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Participation of neighbourhood health committees (nhcs) in developing and implementation of community health action plans in Chisamba district of Zambia
No full textThesisCommunity-based participatory strategies are collaborative approaches that equitably involve all
partners in the process and recognize the unique strengths that each brings. The Alma Ata
Declaration in 1978 framed community participation as central to primary health care. One of the
community-based structures in the health system in Zambia is “Neighbourhood Health
Committees” (NHCs). The NHCs embraces Community Based Health Workers/volunteers,
(CBHWs), and all other members locally trained and working in their own communities. These
are involved in the planning and implementation of community health action planned activities.
Even though studies have been done on community-based health activities implemented in the
Communities either pulled or pushed, not much has been done to assess the level of participation
of Neighbourhood Health Committees (NHCs) in developing and implementation of Community
Health Action Plans. A qualitative narrative approach of the Community participatory design
was used. Data was collected using five (5) focus group discussions consisting of 8-10 members
from each NHC in the respective RHC catchment area. Six key informant interviews for health
Centre in charges, 51 NHC community participatory interviews were conducted.
Community level participation and involvement in the development and implementation of
community action plans qualitative assessment revealed that 46/51 NHC members are actively
involved by their health Centre in implementation of Community based health activities, but not
all are actively involved in the development of community health action plans, 5/51 are inactive
NHC members. The study also revealed that 31/51 NHC members are actively participating in
NHC activities, while 15/51 are inactive due to various reasons such as;- lack of support given
to volunteers, no transport, lack of information flow and feedback from the health Centre. The
study also observed that most of the NHC membership feel left out in the implementation of
Community based activities hence not actively participating in the development and full
implementation of Community health action plans due to poor information dissemination. It was
observed that if community involvement and participation is to improve there should be proper
and enhanced information dissemination from the Health facilities to the Neighbourhood Health
Committee.
Key words: - Neighbourhood Health Committees, Community action plans, Community based
participatory approache
Aspect épidémio-cliniques, thérapeutiques et pronostique des complications métaboliques aigues du diabète au SAU du CHU Gabriel Touré du 1er Octobre 2018 au 31 Septembre 2019
No full textContexte : Du 1er Octobre 2018 au 31 Septembre 2019, nous avons mené une étude sur les aspects épidémio-cliniques thérapeutiques et pronostique des complications métaboliques aigües du diabète au Centre Hospitalier Universitaire Gabriel Touré de Bamako. Cette étude s’est basée sur l’analyse de la fiche d’enquête.
Objectifs : Il s’agissait d’étudier les aspects épidémiologiques, cliniques thérapeutiques et pronostiques des complications métaboliques aigües du diabète, à travers la détermination de leur fréquence, l’identification des facteurs de risque associés à leur survenue, la description des manifestations cliniques et la détermination des facteurs de mortalité.
Résultats : Au total, 33 patients ont été colligés. L’âge moyen des patients était de 52,5 ± 17ans. Le sex-ratio était de 0,33. La majorité des patients nous était amenée du domicile dans 57,6% des cas et l’altération de la conscience était le motif d’admission le plus fréquent dans 42,4% des cas. A l’admission, la clinique était majoritairement marquée par unepolypnée, une dyspnée de Kussmaul, une déshydratation, une tachycardie et une hyperthermie. L’infection aété le facteur de décompensation chez 63,6% des patients. Dans la majeure partie des cas nos patients avaient des chiffres glycémiques élevées. La cétoacidose a été la complication majeure avec 54,5% suivie du comahyperosmolaire avec 24,2% et du coma hypoglycémique avec 21,2%.
L’évolution a été défavorable chez 09 patients soit 27,3%.
De façongénérale, l’évolution a été favorable chez 72,7% des patients
Modeling deaths associated with Road Traffic Accidents and related factors on Great North Road In Zambia between the years 2010 and 2016 using poisson models.
No full textWorld Health Organization reports that about 1.24 million people die annually on the world’s roads, with 20–50 million sustaining non-fatal injuries. More than 85% (1.05 million) of the global deaths due to injuries occur in the developing world.
