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L’insuffisance cardiaque du sujet âgé dans le service de cardiologie du CHU Point G
No full textL’insuffisance cardiaque est une maladie fréquente surtout chez le sujet âgé. Notre étude avait pour objectif de déterminer les aspects clinique, thérapeutique et évolutif de l’insuffisance cardiaque dans le service de cardiologie du CHU Point G.
Il s’agissait d’une étude transversale descriptive sur l’insuffisance cardiaque du sujet âgé au service de cardiologie du CHU Point G du 01 Janvier au 31 Décembre 2018. Deux cents douze patients ont été inclus dans notre étude. La tranche d’âge de moins 70 ans était la plus représentée avec 49% et le sexe masculin était prééminent (58,5%). Les principaux facteurs de risque rencontrés étaient l’HTA (65,6%). La dyspnée était le principal symptôme avec 84,4%, suivi de la douleur thoracique (31,1%). Les BDC étaient irréguliers dans 46,2% des cas et étaient dues à une arythmie complète par FA dans 24,1% des cas et le galop proto-diastolique chez (24,1%). Les râles crépitants étaient les signes physiques majeurs (55,7%) et l’hépatomégalie (43, 9%).A la radiographie pulmonaire la cardiomégalie était présente chez 56,1% des patients avec des signes d’hypertension veino-capillaire chez 40,1%. L’anomalie électrique la plus rencontrée était l’HVG chez 43,9% des patients suivi des séquelles de nécrose dans 19,8% des cas. L’échographie cardiaque objectivait une dilatation cavitaire chez 76,5% des cas et la fraction d’éjection était effondrée chez 55,7%. Au cours de notre étude les pathologies associées étaient l’AVC avec 17,0% suivi d’atteinte pulmonaire chez 18,9%. Les étiologies étaient dominées par la cardiopathie hypertensive (66,5%), la myocardiopathie primitive (40,1%) et l’insuffisance coronarienne (15,1%). Les diurétiques (79,7%), les bétabloquants (78,3%), les IEC (73,1%), et les anti aldostérones étaient les médicaments les plus utilisés. L’évolution était favorable chez 85,8% des patients, le taux de décès était de 9,9%
Caregivers’ experiences of violence by mentally ill patients discharged from Chainama hospital attending reviews at filter clinic, Lusaka-Zambia
No full textThesisBackground:
Caring for Mentally ill patients is a major task many Caregivers face globally. Many people have argued that caring for such a group of patients is followed with unique challenges. Despite the information about caring for patients suffering from mental illness, little information is available and known about lived experiences of caregivers at filter clinic coming for reviews and admitted in wards at Chainama Hills Hospital Lusaka Zambia, worse in the community where such cases are occur.This study deals with an exploration of caregives’ experiences of physical violence from discharged mentally ill patients at Chainama Hills Hospital.The purpose is to explore the aggressiveness of violent behavior by discharged mentally ill patients from Chainama Hills Hospital towards the caregivers.
This study’objective is to discover and describe the lived experiences of caregivers who care for mentally ill patient at home but attending reviews at Chainama hills Hospital Lusaka Zambia.
The study employed a descriptive survey design in which qualitative techniques, phenomelogical were used to conduct the research and collect the required data. A purpose sampling process was applied.The sample population was the caregivers of discharged mentally ill patients coming for reviews at the hospital. A sample of 40 Caregivers was used and divided into 4 focus groups with 10 people in each group. The focus group discussions was conducted by the researcher using guidelines. The group were homogenous sampled to participate in the discussions. The
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data was analyzed using content analysis and thematic analysis by using emerging themes. In-depth, individual, semi-structured interviews were conducted and the interviews were recorded and transcribed verbatim and the researcher used vivo method to analyse data.
Both positive and negative experiences were repoted by respondents.The findings of the study :is that physical violence to the caregivers is prevalent. The violence is preceded by disorderly behavior, disobedience, and excessive and irrational demands of things by the patients. Failure to get attention and positive response ignites the violence. The next finding was that the care-givers rarely had escape alternative and protection because of the nature of the illness the patient’s suffer from. On the negatives there was lack of support from relatives, government and NGOS, also the feeling of being unappreciated by relatives.
