-care system across primary-, secondary- and tertiary-level facilities. This requires the integration of professionals at all levels and all relevant specialties.