Treating dehydrating diarrhoea at district hospital level in sub-Saharan Africa: from policy to reality

Introduction: Peritonitis remains a public health problem in Africa. We aim to describe the epidemiological, etiological and therapeutic aspects of acute peritonitis in a district hospital in Sub Saharan Africa. Methods: This was a descriptive study with prospective data collection over a period of 15 months from May 1 st 2015 to July 31st 2016 in Bembereke district hospital. It has taken into account all the patients managed in the general surgery department for acute generalized peritonitis that has been confirmed at laparotomy. Results: Fifty-three patients, 38 men (71.7 %) and 15 women (28.3 %) had been registered. The average age of the patients was 19.8 ± 16.9 years. The main etiologies were: non-traumatic ileal perforation from typhoid infection 52.8%; perforated gastric or duodenal ulcer 17%; complicated appendicitis and abdominal traumas 11.3% each one. Twenty nine patients (54.7%) have been operated by a surgeon and the 24 remaining (45.3%) by a general practitioner with surgical skills. Twenty one patients (39.6%) had postoperative complications of which 11 cases of parietal suppurations (52.4%). The mortality rate was 11.3%. The mean hospital stay was 22.5 ± 4 days. Conclusion: In northern-Benin, peritonitis remains dominated by the complications of typhoid fever. The mortality rate remains high. Prevention requires good hygiene and awareness of early consultations.

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Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa

The Lancet ◽

10.1016/s0140-6736(00)04897-2 ◽

2001 ◽

Vol 357 (9270) ◽

pp. 1753-1757 ◽

Cited By ~ 59

Author(s):

James A Berkley ◽

Isiah Mwangi ◽

Caroline J Ngetsa ◽

Salim Mwarumba ◽

Brett S Lowe ◽

...

Keyword(s):

Bacterial Meningitis ◽

District Hospital ◽

Sub Saharan Africa ◽

Acute Bacterial Meningitis ◽

Sub Saharan ◽

Meningitis In Children

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Patients’ Perceptions of Health Information Given by Nurses and Clinicians at Discharge at Chiradzulu District Hospital in Malawi, Sub-Saharan Africa

European Scientific Journal ESJ ◽

10.19044/esj.2018.v14n18p65 ◽

2018 ◽

Vol 14 (18) ◽

pp. 65

Author(s):

Reuben Solomon Mumba

Keyword(s):

Health Information ◽

District Hospital ◽

Self Care ◽

Study Data ◽

Sub Saharan Africa ◽

Care At Home ◽

Sub Saharan ◽

Discharge From Hospital ◽

Information Providers ◽

At Home

Background: Hospital discharge information is a critical component of preparation to facilitate patient transition from hospital to home. Numerous studies elsewhere provide evidence that patients and families encounter a variety of problems after discharge from hospital such as difficulties with functional abilities and carrying out personal care. These problems are often attributed to having unmet informational needs at discharge. Objective: The main objective of the study was to assess patients’ perceptions of the health information provided by nurses and clinicians at discharge. Methods: The study was conducted at Chiradzulu District Hospital in Malawi. A qualitative method of data collection (in-depth interviews) was used. Convenience sampling method was used to select patients into the study. Data was analyzed using Nvivo 9 software. Findings: The study found that most patients were given information by nurses and clinicians on how to perform self-care at home on discharge from hospital. The study revealed that most patients perceived the discharge information as relevant in assisting them with home care. In addition, the study found that most patients perceived it as inadequate. The study also found that the factors that facilitated patients understanding of information were clear explanation of information and use of understandable language by information providers. Barriers included lack of encouragement from information providers to make patients speak, incomprehensive information provided to the patients and patients fear of asking information providers’ questions. Conclusion: Nurses and clinicians should make sure that all patients are given some discharge information to help them to manage their self care at home. Those patients who are at high risk for readmission should be given detailed information.

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Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda

PLoS ONE ◽

10.1371/journal.pone.0247464 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247464

Author(s):

Joseph H. Stephens ◽

Aravind Addepalli ◽

Shombit Chaudhuri ◽

Abel Niyonzima ◽

Sam Musominali ◽

...

