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1.
Mymensingh Med J ; 31(1): 129-134, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999692

RESUMO

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.


Assuntos
Hospitais de Distrito , Mortalidade Infantil , Bangladesh/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino
2.
J Glob Health ; 11: 04069, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956636

RESUMO

Background: Over the past 25 years Sierra Leone has made progress in reducing maternal and child mortality, but the burden of preventable paediatric deaths remains high. Further progress towards achieving the Sustainable Development Goals will require greater strengthening of the health care system, including hospital care for perinatal and paediatric conditions. Emergency Triage Assessment and Treatment Plus (ETAT+) may offer a useful tool. Methods: The five-day ETAT+ course was adapted as a six-month programme of in-situ training and mentoring integrated with patient flow and service delivery improvements in 14 regional and district government hospitals across the country. Nurses were trained to carry out the initial resuscitation and assessment of the sick paediatric patient, and to administer the first dose of medication per protocol. The course was for all clinical staff; most participants were nurses. Results: The intervention was associated with an improvement in the quality of paediatric care and a reduction in mortality. In 2017 mortality decreased by 33.1%, from 14.5% at baseline to 9.7% after six months of the intervention. Mortality at the start of the 2018 intervention was 8.5% and reduced over six months to 6.5%. Care quality indicators showed improvement across the two intervention periods, with some evidence of sustained effect. Conclusions: These results suggest that adapted ETAT+ training with in-situ mentoring alongside improved patient flow and service delivery supports improvements in the quality of paediatric care in Sierra Leonean hospitals. ETAT+ may provide an affordable framework for improving the quality of secondary paediatric care in Sierra Leone and a model of nurse-led resuscitation may allow for prompt and timely emergency paediatric care in Sierra Leonean hospitals where there are fewer physicians and other resources for care.


Assuntos
Melhoria de Qualidade , Triagem , Criança , Atenção à Saúde , Hospitais de Distrito , Humanos , Serra Leoa
3.
West Afr J Med ; Vol. 38(11): 1120-1128, 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34922413

RESUMO

BACKGROUND: The COVID -19 pandemic spread rapidly across the globe, making a land-fall on the Nigerian geo-space in early 2020. Key presenting features were; fever, dry cough, fatigue, myalgia, headache, sore-throat, abdominal pain, diarrhea, dyspnoea amongst others, with a clinical spectrum ranging from mild through severe forms. Aside infection control and supportive care, there was no specific therapy until trials with Remdesivir. Studies have described limited epidemiological findings, presentations and outcomes of COVID patients in Nigeria and elsewhere, but not for the Federal Capital Territory, (FCT) specifically Abuja, the Nation's capital city and the second epicenter of the pandemic in Nigeria. The objective of this study therefore, was to describe the Clinical and demographic characteristics of the patients admitted at the Asokoro District Hospital (ADH), Abuja. METHODS: Retrospective study that used records of patients admitted, between April and September 2020. Data include; Socio-demographics, medical history, exposure, residential area, co-morbidities, symptoms, signs, treatment measures, duration of hospital stay and outcomes. RESULTS: 270 patients were enrolled for this study. 170(63%) males and 100(37%) females. Mean age was 40.03+13.5years. Forty-one(15.2%) had travel history while 99(36.7%) had contact with confirmed cases. Majority of the patients were married(63.33%), and had tertiary education(74.82%). Commonest symptoms were cough(43.33%), fever(36.67%), headaches(32.22%) and fatigue(31.48%). The duration of stay at the ADH ranged from 2 hours to 28 days. CONCLUSION: Our patients were young, mainly of the upper class, educated people with mild to severe disease. There was one death, a case with multiple comorbid factors.


Assuntos
COVID-19 , Dor Abdominal , Adulto , Feminino , Hospitais de Distrito , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
4.
Ann Glob Health ; 87(1): 118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34900618