Statistical techniques known and applied to model these scenarios are limited to basic statistics such as linear and Poisson regression that do not account for over dispersion. Further, Road Traffic Accident data violates assumptions that standard Poisson regression models is based. Appropriate extensions of this model, even though available, are rarely used by most applied statisticians.
Data was collected from Zambia Police, Traffic Section on accidents that occurred on the Great North Road (GNR) highway between Lusaka and Kapiri-Mposhi in Zambia from January 1, 2010 to December 31, 2016. Results from standard Poisson regression were compared to those obtained using the Negative Binomial (NB), Zero-Truncated Negative Binomial (ZTNB) and the Zero-Truncated Poisson (ZTP) regression models. Diagnostic tests were used to determine the best fit model. The data was analysed using STATA software, version 14.0 SE (Stata Corporation, College Station, TX, USA).
A total of 1, 023 Road Traffic Accidents (RTAs) were analysed in which 1, 212 people died. Of these deaths, 82 (7%) were Juveniles and 1, 130 (93%) were adults. Cause of accident such as pedestrians crossing the road accounted for 30% (310/1,023) while 29% (295/1,023) were as a result of driver’s excessive speed. The study revealed that driving in the early hours of the day as compared to driving in the night had a significant increase in the incidence rate of death from RTAs, Incident Rate Ratio (IRR) of 2.1, (95% CI={1.01-4.41}), p-value=0.048, further, public transport as compared to private transport had an increased incidence of death from RTAs (IRR=5.65, 95% CI={2.97-10.73}), p-value<0.0001.
There is a reduced incidence of dying if one is using a private vehicle as compared to a public vehicle or a truck. Driving in the early hours of the day (between 1AM and 7AM) had an increased incidence of death from RTAs. This study suggests that when dealing with counts in which there are a few zeros observed such as in serious and fatal RTAs, ZTNB fits the data well as compared to other models.
Key words: Road Traffic Accidents, Poisson, Zero Truncated Poisson, Negative Binomial, Zero Truncated Negative Binomial, Number of deaths
Réalisation de la Consultation prénatale, évolution de la grossesse au CSRef de San: étude portant sur 2132 cas
No full textIl s'agissait d'une étude rétrospective portant sur 2132 cas d'accouchements dans la maternité du CSRef de San, de Janvier 2016 à décembre 2016. Il ressort de notre étude que la tranche d'âge de 18 à 35 ans était la plus représentée avec 77,7 p.100, la majorité de nos parturientes était des ménagères avec 94,6 p.100 . La fréquence des grossesses non suivies était à 16,9 p.100 . Au cours de notre étude 23,5 p.100 de nos parturientes étaient évacuées et les motifs les plus fréquemment retrouvés étaient : la hauteur utérine excessive 15, 16 p.100, la dilatation stationnaire 11,63 p.100, Grande multipare 10,85 p.100 ; Souffrance foetale 10,07 p.100 et utérus cicatriciel 6,54 p.100, etc. 90,3 p.100 des gestantes ont atteint le terme normal de la grossesse. L'analyse de nos résultats a permis d'établir la fréquence de la CPN, un lien entre l'occupation et la CPN, de même que le nombre de CPN et complications maternelles pendant la grossesse de l'accouchement et le pronostique des nouveaux nés
Abcès amibien du foie dans le service de chirurgie pédiatrique du Centre Hospitalière Universitaire Gabriel TOURE
No full textObjectifs généraux : Déterminer la fréquence hospitalière de l'abcès amibien du foie en milieu chirurgical pédiatrique ; - Décrire les aspects cliniques, para-cliniques et thérapeutiques de l'abcès amibien du foie ; - Évaluer le résultat du traitement de l'abcès amibien du foie ; - Evaluer le coût de la prise en charge. Matériels et méthodes : Il s'agissait d'une étude rétrospective de 8 ans, allant du 1er Janvier 2010 au 31 Décembre 2017 effectuée dans le service de chirurgie pédiatrique du Centre Hospitalière Universitaire Gabriel TOURE. Pour 10164 admissions, 50 cas d'abcès amibiens du foie en ont été colligés, ce qui a représenté une fréquence hospitalière de 0,49 p.100 . L'âge moyen de nos patients a été de 6,7 ans. Le sexe masculin a été prédominant avec une sex-ratio de 1,4. Les signes cliniques les plus fréquents ont été la fièvre (100 p.100 ), l'hépatalgie (94,1 p.100 ), l'hépatomégalie (72 p.100 ) et nausées et/ou vomissements (62 p.100 ). Les collections objectivées à l'échographie abdominale étaient localisées dans le lobe droit dans 88,2 p.100, uniques dans 76,5 p.100 . La sérologie amibienne effectuée dans 100 p.100 des cas, a été positive dans 50 cas (100 p.100 ). Le traitement médical a été exclusif dans 6 cas (12 p.100 ), une ponction évacuatrice écho-guidée a été nécessaire dans 88 p.100 des cas. La chirurgie a été pratiquée dans 6 cas de péritonite (12 p.100 ). La morbidité est faible (6 p.100 ). Nous n'avons pas enregistré de décès dans notre série. Une prise en charge multidisciplinaire des abcès amibiens du foie associant le pédiatre, le chirurgien pédiatrique et le radiologue permettrait d'améliorer le pronostic
