Diagnostic yield and appropriate indication of upper endoscopy in Jordanian children.

BACKGROUND: Upper endoscopy is an essential tool for diagnosing pediatric gastrointestinal issues. This study aimed to assess the indications, diagnostic yields, concordance between histopathological and endoscopic findings and suitability of upper endoscopies performed at a tertiary university hospital in Jordan. METHODS: Hospital records of children who underwent upper endoscopy were retrospectively reviewed. Demographics, endoscopic details (e.g., indications, findings and any complications), and histopathological findings were collected. The relationship between endoscopic findings and histopathological abnormalities was reported. RESULTS: The study included 778 patients (age, 92.5 ± 54.5 months; 380 girls, 48.8%). The most common age group was children younger than 60 months (273 patients, 34.3%). The most common indication for endoscopy was abdominal pain, followed by vomiting and failure to thrive or weight loss. Normal upper endoscopy was reported in 411 patients (52.8%). Age below 60 months, abdominal pain, dysphagia/odynophagia, and heartburn were predictive of abnormal endoscopy in multivariate analysis with p-value 0.000, 0.048, 0.001 and 0.01 respectively. Abnormal endoscopy showed 67.3% sensitivity and 69.9% specificity to predict histopathological abnormalities. Of those performed, 13.6% endoscopies were described as inappropriate indication. The suitability of the procedure was a sensitive predictor for abnormal endoscopic and histopathological findings. CONCLUSIONS: Abdominal pain is the most common indication for upper endoscopy in our population. It is associated with a higher chance of abnormal endoscopy. Concordance between endoscopic and histopathological findings is not high. Normal endoscopic findings shouldn`t discourage the endoscopist from obtaining tissue biopsies. Considering more biopsies may improve pathological detection rates. Compliance with established endoscopy guidelines may reduce unnecessary procedures.

"If there are no female nurses to attend to me, I will just go and deliver at home": a qualitative study in Garissa, Kenya.

BACKGROUND: The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. METHODS: The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. RESULTS: Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. CONCLUSION: To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.