Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up.

BACKGROUND: Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood. OBJECTIVE: To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres. METHOD: The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU. RESULTS: Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management. CONCLUSIONS: The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

Effect of interscalene anaesthesia on cerebral oxygen saturation.

Interscalene blockade (ISB) is commonly associated with Horner's syndrome, indicating spread of injectate to the cervical sympathetic chain. Cervical sympathetic nerve activity (SNA) is believed to influence cerebral autoregulation, and a decrease in sympathetic tone may alter cerebral blood flow (CBF). This study investigated whether ISB influenced CBF in patients undergoing shoulder surgery. Patients (n=30) scheduled for elective shoulder arthroscopy were recruited. Cerebral oxygen saturation (ScO(2)) of the left and right frontal cortices was continuously measured during ISB administration, sedation and anaesthetic induction. Baseline ScO(2) was similar in blocked and unblocked sides (74 ± 5% and 73 ± 5% respectively, P=0.70). ScO(2) decreased with sedation (-3 ± 3% and -4 ± 3%, P=0.93), and increased with pre-oxygenation and general anaesthesia (P <0.01). Following ISB there was no change in ScO(2) between blocked and unblocked sides (P=0.18), or any difference between right- or left-sided ISB. ISB is not associated with an increase in CBF as indicated by ScO(2), despite the presence of Horner's syndrome.

Trends of acute myocardial infarction admissions over a decade, Tikur Anbessa Hospital.

This is a case series analysis undertaken to evaluate the importance of acute myocardial infarction (AMI) as a cause of admission at the Tikur Anbassa medical intensive care unit (MICU) and the trend of that importance over a decade (1988-1997). Clinical presentations and the frequencies of major coronary risk factors in the individual patient were also assessed for the later half of the decade (1993-1997). In the decade under study 2313 patients were admitted to MICU according to its register. Overall AMI was the third commonest cause of admission and accounted for 8.8% (N = 203) of all MICU cases. AMI annual admissions increased consistently over the years. Of the 122 AMI admissions during the second half of the decade, 92 charts were available for detailed analysis. 86% (79/92) fulfilled the stated criteria for the diagnosis. The mean age of these patients was 55.1 +/- 13.0 years. Males constituted 82% of all AMI cases. Eighty seven percent (69/79) of the cases were first admissions with the diagnosis of AMI. Ninety-four percent (74/79) of them were brought to the emergency room due to chest discomfort and 20% were in frank pulmonary oedema. Nineteen percent died in hospital. 81% and 34% of the patients had one or more and two or more major coronary risk factors excluding age and gender respectively. Raised total cholesterol and hypertension were commonest risk factors being reported in 69% and 47% of AMI patients respectively. In conclusion, this study has demonstrated that AMI is indeed on the rise at least at Tikur Anbassa Teaching Hospital, and possibly at other health institutions. The conventional coronary risk factors seem to operate in the Ethiopian series as well. The study highlights the need for coronary risk factors surveys at least in the susceptible population group to assess the gravity of the problem.