Diagnostic Accuracy of Malaria Microscopy in the Highlands of Central Kenya: Implications for Proper Treatment
No full textp. 148 - 158Over-diagnosis of malaria is a problem in many African countries and appears to be occur¬ring in the highlands of central Kenya. Blood-smear microscopy, the standard technique for malaria diagnosis in this area, relies heavily on technician skill. Hence, Rapid Diagnostic Tests (RDTs) are increasingly considered the gold standard for diagnosis, but are often not available in resource-constrained settings. We compared the results of microscopy and RDTs performed on finger-prick blood samples from 250 patients referred to laboratory malaria testing at one private and two government health facilities in/near Meru, Kenya. Across the three sites, 97 .1%-100% of microscopy-diagnosed Plasmodium-positive samples were found negative by RDT. Of the three study sites, the government district hospital had the highest microscopy-based positive rate (27.3% as compared to 5.9% and 9.3% in the other two set¬tings). These results indicate alarming levels of inaccurate malaria diagnosis in the Meru re¬gion. Many factors may play a role in this phenomenon, and it is likely that a "systems level" approach is necessary to remedy this problem
Barriers to effective communication between student nurses and older- patient at chogoria hospital
No full textRT 84.P4 2013Older adults constitute a majority and a growing proportion of people who receive nursing care in Kenya. It's projected that by 2050; there will be a 470% increase in the number of older persons, representing 10% of the Kenyan population. This projected increase calls for action by the government because it's likely to pose a challenge to the health care system if tomorrow's nurses are not adequately equipped to communicate effectively with this generation. Though they are living longer, 80% of them have at least two chronic conditions known to cause communication problems. However, research findings indicate that the quality of nurse-older person communication has been and continues to be poor. Barriers to effective communication between student nurses and older patients are increasing their length of stay and resource use, eroding the quality of nursing care. The purpose of this descriptive research study was to examine the barriers to effective communication, determine how students and older patients perceive their communication and explore ways of improving communication between student nurses and older patients. This is relevant as today's Nursing students are tomorrow's registered nurses and the manner in which they currently communicate with older persons may indicate how they will interact with them in future. Simple random sampling technique was used to select a total sample size of 172 (patients n=84 and student nurses n=88) participants from Chogoria Hospital and Nursing Training School. Data was collected from the subjects using a questionnaire for both students and patients. Data was analyzed using statistical package for social sciences (SPSS) software version 17.0. The respondents acknowledged that there were barriers to effective communication. Fifty-four (64.3%) of the patients and 84 (95%) of the students asserted that age-related changes affected communication, 66 (78.6%) of the patients and 76 (87.4%) of the students believed that there was the need for additional information. It was found out that Eighty-three (98.8%) of the patients and 76 (87.4%) of the students thought that attachment of the students to qualified Registered Nurses would boost communication. These results expand our understanding of the barriers to effective communication between Nursing students and older patients. These insights will be used in training to reinforce a positive attitude of student nurses with regards to effective communication with older patients, improving the quality of nursing care. In subsequent research, these findings will be used to study faculty members' attitudes towards older patients since their attitudes have been found in studies to affect their students' attitudes
Association of maternal factors and iron deficiency anaemia in pregnant women attending antenatal care at Chongwe rural health centre in Chongwe district.
