Australasian Medical Journal
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Determinants of Recurrent Diarrhoea among Children
Get PDFBackgroundAbout 2 million episodes of diarrhoea occur each year in India. Of the 6.6 million deaths among children aged 28 days to 5 year; deaths from diarrhoea are estimated to account for 1.87 million. An average Indian child less than 5 years of age can have 2-3 episodes of diarrhoea. Mother's literacy, family income, feeding practices, environmental conditions are important determinants of the common childhood infection like diarrhoea. The present study was undertaken to study these important determinants of recurrent diarrhoea among children under five in a rural area of western Maharashtra, India.Method A cross-sectional study was conducted in six randomly selected villages of Ahmednagar district in western Maharashtra, India. Three villages from two primary health centres and 652 children under five from these villages were chosen by a simple random sampling technique (every fifth child enrolled in Anganwadi). House-to-house survey was done and data was collected by interviewing the mothers of these children. Nutritional status was assessed by measuring the weight and mid-arm circumference of the child. Statistical analysis was done with Microsoft Excel and StatistiXL 1.8 using percentage, proportions and chi-square test wherever applicable.ResultsThe prevalence of recurrent diarrhoea was 9.81%. Recurrent diarrhoea was more common in the age group of 13 - 24 months (29.6%) and 25 – 36 months (23.4%) and children belonging to lower socioeconomic class (64%). Malnutrition was significantly associated with recurrent diarrhoea and 21% of malnourished children had the same. Recurrent diarrhoea was significantly more common (39.1%) among children with introduction of top-up feeds before four to six months.ConclusionLow socioeconomic status, bad sanitary practices, nutritional status and weaning practices significantly influence the prevalence of recurrent diarrhoea
Small Teaching at a Nepalese Medical School
No full textBackgroundSmall group learning sessions are used in pharmacology at the KIST Medical College, Lalitpur, Nepal. Feedback about student behaviours that enhance and hinder small group effectiveness was obtained. This will help us improve the small group sessions and will also be useful to educators using small groups in other medical schools. Method The small groups were self-managing with a group leader, time-keeper, recorder and presenter. Small group effectiveness was measured using the Tutorial Group Effectiveness Instrument (TGEI) developed by Singaram and co-authors. The instrument was administered in June 2010 and key findings obtained were shared with students and facilitators. The instrument was administered again in August. The mean cognitive, motivational, demotivational and overall scores were compared among different categories of respondents in June and August. Scores were also compared between June and August 2010. ResultsA total of 89 students participated in the study in June and 88 in August 2010. In June, females rated overall group productivity higher compared to males. The cognitive and motivational scores were higher in August 2010 while the demotivational score was lower.ConclusionThe small group effectiveness was higher in August after the educational intervention which utilised feedback about problems observed, theoretical considerations of effective small groups and how this information can be applied in practice
Antenatal Care in Uganda
Get PDFBackgroundOver 99% of mothers who die of complications related to pregnancy and childbirth each year are found in developing countries. In Uganda, maternal mortality is estimated at 435 deaths per 100,000 live births. We sought to understand the factors influencing frequency and timing of antenatal care in Uganda in order to inform policy on the key aspects that need to be influenced. Method We used data from the Uganda Demographic and Health Survey (UDHS) 2006 and employed both descriptive and quantitative approaches (probit estimation). After a probit estimation, we generated marginal effects to interpret the results as probabilities of utilisation of antenatal care given particular background characteristics.ResultsOn average, only 17% and 47% of mothers initiate the first antenatal visit in the first trimester and attain at least four antenatal visits, respectively. The timing and frequency of antenatal visits were significantly associated with education of the mother and her partner, wealth status, regional disparities, religious differences, access to media, maternal autonomy in taking a health decision, occupations of the mother and her partner, timing of pregnancy, birth histories, and birth order.ConclusionEfforts are needed to educate girls beyond secondary level, establishment village outreach clinics with qualified staff to attract the hard-to-reach women, and to ensure universal access to prenatal care services irrespective of the ability to pay. Media penetration should also be increased amongst the population and this channel can be used to disseminate a standard piece of information concerning what pregnant women should expect and do during the prenatal period
Sexuality and Intimacy in Cancer and Palliative care