RESUMO

Background: Remarkable gains have been made in global health with respect to provision of essential and emergency surgical and anesthesia care. At the same time, little has been written about the state of surgical care, or the potential strategies for scale-up of surgical services in sub-Saharan Africa, southeast Nigeria inclusive. Objective: The aim was to document the state of surgical care at district hospitals in southeast Nigeria. Methods: We surveyed 13 district hospitals using the World Health Organization (WHO) tool for situational analysis developed by the "Lancet Commission on Global Surgery" initiative to assess surgical care in rural Southeast Nigeria. A systematic literature review of scientific literatures and policy documents was performed. Extraction was performed for all articles relating to the five National Surgical, Obstetric and Anesthesia Plans (NSOAPs) domains: infrastructure, service delivery, workforce, information management and financing. Findings: Of the 13 facilities investigated, there were six private, four mission and three public hospitals. Though all the facilities were connected to the national power grid, all equally suffered electricity interruption ranging from 10-22 hours daily. Only 15.4% and 38.5% of the 13 hospitals had running water and blood bank services, respectively. Only two general surgeon and two orthopedic surgeons covered all the facilities. Though most of the general surgical procedures were performed in private and mission hospitals, the majority of the public hospitals had limited ability to do the same. Orthopedic procedures were practically non-existent in public hospitals. None of the facilities offered inhalational anesthetic technique. There was no designated record unit in 53.8% of facilities and 69.2% had no trained health record officer. Conclusion: Important deficits were observed in infrastructure, service delivery, workforce and information management. There were indirect indices of gross inadequacies in financing as well.


Assuntos
Anestesia , Cirurgiões , Feminino , Hospitais de Distrito , Humanos , Nigéria , Gravidez , Organização Mundial da Saúde
5.
PLoS One ; 16(12): e0261231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34941883

RESUMO

INTRODUCTION: Few economic evaluations have assessed the cost-effectiveness of screening type-2 diabetes mellitus (T2DM) in different healthcare settings. This study aims to evaluate the value for money of various T2DM screening strategies in Vietnam. METHODS: A decision analytical model was constructed to compare costs and quality-adjusted life years (QALYs) of T2DM screening in different health care settings, including (1) screening at commune health station (CHS) and (2) screening at district health center (DHC), with no screening as the current practice. We further explored the costs and QALYs of different initial screening ages and different screening intervals. Cost and utility data were obtained by primary data collection in Vietnam. Incremental cost-effectiveness ratios were calculated from societal and payer perspectives, while uncertainty analysis was performed to explore parameter uncertainties. RESULTS: Annual T2DM screening at either CHS or DHC was cost-effective in Vietnam, from both societal and payer perspectives. Annual screening at CHS was found as the best screening strategy in terms of value for money. From a societal perspective, annual screening at CHS from initial age of 40 years was associated with 0.40 QALYs gained while saving US$ 186.21. Meanwhile, one-off screening was not cost-effective when screening for people younger than 35 years old at both CHS and DHC. CONCLUSIONS: T2DM screening should be included in the Vietnamese health benefits package, and annual screening at either CHS or DHC is recommended.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Programas de Triagem Diagnóstica/economia , Centros Comunitários de Saúde/economia , Análise Custo-Benefício , Atenção à Saúde , Diabetes Mellitus Tipo 2/economia , Hospitais de Distrito/economia , Humanos , Hipoglicemiantes/economia , Programas de Rastreamento/economia , Anos de Vida Ajustados por Qualidade de Vida , Vietnã/epidemiologia
6.
Curationis ; 44(1): e1-e7, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34797104

RESUMO

BACKGROUND: South Africa has included birth companions in its national guidelines for maternity care and the revised Maternity Case Record, in and effort to improve the quality and experience of care. However, reservations amongst healthcare providers remain about the acceptability of birth companions in the labour ward. OBJECTIVES: To document the experiences and perceptions of birth companions who supported women in labour in a rural hospital in Limpopo Province where a Respectful Maternity Care (RMC) project was piloted. METHOD: An institution-based cross-sectional study design was employed. Purposive sampling was employed where all birth companions who supported a woman during labour and birth were included in the study. The experiences and perceptions of birth companions were captured using a birth companion feedback book during the period of 1st April to 30th August 2019. Thematic analysis was used to analyse the data. RESULTS: Seventy-one (71) of the 73 birth companions only had positive responses about the birthing experience and how both the birth companion and woman in labour were treated. Two birth companions were dissatisfied with the treatment provided by the midwife that supported the birth. CONCLUSION: It is important for healthcare providers to understand the far reaching emotional and psychological impact of their attitudes and behaviour on, not only women in labour but also on others who witness their (healthcare providers) behaviour. Mechanisms to obtain feedback from birth companions should be integrated into strategies to improve the quality and experience of care for women during childbirth.