No full textThesisIntroduction
Iron deficiency anaemia (IDA) is estimated to occur in (18%) of pregnant women in Africa despite universal supplementation programs being implemented since 2001, as recommended by the World Health Organisation. A lack of data on iron status and maternal factors associated with iron deficiency anaemia make it difficult to manage specific patients and prevent adverse outcomes. Therefore, this study aimed to determine the prevalence and maternal factors associated with IDA in women attending antenatal care in a rural setting in Chongwe, Lusaka.
Methods: This cross-sectional study included 225 pregnant women visiting antenatal clinic at Chongwe Rural Health Centre in Chongwe District. Demographic data and information on maternal age, gestational age, educational status, socioeconomic status and clinical data were collected from all the subjects via a standard questionnaire. Complete blood count was performed, and Soluble Transferrin Receptor levels were measured to assess anaemia and iron status, respectively. Data was analysed using SPSS software version 23.
Results: The prevalence of anaemia was (39.1%) 88/225 out of which (9.1%) 8/88 presented with iron deficiency. It was found that (78.13%) 50/64 were on Iron supplements and (44.68%) of them were anaemic but none were iron deficient. Abdominal pains (OR 5.11 [1.15-22.80], p > 0.032) and primary education relative to secondary education (OR 2.18 [1.24-3.84], p < 0.007) were the maternal factors with the highest odds for IDA and anaemia without iron deficiency, respectively
Conclusion: Women not receiving iron supplementation were at a significant risk of presenting with IDA. Participants with IDA were likely to present with abdominal pain unlike other types of anaemia. A decrease in monocyte count was the only blood parameter that could potentially differentiate IDA from other types of anaemia. Therefore, pregnant women with the above features should be screened stringently to prevent and/or manage IDA
Morbidité palustre chez les enfants de 0-59 mois au centre de santé catholique de Nafadji
No full textDe janvier à juin 2017 nous avons reçus 632 enfants (fébriles ou antécédent de fièvre depuis 24 heures). L‟analyse des données a signalé que : la prévalence du paludisme présumé était de 65,35 p.100 .Cette prévalence était de 48,10 p.100 avec la GE. Les enfants de 12-36 mois représentaient 60,85 p.100 des cas positifs à la GE. Le sexe ratio était de 1,27 en faveur des masculins. Dix-sept pour cent (17,10 p.100 ) des patients positifs à la GE avaient une température inférieure à 38°C à l‟entrée. L‟automédication est une pratique courante dans notre population d‟étude. Les MII sont utilisés de façon incorrecte. La transmission du paludisme est importante en saison sèche dans notre zone d‟étude
Prevalence and factors contributing to gender based violence towards women in Lusaka urban, Zambia
No full textThesisGender based violence (GBV) is defined as an act of violence that results in physical, sexual or psychological harm or suffering to a person. The World Health Organisation (WHO) estimates that one in five of the world‟s female population has been physically and sexually abused at some time in Sub-Saharan Africa. The proportion of women who experienced physical violence was between 13 and 45%. Zambia is ranked as having the highest number of GBV in Southern Africa, however there is little known about the prevalence and factors contributing to the vice in Lusaka urban. This study sought to determine the prevalence and explore factors contributing to GBV towards women in Lusaka urban. The study used a descriptive cross sectional design with a structured interview schedule administered to GBV victims aged between 19 to 49 years. Total of 229 respondents participated in the study. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 22. The results confirmed the prevalence of GBV towards women in Lusaka urban. The prevalence of physical abuse was at 44%,while psychological was 42%, and sexual was 16%. The study also revealed that alcohol abuse by perpetrators was associated with GBV towards women in Lusaka urban, as it was found that 90.4%. Based on the above findings the Government of the republic of Zambia (GRZ) should hasten the implementation of the alcohol policy in order to reduce GBV cases.
Keywords; Gender Based Violence, Alcohol abuse, pepetrato