African Digital Health Library- University of Ibadan
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Factors associated with failed vaginal delivery in women with one previous caesarean section at the university teaching hospital, Lusaka, Zambia
No full textThesisTrial of labour after one previous caesarean section is safe in appropriately selected women with the addition of adequate intrapartum monitoring and ready access to theatre when emergency caesarean section is indicated. The primary objective of this study was to explore the major obstetric outcomes and factors associated with failed VBAC at UTH- WNH Lusaka Zambia.
This was a comparative prospective cross-sectional study spanning from July 2017 to December 2017. A purposeful sample of 356 consenting women with one previous caesarean section who had a failed VBAC and women who had a successful VBAC in a ratio of 1:1 was studied.
The average annual delivery was 14,835. Successful VBAC accounted for 70.67% while 29.33% had failed VBAC. The data obtained from questionnaires was analysed using Statistical Package for Social Science (SPSS). There were 104(29.3%) women booked at UTH antenatal clinic as compared to 252 (70.7%) women enrolled in this study who were referred to UTH- WNH as it is a tertiary level referral hospital. Furthermore, although not statistically significant, more women with failed VBAC 39 (22%) had low birth weight babies compared to 25 (14%) of those with successful VBAC (p 0.132) and 20 (11%) had birth weight > 4000g versus successful VBAC 12 (7%) with (p 0.323). There was a great association with failed VBAC regarding maternal age, parity, number of ANC visits, gestational age at delivery, birth weight, Apgar score at one minute and Apgar score at five-minutes. TOLAC remains a moderately safe option for child birth at UTH-WNH Lusaka Zambia.
There is a significantly high VBAC success rate among carefully selected women undergoing trial of scar in Zambia although a decreasing trend towards TOLAC and a rising caesarean section rate were determined.
Key Words: Trial of Labour after Caesarean Section, Vaginal birth after caesarean sectio
The Relationship between Policy Availability and Capacity Levels for Disaster Preparedness in Hospitals within Nairobi County.
No full textP 109-121Increased disaster cases coupled with the fact that Nairobi County joined the World Disaster Reduction Campaign among which one of the themes was 'Hospitals safe from disasters', made it important that disaster preparedness in hospitals within Nairobi County be examined. No studies have been done regarding disaster preparedness in hospitals within Nairobi County, making this study a key resource for evidence-based decision making, especially in resource needs prioritization. The broad objective of this study was to determine the relationship between policy availability and capacity levels for disaster preparedness in hospitals within Nairobi County. The specific objective was to determine the relationship between availability of policies and level of capacities in hospitals within Nairobi County. This was a descriptive cross sectional study. The study setting was in Nairobi County, Kenya. A total of 32 hospitals and 263 respondents were sampled. Research instruments used comprised questionnaires and key informant interviews. Quantitative and qualitative data was obtained. Quantitative data was of use in determining the statistical significance of the study. Qualitative data aimed at obtaining in depth information regarding challenges and recommendations to hospital disaster preparedness on the basis of how policy availability and capacity levels relate. Study results revealed that there were problems related to staffing, hospital equipment, hospital infrastructure, policies, training and drills. In conclusion, a positive relationship existed between policy availability and capacity levels with capacities being dependent on policies. Policy availability was established to be dependent on the finance and stewardship health system pillars. This study recommends that for maximization of health resources towards disaster preparedness in hospitals within Nairobi County, policy formulation and implementation should be prioritized with emphasis on funding and good stewardship. This will result in a strengthened health system with institutional capacities in place
Factors influencing provision of nutrition education and counselling to pregnant women by nurses during antenatal care in Nairobi County.