Assuntos
Hospitais de Distrito , Serviços de Saúde Materna , Estudos Transversais , Parto Obstétrico , Feminino , Amigos , Humanos , Parto , Percepção , Gravidez , Relações Profissional-Paciente , África do Sul
7.
Afr J Prim Health Care Fam Med ; 13(1): e1-e3, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34797116

RESUMO

The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals. In South Africa significant skills gap exist at district hospitals, particularly in the area of surgery and anaesthesia. These small to moderate sized hospitals are too small to support a range of full time specialists even if they could be recruited and were cost-effective. Family physicians (FPs) are trained in the clinical skills required for district hospitals and primary health care. Clinical associates have also been introduced to perform procedures at district hospitals. This report illustrates the contribution of a FP to surgical care at Zithulele Hospital in the Eastern Cape. Family physicians not only bring the necessary clinical skills set but also increase the confidence and capacity of the whole team. Outreach and support by surgeons, as well as continuing professional development, are important. Surgical and anaesthetic skills must be developed together. Family physicians also bring leadership and clinical governance skills that ensure the inputs to support surgery, such as equipment and information systems are available. The contribution of FPs to surgery and district hospitals is overlooked in both policy and practice. Human resources for health policy should recognise their contribution and increase the numbers available and FP posts at district hospitals. There is also a need to update the package of emergency and essential surgical procedures in policy.


Assuntos
Hospitais de Distrito , Médicos de Família , Atenção à Saúde , Humanos , Atenção Primária à Saúde , África do Sul
8.
Afr J Prim Health Care Fam Med ; 13(1): e1-e4, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34797119

RESUMO

This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP's roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.


Assuntos
Hospitais de Distrito , Médicos de Família , Humanos , Atenção Primária à Saúde , África do Sul
9.
Pak J Pharm Sci ; 34(3(Supplementary)): 1135-1142, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34602443

RESUMO

Pakistan has reported a substantial number of COVID-19 cases since 2020. A multicenter observational study was conducted to identify the pattern of SARS-CoV-2 infection, transmission, and treatment in patients admitted to seven low to middle-income district hospitals in the Province of Punjab, Pakistan from March to June 2020. A total of 102 patients were recruited. 57 patients tested positive and 45 developed moderate-severe COVID-19 disease. About 67% of the patients in March-April and 93% in May-June have contracted the disease from the local transmission. The mean number of symptoms in SARS-CoV-2 positive patients was significantly higher than suspected patients (6.46 vs 5.04, p=0.003). The number of deaths was low (n=8) with 86% recovery rate. Mild COVID patients received acetaminophen (n=102), azithromycin (n=8), and hydroxychloroquine (n=4) in addition to standard medical care. The treatment provided to moderate-severe cases included acetaminophen (45/45), azithromycin (45/45), Ivermectin (14/45) and corticosteroids (13/45). The mean number of antimicrobials was significantly higher in moderate-severe patients than mild cases (1.80 vs 1.12, p=0.001). Low number of deaths with a high recovery rate was reported. Diabetes was the most common comorbid condition followed by hypertension. Many antimicrobials were prescribed in both mild and moderate-severe cases that require careful review.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/transmissão , SARS-CoV-2/efeitos dos fármacos , Adulto , Antivirais/uso terapêutico , Feminino , Hospitais de Distrito , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Pobreza
10.
Afr J Prim Health Care Fam Med ; 13(1): e1-e6, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34636608

RESUMO

BACKGROUND: Life expectancies of HIV-positive patients have been increasing with the rapid implementation of antiretroviral therapy (ART). This has led to an increase in comorbidities such as diabetes mellitus (DM) and hypertension (HT) amongst the HIV population. The burden of the non-communicable diseases (NCDs) such as DM and HT need to be quantified in order to ensure that patients receive optimal integrated care as patients often access care at different clinics compromising holistic care. AIM: The aim of the study was to determine the prevalence of DM and HT amongst the HIV-positive population. SETTING: The study was conducted at Wentworth Hospital, a district facility in South Durban, KwaZulu-Natal. METHODS: This cross-sectional study was undertaken to determine the prevalence of two NCDs, namely DM and HT in HIV-positive patients attending the ART clinic at a district hospital in the eThekwini district. We compared the socio-demographic and clinical profiles of those with and without comorbidities. A sample of 301 HIV-positive patients were administered a structured questionnaire. RESULTS: Of the 301 patients, 230 (76.41%) had HIV only (95% confidence interval [CI]: 71.25-80.89) and 71 (23.59%) had HIV and at least one comorbidity, namely DM and/or HT (95% CI: 19.11-28.75). Hypertension was the most prevalent comorbidity. This study revealed that there was no association between the duration of ART and comorbidities. Older age and body mass index (BMI) were associated with comorbidities, whilst gender and ethnicity were not associated. CONCLUSION: Non-communicable diseases such as DM and HT do pose a burden for HIV-positive patients attending the ARV clinic at this district facility. This study highlights the definite need to plan for the increased burden of NCDs as HIV-positive patients live longer and gain weight.