Limitation fo this study only covered only those patients who were coming back for review and those did not come back.
In summary, this study shows that the majority of the patients who are dischanged do not come back for reviews and makes the violence in the community to be on the high side especially when they relapse
Training about management of aggression needs to be provided, debriefing sessions to deal with stress experienced needs to be arranged, and research to quantify the levels of anxiety should be conducted.
Key words: violence, discharged, care-givers
Evaluation de la qualité des soins obstétricaux en salle d’accouchement au CSREF de Kayes
No full textUne étude transversale, prospective et qualitative a été menée au CS Réf de Kayes sur une période de 6 mois au cours de laquelle quatre cent soixante deux (462) cas ont été colligés. Ont été inclus dans cette étude les parturientes venues d’elles-mêmes en salle de naissance pendant la période d’étude et ayant accepté de participer aux enquêtes après un consentement éclairé. Non pas été inclus dans cette étude les accouchements à domicile, les accouchements en dehors des heures d’enquête et les parturientes évacuées à l’Hôpital Al Fousseini DAOU de Kayes.
La collecte et la saisie des données ont été faites à partir des questionnaires individuels et l’analyse faite à travers le logiciel SPSS version 20.
Les références évaluées étaient assez bonnes dans 74% soit 37/52 sur le plan structural ; les gestes techniques de l’examen général étaient d’assez bonne qualité avec 86,50% ainsi que l’examen obstétrical 95% et le respect des mesures d’hygiène réalisé à 100%. Le Centre a été classé de niveau II sur le plan structurel et de niveau III selon la qualité de l’examen général.
L’analyse de la compétence des prestataires a été qualifiée de satisfaisante.
L’étude nous a permis de montrer que le respect des normes et procédures étaient indispensables pour offrir des soins de qualité.
La présente étude avait pour objectif d’évaluer le niveau actuel de la qualité de accouchements au centre de santé de référence de Kayes, de décrire les caractéristiques socio-démographiques des accouchées et de déterminer leur degré de satisfaction
ANALYSE DE LA PRESCRIPTION ET DE LA DISPENSATION DES COMBINAISONS TERAPEUTIQUES A BASE D’ARTEMISININE (CTA DANS 6 OFFICINES DU DISTRICT DE BAMAKO
No full textDe juin 2018 à novembre 2019, nous avons fait une étude sur la prescription et de la
dispensation des Combinaisons Therapeutiques à base d’Artemisinine (CTA) dans (06)
Officines du district de Bamako
Notre étude a concerné 300 cas de prescriptions.
L’Artemether -Lumefantrine a été la CTA la plus prescripte avec 83,33% ; après réalisation
d’un exame biologique, de part sa disponibilité avec un cout moyen de 2455,43 _+933,32F.
Le sexe feminin était le plus représenté soit 66% des cas dans notre serie.
La tranche d’age la plus touchée était de 0 à 5 ans la majorité de prescription était faite par les
prescripteus officiels soit 81,7% dans notre serie
Etude des mutations du fond génétique de résistance de Plasmodium falciparum à l'artémisinine dans deux localités d’endémicités différentes au Mali : Nioro du Sahel et Dangassa
No full textBien que la résistance à l’artémisinine n’ait pas été encore décrite en Afrique, la possibilité de
son émergence et de sa propagation dans cette zone préoccupe énormément l’OMS. Il parait
donc important de surveiller l’émergence de cette résistance en Afrique. La présente étude a
pour but d’étudier les mutations du fond génétique de résistance à l’artémisinine dans deux
zones éco-climatiques différentes du Mali.