No full textGood maternal nutrition is essential for health, development and reproductive performance of the pregnant woman, and for the growth, survival and general health of the child. One strategy for ensuring pregnant women get information on the importance of adequate nutrition is through nutrition education and counselling. However many barriers hinder effective provision of nutrition education and counselling; one may be inadequate nutrition knowledge by nurses among other factors. The objective was to determine the factors that influence provision of nutrition education and counselling to pregnant women who attend antenatal care by nurses in Nairobi County. A cross-sectional descriptive study was used. The sample comprised of 150 nurses working in the antenatal clinics from 30 health centres in Nairobi County. A semi-structured self-administered questionnaire was used to collect quantitative data, and seven key informant interviews with clinic in-charges for qualitative data. Data was analysed using SPSS version 21. Descriptive statistics was done on all variables. The chi-square tests was used to determine relations between key study variables. Nurses who had a clear understanding of nutrition education and counselling were 36%. The nurses who had knowledge on the importance of nutrition to birth outcomes were more likely to provide NEC (P=0.002). Nurses self -perceived knowledge and skills for provision of nutrition education was 34%. 66% reported that they were not adequately trained. Inadequate knowledge on was similar to all levels of nursing training, whether trained in private or public institutions. Majority (73%) reported they provided nutrition education in group sessions. However the content and quality provided is likely to be affected by inadequate knowledge and skills of nurses and lack of structure. 47% reported they had guidelines at the health facilities. In conclusion, this study has found that nurses' self—perceived knowledge and skills for provision of nutrition education and counselling was inadequate. Secondly. lack of structure lead to inconsistency in the content and quality provided. Thirdly, unavailability of guidelines and irregular use affected delivery of services. It is recommended that basic nursing training should provide trainees with adequate competences. Nurses should have continuing education on nutrition to enhance their knowledge and skills. There should be a structure to guide and ensure uniformity of NEC service provision and guidelines should be provided to all health facilities and used as reference materials
Echographie des urgences obstétricales à l’unité d’imagerie médicale du centre de santé de référence de la commune V à propos de 300 cas
No full textMéthodologie :IL s’agit d’une étude prospective et transversale réalisée dans l’unité d’imagerie médicale du centre de santé de référence de la V à Bamako d’octobre 2017 au Mars 2018. L’objectif de ce travail était de déterminer la fréquence des motifs de demande et des urgences obstétricales diagnostiquées à l’échographie. Résultats : Durant cette période, nous avons colligé trois cent (300) cas d’urgence obstétricale sur six mille cinq cent échographies réalisées soit une fréquence de 4,6%. L’âge moyen de nos gestantes était de 26,50 ± 6,2 ans avec des extrêmes de 16ans et 40ans. La métrorragie et les douleurs pelviennes étaient les motifs les plus évoqués de la demande d’échographie soit respectivement 65,6% et 15%.Les avortements incomplets, les décollements ovulaires, les grossesses arrêtées et extra-utérines, étaient les diagnostics les plus retrouvés à l’échographie du premier trimestre soit respectivement 30,5% ; 16, 1% ; 12,6% et 13,7%.Une confrontation écho- clinique avait montré que 95,65% des G.E.U étaient confirmées en peropératoire avec une marge d’erreur de 04, 35%. Les béances cervicales, l’hématome retro- placentaire (HRP) et le placenta bas inséré étaient les anomalies les plus diagnostiquées au 2 ème et 3 ème trimestre soit 32% ; 37,8% ; 21,6% respectivement. La rupture utérine était rare soit 01,6%. Conclusion : L’échographie constitue un examen de premier choix dans le diagnostic des urgences obstétricales
Evaluation des mesures de prévention contre les infections nosocomiales dans le service des maladies infectieuses du C.H.U. de Point G.
No full textLes infections nosocomiales sont le plus souvent les résultats des soins non sécurisés et des mauvaises pratiques d’hygiène. Cependant la place des agents de santé dans la sécurité des soins des patients et l’application des mesures de prévention font quelques fois défaut dans le service des maladies infectieuses du CHU de Point-G. Les objectifs de notre étude étaient i) de déterminer le niveau de connaissance des agents de du service des maladies infectieuses en matière de prévention des IN ; ii) déterminer le niveau d’application des mesures de prévention contre les IN ; iii) identifier les dispositifs mis en place pour la prévention et iv) décrire le mécanisme de gestion des déchets biomédicaux au service des maladies infectieuses.
Méthodes : Nous avons réalisé une étude transversale du 10 Juin au 12 Septembre dans le service des maladies infectieuses du CHU de Point-G. Nous avons adressé individuellement des questionnaires aux personnels de santé, techniciens de surface, malades et accompagnateurs. Résultats : Au total seulement 20% du personnel de santé avaient une bonne connaissance sur les mesures de prévention des IN ; tous les techniciens de surface avaient une fois entendus parler des IN. Au total, seulement 18% du personnel de santé avaient une bonne pratique des mesures de prévention des IN ; tous les techniciens de surface ont affirmé qu’ils avaient une bonne application des mesures de prévention des IN et tous les malades et accompagnateurs avaient une mauvaise application des mesures de prévention des IN. Sur tous les dispositifs des mesures de prévention, seulement 10% étaient bonnes et 58,5% des déchets étaient incinérés.