Assuntos
Diabetes Mellitus , Infecções por HIV , Hipertensão , Idoso , Estudos Transversais , Diabetes Mellitus/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hospitais de Distrito , Humanos , Hipertensão/epidemiologia , Prevalência , Fatores de Risco , África do Sul/epidemiologia
11.
PLoS One ; 16(9): e0257597, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587196

RESUMO

BACKGROUND: Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. METHODS: Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. RESULTS: The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. CONCLUSIONS: Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.


Assuntos
Tutoria/métodos , Políticas , Procedimentos Cirúrgicos Operatórios/educação , Pessoal Administrativo/psicologia , Hospitais de Distrito , Humanos , Tutoria/organização & administração , Encaminhamento e Consulta , Zâmbia
12.
Ann Glob Health ; 87(1): 82, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34513594

RESUMO

Background: Village health workers (VHWs) can serve as a valuable resource to address public health needs in resource-limited settings such as Uganda. However, the successful implementation of VHW programs can be limited by poor acceptability among community members. Kisoro District Hospital (KDH) in Kisoro District, Uganda operates a VHW program and, at the time of the study, was expanding its services to 11 additional villages. Objective: The objective of this study was to evaluate community perceptions of VHWs in villages of Kisoro District with no prior exposure to the KDH VHW program in order to improve community acceptance when expanding the program to additional villages. Methods: We administered surveys to 658 community members from 11 villages to evaluate their perceptions of VHWs prior to receiving VHW services. Additionally, we conducted focus group discussions among 97 participants to explore perceptions of VHWs in further depth. Findings: Community members were generally accepting of VHWs. They preferred that VHWs provide both curative and preventive services across a broad range of health domains as opposed to a single disease. Expectations of the responsibilities of a VHW were influenced by agricultural occupational and household responsibilities, particularly for women. Participants expressed a preference to be actively involved in the selection and oversight of VHWs and that VHWs receive compensation. Conclusions: 1) Community members' expectations of VHWs are shaped by environmental, cultural, and social factors. 2) Active community engagement in the VHW program is key. 3) Aligning a VHW program with community perceptions may improve acceptance, in turn influencing effectiveness and sustainability. These findings were used to expand the KDH VHW Program into the participating villages in a manner consistent with community preferences. Our findings may provide guidance on enhancing the uptake of community-based VHW programs for VHW stakeholders and policymakers in other settings.


Assuntos
Agentes Comunitários de Saúde , Hospitais de Distrito , Feminino , Grupos Focais , Humanos , Percepção , Uganda
14.
BMJ Open ; 11(9): e045965, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518249

