African Digital Health Library- University of Ibadan
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Plaquette résultats clés
No full textCette plaquette donne le résumé des résultats clés du projet Keneya Jemu Kan financé par USAID
Assessment of the prescribing patterns of lipid lowering drugs at the adult university teaching hospital in Lusaka Zambia
No full textThesisBackground: Appropriate drug utilization has a huge contribution to global reduction in morbidity and mortality. While thousands of patients have been wrongly prescribed statins, others at high risk of cardiovascular accidents (CVA) have been deprived of treatment. According to the Adult Treatment Panel fourth guidelines (ATP IV), prescription of Lipid Lowering Drugs (LLDs) should not only be based on cholesterol but also on other Atherosclerotic Cardiovascular Disease (ASCVD) risk factors.
Methods: A cross sectional design was applied to 140 files of patients at clinic 5 (medical clinic) of the Adult University Teaching Hospital (Adult UTH) and it aimed to determine whether the prescribing patterns of LLDs were in conformity with the ATP IV guidelines. This sample size was based on a 10% (0.1) estimated prevalence of prescriptions containing LLDs in line with the 2014 WHO country profile on Non-communicable diseases (NCDs) which accounted for 23% death estimates in Zambia out of which 8% were due to CVDs. Based on prescriptions given, files of patients for whom LLDs were prescribed were identified out of which study samples were randomly selected. IBM SPSS version 21.0 was used for statistical analyses.
Results: There were 89(63.6%) female and 51(36.4%) male patient’s files reviewed. Hypertension (HTN) was the most frequent risk 126(90%) while CVDs were the most common diagnosis category 93(66%). Among the 140 patients whose files were reviewed, 64(45.5%) were found to be eligible for the LLD therapy while 76(54.3%) were not though the difference was not statistically significant (p-value = 0.31). The most commonly prescribed LLD was atorvastatin 20mg 91(65%) while rosuvastatin 20mg and omega-3 were the least prescribed each representing 1 patient (0.7 %). All 64 eligible patients were prescribed atorvastatin out of whom 10(15.6%) received appropriate dosing while 54(84.4%) received inappropriate dosing (Statistically significant: p-value < 0.001). The chi-square exact test results showed that only diagnosis category and prescribed LLDs were significantly associated with dosing appropriateness among the categorical variables (P-values = 0.02 and < 0.001 respectively) while for continuous variables, lipogram duration was significantly associated with dosing appropriateness(P-value <0.001). The unadjusted odds ratios (OR) showed that patients with CVD diagnosis had on average 13 times increased odds for inappropriate dosing (OR = 13.2, CI = 1.76 – 98.93, p-value = 0.01).
Conclusion: This study suggests that the prescribing patterns were not in conformity with the ATP IV guidelines as they were more inclined to individual CVD risk factors and not the individual patients’ overall levels of risk.
Key words: Assessment, Prescribing Patterns, Lipid Lowering Drug
Spot promotion de la vaccination
No full textCe spot fait la promotion de la vaccination au Mali. il utilise les 5 doigts d'une main pour rappeler les périodes clés de vaccination
Audit de la transfusion sanguine dans la prise en charge des hémorragies du post partum immédiat au Csref de Kalaban Coro
No full textil s'agissait d'une étude prospective effectuée au service de gynécologie obstétrique du CSRéf de Kalaban Coro du 01 Janvier 2018 au 31Octobre 2018 dont l'objectif principal était de contribuer à l'évaluation des besoins transfusionnels dans la prise en charge des hémorragies du post partum immédiat. Durant la période d'étude nous avons enregistré 32 cas de transfusion du post partum immédiat sur 109 cas d'hémorragie soit 29,35 p.100 ; pour un total de 2425 accouchements soit une fréquence 1,31 p.100 . Les principales indications de la transfusion sanguine étaient: l'hémorragie du post partum par déchirure des parties molles 21,9 p.100 ; de l'hématome rétro placentaire 18,6 p.100 ; de la rupture utérine 12, 5 p.100 ; et du le PPRH 12,5 p.100 . Plus de la moitié des transfusées étaient des évacuées soit 62,5 p.100 . Les besoins transfusionnels non couvert étaient de 59,4 p.100 . Les produits sanguins demandés ont été : du sang total dans 99 p.100 des cas et du le plasma frais congelé seulement dans 1 p.100 des cas. Conclusion : le besoin en produit sanguin reste une réalité en obstétrique. L'utilisation adéquate des produits sanguins contribue à réduire la mortalité maternelle tout en améliorant le pronostic maternel
Perspectives and practices of self-medication in Shibuyunji district, Lusaka province, Zambia
No full textThe concept of self-medication which encourages an individual to look after minor illnesses with simple and effective medicines has been adopted worldwide. Although self-medication has been reported to have several benefits, it has also been associated with many risks. Self-medication among poorly informed segments of the population may result in a waste of household and government resources. Regardless of the growing research attention in self-medication, little information has been available about perspectives and practices of self-medication especially in developing countries. In Zambia, particularly the study site, little information is available on the subject. The purpose of this study was to explore the perspectives and practices of self-medication.
