Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool.

BACKGROUND: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. METHODS: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. RESULTS: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). CONCLUSIONS: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.

Three parallel information systems for malaria elimination in Swaziland, 2010-2015: are the numbers the same?

Background: To be able to eliminate malaria, accurate, timely reporting and tracking of all confirmed malaria cases is crucial. Swaziland, a country in the process of eliminating malaria, has three parallel health information systems. Design: This was a cross-sectional study using country-wide programme data from 2010 to 2015. Methods: The Malaria Surveillance Database System (MSDS) is a comprehensive malaria database, the Immediate Disease Notification System (IDNS) is meant to provide early warning and trigger case investigations to prevent onward malaria transmission and potential epidemics, and the Health Management Information Systems (HMIS) reports on all morbidity at health facility level. Discrepancies were stratified by health facility level and type. Results: Consistent over-reporting of 9-85% was noticed in the HMIS, principally at the primary health care level (clinic and/or health centre). In the IDNS, the discrepancy went from under-reporting (12%) to over-reporting (32%); this was also seen at the primary care level. At the hospital level, there was under-reporting in both the HMIS and IDNS. Conclusions: There are considerable discrepancies in the numbers of confirmed malaria cases in the HMIS and IDNS in Swaziland. This may misrepresent the malaria burden and delay case investigation, predisposing the population to potential epidemics. There is an urgent need to improve data integrity in order to guide and evaluate efforts toward elimination.

Contexte : Si l'on veut éliminer le paludisme, il est crucial que tous les cas confirmés de paludisme bénéficient d'une déclaration exacte et prompte et soient suivis. Le Swaziland, un pays en cours d'élimination, a trois systèmes parallèles d'information de santé.Schéma : Une étude transversale basée sur des données du programme national de 2010 à 2015.Méthodes : Le Malaria Surveillance Database System (MSDS) est une base de données exhaustive du paludisme ; l'Immediate Disease Notification System (IDNS) est destiné à fournir une alerte précoce et à déclencher les investigations des cas pour prévenir la transmission ultérieure du paludisme et des épidémies potentielles ; les rapports de Health Management Information Systems (HMIS) déclarent toute la morbidité au niveau des structures de santé. Les disparités ont été stratifiées par niveau et par type de structure de santé.Résultats : Une sur-déclaration régulière de 9% à 85% a été constatée dans le HMIS et principalement au niveau des soins de santé primaires (dispensaires et/ou centres de santé). Dans l'IDNS, les disparités sont allées d'une sous-déclaration de 12% à une sur-déclaration de 32% et ceci a également été vu au niveau des soins de santé primaires. Au niveau des hôpitaux, il y a eu une sous-déclaration à la fois dans le HMIS et dans l'IDNS.Conclusions: Il y a une considérable disparité dans les nombres de cas de paludisme confirmés dans le HMIS et l'IDNS au Swaziland. Ceci peut fausser le poids du paludisme et retarder l'investigation des cas, prédisposant la population à des épidémies potentielles. Il y a un besoin urgent d'améliorer l'intégrité des données de façon à guider et à évaluer les efforts vers l'élimination.

Marco de referencia: Con el fin de eliminar el paludismo, es primordial practicar la notificación y el seguimiento precisos y oportunos de todos los casos confirmados. Swazilandia está en vía de eliminación del paludismo y cuenta con tres sistemas paralelos de información sanitaria, a saber: el Sistema de Información sobre Gestión Sanitaria (HMIS, por Health Management Information System), el Sistema de Notificación Inmediata de Enfermedades (IDNS, por Immediate Disease Notification System) y el Sistema de la Base de Datos de Vigilancia del Paludismo (MSDS, por Malaria Surveillance Database System).Método: Un estudio transversal con datos del programa de ámbito nacional (del 2010 al 2015).Métodos: El MSDS consiste en una base de datos exhaustiva; el IDNS se propone aportar una alarma temprana y desencadenar la investigación de los casos con el fin de evitar la transmisión del paludismo y eventuales epidemias; y el HMIS notifica todos los casos a escala de los establecimientos de salud. Las discrepancias entre los sistemas se estratificaron por nivel y por tipo de establecimiento de salud.Resultados: Se observó una sobrenotificación sistemática del 9% al 85% en el HMIS, sobre todo a escala de la atención primaria (consultorio o centro de salud). En el IDNS, la discrepancia osciló entre una subnotificación del 12% y una sobrenotificación del 32%, en especial al nivel de la atención primaria. A escala de los hospitales se observó una subnotificación en el HMIS y también en el IDNS.Conclusión: Existen discrepancias notables sobre el número de casos confirmados de paludismo en el HMIS y el IDNS en Swazilandia. Esta situación da una imagen errada de la carga de morbilidad por paludismo y retrasa la investigación de los casos, con lo cual se expone la población a posibles brotes epidémicos. Es urgente mejorar la integridad de los datos, con el fin de orientar las iniciativas encaminadas a eliminar el paludismo y evaluar la repercusión de las mismas.

Work-related musculoskeletal disorders among registered general nurses: a case of a large central hospital in Harare, Zimbabwe.

OBJECTIVE: Worldwide, work-related musculoskeletal disorders (WMSDs) are a common cause of morbidity affecting occupational individuals such as health-care professionals. However, nothing is known about WMSDs in hospital nurses in Zimbabwe. This study was conducted to provide cross-sectional evidence of the 12-month prevalence, consequences and factors associated with WMSDs among 208 nurses at Parirenyatwa Group of Hospitals (PGH). RESULTS: The response rate for the study was 55.7%. The median age for the participants was 32.0 years (interquartile range = 29-36 years). The lifetime prevalence of WMSDs in nurses was 95.7% (n = 112). The first episodes were experienced in the first 5 years of working (n = 59, 52.7%). However, 82.1% (n = 96) nurses experienced WMSDs in the last 12 months. Low back pain was the most common WMSDs reported (n = 55, 67.9%). WMSDs were significantly associated with qualification attained, postgraduate ergonomic training and working experience. Overall, 87.5% (n = 84) nurses experienced at least one of the consequences of WMSDs. Cognisant of the limitations of the study, the present study found that WMSDs are a common occurrence among nurses at PGH. This creates a need for prompt hospital education programs aimed at raising awareness among nurses on the existence of WMSDs and the consequences at PGH.

Using molecular beacons to detect single-nucleotide polymorphisms with real-time PCR.

Detection of single-nucleotide polymorphisms (SNPs) in high-throughput studies promises to be an expanding field of molecular medicine in the near future. Highly specific, simple, and accessible methods are needed to meet the rigorous requirements of single-nucleotide detection needed in pharmacogenomic studies, linkage analysis, and the detection of pathogens. Molecular beacons present such a solution for the high-throughput screening of SNPs in homogeneous assays using the polymerase chain reaction (PCR). Molecular beacons are probes that fluoresce on hybridization to their perfectly complementary targets. In recent years they have emerged as a leading genetic analysis tool in a wide range of contexts from quantification of RNA transcripts, to probes on microarrays, to single-nucleotide polymorphism detection. The majority of these methods use PCR to obtain sufficient amounts of sample to analyze. The use of molecular beacons with other amplification schemes has been reliably demonstrated, though PCR remains the method of choice. Here we discuss and present how to design and use molecular beacons to achieve reliable SNP genotyping and allele discrimination in real-time PCR. In addition, we provide a new means of analyzing data outputs from such real-time PCR assays that compensates for differences between sample condition, assay conditions, variations in fluorescent signal, and amplification efficiency. The mechanisms by which molecular beacons are able to have extraordinary specificity are also presented.