RESUMO

OBJECTIVES: To investigate the bacterial aetiologies and associated risk factors of gastroenteritis among typhoid suspected cases. DESIGN: Cross-sectional study. SETTING: This study was conducted at Dschang District Hospital of the Menoua Division, West Region of Cameroon, between April-November 2019 and June 2020. PARTICIPANTS: Participants aged ≥2 years (mean 34±18.77 years) and of both sex suspected of having typhoid fever were included, while non-suspected typhoid cases were excluded. Self-reported sociodemographic and health information at recruitment was obtained from 556 participants. METHODS: Collected stool samples were examined macroscopically and microscopically and subjected to culture. After culture, Gram staining was performed, followed by biochemical testing and characterisation using the Analytical Profile Index (API-20E) test kit. INTERVENTIONS': No intervention was done during the period of study. OUTCOME MEASURES: We identified bacterial causing gastroenteritis, and associated risk factors calculated using binary regression, adjusting for sociodemographic and health variables. RESULTS: Of 556 patients, 74.28% tested positive for gastroenteritis. Among pathogens responsible for gastroenteritis, Escherichia coli was found to be the main cause (21.1%), followed by Salmonella typhi (10.4%), Citrobacter diversus (8.2%), and Proteus mirabilis (8.2%), Proteus vulgaris (7.3%), whereas Citrobacter spp and Yersinia enterocolitica were less represented among pathogens causing the disease among patients. A significant difference (p=0.002) was observed between abdominal pain and all the micro-organisms isolated from the patients. Patients having primary level of education were significantly associated (p=0.017; 3.163 (95% CI 1.228 to 8.147)) with the prevalence of gastroenteritis. Consumption of beverages (Wald statistic: 4.823; OR: 2.471; 95% CI (1.102 to 5.539); p=0.028), use of modern toilet (Wald statistic: 4.471; OR: 1.723; 95% CI (1.041 to 2.852); p=0.034) were strongly associated with gastroenteritis and rearing of bird (Wald statistic: 4.880; OR: 0.560; 95% CI (0.335 to 0.937); p=0.027), was found to be protective. CONCLUSION: Acute bacterial gastroenteritis is a significant cause of morbidity in Dschang, with the prevalence of 74.28%. Many pathogens accounted for gastroenteritis, and E. coli (21.1%) could be a major cause, followed by S. typhi (10.4%), C. diversus (8.2%), P. mirabilis (8.2%), P. vulgaris (7.3%), whereas Citrobacter spp and Y. enterocolitica were less represented. Gastroenteritis was highly associated with primary level of education, consumption of beverages, use of modern toilet while rearing of birds was unexpectedly found to be protective against Gastroenteritis. Further characterisation is planned.


Assuntos
Gastroenterite , Hospitais de Distrito , Camarões/epidemiologia , Estudos Transversais , Escherichia coli , Gastroenterite/epidemiologia , Humanos , Pacientes Ambulatoriais , Fatores de Risco
15.
Med J Malaysia ; 76(5): 630-636, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34508367

RESUMO

INTRODUCTION: Pseudomonas aeruginosa is known to be the epitome of nosocomial infections associated with high morbidity and mortality. The dearth of local pseudomonal studies has prompted us to conduct this study with the following objectives: (1) to examine the local pseudomonal bacteraemia (PB) epidemiology and clinical characteristics, (2) to compare the 30-day mortality among PB of different onsets and (3) to determine the predictors of 30-day mortality outcome. METHODS: This retrospective study was conducted in Hospital Seri Manjung, Perak, Malaysia. All cases of blood culture proven PB that occurred between 1st January 2015 and 31st December 2019 were reviewed. Subjects below 12 year old and whose index blood cultures grew more than one organism were excluded. Demographic, clinical and treatment data were collected using pre-tested data collection forms and analysed using SPSS version 20.0. RESULTS: Among the 59 subjects included, healthcare associated (HCA) infections were the most prevalent, next to hospital onset (HO) and community onset (CO) infections. The commonest underlying comorbidities were cardiovascular disease, diabetes mellitus, and chronic kidney disease. Respiratory tract was the most frequently implicated source amongst all, while the urinary tract was more frequently implicated as the source of infection among HCA cases. Seventeen patients were admitted to ICU, and they were predominantly from the HO group. Despite having a higher rate of adequate empirical antibiotics administered, the HO group reported the lowest 30-day survival rate. Multiple logistic regression analysis demonstrated the following were independent predictors of 30-day mortality: requiring mechanical ventilator support, requiring central venous line insertion, not requiring surgery, and receiving inappropriate definite antibiotics. CONCLUSION: The incidence of community onset PB was appreciably low, as cases were predominantly HCA and HO in origin. Significant morbidities were observed among pseudomonal infections, with HO infections portending the worst prognosis. Lastly, prognostic factors for determining the mortality caused by PB depended more on the severity of sepsis than the timeliness of appropriate antibiotics.


