The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana.

BACKGROUND: Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. RESULTS: Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). CONCLUSION: There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

Penile shaft sinus: A sequalae of circumcision in urethral duplication.

Urethral duplication (UD) is rare congenital anomalies with varied presentation. Careful clinical evaluation of children by specialist would enhance diagnosis, adequate management and reduce occurrence of complication. We present a 12-year-old boy with chronic post circumcision ventral penile sinus that was successfully managed for urethral duplication.

Clinical spectrum of discharges against medical advice in a developing country.

BACKGROUND: Patients who leave the hospital before clinician certification of fitness are referred to as discharge against medical advice (DAMA). This phenomenon of discharges against medical advice is an undesirable but relatively common occurrence worldwide. Professional liability and harmful effect of this practice to individual health are of concern. AIMS: The essence of this study is to determine the spectrum of patients who DAMA in a Nigerian teaching hospital. DESIGN: Descriptive study over a two-year period in an urban teaching hospital in Nigeria. MATERIALS AND METHODS: All consecutive patients who discharge against medical advice at the surgical emergency room of University Teaching Hospital, Ilorin from January 2004 to December 2005 were studied prospectively. The patients' demographic details, diagnosis, reason for discharge, signatory to discharge and length of hospital stay were studied. STATISTICAL ANALYSIS: Analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 11. RESULTS: Prevalence rate of DAMA was 4.2%, comprising 110 of a total of 2,617 patients admitted during the study period. Male to female ratio was 3.8:1, the mean age was 30.0 years (range, 4-70 years). Trauma accounted for the highest number of patients 102(97.2%) out of whom 52 (51%) had long bones fracture. Patients who wish to seek alternate medical care accounted for 43.6%, while financial constraint contributed to 29.1% DAMA. Forty-five out of forty-eight (93.7%) of patients who DAMA to seek alternate medical care had fracture. CONCLUSION: Trauma was the most common clinical condition for patients who DAMA. Most common reason for DAMA was to seek alternate treatment followed by financial constraint. Health education on potential benefit of orthodox treatment of fracture, treatment subsidy and full implementation of national health insurance scheme will reduce incidence of DAMA.