Bacterial aetiology of gastroenteritis in children; experience from a paediatric unit in a tertiary hospital of Sri Lanka

Background: Poor quality records management in Sri Lankan Hospital offices is a major dissatisfaction and demotivation for healthcare staff. An intervention research project to improve the record management of selected Human Resource (HR) records of nurses in an Office of a Tertiary Care Hospital in Sri Lanka was carried out to identify the gaps, implement improvements and to test the outcome. Methods: Grade promotion and annual increment HR processes considered for the improvements. Qualitative and quantitative techniques used for gap identification, planning of interventions and assessment of the effectiveness. A package of quality improvements initiatives implemented following literature review and stakeholder participation. Results: Absence of instructions/sample filled-forms and issues in the document flow were the inconsistencies noted. The record processing time was 30.83 days with an SD of ±4.84 for completion of annual increments and 24.33 days with an SD of ±4.21 for authorisation of grade promotions. The package of interventions included e-based/ paper-based guides and specimen request forms and a document movement register to track the records. Increased accessibility, accuracy, improved quality, timeliness and improved traceability of submitted forms and improvements in the average time spent for annual increments and grade promotions noted; 17.52 days (SD ±3.39) and 12.13 days (SD ±2.33) respectively, a statistically significant reduction (p<0.05). Conclusion: Implementation of quality improvement interventions using computer based initiatives with stakeholder participation can improve office management issues in the tertiary hospital setting.

Download Full-text

Domestic violence and self-poisoning in Sri Lanka

Psychological Medicine ◽

10.1017/s0033291720002986 ◽

2020 ◽

pp. 1-9

Author(s):

Piumee Bandara ◽

Andrew Page ◽

Lalith Senarathna ◽

Judi Kidger ◽

Gene Feder ◽

...

Keyword(s):

Domestic Violence ◽

Sri Lanka ◽

Suicidal Behaviour ◽

Emotional Abuse ◽

Physical Violence ◽

Local Population ◽

Tertiary Hospital ◽

Psychological Services ◽

Logistic Regression Models ◽

Population Attributable Fractions

Abstract Background There is increasing evidence that domestic violence (DV) is an important risk factor for suicidal behaviour. The level of risk and its contribution to the overall burden of suicidal behaviour among men and women has not been quantified in South Asia. We carried out a large case-control study to examine the association between DV and self-poisoning in Sri Lanka. Methods Cases (N = 291) were patients aged ⩾18 years, admitted to a tertiary hospital in Kandy Sri Lanka for self-poisoning. Sex and age frequency matched controls were recruited from the hospital's outpatient department (N = 490) and local population (N = 450). Exposure to DV was collected through the Humiliation, Afraid, Rape, Kick questionnaire. Multivariable logistic regression models were conducted to estimate the association between DV and self-poisoning, and population attributable fractions were calculated. Results Exposure to at least one type of DV within the previous 12 months was strongly associated with self-poisoning for women [adjusted OR (AOR) 4.08, 95% CI 1.60–4.78] and men (AOR 2.52, 95% CI 1.51–4.21), compared to those reporting no abuse. Among women, the association was strongest for physical violence (AOR 14.07, 95% CI 5.87–33.72), whereas among men, emotional abuse showed the highest risk (AOR 2.75, 95% CI 1.57–4.82). PAF% for exposure to at least one type of DV was 38% (95% CI 32–43) in women and 22% (95% CI 14–29) in men. Conclusions Multi-sectoral interventions to address DV including enhanced identification in health care settings, community-based strategies, and integration of DV support and psychological services may substantially reduce suicidal behaviour in Sri Lanka.