Keyword(s):

Chronic Disease ◽

Health Workers ◽

District Hospital ◽

Communicable Disease ◽

Sub Saharan Africa ◽

Hypertension Prevalence ◽

Village Health Workers ◽

Sub Saharan ◽

Village Health ◽

Non Communicable Disease

Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.

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A geospatial analysis of two-hour surgical access to district hospitals in South Africa

10.21203/rs.3.rs-20559/v3 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan ◽

Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

BMJ Global Health ◽

10.1136/bmjgh-2019-001449 ◽

2019 ◽

Vol 4 (3) ◽

pp. e001449 ◽

Cited By ~ 6

Author(s):

Lauren Anne Eberly ◽

Christian Rusangwa ◽

Loise Ng'ang'a ◽

Claire C Neal ◽

Jean Paul Mukundiyukuri ◽

...

Keyword(s):

Heart Failure ◽

Chronic Care ◽

District Hospital ◽

Sub Saharan Africa ◽

Primary Health ◽

Start Up ◽

Primary Health Centres ◽

Health Centres ◽

Per Capita ◽

Sub Saharan

BackgroundIntegrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.MethodsA retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined.ResultsA total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing.ConclusionsThis is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems.

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Sickle cell disease in anaemic children in a Sierra Leonean district hospital: a case series

Oxford Medical Case Reports ◽

10.1093/omcr/omz061 ◽

2019 ◽

Vol 2019 (7) ◽

Author(s):

Maria B Italia ◽

Sandy Kirolos

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

District Hospital ◽

Case Series ◽

Severe Anaemia ◽

Sub Saharan Africa ◽

Diagnostic Tools ◽

Cell Disease ◽

Sierra Leonean ◽

Sub Saharan

Abstract Sickle cell disease (SCD) is the most common inherited haemoglobinopathy wordwide, with the highest prevalence in sub-Saharan Africa. Due to the lack of national strategies and scarcity of diagnostic tools in resource-limited settings, the disease may be significantly underdiagnosed. We carried out a 6-month retrospective review of paediatric admissions in a district hospital in northern Sierra Leone. Our aim was to identify patients with severe anaemia, defined as Hb < 7 g/dl, and further analyse the records of those tested for SCD. Of the 273 patients identified, only 24.5% had had an Emmel test, among which 34.3% were positive. Furthermore, only 17% of patients with a positive Emmel test were discharged on prophylactic antibiotics. Our study shows that increased awareness of SCD symptoms is required in high-burden areas without established screening programmes. In addition, the creation or strengthening of follow-up programmes for SCD patients is essential for disease control.

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Two-hour surgical access in South Africa: a useful indicator in a middle-income country?

10.21203/rs.3.rs-16476/v1 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Middle Income ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan

Abstract Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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A qualitative study to explore the experience of parents of newborns admitted to neonatal care unit in rural Rwanda

PLoS ONE ◽

10.1371/journal.pone.0252776 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0252776

Author(s):

Samuel Byiringiro ◽

Rex Wong ◽

Jenae Logan ◽

Deogratias Kaneza ◽

Joseph Gitera ◽

...

Keyword(s):

Qualitative Study ◽

District Hospital ◽

Healthcare Providers ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Traumatic Experience ◽

Environment Interaction ◽

Care Services ◽

Sub Saharan ◽

Neonatal Care Unit

Background Neonatal Care Units (NCUs) provide special care to sick and small newborns and help reduce neonatal mortality. For parents, having a hospitalized newborn can be a traumatic experience. In sub-Saharan Africa, there is limited literature about the parents’ experience in NCUs. Objective Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda. Methods A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. Interviews were conducted using a semi-structured guide in the participants’ homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data were organized using Dedoose software for analysis. Results Twenty-one interviews were conducted primarily with mothers (90.5%, n = 19) among newborns who were most often discharged home alive (90.5%, n = 19). Four themes emerged from the interviews. These were the parental adaptation to having a sick neonate in NCU, adaptation to the NCU environment, interaction with people (healthcare providers and fellow parents) in the NCU, and financial stressors. Conclusion The admission of a newborn to the NCU is a source of stress for parents and caregivers in rural Rwanda, however, there were several positive aspects which helped mothers adapt to the NCU. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for parents and families in general.

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