De juillet 2016 à janvier 2017, nous avons mené une étude transversale de détection passive
de cas de paludisme à Nioro et Dangassa. Tous les cas confirmés de paludisme ont été enrôlé
dans l’étude et des échantillons de sang ont ࡒté collecté sur du papier buvard. Nous avons
extrait l’ADN parasitaire à partir de ces échantillons et les mutations Pfarps10_V127M,
Pfarps10_D128Y/H, Pffd_D193Y, Pfcrt_N326S, Pfcrt_I356T, and Pfmdr2_T484I ont été
recherché. Les prévalences de ces mutations ont été évaluées ainsi que leurs associations
mutuelles
Dans notre étude, nous avons observé que les mutations les plus répandues étaient
Pfcrt_I356T et les mutations Pffd_D193Y avec respectivement 46,4% et 4,3% à Dangassa
contre 51% et 9,4% à Nioro. Il n’a pas été observé de différences statistiquement significatives
entre les prévalences des mutations dans les deux sites d’étude. Toutes les mutations étudiées
ont été détectées à Dangassa. Cependant, les mutations Pfarps10_D128Y / H, Pfcrt_N326S et
Pfmdr2_T484I n’ont pas été détectées à Nioro. De surcroît, 41,1% des isolats de P. falciparum
portaient au moins une des mutations étudiées, 3.7% des isolats de P. falciparum en portaient
deux. Seuls 0.3% des isolats cumulaient 3 des mutations étudiées. Aucun isolat ne cumulait
plus de trois mutations.
Nous n’avons pas retrouvé le fond génétique de résistance à l’artémisinine chez les isolats
collecté dans cette étude. Cependant toutes les mutations constitutives du fond ont été
retrouvées de façon séparée à Dangassa
Carriage rate of staphylococcus aureusamong healthcare workers at the University Teaching Hospital in Lusaka
No full textStaphylococcus aureus is a frequent cause of hospital-acquired infections worldwide. The carriage of S. aureus among healthcare workers has been associated with transmission of the bacterium to susceptible patients. The aim of this study was to determine the carriage rate, antimicrobial susceptibility profile and spa type of S. aureus among healthcare workers at a large tertiary referral hospital in Lusaka, Zambia. This was a prospectivecross-sectional study that involved the collection of nasal and hand swabs from 140 healthcare workers from May to July 2017 at the University Teaching Hospital in Lusaka. In this study, we recruited 103 nurses, 28 doctors and 9 laboratory scientists. Conventional microbiological methods were used to isolate and identify S. aureus. Antimicrobial susceptibility testing, including methicillin resistance was determined using the disc diffusion method, while molecular analysis of the isolates was achieved by spa typing. The overall S. aureus carriage among the health care workers was 17.1% (24/140).Of these, 13.6% (19/140) and 8.6% (12/140) were nasal and hand carriers, respectively. Carriage rate was highest among doctors (17.9%,5/28),followed by nurses (17.5%,18/103) and laboratory scientists (11.1%,1/9). About25.8% (8/31) of the S. aureus isolates were methicillin-resistant and showed resistance to more than four antibiotics. About 25.8% (8/31) of the S. aureus isolates were positive for the spa gene. Of these, seven were typeable. Two spa types, t015 (42.8%, 3/7) and t069 (14.3%, 1/7) were detected, whereas the spa type for 42.8% (3/7) of the isolates were unknown. The carriage of S. aureus and prevalence of Methicillin-resistant S. aureus among healthcare workers examined was high. This calls for regular intervention measures such as screening and decolonizing of healthcare workers to reduce the carriage and spread of this pathogen in healthcare centres in Zambia.