A qualitative case study design was used. A total number of 63 participants participated in the study, four (4) focus group discussions, six (6) key informant interviews and 22 in-depth interviews were conducted during data collection. The study incorporated free listing and pile sorts in focus group discussions and In-depth interviews. Key informant interviews were also conducted with relevant individuals. Purposive sampling using maximum variation was used to select study participants. Data was analysed using grounded theory to see how emerging issues were related. From the information recorded in each interview and discussion, major themes and sub-themes were identified.
The findings of the study revealed that the study participants did not follow a specific dosage or timeframe when self-medicating. Both health workers and the general population follow the same pattern when self-medicating. However, health workers perceived self-medication as being risk while the general population viewed it as being of benefit to them. The results also showed that diseases that are seen to be relatively minor and common, self-medication would be preferred. On the other hand, if the disease was thought to be severe, unfamiliar or injuries, the patient would much more likely go to the health centre for treatment.
In conclusion, self-medication practices are influenced among others by income, distance to health facility, condition of the disease and disease severity. People don‟t have a specific dosage and duration to follow when self-medicating. The perceived benefits of self-medication are likely to result in it being a common health seeking behaviour.
Key words: Self-medication, Practices, Perspectives, Responsible self-medication
Knowledge and Perception of Women towards Cervical Cancer Screening in Meru County, Kenya.
No full texthttp://library.kemu.ac.ke/ijpp/index.php/ijpp/article/view/12Globally, epidemiological transition from communicable to non-communicable diseases is on increase with Cervical cancer associated with human papilloma virus being among leading causes of morbidity and mortality in women.Cervical cancer is preventable but majority of Kenyan women have never been screened yet free services are available in most health facilities. Cervical cancer screening for all women aged 18 to 69 years in Kenya is reported to be 3.2%as compared to the National Cervical Cancer Prevention program target of 70%.Underutilization of screening services is cited to result from lapses in service availability, negative perception among others.The study aimed at assessing knowledge and perception of women towards cervical cancer screening in Meru Teaching and Referral Hospital. A descriptive cross-sectional study design was used. Data was collected from 352 respondents (n=352) selected through purposive sampling technique using structured questionnaires. Data was cleaned, coded and entered using SPSS version 23,analysed using descriptive and inferential statistical techniques and presented using tables and charts.Results showed that 69% were aware of cervical cancer while 46.29% were not, 86.9% did not know the cause of cervical cancer.61.9% had heard about cervical cancer screening but 38.1% had not. 78.4% had never heard about human papilloma virus vaccine.The correlation between utilization of cancer screening services and knowledge of cervical cancer screening, was found to be statistically significant r= 0.294, p < 0.001, two tailed. An inverse relationship between screening and perceived pain, r= -0.117, p=0.029 and perceived embarrassment r= -0.109, p=0.041 was also established. This suggests that perception influences utilization of screening negatively.The results would help county managers in decision making and planning for cervical cancer screening as a priority for strengthening service delivery.This study recommends sustained public health education to create positive social change that will include increased awareness, change of perception to cervical cancer and improved screening practices
Fréquence de la cétoacidose chez les diabétiques hospitalisés dans le Service de Médecine et d’Endocrinologie de l’Hôpital du Mali
No full textIntroduction : Notre travail avait pour but d’étudier la fréquence de cétoacidose chez les diabétiques hospitalisés dans le service de Médecine et d’Endocrinologie de l’Hôpital du Mali.
