Consumption of psychotropic medicines at a referral hospital Namibia: findings and implications

Setting: In Namibia, the burden of mental illnesses is estimated at 25.6% and is expected to double by 2025. Few studies in sub-Saharan Africa estimate the consumption rates of psychotropic medicines as a proxy of irrational use. Aim: The consumption rate of psychotropic medicines at a referral hospital was determined. Method: A hospital-based retrospective medicine utilization analysis of Facility Electronic Stock Card (FESC) psychotropic medication was conducted at Intermediate Hospital Katutura over a 7 year period, 2011-2017. Data on consumption and expenditure on psychotropic medicines were abstracted from FESC and analysed using descriptive statistics in SPSS v22. The main outcomes were consumption rates, daily Defined Dose, (DDD) and/or expenditure. Results: Of the 580 351,4 DDD of psychotropic medicines consumed, 84% were anti-psychotics, 9.2% anti-depressants and 6.8% anxiolytics. Anti-psychotics (48.8%) and anxiolytics (47.9%) had the highest consumption by cost relative to anti- depressants (3.3%). The most consumed antidepressants were imipramine (62%) by DDD and fluoxetine (55.8%) by cost. The most consumed anti-psychotics were chlorpromazine (74.6%) by DDD and haloperidol (68.4%) by cost respectively. Diazepam (79.4%) and hydroxyzine (94.2%) were most consumed sedative-hypnotics by DDD and cost respectively. Conclusion: The consumption of new psychotropics contributes to higher costs. There is need for cost-effectiveness anal- ysis of new versus conventional psychotropics to optimize treatment, outcomes and costs. Keywords: Pyschotropics, consumption rate, DDD, Namibia.

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Hypertensive crises in sub-Saharan Africa: Clinical profile and short-term outcome in the medical emergencies department of a national referral Hospital in Burkina Faso

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2019.05.049 ◽

2019 ◽

Vol 11 (3) ◽

pp. e351

Author(s):

D.G. Mandi ◽

R.A. Yaméogo ◽

C. Sebgo ◽

J. Bamouni ◽

D.T. Naibé ◽

...

Keyword(s):

Burkina Faso ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Medical Emergencies ◽

Sub Saharan ◽

Hypertensive Crises ◽

National Referral Hospital

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Effectiveness of preoperative bath using Chloroxylenol antiseptic soap on the incidence of post emergency Cesarean section surgical site infection at Mbarara Regional Referral hospital, Uganda: a Randomized Controlled trial

10.21203/rs.3.rs-16138/v1 ◽

2020 ◽

Author(s):

Henry Lukabwe ◽

Rogers Kajabwangu ◽

Dale Mugisha ◽

Horace Kizito ◽

Baraka Munyanderu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cesarean Section ◽

Controlled Trial ◽

Surgical Site Infections ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Regional Referral Hospital ◽

Randomized Controlled ◽

Emergency Cesarean ◽

Sub Saharan

Abstract Introduction: Surgical Site Infections (SSIs) are infections that occur at or near the surgical incision within 30 days of the surgery. SSIs are the commonest form of hospital acquired infections in sub Saharan Africa with estimates between 15%-45%. Cesarean section (CS) is the single most important risk factor for postpartum infections, carrying a 5 to 20-fold increase in the risk of developing sepsis, with an even higher risk when the operation is an emergency. In sub Saharan Africa, the leading cause of maternal mortality is puerperal sepsis. There is a need for simple interventions that can reduce this burden of SSI in the limited resource settings. Therefore, the purpose of this study was to measure the effectiveness of chloroxylenol in reducing the incidence of post Cesarean section surgical site infections at Mbarara Regional Referral Hospital (MRRH).Methods: We conducted a single blinded randomized controlled trial at MRRH maternity ward in which women due for CS were randomized into either control or intervention arms. The intervention was a complete body bath with chloroxylenol antiseptic soap before the operation, while the control arm study participants received a standard pre-operative preparation procedures according to the existing ward protocol. All participants were followed up for 30 days and assessed using a standard SSI screening tool. Results: Ninety-six women were randomized, and 48 were assigned to either arm. The overall incidence of SSI was 30.21%. The incidence of SSI was significantly lower in the intervention compared to the control arm, at 6.25% in the intervention arm versus 54.17% in the control arm (p value<0.001). Chloroxylenol bath was protective of SSI with a 90% risk reduction for SSI (95% confidence interval of 67% – 97%). Conclusion: A preoperative bath with chloroxylenol for pregnant mothers is associated with a significantly lower risk of post Cesarean section surgical site infections. Health facilities with a high burden of post SSI should consider adding this simple and effective intervention to the existing infection prevention measures. Clinical Trials.gov registration (NCT03544710).