Assuntos
Bacteriemia , Infecções Comunitárias Adquiridas , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Criança , Hospitais de Distrito , Humanos , Pseudomonas aeruginosa , Estudos Retrospectivos , Fatores de Risco
16.
JNMA J Nepal Med Assoc ; 59(238): 550-553, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508406

RESUMO

INTRODUCTION: The corona virus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 belonging to corona viruses which are enveloped positive stranded RNA viruses. Non-critical coronavirus disease 2019 patients often lack follow up visits which has led to incomplete understanding of disease process. The aim of this study was to find out the prevalence of persistent symptoms in such patients during two months follow-up to a district hospital. METHODS: This descriptive cross-sectional study was conducted in a district hospital from September 2020 to February 2021 among non-critical corona virus disease 2019 patients admitted to the isolation center of Nepal. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 1707). Convenience sampling was done. Data was collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 132 patients, 66 (50%) (41.5-58.5 at 95% Confidence Interval) patients had persistent symptoms at two-month follow-up. Forty-eight (36.4%) patients showed one symptom, 15 (11%) had two symptoms, and 3 (2%) had two or more symptoms. The most frequent symptom reported was fatigue in 17 (13%), cough in 15 (11%), myalgia in 9 (7%), and headache in 9 (7%). CONCLUSIONS: The prevalence of persistent symptoms at two months follow up in our study was lower than findings from other international studies.


Assuntos
COVID-19 , Hospitais de Distrito , Estudos Transversais , Seguimentos , Humanos , SARS-CoV-2
17.
Int Breastfeed J ; 16(1): 72, 2021 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-34565391

RESUMO

BACKGROUND: Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. METHODS: The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. RESULTS: The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. CONCLUSIONS: Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.


Assuntos
Aleitamento Materno , Mães , Criança , Aconselhamento , Feminino , Hospitais de Distrito , Humanos , Lactente , Recém-Nascido , Malaui , Gravidez
18.
World J Surg ; 45(10): 3016-3018, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34338826

RESUMO

Strengthening and defining the role of rural hospitals within a surgical ecosystem is essential to improving quality and timely surgical access for rural people in low and middle-income countries (LMICs). Regional hospitals are the cornerstone of LMIC rural surgical care but have insufficient human resources and infrastructure that limit the surgical care they can provide. District hospitals are most accessible for many rural patients but also have limited surgical capacity. In order to surgical access for rural people, both regional and district hospital surgical services must be strengthened. A strong relationship between regional and district hospitals through a hub and spoke model is needed. Regional hospital surgeons can support training and supervision for and referrals from district hospitals. Telemedicine can play a key role to leapfrog physical barriers and surgical specialist shortages. The changing demographics of surgical disease will continue to worsen the strain on tertiary hospitals where most subspecialists in LMICs work. The fewer rural patients who need to travel to urban referral and tertiary facilities for problems that can be managed at lower-level facilities, the better access to timely surgical care for all.


Assuntos
Ecossistema , Hospitais Rurais , Recursos em Saúde , Hospitais de Distrito , Humanos , Encaminhamento e Consulta
19.
Afr J Prim Health Care Fam Med ; 13(1): e1-e8, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34342478

RESUMO

BACKGROUND: Preceptors are key stakeholders in distributed health professions' education. They supervise students in the clinical setting to enable them to have a practical experience with patients, and they assess students' skills at the highest tier of clinical assessment. The university where this study was done conducts a distributed Bachelor of Clinical Medical Practice course on a distributed platform which is dependent on preceptors at the training sites. Understanding the perceptions of preceptors, as major stakeholders, regarding the student assessment they do will assist the faculty to provide better support and development that might be needed and assist in maximising the benefits of distributed training. AIM: The aim of this study was to explore the perceptions of preceptors regarding assessing clinical associate students at district hospitals in the Bachelor of Clinical Medical Practice programme. SETTING: The study was conducted at a rural university in the Eastern Cape province of South Africa. METHODS: This was a qualitative study involving nine preceptors who were purposively selected from three district hospital training sites based on their involvement in assessing clinical associate students. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed. RESULTS: Four themes emerged from thematic analysis: assessment issues, preceptor issues, student issues and university support issues. Preceptors are committed and enthusiastic in training and assessing the clinical associate students but require input from the university in terms of training and ongoing support. CONCLUSION: Lack of training threatens the validity of preceptor assessment. Academic institutions should train and support preceptors to enable them better to fulfil their roles.


Assuntos
Pessoal Técnico de Saúde/psicologia , Percepção , Preceptoria , Estudantes de Ciências da Saúde/psicologia , Adulto , Competência Clínica , Avaliação Educacional , Hospitais de Distrito , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , África do Sul
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