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Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania
Get PDFBackground: Despite the fact that it is possibly preventable,
postpartum haemorrhage (PPH) is the global most deadly form of
obstetric bleeding, mainly sub-Saharan Africa with at least one-fourth
of maternal deaths in East African regions. Active management of third
stage of labour (AMTSL) is recommended to prevent PPH. However, AMTSL
guidelines have been revised since 2006. Objectives: To examine the
current status of nurse-midwives\u2019 knowledge on modified AMTSL
guidelines and highlight barriers to AMTSL correct use. Method:
Descriptive cross sectional survey was conducted to 160 nurse-midwives
at three referral hospitals in Dar es Salaam, Tanzania. One-way,
interactive modes ANOVA and Chi square (\u3c72) test were run in SPSS
21 version to compare the association of independent and dependent
variables. Results: Virtually all nurse-midwives knew the first
recommended uterotonic (99.4%) and delayed cord clamping (98.8%)
protocols as modified. Knowledge was significantly contributed by
multiple factors; p=0.001. Reported correct AMTSL use was 46.8% which
was significantly affected by AMTSL training (\u3c72 = 6.732, p =
0.009) and prioritizing atteding an asphyxiated baby (\u3c72 = 5.647,
p = 0.017). Conclusion: Regardless of high nurse-midwives\u2019 AMTSL
knowledge; it is imperative that responsible authorities plan
appropriate strategies to solve reported barriers affecting correct
AMTSL use
Safe birth matters: facilitators and barriers to uptake of the WHO safe childbirth checklist tool in a Tanzania Regional Hospital
Get PDFBackground: The World Health Organization (WHO) developed the Safe
Birth Checklist (SCC) to facilitate best practices in safe birthing
practices. The SCC is utilizing existing evidence-based WHO guidelines
and recommendations which has combined those into a single and
practical bedside tool. The SCC is the first checklist-based
intervention to target the prevention of maternal and neonatal deaths.
Objective: The objective of this project was to pilot-test the World
Health Organization Safe Childbirth Checklist with Maternity Regional
Hospital in, Tanzania. Study Design and Methods: Retrospective analysis
on 35 charts were completed to identify presence or absence of
documentation aligned with evidenced based checklist items. Staff
training, end user observations and focus group discussions were
utilized to elicit feedback about the tool and the process. Descriptive
statistics and manual content analysis were used to analyze the rate of
uptake and ownership over the checklist. The Checklist is broken down
into four sections or time points (that are considered natural pause
points in the care of laboring women). The four different pause points
are admission, delivery, post-partum, and discharge Results: We trained
26 participants out of 32 staff how to use the SCC. Delivery time point
had the lowest at SCC completion rate at 39% compared to discharge
having the highest completion rate at 93%. There was variation in
completion rate of the checklist items at each time point. Checklist
items at the beginning of each time point were completed between 94%
and 100% of the time with the latter checklist list items completed
between 29% and 57% of the time Conclusion: This project was able to
identify facilitators and potential barriers to the successful uptake
of the Safe Childbirth Checklist in Shinyanga Regional Hospital. Based
on these findings, the MOH have opportunities to utilize those findings
in the scale-up of the implementation of the checklist and future
evaluation activities
Characteristics and outcomes of patients with multiple myeloma at the Uganda Cancer Institute
Get PDFPurpose: Data on multiple myeloma (MM) in sub-Sahara Africa is scarce.
In Uganda, there is a progressively increasing incidence of MM over the
years. Methods: We performed a retrospective study on 217 patients with
MM at the UCI using purposive sampling method. The objectives of the
study were to determine the clinical characteristics, treatment
outcomes, 5 year overall survival and predictors of survival of
patients with MM at the UCI from 01 January 2008 to 31 December 2012.
Results: There were 119 (54.8%) males; the mean(SD) age of the study
population at presentation was 59(12.8) years; 183(84.3%) patients
presented with bone pain, and 135 (61.9%) had skeletal pathology;
186(85.3%) were HIV negative, and 152(70%) had Durie-Salmon stage III.