Conclusion : la démarche qualité de soins et sécurité des patients doit prendre en compte la dimension de la formation et un changement de comportement des professionnels de sant
Perspectives of health workers on traditional medicine Integration into conventional medicine in selected Health facilities in Zimba district
No full textOver the years, many researchers have tried to address how to integrate traditional
medicine with investment expropriation. While some countries have well
managed to combine both Traditional Medicine (TM) and Conventional Medicine
(CM) others have not. In many African, South American and Asian countries, TM is
used in parallel with conventional medicine but this often comes with considerable
difficulties. This is particularly true for what may be considered indigenous diseases
that may not easily relate to a conventional diagnosis and poses issues regarding patient
centred communication. With this situation at hand some integration between the two
systems needs to be encouraged and further, this is because the practice of traditional
medicine in Zambia is probably on the increase in spite of the great advances in
orthodox medicine. This study aimed at studying the perspectives of health care
providers on the integration of traditional medicine with conventional medicine. This
was done by exploring attitudes towards integration of TM and CM, assessing the
perceived benefits and risks of TM and by understating the motive behind referring
patients to traditional healers.
The study employed a case study design and was conducted in Zimba district in
Southern province of Zambia and targeted health workers among them nurses, doctors,
clinical officers and community health assistants. The study sample was 20 key
informants purposely selected. Purposive sampling was also used to select six health
facilities out of 11 found in Zimba. Content analysis was used for data analysis. Firstly,
the data was transcribed manually and themes were identified upon which content
analysis was based. Further some background data such as age, sex, occupation, beliefs
of respondents in witchcraft etc. was entered and analysed using SPSS version 22 and
presented in form of descriptive statistics.
In terms of background characteristics, the study found that majority of the respondents
were male (60%), and in the age bracket of 25-36 (50%) and majority were community
health assistants (45%). The study also found that majority of respondents (75%)
believed that some illnesses were caused by supernatural powers such as witchcraft.
Further, the study found that majority of respondents believed that TM has power to
cure certain illnesses such as epilepsy, STIs etc. Furthermore, the study established that
majority of health workers support the integration of TM and CM with those against
integration being in the minority. Additionally, the study established that majority of
health workers interviewed were comfortable to refer a patient to try TM if CM fails.
The study found that TM use was characterized by uncertainties in terms of its benefits
and risks. Health workers support its integration. The study therefore recommends that
government must come up with a policy to support the integration of TM with CM.
Keywords: Integration, Tradition medicine, Convention medicine, Healthcare
provider
Aspects épidémio-cliniques et thérapeutiques des lithiases urinaires dans le service d’urologie du CHU Pr Bocar Sidy Sall de Kati
No full textIntroduction : L’objectif de cette recherche consistait à étudier les aspects épidémiologiques,
cliniques et thérapeutiques de la lithiase urinaire au service d’urologie du CHU Pr Bocar Sidy
SALL de kati.
Matériels et méthode : Nous avons réalisé une étude descriptive transversale et à collecte
prospective de 81 cas hospitalisés au service d’urologie du CHU Pr Bocar Sidy SALL de kati,
durant une période de 36 mois : allant du 1er Janvier 2016 au 31 Décembre 2018.
Résultats :la lithiase a représenté 16,67 % des activités chirurgicales du service. La localisation
urétérale des calculs avait été la plus représentée avec 29,6% des cas, la douleur, du type de
lombalgie était le maitre symptôme (soit 34,56 %). La fonction rénale a été perturbée chez 7
patients, soit 8,6 % de l’ensemble de nos malades. L’ECBU a révélé une infection urinaire dans
27,2%, dont le germe le plus fréquent était E.Coli. La TDM a révélé la présence d’obstacle
dans 67,9% soit 55 patients.
La quasi-totalité des lithiases avaient une densité supérieure à 500 Unités Hounsfield, la quasitotalité
des malades ont été opérés chirurgicalement. L’extraction du calcul s’est faite par
chirurgie à ciel ouvert, un cas de montée de sonde double J soit 1,23%, un cas néphrourétérectomie
soit 1.23%, un cas de néphrectomie totale soit 1.23%, les suites post-opératoires
ont été simples dans l’ensemble. Trois cas décès soit 3,7 %
Evacuations sanitaires obstétricales : profil épidémiologique et pronostic materno-fœtal au Centre de Santé de Référence de la Commune V de Bamako ( à propos de 4280 cas)
No full textLe but de notre étude était d’étudier les motifs de références/évacuations au Centre de Santé de Référence de la Commune V du District de Bamako. Nous avons réalisé une étude descriptive avec recueil rétrospectif des données.Au cours de notre étude menée pendant 3 ans, nous avons enregistré 4280 références/évacuations sur un total de 28974 admissions dans le service ; ce qui représente 14,8% des admissions au CSRéf CV.
