Practicing medicine without borders: tele-consultations and tele-mentoring for improving paediatric care in a conflict setting in Somalia?

OBJECTIVES: In a district hospital in conflict-torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians. METHODS: A 'real-time' audio-visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians. RESULTS: Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life-threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92-29%, P = 0.001), lower respiratory tract infection (75-45%, P = 0.02) and complicated malnutrition (86-40%, P = 0.002). Adverse outcomes (deaths and lost to follow-up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57-0.88, P = -0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value. CONCLUSION: The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.

Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

SETTING: A district hospital in conflict-torn Somalia. OBJECTIVE: To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. DESIGN: Cross-sectional study. RESULTS: Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. CONCLUSION: Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage.

Participatory rural appraisal techniques in disenfranchised communities: a Kenyan case study.

BACKGROUND: Developing countries have made great progress in the field of health. However, disparities exist in the distribution of healthcare services. Given the lifestyle of the nomadic Somali community, very little was known about their perceptions about preventive healthcare services or their health needs in general. The best source of information regarding these matters is the community itself. OBJECTIVE: To apply participatory rapid rural appraisal techniques to health needs and plan nursing services for a disenfranchised, nomadic Somali community of north-eastern Kenya. METHODS: Participatory rural appraisal (PRA) is an innovative approach to data collection in participatory research. The philosophy is that the researcher is required to acknowledge and appreciate that the research participants have the necessary knowledge and skills to be partners in the whole research process. Illuminating data were collected in late 1999 using PRA techniques, which underscored the Somali community's perception of the healthcare services and how they could be improved to suit their nomadic lifestyle. FINDINGS: The nomads diagrammatically described their seasonal movements extensively and postulated that these could be used for planning mobile/outreach services for the community. The study also reveals how the current nursing services have failed to utilize the intricate information network of the community. IMPLICATIONS FOR PRACTICE: Nursing personnel need to make friendly participatory relationships with a better understanding of communities' health problems and their socio-cultural practices in order to ensure efficient and effective nursing services.