The median overall survival was 2.5 years, (95% CI, 0.393-0.595);
factors significantly associated with worse survival were Durie-Salmon
stage III disease, HR=5.9, 95% CI (1.61 \u2013 21.74; P=0.007) and LDH
>225 U/L HR=3.3, 95% CI (0.57 \u2013 5.92; P=0.029). Conclusion:
Most patients with multiple myeloma at the UCI were diagnosed at a
relatively young age, presented with late stage disease and bone pain,
and had a shorter survival time. Factors associated with worse survival
were Durie-Salmon stage III and LDH >225 U/L
Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections
Get PDFBackground: Urinary tract infections (UTIs) are one of the most seen
infection among community. Objectives: In this cross-sectional study we
aimed to investigate the risk factors of multidrug-resistant (MDR)
bacteria that caused community-acquired UTI (CA-UTI). Methods:
Consecutive patients admitted to the Urology and Infectious Diseases
policlinics with the diagnosis of CA-UTI were included in the study. A
standard form including possible predisposing factors for MDR bacteria
was applied. Results: In total, 240 patients (51.3% females) were
enrolled in the study. The mean age of participants were 59.8 \ub1
18.3 years old. Escherichia coli (n =166; 69.2%)was the most
frequently isolated bacteria and its incidence was higher in females
than in males (p=0.01). In total, 129 (53.8%) of the identified
pathogens were MDR bacteria. According to multivariate analysis, the
use of antibiotics three or more times increased the risk of infection
with MDR bacteria by 4.6 times, the history of urinary tract infection
in the last 6 months by 2 times, being male and over 65 years old by 3
times. Conclusion: Doctors should consider prescribing broad-spectrum
antibiotics in patients with severe UTIs with a history of UTI,
advanced age, male gender, and multiple antibiotic usage, even if they
have a CA-UTI
Prevalence and antimicrobial susceptibility of extended-spectrum beta lactamases-producing Escherichia coli and Klebsiella pneumoniae isolated in selected hospitals of Anyigba, Nigeria
Get PDFBackground: Escherichia coli and Klebsiella pneumoniae are commonly
implicated in urinary tract infections accounting for majority of the
antimicrobial resistance encountered in hospitals. Objectives: To
determine the prevalence and antimicrobial susceptibility of
extended-spectrum beta-lactamases (ESBLs) producing E. coli and K.
pneumoniae among patients in Anyigba, Nigeria. Methods: This
hospital-based cross-sectional study was conducted using urine samples
from 200 patients of Grimmard Catholic hospital and Maria Goretti
hospital. Urine samples were processed to identify ESBL-producing E.
coli and K. pneumoniae using standard microbiological techniques.
Isolates were then tested against antimicrobial agents. Results: A
total of 156 bacterial isolates were recovered consisting 128 of E.
coli and 28 of K. pneumoniae. Extended spectrum beta-lactamases
production was observed in 69% of E. coli and 31% of K. pneumoniae.
These pathogens were resistant to 3 or more antibiotics. Of the
antimicrobials tested, cefotaxime demonstrated the highest rates of
resistance (100%) for both ESBL-producing E. coli and K. pneumoniae.
Fifty-four isolates of ESBL-producing E. coli showed a high level of
resistance to amoxicillin clavulanic acid (83.3%), ciprofloxacin
(83.3%), and ceftazidime (79.6%). ESBL-positive K. pneumoniae isolates
were highly resistant to ciprofloxacin (75%), and amoxicillin
clavulanic acid (83.3%). Cefoxitin (62.5%) and gentamicin (66.7%)
showed substantially higher rates of resistance against these isolates
while all 24 strains were resistant to imipenem. Conclusion: This study
indicated the prevalence of ESBL-positive Gram-negative pathogens in
these study sites and also demonstrated their resistance to a few
antibiotics. This highlights the need for new antimicrobials that are
potent and improved policy on use of antibiotics
Application of Integrated Behavioral Model (IBM) to measure intention to get early screening and treatment of Sexually Transmitted Infections (STIs) among HIV at- risk sub-populations in Ethiopia
Get PDFBackground: Sexually Transmitted Infections (STIs) increase the risk of
contracting Human Immunodeficiency Virus (HIV). Hence, early screening
and treatment of STIs as a behavioral practice will reduce the odds of
HIV infection among at risk and vulnerable sub-populations. To that
end, HIV prevention strategies need to design evidence-based
interventions using behavioral models or theories to help at-risk
individuals adopt early screening and treatment of STI as preventive
health behavior. In this study, commercial sex workers were considered
as HIV at-risk sub-populations. Objective: Measuring to what extent
that Integrated Behavioral Model constructs explain individuals\u2019
intention to practice early screening and treatment of sexually
transmitted infections as healthy behavior of interest in HIV
prevention. Design: Integrated Behavioral Model (IBM) measurement
survey was conducted using Respondent Driven Sampling (RDS) in six
towns located in the main transport corridors of Ethiopia.
Respondents\u2019 answers to model construct-based questions and
intention to practice the health behavior of interest were measured
using Likert Scale. Analysis was done to assess the correlation and
level of association of model construct-based questions with intention
to practice the preventive health behavior. Results: Respondents\u2019
attitude explained 32%, perceived control 2%, normative influence 21%,
and self-efficacy 53 % of their intention to get early screening and
treatment of sexually transmitted infections. Conclusion: Self-efficacy
explained the variability of respondents\u2019 intention to get early
screening and treatment of STIs most, while perceived control was the
least. Hence, HIV prevention behavioral interventions targeting early
screening and treatment of STIs should give high emphasis to
self-efficacy
Predictors for tuberculosis co-infection in people living with HIV/AIDS
Get PDFBackground/aim: Tuberculosis (TB) is one of the most common chronic
infectious conditions causing mortality and severe outcomes,
particularly in people living with HIV/AIDS (PLWHA). In this study, we
aimed to determine the prevalence and predictors of TB among PLWHA.
