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COMPARISON OF FOUR-DAY AND TEN-DAY POST-MASTECTOMY PASSIVE DRAINAGE IN ACCRA, GHANA
No full textABSTRACTObjectives: To determine the optimum period for passive post-mastectomy drainagein Accra, Ghana, comparing early (day 4) to late (day 10) drain removal.Design: Randomised prospective clinical study.Setting: Surgical Department, Korle Bu Teaching Hospital, Accra, GhanaSubjects: Patients with breast cancer scheduled for total mastectomy and level 11axillary clearance.Interventions: Patients were randomised to one of the two groups: early (day 4) andlate (day 10) passive drainage.Main outcome measures: Duration of hospital stay, seroma formation and postoperativewound infection.Results: Forty five patients had 4-day drainage and 42 had 10-day drainage. Lateremoval of drains (Day 10) was associated with a significantly higher drainage(1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Lateremoval, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspiratevolumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Earlyremoval had a shorter hospital stay of 6.2 (+1.52) days compared to 11.07 (+ 0.76)days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There wasa low incidence of seromas when drainage was <30 ml/day at the time of drainremoval.Conclusions: Post-mastectomy passive drains may be removed when drainage is <30ml in 24 hours. When there is a persistent large volume of axillary drainage, patientsshould be counselled about the relative risks of early and late drain removal. Forpatients who do not find seroma aspiration unacceptable, early (day 4) removalappears preferable to late (day 10) removal of drains
SONOGRAPHY AND RISK FACTORS FOR LOWER LIMB DEEP VENOUS THROMBOSIS AT MULAGO HOSPITAL,UGANDA
No full textBackground: Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have made it the imaging modality of choice in the diagnosis of lower limb DVT.Objectives: To determine the sonographic pattern, and identify the risk factors of lower limb DVT.Design: Cross sectional, descriptive study carried out between April 2002 and March 2003.Setting: Mulago Hospital, Uganda.Subjects: Eighty six consecutive patients (92 limbs), with clinically suspected DVT, were studied by duplex sonography after a thorough risk factor evaluation.Results: Out of a total of 86 patients clinically suspected to have lower limb DVT, 38(44.2%) were found to have DVT after sonography. The gender incidence was similar. The left limb was affected in 60% of cases and the right in 40%. Bilateral DVT was noted in two patients. Most of the patients had acute and extensive DVT.Conclusion: Duplex ultrasonography is a very useful modality for assessing lower limb DVT, even in a low resource country like Uganda. It demonstrates the wealth of information obtained from sonography
Botswana, Africa's Haven of Ethnic Peace and Harmony: Status and Future Prospects
Get PDFThis paper has the dual objectives to highlight some of the factors that account for the absence of ethnic tensions and conflict in Botswana since independence and to reflect on the future of ethnic relations in the country. It identfles factors such as the nature of ethnic relations during the colonial period, the nature of British indfrect rule, the relatively even development across regions occupied by different ethnic groups, deliberate government efforts to create national as opposed to tribal consciousness and the institutions of chieftaincy as having contributed to harmonious ethnic relations. An examinatn of the current situation, however, points to emerging disintegrative ethnic consciousness. This is evident from three factors: I) The political debates centred on ethnic representation in the House of Chiefs and the fairness of sections 77, 78, and 79 of the Constitution that are sweeping across the country; 2) the appointment of a Presidential Commission to review sections 77, 78 and 79 of the Constitution, and 3) the focus the subject of ethnicity has received in the print ,?ledia. It is concluded that Botswana is no longer safe from the ethnic strjfe, tensions and conflicts that have engulfed most other Africa countries, unless deliberate corrective measures are adopted by the state, drawing from other African countries to ident5.' what works and what does not work
statUs oF HEaltH sECtor stratEGiC PlaNs iN FiVE CoUNtriEs oF tHE wHo aFriCaN rEGioN