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Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda

Wellcome Open Research ◽

10.12688/wellcomeopenres.17316.1 ◽

2021 ◽

Vol 6 ◽

pp. 302

Author(s):

Olivie C. Namuju ◽

Richard Kwizera ◽

Robert Lukande ◽

Katelyn A. Pastick ◽

Jonee M. Taylor ◽

...

Keyword(s):

Family Satisfaction ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Next Of Kin ◽

Perceived Benefit ◽

Immunodeficiency Virus ◽

Sub Saharan ◽

Acceptance Rates ◽

National Referral Hospital

Background: Human immunodeficiency virus (HIV)-related mortality remains high in sub-Saharan Africa. Clinical autopsies can provide invaluable information to help ascertain the cause of death. We aimed to determine the rate and reasons for autopsy refusal amongst families of HIV-positive decedents in Uganda. Methods: We consented the next-of-kin for post-mortem examinations among Ugandan decedents with HIV from 2017-2020 at Kiruddu National Referral Hospital. For those who refused autopsies, reasons were recorded. Results: In this analysis, 165 decedents with HIV were included from three selected wards at Kiruddu National Referral Hospital. Autopsy was not performed in 45% of the deceased patients; the rate of autopsy refusal was 36%. The most common reasons for autopsy refusal were time constraints (30%), family satisfaction with clinical diagnosis (15%), fear of disfigurement of the remains (15%), and lack of perceived benefit (15%). By seeking consent from multiple family members and clearly explaining to them the purpose of performing the autopsy, we found a reduction in the rate of autopsy refusal among relatives of the deceased patients at this hospital compared to previous studies at the same site (36% vs. 60%). Conclusions: We found lower rates of autopsy refusal compared to previous studies at the same site. This underscores the importance of clearly explaining the purpose of autopsies as they increase active sensitization about their relevance and dispel myths related to autopsies among the general population. Good, culturally sensitive, and timely explanations to the family of the benefits of autopsy increase the rate of obtaining permission. Building capacity for performing autopsies by training more pathologists and increasing laboratory resources to decrease the turn-around-time for autopsy reports and extending these services to peripheral health facilities could improve autopsy acceptance rates.

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Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Global Health Research and Policy ◽

10.1186/s41256-019-0122-2 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Praveen Paul Rajaguru ◽

Mubashir Alavi Jusabani ◽

Honest Massawe ◽

Rogers Temu ◽

Neil Perry Sheth

Keyword(s):

Surgical Care ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Surgical Volume ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Emergency Procedures ◽

Sub Saharan ◽

Improve Access ◽

Main Operating

Abstract Background Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa. Methods The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed. Results In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients). Conclusion While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.

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Lower Extremity Injury at a Tertiary Referral Hospital in Sub-Saharan Africa: Injuries, Treatments and Outcomes

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.958 ◽

2012 ◽

Vol 172 (2) ◽

pp. 347

Author(s):

J.A. Tomlinson ◽

T.E. Chilunjika ◽

A.G. Charles ◽

S. Young ◽

M.C. Hosseinipour ◽

...

Keyword(s):

Lower Extremity ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Sub Saharan

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Rehabilitation of Individuals With Schizophrenia: a Scoping Review Protocol of Evidence From Sub-saharan Africa

10.21203/rs.3.rs-45897/v1 ◽

2020 ◽

Author(s):

Oyeyemi Olajumoke Oyelade ◽

Nokuthula Gloria Nkosi-Mafutha

Keyword(s):

Mental Illness ◽

Scoping Review ◽

Psychosocial Rehabilitation ◽

Implementation Strategies ◽

Implementation Process ◽

Principal Investigator ◽

Mental Illnesses ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Independent Decision

Abstract Background: The rehabilitation of an individual with mental illness is an evidenced-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising value for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map articles on how rehabilitation is conducted for people living with the most chronic form of mental illness, schizophrenia, in Africa.Methods: This study will adopt the Arsey and O’Malley scoping review framework to search and compile relevant articles. This process will involve three steps: title screening, which will be performed solely by the principal investigator, followed by abstract and full-text screening, which will be performed independently by two reviewers (the principal investigator and co-investigator). The data charting form will be used by both reviewers for screening, while Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records. The quality of articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT), and content analysis of the screened articles will be performed with NVivo.Discussion: This study has the likelihood of revealing a research gap in rehabilitation approaches and methods. The results of the review will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Saharan Africa. The implementation process also encompasses the dissemination of the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.

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