Materials and methods: We conducted a retrospective and single-center
study of adults ( 6518 years) PLWHA registered at our tertiary
teaching and research hospital between 2000 and 2016. Results: A total
of 711 PLWHA were included. Of whom, 633 (89.0%) were male. Mean age
was 36.53 \ub111.55 years (range, 17-79). Thirty-eight (5.3%)
patients were diagnosed with active TB. TB development was associated
with low CD4+ lymphocyte count (p<0.001), high viral load (p=0.040)
and alcohol consumption (p=0.004) but no association with age
(p=0.392), gender (p=0.928) and duration since anti-retroviral therapy
initiation (p=0.788) was found. Also, a receiver operating
characteristic analysis showed that the area under the curves of CD4+
lymphocyte count as a predictor for TB development in PLWHA was 0.717
(p<0.001). Conclusion: There are still clinical challenges to
predict TB diagnosis. However, CD4+ lymphocyte count and viral load may
be considered as valuable predictors for TB development. Also,
community strategies to reduce harmful effect of alcohol use should be
developed
Comparison of survival models and assessment of risk factors for survival of cardiovascular patients at Addis Ababa Cardiac Center, Ethiopia: a retrospective study
No full textBackground: Cardiovascular diseases (CVDs) is disorders of heart and
blood vessels. It is a major health problem across the world,and 82% of
CVD deaths is contributed by countries with low and middle income. The
aim of this study was to choose appropriate model for the survival of
cardiovascular patients data and identify the factors that affect the
survival of cardiovascular patients at Addis Ababa Cardiac Center.
Method: A Retrospective study was conducted on patients under follow-up
at Addis Ababa Cardiac Center between September 2010 to December 2018.
The patients included have made either post operation or pre-operation.
Out of 1042 cardiac patients, a sample of 332 were selected for the
current study using simple random sampling technique. Non-parametric,
semi-parametric and parametric survival models were used and
comparisons were made to select the appropriate predicting model.
Results: Among the sample of 332 cardiac patients, only 67(20.2%)
experienced CVD and the remaining 265(79.8%) were censored. The median
and the maximum survival time of cardiac patients was 1925 and 1403
days respectively.The estimated hazard ratio of male patients to female
patients is 1.926214 (95%CI: 1.111917-3.336847; p = 0.019) implying
that the risk of death of male patients is 1.926214 times higher than
female cardiac patients keeping the other covariates constant in the
model. Even if, all semi parametric and parametric survival models
fitted to the current data well, various model comparison criteria
showed that parametric/weibull AFT survival model is better than the
other. Conclusions: The governmental and non-governmental stakeholders
should pay attention to give training on the risk factors identified on
the current study to optimize individual\u2019s knowledge and
awareness so that death due to CVDs can be minimized
Factors associated with delayed uptake of cataract surgery among adult patients at Mulago National Referral Hospital, Uganda
No full textBackground: Cataract is the leading cause of blindness globally. Many
patients with cataract in developing countries delay to come for
cataract surgery. Objectives: This study aimed to determine the factors
associated with delayed uptake of cataract surgery among adult patients
seen at Mulago National Referral Hospital eye clinic in Uganda.
Methods: Employing a hospital based cross-sectional study, adult
patients with cataract and having moderate visual impairment or
blindness were recruited. Patient-related factors for delayed surgery
were assessed using a predetermined questionnaire. Data was analyzed
using stata version 14.2. Logistic regressions were used to determine
the factors associated with delayed uptake of cataract surgery among
these patients. Results: Eighty two participants with operable cataract
were evaluated. Females were 44 (54%) and the mean age of participants
was 67 years. Fifty three (65%) had delayed uptake of cataract surgery.
The factors associated with delayed uptake of cataract surgery among
patients with cataract were financial constraint, felt no need for
surgery and good unilateral vision. Conclusions: Financial constraints,
no felt need for cataract surgery and having good unilateral vision are
the factors associated with delayed uptake of cataract surgery among
cataract patients. We recommend cataract surgical outreach to remote
areas and health education
Challenges that healthcare practitioners experience in the comprehensive assessment of patients with non-communicable diseases: a preliminary investigation
No full textBackground: Resource allocation and access to comprehensive treatment
in the public healthcare sector are always under pressure. This
pressure takes the form of staff shortages, treatment models and the
holistic care of patients, compromising basic healthcare in South
Africa. Objectives: The study\u2019s aim was to determine the
challenges that healthcare practitioners experience while assessing
patients with non-communicable diseases, in private and public
healthcare sectors in the Gauteng Province of South Africa. Methods:
The research design was exploratory and contextual. Qualitative data
were collected through focus groups and semi-structured interviews
among healthcare practitioners (n = 12). Data analysis took place using
Atlas.ti 8.4 Windows (2020). Inter-rater reliability (r = 93.68%) was
calculated to ensure the rigour and validity of the results. Results:
From the discussion, four themes emerged: 1) limited consultation time;
2) overwhelming economic impact and healthcare cost for facilities and
patients; 3) holistic patient care encompassing physical, mental and
socioeconomic components; and 4) lack of patient education due to time
constraints experienced by healthcare practitioners. Conclusion:
Consultation times are reduced due to a shortage of medical staff,
patient numbers, equipment, and poor working conditions. By improving
these conditions, patients across all socioeconomic groups will be
better assisted, treated, and educated, benefiting from equal access
and quality healthcare