Méthode : Il s’agissait d’une étude descriptive et transversale avec recueil prospectif des données qui s’étendait du 15 octobre 2018 au 15 avril 2019 soit une période de 6 mois dans le service de Médecine et d’Endocrinologie de l’Hôpital du Mali.
Résultats : Au terme de notre étude nous avons collecté 110 patients diabétiques sur un total de 296 patients hospitalisés pendant la période de l’enquête, soit une fréquence hospitalière du diabète de 37,16% et une fréquence spécifique de cétoacidose de 49,1%. Le sexe féminin était le plus fréquent avec un sex- ratio de 0,58.
L’âge moyen était de 27,87± 18,21 avec des extrêmes allant de 3 à 75 ans. Le diagnostic de cétoacidose a été le motif d’hospitalisation le plus fréquent soit une fréquence de 98,1%.
Le syndrome d’hyperglycémie était le mode de découverte du diabète chez 92,6%.
Les diabétiques de type 1 représentaient 70% contre 30% de type 2.
La durée d’évolution du diabète était courte c'est-à-dire ≤ 3 mois chez 50% de nos patients.
Tous les patients qui avaient réalisé l’HbA1C étaient en déséquilibre glycémique soit une HbA1C ≥ 8% (90,7%).
Le syndrome cardinal, les troubles respiratoires et les déshydratations représentaient 100% des signes les plus constants. Les troubles digestifs, représentaient 74,5%, les troubles de la conscience représentaient 15%, l’haleine cétonique représentait 18,5%. Les infections étaient en tête des étiologies décelées soit 81,5 % des cas. Il s'agissait du paludisme (31,5%), des pneumopathies (9,3%), les infections uro-génitales (14,8%), les infections bucco-dentaires (7,4%) et les infections cutanées (18,5%). Les plaies représentaient 18,5%, et l’arrêt du traitement représentait 18,5%
Prospective cohort study on thirty day outcome of perforation peritonitis at the University Teaching Hospitals, Lusaka, Zambia
No full textThesisPerforation peritonitis is a common surgical emergency seen by surgeons; it remains a life threatening condition with high morbidity and mortality. At the University Teaching Hospitals (UTH), the morbidity for gastro-duodenal perforation has not been studied. Furthermore, based on the available literature at the main referral centre in Zambia the outcome of perforation peritonitis following jejunal, ileal, colonic perforation, with the use of the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) scoring system, was unknown. The study aimed to determine the site of perforation, the post-operative outcomes of leakage, wound dehiscence, re-laparotomy and mortality in relation to the site of perforation, and related the POSSUM score to the outcome.
This was a prospective observational study conducted at the Department of Surgery of the University Teaching Hospitals, Lusaka from July 2018 to March, 2019. During this period a total of 100 patients undergoing exploratory laparotomy for spontaneous perforation peritonitis were included. The morbidity and mortality risks were calculated using the POSSUM and P-POSSUM.
Sites of perforation were:-Gastric (n=49) followed by ileal (n=36), colonic (n=8), jejunal (n=3) duodenal (n=1), combined ileal and colonic (n=1), unidentified (n=1) and urinary bladder (n=1). The mean age was 37.24 (range 18 to 78 years). There were 77 males and 23 females ratio 3.34:1. Thirty six died (36% mortality rate) in the post-operative period and morbidity rate was 17.19%. Post-operative outcomes included leak 9%, wound dehiscence 3%, and re-laparotomy 17%. Thirty four percent of patients needed admission to intensive care unit (ICU) and twenty nine out of thirty four (85.29%) patients who were admitted to ICU died. Hospital stay was 9.53±6.86 days. The most common cause of death was septic shock in nineteen (52.78%) followed by sepsis, and acute kidney injury. The predicted morbidity score correlated positively with size of perforation and the POSSUM score, although not statistically significant. Number of perforation, site of perforation, physiological and operative score positively correlated with mortality score and was statistically significant (p<0.05).
