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INTRODUCTION: Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence of MI in sub-Saharan Africa is rising, but uptake of evidence-based care in northern Tanzania is low. There are currently no published quality improvement interventions from the region. The objective of this study was to determine provider attitudes towards a planned quality improvement intervention for MI care in northern Tanzania. METHODS: This study was conducted at a zonal referral hospital in northern Tanzania. A 41-question survey, informed by the Theoretical Framework for Acceptability, was developed by an interdisciplinary team from Tanzania and the United States. The survey, which explored provider attitudes towards MI care improvement, was administered to key provider stakeholders (physicians, nurses, and hospital administrators) using convenience sampling. RESULTS: A total of 140 providers were enrolled, including 82 (58.6%) nurses, 56 (40.0%) physicians, and 2 (1.4%) hospital administrators. Most participants worked in the Emergency Department or inpatient medical ward. Providers were interested in participating in a quality improvement project to improve MI care at their facility, with 139 (99.3%) strongly agreeing or agreeing with this statement. All participants agreed or strongly agreed that improvements were needed to MI care pathways at their facility. Though their facility has an MI care protocol, only 88 (62.9%) providers were aware of it. When asked which intervention would be the single-most effective strategy to improve MI care, the two most common responses were provider training (n = 66, 47.1%) and patient education (n = 41, 29.3%). CONCLUSION: Providers in northern Tanzania reported strongly positive attitudes towards quality improvement interventions for MI care. Locally-tailored interventions to improve MI should include provider training and patient education strategies.
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INTRODUCTION: Heart failure (HF) is characterized by frequent episodes of decompensation, leading to a high hospitalization burden. More than 50% of index hospitalizations for HF patients return within 6 months of discharge. Once the patient is readmitted, the risk of further disease progression and the mortality rate are increased. A lot of patients are readmitted due to factors such as poor medication adherence, infections, or worsening comorbidities. The aim of our study was to identify the inpatient burden of HF readmission and to identify the factors associated with early readmission. METHODS: A hospital-based cross-sectional analytical study was conducted from November 2018 to April 2019 within the medical wards at Kilimanjaro Christian Medical Centre (KCMC), which is a teaching and referral hospital in north-eastern Tanzania. The study population included all patients with HF admitted within the medical ward. Data were collected using questionnaires and blood and radiological investigations, and analysis was done using Statistical Package for Social Science (SPSS) version 25. Chi-square test was used to compare proportions of categorical variables. Logistic regression was used to determine the likelihood for readmission, and p-value of <0.05 was considered to be statistically significant. RESULTS: A total of 353 patients were identified with HF, of whom 136 (38.5%) had a previous admission. Of the 136 patients analysed, the mean age was 62.8 years (SD 17.1), and 86 (63.2%) were females. Within 30 days after discharge, 34 (25.0%) of the patients were readmissions. Factors for early readmission were unemployment (OR = 2.38, 95% CI = 1.02-5.54, p = 0.043), poor medication adherence (OR = 3.87, 95% CI = 1.67-8.97, p = 0.002), absence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR = 2.40, 95% CI = 1.09-5.31, p = 0.030), and pleural effusion (OR 3.25, 95% CI = 1.44-7.32, p = 0.004). CONCLUSION: Heart failure is a burden due to a large number of admissions and readmissions. Factors such as poor medication adherence and absence of adequate HF therapy, especially the absence of regimes containing ACEI or ARB, need to be targeted to reduce the number of readmissions. This will help reduce the risk of further decompensations, disease progression, and mortality rate.