No full textObjectives: to assess the adequacy of the existing strategic plans and compare the format andcontent of health sector strategic plans with the guidelines in selected countries of the africanregion.Data source: the health strategic plans for Gambia, liberia, Malawi, tanzania and Uganda, whichare kept at the wHo/aFro, were reviewed.Data extraction: all health strategic plans among the anglophone countries (Gambia, Ghana, Kenya,liberia, Malawi, Mauritius, tanzania, Uganda, Zambia and Zimbabwe) that were developed afterthe year 2000 were eligible for inclusion. Fifty percent of these countries that fitted this criterionwere randomly selected. they included Gambia, liberia, Malawi, tanzania and Uganda.the analysis framework used in the review included situation analysis; an assessment ofappropriateness of strategies that are selected; well developed indicators for each strategy; thematch between the service and outcomes targets with available resources; and existence of a clearframework for partnership engagement for implementation.Data synthesis: Most of the strategic plans identify key ill health conditions and their contributingfactors. Health service and resource gaps are described but not quantified in the Botswana, Gambia,Malawi, tanzania strategic documents. Most of the plans selected strategies that related to thesituational analysis. Generally, countries’ plans had clear indicators. Matching service and outcometargets to available resources was the least addressed area in majority of the plans. Most of thestrategic plans identified stakeholders and acknowledged their participation in the implementation,providing different levels of comprehensiveness.Conclusion: some of the areas that are well addressed according to the analysis framework included:addressing the strategic concerns of the health policies; identifying key partners for implementation;and selection of appropriate strategies. The following areas needed more emphasis: quantificationof health system gaps; setting targets that are cognisant of the local resource base; and being moreexplicit in what stakeholders’ roles are during the implementation period
PROGNOSTIC FACTORS IN PATIENTS HOSPITALISED WITH DIABETIC KETOACIDOSIS AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textBackground: In spite of many advances in the management of diabetes in the last 25 years, the mortality associated with diabetic ketoacidosis (DKA) remains high, especially in the developing countries. The mortality appears greatest in the first 24 - 48 hours of their treatment. Most of the previous studies on DKA focused on children and the precipitating factors thereof but not particularly on clinical predictors of outcomes.Objective: To determine the clinico-laboratory predictors of outcomes of patients hospitalised with diabetic ketoacidosis who were undergoing treatment.Design: Cross-sectional descriptive study.Setting: The accident and emergency department and medical wards of the Kenyatta National Hospital.Subjects: Fifty one patients hospitalised with diabetic ketoacidosis over a nine month period were evaluated clinically and by laboratory tests. They were managed in the standard way with insulin, intravenous fluids and appropriate supportive care.Main outcome measures: Serial assays of serum electrolytes, glucose and blood pH, HbA1c and clinical outcome of either discharge home or death.Results: Of the 51 patients enrolled, 47 were included in the final analysis. Fourteen (29.8%) patients died, and the deaths occurred within less than 48 hours of hospitalisation and treatment. Of the patients who died, all (100%) had altered level of consciousness at hospitalisation, 71.4% had abnormal renal functions, 64.3% were newly diagnosed and anequal proportion of 64.3% were females. The alteration in the level of consciousness was significantly associated systolic hypotension and severe metabolic acidosis, (p<0.001).Patients with altered level of consciousness also had poorer renal function.Conclusion: Apparently DKA still carries high mortality during treatment in hospital.Altered level of consciousness, which is an obvious and easily discernible clinical sign, was a major predictor of mortality in our study patients. The majority of patients with altered level of consciousness also had systolic hypotension, severe metabolic acidosis and impaired renal function. Even where and when detailed laboratory evaluation is elusive, clinical signs, especially altered level of consciousness and systolic hypotension are very important markers of severity of DKA that may be associatedwith unfavourable outcomes. Further studies are necessary to establish why DKA still carries high mortality in the patients who are already receiving treatment in hospitals in developing countries