Download Full-text

Burden, clinical manifestation and outcome of severe malaria in children at a tertiary hospital in Northeast, Nigeria

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203158 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1659

Author(s):

Jalo I. ◽

Isaac E. Warnow ◽

Aliu R. ◽

Hassan K. Shina

Keyword(s):

Cerebral Malaria ◽

Severe Malaria ◽

Clinical Manifestation ◽

Teaching Hospital ◽

Tertiary Hospital ◽

Severe Anaemia ◽

Medical Emergency ◽

Intervention Measures ◽

Paediatric Unit ◽

Criteria For Diagnosis

Background: Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. The presentation of severe malaria varies depending on such factors as country, age, immunity, socioeconomic factors, drug resistance and type of intervention measures used. The aim of this study is to document the burden and forms of severe malaria in children in this region. Objective of this study was to determine the prevalence, clinical manifestation and outcome of children with severe malaria in Federal Teaching Hospital, GombeMethods: Case notes of patients admitted to the emergency Paediatric Unit and paediatric medical ward of Federal Teaching Hospital, Gombe with severe malaria from January 2014 to December 2018 (5years) were reviewed. Information sought included age, gender, use of ITN, parents’ education and occupation, criteria for diagnosis, treatment and outcome.Results: A total of 2,808 children were admitted during the period of study, out of these 237 (8.4%) had severe malaria. There were 140 (59.1%) male and 97 (40.9%) female with M: F of 1.4:1. Majority 129 (54.4%) of patients were aged more than 5 years. The most frequent modes of presentation were multiple convulsions 124 (52.3%), cerebral malaria 97 (40.9%) and severe anaemia 61 (25.7%). Some 45 (19.0%) of the subjects presented with multiple diagnostic criteria. Multiple convulsions, cerebral malaria and severe anaemia were significantly related to likelihood of mortality.Conclusions: The prevalence of severe malaria is high and multiple convulsions, cerebral malaria and severe anaemia are significantly associated with risk of mortality.

Download Full-text

Bacterial Aetiology and Antibiotic Susceptibility Profile of Post-Operative Sepsis among Surgical Patients in a Tertiary Hospital in Rural Eastern Uganda

Microbiology Research Journal International ◽

10.9734/mrji/2018/41690 ◽

2018 ◽

Vol 24 (2) ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Masifa George ◽

Jacob Iramiot ◽

Rita Muhindo ◽

Peter Olupot-Olupot ◽

Ann Nanteza

Keyword(s):

Antibiotic Susceptibility ◽

Tertiary Hospital ◽

Surgical Patients ◽

Bacterial Aetiology ◽

Eastern Uganda

Download Full-text

Bacterial aetiology and antimicrobial resistance pattern in culture positive enteric fever in a private hospital in Sri Lanka

Journal of the Postgraduate Institute of Medicine ◽

10.4038/jpgim.8198 ◽

2019 ◽

Vol 6 (1) ◽

pp. 82

Author(s):

Suchetha Charukeshi Illapperuma ◽

Enoka Marie Corea ◽

Suneth Buddika Agampodi

Keyword(s):

Sri Lanka ◽

Antimicrobial Resistance ◽

Enteric Fever ◽

Private Hospital ◽

Resistance Pattern ◽

Bacterial Aetiology ◽

Culture Positive

Download Full-text

An observational study on usage of insulin and self-injection practises among patients with diabetes attending to Diabetic Centre and Medical outpatient clinics of a tertiary care hospital of Northern Sri Lanka

10.21203/rs.3.rs-122005/v1 ◽

2020 ◽

Author(s):

Sathyasagaran Narayanapillai ◽

Peranantharajah Thambipillai ◽

Aravinthan Mahalingam ◽

Rajeshkannan Nadarajah

Keyword(s):