L’âge moyen a été 26,17 avec un écart type=6,214, les extrêmesd’âge étaient 14
et 47 ans.
Les ménagères ont représenté 45,4% et les patientes non instruites 62%. Les dystocies étaient le principal motif de référence/évacuation avec 41,1%. Les motifs de références/évacuations étaient concordants dans 60,3% des cas.
Ces évacuations étaient pertinents dans 21,8% et opportunes dans 18,5%. La mortinatalité a représenté 4,8% et la mortalité maternelle 0,8%
Aspects épidémiologiques et anatomopathologiques des cancers primitifs des os.
No full textLes tumeurs osseuses malignes primitives désignent un groupe hétérogène de tumeurs prenant naissance au niveau des différents éléments constituant l’os, qui se distinguent par leur présentation clinique, leurs caractéristiques épidémiologiques, radiologiques et histologiques.
Le but du travail était d’étudier les cancers primitifs des os en mettant l’accent sur les aspects épidémiologiques et anatomopathologiques. Sur une période d’étude de 5 ans allant de Janvier 2014 à Décembre 2018, nous avons colligé 52 cas de cancers primitifs des os soit une fréquence annuelle de 0,4% au sein du service d’Anatomie et Cytologie Pathologiques du CHU du Point G à Bamako. La biopsie était le type de prélèvement le plus représenté dans 59,6% des cas. Les types histologiques les plus représentés étaient l’ostéosarcome et le chondrosarcome avec respectivement 50% et 15,4%, L’âge moyen des patients était de 28,52 ans ± 18,15 ans avec une prédominance masculine. La tumeur siégeait sur les membres inferieurs chez 50% des patients. Elle intéressait plus fréquemment le fémur avec 32,7%. La prise en charge des cancers primitifs des os, doit nécessairement prendre en compte les données épidémiologiques et anatomopathologique
Assessing HIV Early Infant Diagnosis Commodity Stock Out Frequency In Selected Public Health Facilities in Zambia
No full textThesisSince 2006, low-to medium-income countries in Sub Saharan Africa have been adopting
molecular methods for testing for Early Infant Diagnosis (EID) of Human Immunodeficiency
Virus (HIV) in infants. Such molecular methods require a number of inputs such as; airconditioned
laboratories, training of human resource, regular procurements of reagents and
commodities and a robust logistics information management system among other things.
Various studies conducted in Low-to Medium-Income Countries (LMIC) have shown that
most laboratories in these countries have difficulties providing access to Early Infant
Diagnosis of HIV in children. In 2012, 39%of eligible infants in Zambia were not tested for
HIV. One reason for this situation was the frequent occurrence of reagent and commodity
stock-outs. The frequency of stockouts is a measure of the robustness of the supply chain.
This study conveniently selected the following laboratories to assess the frequency of EID
reagents stock outs; University Teaching Hospital (UTH) and Centre for Infectious Disease
Research in Zambia (CIDRZ) laboratories in Lusaka, Arthur Davison Children’s Hospital
(ADCH) laboratory in Ndola and Livingstone central hospital (LCH) laboratory in
Livingstone.
This was a cross sectional mixed method study. Quantitative data in form of binary data (0 =
stock out, 1= in stock) for each day, was collected using a Checklist; the binary data was
entered into excel then transferred into Stata13for analysis to obtain Frequencies, Mean stock outs
and stock out durations.
Quantitative results were presented in form of pie charts and graphs to show the stock
fluctuations over the 2-year period. Qualitative data was obtained from in-depth interviews
with key informants using a structured interview schedule. Their responses were processed
into major themes, sub themes and categories to come up with the various reasons in the EID
supply chain which cause stock outs.
The study revealed that Stock out frequencies (incidents) for the period of the study (24
months), were few (Mean; 2.4 SD 1.1). However, the durations of the stock out periods were
long (30% of 24 months). This translated to the test not being available for reasons of
commodity stock outs for 4 months of each year.
There were many reasons which led to EID commodity stock outs, prominent amongst which
was the non-allocation of funds by the MoH. This created a persistent funding gap which was
accentuated by other deficiencies in the supply chain of EID commodities