Gastric perforation was the leading cause of perforation peritonitis, with the highest morbidity and mortality at UTH; followed by the ileum, colon, jejunum, duodenum and lastly, urinary bladder. The commonest postoperative outcome was re-laparotomy followed by leak and abdominal wound dehiscence. The commonest cause of mortality in perforation peritonitis was septic shock followed by sepsis. The POSSUM score significantly predicted mortality in perforation peritonitis in patients at the UTH. However, it could not significantly predict the outcome of leak, wound dehiscence and re-laparotomy
Characteristics of Nurses Upgrading to Higher Levels of Nursing Education at a Regional Referral Hospital in Eastern Kenya
No full textP 100-108Upgrading refers to the process of nurses improving their initial educational qualification to a higher level. It enables nurses to add to their knowledge and skills, professional value, self -esteem and are rated higher within the nursing cadres. The number of nurses upgrading in Kenya has continued to increase over the years with adult students becoming the new majority in the student body. The upgrading nurses enter the academic programs with varied characteristics making them a unique group. This study sought to describe the characteristics of nurses upgrading to higher educational levels at a regional referral hospital in Eastern Kenya. The study design was a descriptive cross-sectional survey. Data was collected from 160 nurses using a structured self-administered questionnaire. Data collected was checked for accuracy, coded and analysed using STATA Version 10. Results showed that 63.2% of the respondents were above 35 years with a mode age of 40-44 years and >50 years. The ratio of male to females was 1:5. 53.2% of the respondents had Enrolled Community Health Nursing (ECN) as their initial qualification. 47.7% of the respondents had upgraded while 20%were currently upgrading. Age and initial qualification significantly influenced nurses to upgrade (p= 0.000 and p= 0.04 respectively) with the younger and those with certificate qualification more likely to upgrade. The preferred mode of study was distance learning with 83.65% of those upgrading opting for it. It was recommended that institutions of higher learning should strive to provide upgrading programs in nursing via distance learning mode and work closely with the professional bodies and the hospital to see how best to have it delivered. Nurses could also benefit from continuous medical education especially on the significant characteristics of age and initial qualification to use them for their advantage to take up upgrading
Factors influencing routine health management information use in public health facilities in Tharaka Nithi County, Kenya.
No full textRoutine health management information systems are the foundations of all health systems which strengthen other five pillars hence, strengthening health systems performance. But despite their essential benefits, at the facility level, health workers commonly spend 40 percent or more of their time filling in Health Information Systems forms but may make little or no use of the information for decision making. Information use is determined by multiple factors ranging from technical, organizational and behavioural factors which were drawn from the theoretical framework. The objectives of the study were to determine the technical factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County; to establish the organizational factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County and to establish the behavioural factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County. A descriptive cross-sectional study was conducted in 12 Dispensaries, three Health Centres and one Sub County Hospital in Tharaka Nithi County. Data was collected through researcher administered questionnaires and observation checklist. The respondents were purposely selected from the sampled public health facilities, which included 22 information producers and 53 users in Tharaka Nithi County. The study results identified a set of factors influencing health information use for each of the three categories of factors: technical factors (lack of staff competence at 74 (98.7%), multiple HIS tools at 74 (98.7%) and lack of computers at 74 (93.7%); organizational factors (lack of information use culture promotion at 73 (97.3%) lack of staff training in HIS skills at 69 (92%), and lack of support supervision on information use at 71 (94.7%) and behavioural factors (lack of staff motivation at 73 (97.3 %) and recognition for well done job at 74 (98.7%). The researcher concludes that, for health systems to use health information for evidence-based decisions, technical factors, organizational and behavioural factors must be provided to information producers and users in public health facilities in Tharaka Nithi County. The study recommends: To provide adequate positive technical factors in terms of competent personnel, computers and user-friendly HIS tools to enhance information use; To promote positive organizational factors in terms of promotion of information use culture, support supervision on HIS and support staff training in HIS skills to enhance information use; To initiate and implement motivation and recognition mechanisms in workers' accurate information for use in evidence-based decisions. The researcher suggests further studies to; establish other factors influencing health information use in the public health sector other than those covered by this study; establish interventions to enhance health information use in decision making in public health setting