PATIENTS’ SATISFACTION WITH DENTAL CARE PROVIDED BY PUBLIC DENTAL CLINICS IN DAR ES SALAAM, TANZANIA
No full textBackground: In Tanzania, patient satisfaction with dental services has received only minor attention.Objective: To assess patients’ satisfaction with public dental health services in Dar es Salaam.Design: A cross-sectional study.Setting: Five public dental clinics randomly selected from a list of all the nine public dental clinics in Dar es Salaam.Subjects: Five hundred and sixteen consecutive patients, 193 males and 323 females aged between 12 and 77 years who, during the study period between July and November, 2002 were attending five dental clinics were randomly selected.Results: No significant differences in patients’ satisfaction level (overall or for the specific studied items) were found in all the five public dental clinics. The answers to the specific sub-items, apart from time spent with doctor, were around the average with very few responses with a high ranking.Conclusions: Findings indicate a moderate level of patient satisfaction with dental care offered in public dental clinics in Dar es Salaam. Areas identified as needing improvement included; technical quality of care, interpersonal aspects and communication
EVALUATION OF ASSESSMENT INSTRUMENTS USED ON CHILDREN PRESENTING WITH ALTERED LEVEL OF CONSCIOUSNESS
No full textObjective: To compare current care with a proposed gold standard (formal coma scale use) for assessment of children presenting with altered consciousness.Design: A prospective case record review (n = 170).Setting: Kenyatta National Hospital, Nairobi, Kenya.Subjects: One hundred and seventy children consecutively admitted to the Hospital.Main outcome measures: Proportion of children assessed using a formal coma scale (gold standard) while presenting with altered consciousness.Results: Findings revealed that only eight percent of children were assessed using the formal coma scale at admission. The level of neurological defi cit was described using general and potentially misleading descriptive terms rather than formal coma scales.Conclusion: The use of a formal coma scale and relevant simple investigations were seldom used. The quality of care of children admitted to the hospital with altered consciousness standard would benefi t from defi ning and implementing management guidelines (protocols)
DAILY VERSUS WEEKLY IRON SUPPLEMENTATION AND PREVENTION OF IRON DEFICIENCY ANAEMIA IN LACTATING WOMEN
No full textABSTRACTObjective: To demonstrate the effectiveness and social feasibility of weekly versus daily ironsupplementation in preventing and treating iron deficiency anaemia among anaemicmothers.Design: A longitudinal in nature.Setting: Seven urban slum communities in Teklehaimanot Wereda, Addis Ababa, Ethiopia.Subjects: Two hundred seven eligible mothers were assigned to the daily supplementation,weekly supplementation or control groups following randomisation between March andMay 2001. The daily supplemented groups (n=71) received 60 mg of elemental ironcontaining 300 mg ferrous sulphate and 400 μg folic acid from monday to friday. The weeklygroup (n=68) received one tablet once a week every monday supervised while the controlgroup (n=68) was advised to take no medications without the knowledge of the investigatorsuntil the completion of the study. To eliminate a major source of variation, subjectsparticipating in the study were de-wormed at the beginning of the study.Main outcome measures: Haemoglobin and serum ferritin concentrations were comparedbefore and after the intervention among the groups.Results: The mean haemoglobin (Hgb), and serum ferritin concentration (SFC) at baselinewere practically similar among the groups. Haemoglobin levels significantly increased atthe end of the study in all the groups and the proportion of anaemia decreased from 6.9%to 1.6% in the daily, 6.7% to 1.7% in the weekly supplemented and 6.7% to 6.1% in thecontrol groups. The difference noted between the daily and weekly supplemented groupswas not significant. The improvement of SFC concentration was better in the daily than theweekly group but not statistically significant. Daily supplementation schedule caused moreside effects and lower compliance level than the weekly supplementation schedule.Conclusion: Weekly supplementation is simple, comparable to daily supplementation andeconomically advantageous. Thus, it is recommended to adopt the strategy for controllinganaemia. Further because of higher compliance rate and lower side effects, it is deemed tobe socially feasible