Sri Lanka ◽

Injection Site ◽

Low Income ◽

Tertiary Care ◽

Insulin Injection ◽

Tertiary Hospital ◽

Low Income Countries ◽

Care Hospital ◽

Premixed Insulin ◽

Cross Sectional

Abstract Background: Prevalence of diabetes increasing world-wide particularly in low income countries. Management of diabetes sometimes requires insulin injection due to various reasons. Proper usage of insulin and injection techniques are important for diabetes control among who requires insulin. This study was aimed to assess current insulin practices and associated complications.Methods and material: This was a cross sectional study conducted among diabetes patients attended all medical clinics and Diabetic Centre in Jaffna teaching Hospital which is the only tertiary hospital in the Northern Sri Lanka in May 2020.Insulin practices retrieved by using interviewer administered questionnaire. Data was analyses by using SPSS 26.Results: Out of 360 patients 64.2% were female and mean age was 58.19 (12-89).Majority (61.9%) of them belongs to low income category and most (73.3%) of them using insulin more than 1 year. Main reason for the insulin initiation was oral hypoglycaemic failure (81.7%) and majority of them (80.0%) were using twice daily premixed insulin regime followed by daily basal insulin (11.4%) and basal bolus insulin (5.6%) regime. Most of the participants (81.4%) reported they do cleaning of the injection site before injection and 89.7% usually rotate the injection site. Approximately half of them (50.8%) inject themselves and majority use syringes (91.4%). Common injection site complications reported were skin changes (25%), followed by 15.3% persistent swelling (15.3%) and thinning of skin(7.8%). Angle of injection (P-0.039) and insulin regime (P<0.001) showed statistically significant association with skin changes.High proportion of participants 68.6% (95%CI: 63.7%-73.2%) experienced hypoglycaemia, using syringes 2.21 times (95%CI-1.05-4.64) more risk of compare to pen users and missing meals 2.22 times more risk of hypoglycaemic events (95%CI: 1.18-4.17). Majority of them reported reusing the needles for injection (83.6%) and 35% were disposing needle into common garbage pin.Conclusion: This study revealed significant gaps in current insulin practices from expected norm and hypoglycaemic events alarmingly high among participants. Exploring Continuous Glucose Monitoring Devices or flash monitoring can be a mitigation strategy and urgent attention from health professionals needed to improve the safe insulin practices.

Download Full-text

A retrospective review of serious infections in febrile infants 0–90 days old

Proceedings of Singapore Healthcare ◽

10.1177/20101058211026003 ◽

2021 ◽

pp. 201010582110260

Author(s):

Zi Xean Khoo ◽

Cherie Chua ◽

Zhi Min Yap ◽

Janine Cynthia Koh ◽

Sarah Xin Chong ◽

...

Keyword(s):

Clinical Problem ◽

Severity Index ◽

Tertiary Hospital ◽

Reactive Protein ◽

Serious Infection ◽

Paediatric Unit ◽

Serious Infections ◽

Severity Index Score ◽

Invasive Bacterial Infection ◽

Male Sex

Background: Fever without source in infants is a common clinical problem that accounts for many ambulatory care visits and hospitalisations. Currently, there is no reliable method of identifying those at risk of serious infection (SI). Objective: The goal of this study was to determine the incidence and identify the predictors of SI in febrile infants who presented to the emergency department (ED). Methods: This was a single-centre retrospective cohort study of children presenting to a Singapore tertiary hospital paediatric unit between 1 July 2018 and 31 December 2018. Children were included if they were aged 0–90 days and presented to the ED with a fever. SI was defined as urinary tract infection (UTI), sepsis, bacteraemia, meningitis (viral and bacterial), enterocolitis, osteomyelitis, abscess or pneumonia. Results: Of the 659 infants, 161 (24.4%) were diagnosed with SI. Meningitis (49.7%) was the most common SI, followed by UTI (45.3%), enterocolitis (5.6%), sepsis (3.1%) and bacteraemia (2.5%). Factors significantly associated with SI were aged 29–60 days, male sex, Severity Index Score (SIS) <10, absolute neutrophil counts >10×109/L, C-reactive protein (CRP) >20 mg/L and procalcitonin >0.5 ng/mL. Multivariate analysis entering all these items retained only male sex, SIS <10 and CRP >20. Conclusion: Among hospitalised infants aged 0–90 days, the incidence of SI was 24.4%, and invasive bacterial infection was 0.6%. Meningitis was the most common SI followed by UTI. SIS and CRP can be used to predict SI in infants <90 days old.

Download Full-text