Get PDFBackgroundCancer often has a profound and enduring impact on sexuality, affecting both patients and their partners. Most health care professionals in cancer and palliative care are struggling to address intimate issues with the patients in their care.MethodsStudy 1: An Australian study using semi-structured interviews and documentary data analysis. Study 2: Building on this Australian study, using a hermeneutic phenomenological approach, data were collected in the Netherlands through interviewing 15 cancer patients, 13 partners and 20 health care professionals working in cancer and palliative care. The hermeneutic analysis was supported by ATLAS.ti and enhanced by peer debriefing and expert consultation.ResultsFor patients and partners a person-oriented approach is a prerequisite for discussing the whole of their experience regarding the impact of cancer treatment on their sexuality and intimacy. Not all health care professionals are willing or capable of adopting such a person-oriented approach. ConclusionA complementary team approach, with clearly defined roles for different team members and clear referral pathways, is required to enhance communication about sexuality and intimacy in cancer and palliative care. This approach, that includes the acknowledgement of the importance of patients’ and partners’ sexuality and intimacy by all team members, is captured in the Stepped Skills model that was developed as an outcome of the Dutch study
Radio-Imaging for Defective Metabolic Pathways
No full textCongenitally defective metabolic pathways adversely affect the quality of life of patients as well as their care givers. Early diagnosis is therefore vital. Frequently, radio-imaging alone raises a strong suspicion and sometimes even provides conclusive evidence of defective metabolic pathways, when the patient presents with signs and symptoms that clinically fail to lead to a definitive diagnosis. This article discusses the role of radiological imaging that can lead to a strong suspicion, or even a diagnosis of these errors
Telepathology in Developing Nations
No full textTelepathology has grown immensely due to rapid advances in information and technology. It has a wide variety of applications especially in the developing world, namely for remote primary diagnosis, specialist referrals, secondary opinions, remote teachings and in research. Basic infrastructure and skilled and experienced staff are the prerequisites for its successful implementation.Socio-economic differences in developing nations result in a chaotic scenario so that, the advanced areas have expertise, while rural and remote areas remain deprived. Telepathology has the potential to bridge this gap.This article discusses how successful use of the internet for telepathology is bridging this gap in developing nations and thereby contributing positively to effective healthcare. Possible constraints to telepathology and some solutions to overcome them are also discussed
Clinical Observership: An Adjunct to Preclinical Training
No full textIn the existing system of medical education in India, students are exposed to the hospital environment only after they start their clinical years of training. Hence, during the preclinical phase of their training most students are unaware of the relevance of basic sciences to clinical medicine. The preclinical student needs to be made aware of the relevance of basic sciences in clinical practice as early as possible during their training period. In an attempt to achieve the above-mentioned goals, the first year medical students in a private medical school in India were exposed to a ‘clinical observership’ programme. This observership, spread over a period of eight weeks took the students by rotation through eight clinical disciplines wherein they observed the activities in these clinics and interacted with the consultants, laboratory personnel and patients. The programme was designed to introduce them to hospital scenarios and to impress upon them the fact that the basic sciences form the foundation for their clinical training. It was highly appreciated by the students, who found it very useful, interesting and motivating in its contents and delivery. A project of this nature requires careful planning, and calls for co-operation of the teachers in basic sciences, clinical consultants and administrators to make a success of such an effort. In the light of this experience and taking into account the promising educational value of such a programme, it is suggested that similar innovations may be incorporated into the academic schedule to make the preclinical training interesting, motivating and meaningful to a student who is at the threshold of being moulded into a physician
Competencies for Undergraduate Pharmacology Education
Get PDFMedical schools have a major challenge in teaching students to choose and prescribe medicines safely and effectively. Problem-based learning based on national essential medicine lists and standard treatment guidelines has been strongly recommended to improve prescribing. In Nepal, pharmacology is taught during the first two years of the undergraduate medical course. At KIST Medical College, Lalitpur the Department of Clinical Pharmacology teaches students to use essential medicines rationally. Small group, activity-based learning is used during practical sessions. In this article the author lists the 10 basic competencies which students should have developed by the end of the pharmacology practical module and also describes a selection of activities with regard to a particular competency used during the practical module and an exercise used to assess these competencies during the practical examination.