Key words: Antimicrobial resistance; Carriage rate; Healthcare workers; Methicillin-resistant Staphylococcus aureus; spa typing
Alcohol, tobacco and other Drug Use and Bullying among High School Students in Nakuru District, Kenya
No full textp. 75 - 82The objective of this study was to determine the prevalence of alcohol, tobacco and other drugs (ATOD) use among secondary school students in Nakuru District, Kenya, and its association with bullying. A total of 1000 form one to four male and female students aged between 13 and 19 years were selected from 40 private and 45 public secondary schools were surveyed between January and June, 2009. The mean or median age for male students was 14 (SD=4.90) and for female students 13.8 (SD=4.8). GSHS was used to collect data which was analyzed by frequencies, chi-square and logistic regressions. In the study, 33.7% of students reported having been bullied by students abusing ATOD in the last 30 days preceding the survey and 15.9% reported the use of alcohol, 12% cigarettes and 8% smokeless tobacco in the last 30 days preceding the survey. Cumulatively, 9.6% of students recorded having used other drugs. There was a significant relationship between alcohol and tobacco use with bullying. However, there was no statistically significant association between the use of other drugs and bullying (X2 = 3.583, df= 1, p=0.058). The prevention of ATOD and bullying among students represents an essential public health measure that may allow for total children's development, qualifying them for a healthy and safe social coexistence. The researchers recommend that focus on prevention programs against alcohol and drug use in secondary schools in general should be mounted to reduce or eliminate bullying altogether
Histomorphology of Bone marrow from Adult Pancytopenic Patients at the University Teaching Hospital in Lusaka, Zambia
No full textDetermination of the histomorphology of the bone marrows of adult pancytopenic patients admitted to the UTH in Zambia.Pancytopenia is a haematologic condition characterised by leukopenia, anaemia and thrombocytopenia. Pancytopenia is not a diagnosis and has to be qualified by determination of its cause. The aetiologies of pancytopenia are diverse, and study of bone marrow histomorphology via cytology and histology are key components that assist in the determination of the underlying cause. Pancytopenia is encountered regularly in medical practice in Zambia, however, no studies have been conducted on pancytopenia to date. This was a descriptive cross-sectional study done on adult pancytopenic patients admitted to the medical wards of the University Teaching Hospital (UTH) over an eight-month period. The aim of this study was to determine the histomorphology of the bone marrows of adult pancytopenic patients admitted to the UTH. A total of 45 bone marrow biopsies were collected over the study period. In all cases the indication was pancytopenia that had been confirmed by a full blood count done at the UTH and the biopsy site was either the anterior superior iliac spine or the posterior superior iliac spine. Demographic and clinical details were obtained using data collection sheets and from review of patient records. The collected data was analysed using the Statistical Package for the Social Sciences (SPSS) version 21. A Chi square test was used to
measure association between categorical variables. A p value of < 0.05 at 95% confidence interval was considered statistically significant. Results: There were 32 females (71%) and 13 males (29%), and the age ranged from 15 to 72 years with an average age of 35 years. Forty percent (n=18) of the study participants had human immunodeficiency virus (HIV) and all of these all were on highly active antiretroviral therapy (HAART). There were 6 histologic patterns found the commonest being megaloblastosis seen in 38% of the patients, followed by malignancy and myelodysplasia both at 17.0%. Bone marrow aplasia accounted for 13.0%, non-megaloblastic erythroid hyperplasia accounted for nine percent and myelofibrosis for four percent. A chi square test was used to determine if there was association between each histomorphology and HIV status, the only significant result was obtained from the Chi test applied to HIV status and myelodysplasia which gave a p value of 0.026. The Chi square test involving the other histomorphologies all yielded a p value greater than 0.05. The bone marrow biopsies of the study population showed six histomorphologic pictures which in order of frequency were megaloblastosis, malignancy and myelodysplasia, bone marrow hypoplasia, non-megaloblastic erythroid. Association was found between HIV status and myelodysplasia via the Chi square test.Office of Global AIDS/Department of State
Factors influencing demand for healthcare insurance:A study of jua kali workers in Nairobi
No full textP 159-173Health systems are a means to achieving better health outcomes for all. However, where patients depend largely on out of pocket (OOP) payments to access health services, there is often lack of care for those who cannot afford. This study aimed at establishing the fac¬tors influencing the demand for health insurance among Jua Kali workers in Nairobi. This was a cross-sectional research study involving mixed approach (simple random, purposive sampling, qualitative and quantitative methods) involving 130 Jua Kali workers from Associations/Cooperatives and 258 Jua Kali workers from non-organized groups; key informants from NHIF and the Department of Micro and Small Enterprise Department and was. The study was conducted between January to March 2012 within Pumwani Division in Nairobi County. Findings indicated that 113 (29.1%); 21.1% members of Jua Kali association and 11.8% individualJua Kali workers out of 388 were enrolled in NHIF while 262 (67.5%) were not enrolled in NHIF. Inadequate Knowledge of NHIF benefit and the KShs. 480 upfront NHIF premium payment were the main contributing factors to non-enrolment of262 (67.5%) of Jua Kali workers. 42.3 % individual Jua Kali and 6.1 % members of association with a monthly income less than KShs. 9,000 did not enrol in NHIF. To enhance more enrolment of Jua Kali workers, the study recommends that NHIF should design strategies that target the younger, low income and Jua Kali workers with low level of education with key information on health insurance benefits and the benefits of enrollment in NHIF , establish satellite pay¬ment offices within Jua Kali working zones to bring services closer to them, apply KShs. 160 per month instead of KShs. 480 and enhance networking and engage Jua Kali association as strategic partners for the purpose of motivating Jua Kali workers enrollment
The role of social cash transfer in influencing educational and sexual decision making among girls in Mazabuka, Monze and Pemba districts, Zambia
No full textThesisThe importance of ensuring that girls are educated at the secondary level has been recognized
as critical to the national development of any country. Worldwide 62 million adolescents are
estimated to have dropped out of school due to poverty. Many unmarried adolescent girls in
low income countries engage in sexual relationships for cash and gifts, this has led to an
increase in early pregnancy, early marriages and school drop-outs. Social Cash Transfers
(SCTs) are the main social assistance intervention used in developing countries to mitigate
effects of poverty and are viewed as key to social solidarity and development. Social Cash
Transfers have shown effectiveness in improving girls’ school participation and help
postpone pregnancy and marriage. The purpose of this study was to explore the role of social
cash transfers in influencing education and sexual decision making among girls.
The study utilized qualitative case study design. Data was collected from 18 IDIs and 4 FGDs
among 48 school-going girls aged 14 to 17 years and in grade 8 receiving SCTs from the
Research Initiative to Support Girls’ Education (RISE). The participants and schools were
selected using purposive sampling and 6 schools participated in the study. Scripts from the
field were transcribed manually, thematic method was used to analyse data by identifying
major themes and sub-themes.
SCTs impacted on girls’ sexual decision making and also led to economic empowerment.The
girls had experience in the following five areas; benefits of girls’ education; SCTs led to
concentration on education and hope for a bright future. On experience with family and
community; SCTs increased support for girls from parents and resistance to bad advice. On
Sexual decision making; SCTs led to assertiveness, enhanced self-esteem and independent
decision making. On economic empowerment; SCTs saved as a source of pocket money, led
to reduced chances of early pregnancy and early marriages, improved school attendance and
reduced burden of school fees. Experience with community, siblings and friends; SCTs led to
supportive and unsupportive atmospheres. The support given to girls by RISE helped to
reduce the desire for sexual relationships with boys for cash and gifts hence also contributed
to a decrease in early pregnancy, early marriages and school drop outs. Girls were now more
focused on their education.
SCTs led to the following benefits for girls; concentration on education and gave hope for a
bright future for both the girls and their parents; Increased support for girls from parents,
siblings and community; Increased girls’ resistance to bad advice; Led to girls’ assertiveness,
enhanced self-esteem and independent decision making; Source of pocket money for the girls
and reduced chances of early pregnancy and early marriages; Improved school attendance
and reduced burden of school fees; Created both supportive and unsupportive atmospheres in
the community.
The Government, RISE and stakeholders should roll out SCTs to other schools within the
country experiencing an increase in the number of early pregnancy; early marriages and
school dropout.
Keywords: Early pregnancy, marriage, social cash transfer, sexuality, school drop-outs