Antimicrobial Resistance of Neisseria gonorrhoeae Isolated from Out Patients Presenting with Urethral and Vaginal Discharges at Mbarara Regional Referral Hospital

Background: Gonococcus is one of the most common sexually transmitted diseases in developing countries and it has become a global health burden, hence a need for effective treatment. However, there is growing trend of antimicrobial resistant strains, in many parts of the world, to the previously effective antimicrobials thus creating serious health concerns. Setting: Mbarara Regional Referral Hospital -South-Western Uganda. Objectives: 1) To determine the prevalence of gonococcus among out patients presenting with urethral and vaginal discharges at MRRH. 2) To determine the level of antimicrobial resistance of gonococcus based on phenotypic methods at MRRH. Design: The study was cross sectional and enrolled 189 participants presenting with urethral and vaginal discharges. The urethral and endo cervical swab samples collected were cultured on Chocolate media supplemented with 5%-10% carbondioxide in candle jar (inoculated plates were placed in a jar and a burning candle placed in the same jar, then closed, by the time the candle went off, that 5%-10% carbondioxide atmosphere would have been created). Isolates obtained were identified according to the laboratory standard operating procedures. Drug Sensitivity Test (DST) on confirmed Neisseria gonorrheae isolates was performed using the Kirby Bauer technique. The colonies of the test organism were emulsified in peptone water and then inoculated on prepared sterile chocolate agar and the following discs were applied to it (Ceftriaxone discs (30µg), Erythromycin (15ug), Ciprofloxacin (10ug) and Penicillin (10IU). The plates were incubated at 37°C for 24- 48 hours under 5% carbon dioxide atmospheres. The Zone of inhibition was seen around an antibiotic disc to which the organism was sensitive. Results: Out of the 189 participants whose urethral swabs and Endo cervical swabs were cultured, 89 were positive cultures (47%), out of which 25 (28%) were found to have gonococcal infection, 64 (72%) patients had other micro-organisms. The prevalence of Neisseria Gonorrhoeae was 13%. In total, 4% of the isolates were resistant to Ceftriaxone, 28% to Ciprofloxacin, 68% to Erythromycin and 80% to Penicillin. A high percentage of resistance was observed against Penicillin (80%) and Erythromycin (68%). Conclusion: Adults aged 18 years and above who present at Mbarara Regional Referral Hospital with urethral or vaginal discharges are more likely to have a Neisseria gonorrhoeae which is resistant to Penicillin and Erythromycin.

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Prevalence of urogenital, anal, and pharyngeal infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium: a cross-sectional study in Reunion island

BMC Infectious Diseases ◽

10.1186/s12879-021-05801-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

A. Calas ◽

N. Zemali ◽

G. Camuset ◽

J. Jaubert ◽

R. Manaquin ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Mycoplasma Genitalium ◽

Cross Sectional Study ◽

Sectional Study ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Urogenital Infection ◽

High Prevalence

Abstract Background Recommendations for sexually transmitted infection (STI) screening vary significantly across countries. This study evaluated the prevalence of urogenital and extragenital infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG) in patients visiting a French STI clinic in the Indian Ocean region to determine whether current STI screening practices should be updated. Methods This cross-sectional study examined all patients who visited the STI clinic between 2014 and 2015. Triplex polymerase chain reaction screening for CT, NG, and MG was performed on urine, vaginal, pharyngeal, and anal specimens (FTD Urethritis Basic Kit, Fast Track Diagnostics, Luxembourg). Results Of the 851 patients enrolled in the study, 367 were women (367/851, 43.2%) and 484 were men (484/851, 56.0%). Overall, 826 urogenital specimens (826/851, 97.1%), 606 pharyngeal specimens (606/851, 71.2%), and 127 anal specimens (127/851, 14.9%) were taken from enrolled patients. The prevalence of urogenital CT and MG was high in women ≤25 years (19/186, 10.21%; 5/186, 2.69%) and in men who have sex with women ≤30 years (16/212, 7.54%; 5/212, 2.36%). Among patients with urogenital CT infection, 13.7% (7/51) had urethritis. All patients with urogenital MG infection were asymptomatic. Men who have sex with men had a high prevalence of pharyngeal CT (2/45, 4.44%) and NG (3/44, 6.81%) and a high prevalence of anal CT (2/27, 7.41%), NG (2/27, 7.40%), and MG (1/27, 3.70%). After excluding patients with concomitant urogenital infection, extragenital infections with at least 1 of the 3 pathogens were found in 20 swabs (20/91, 21.9%) taken from 16 patients (16/81, 19.7%), all of them asymptomatic. Conclusions Routine multisite screening for CT, NG, and MG should be performed to mitigate the transmission of STIs in high-risk sexually active populations.

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Non-Proteinuric Preeclampsia: Prevalence, Factors Associated and End-Organ Dysfunction at Mbarara Regional Referral Hospital in Southwestern Uganda

10.21203/rs.3.rs-242190/v1 ◽

2021 ◽

Author(s):

Asiphas Owaraganise ◽

Wasswa GM Ssalongo ◽

Leevan Tibaijuka ◽

Musa Kayondo ◽

Godfrey Twesigomwe ◽

...

Keyword(s):

Organ Dysfunction ◽

Complete Blood Count ◽

Referral Hospital ◽

Chronic Hypertension ◽

Care Providers ◽

Cross Sectional ◽

Regional Referral Hospital ◽

Pregnancy Hypertension ◽

Factors Associated ◽

Significant Difference

Abstract Background: Formerly, preeclampsia was only diagnosed if high blood pressure and proteinuria were present in a gravid woman at or past 20 gestation weeks. Although it is possible to have preeclampsia yet never have proteinuria, the literature on how common and factors associated with non-proteinuric preeclampsia as well as whether the frequency of end-organ dysfunction among women with non-proteinuric differs from those with proteinuric pre-eclampsia is scant.Objectives: To determine the prevalence of, factors associated with non-proteinuric preeclampsia, and compare the frequency of end-organ dysfunction between women with non-proteinuric and proteinuric preeclampsia.Methods: Between November 2019 and May 2020, women with pre-eclampsia were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital. We interviewed all pregnant women ≥20 gestation weeks presenting with hypertension ≥140/90mmHg and recorded their socio-demographic, medical, and obstetric characteristics. We excluded women with chronic hypertension and pregnancy hypertension. We measured bedside proteinuria on clean-catch urine, complete blood count, and renal function and liver enzyme tests. Pre-eclampsia was defined as hypertension plus any feature of severity including <100,000 platelets/ul, creatinine >1.1g/dl, and liver transaminases ≥ twice upper normal limit with or without proteinuria. We computed the proportion of total participants with non-proteinuric pre-eclampsia at ≤+2 urine dipstick cut-off, determined the factors associated with non-proteinuric preeclampsia using logistic regression; and used Chi-square test to compare the frequency of end-organ dysfunction between non-proteinuric preeclampsia and proteinuric groups.Results: We enrolled 134 of the screened 136 participants. Their mean age was 26.9 (SD±7.1) years and 51.5% were primigravid. The prevalence of non-proteinuric preeclampsia was 24.6% (95% CI: 17.9-32.7). Primigravidity (aOR 2.70 95%CI:1.09-6.72, p=0.032) was the factor independently associated with non-proteinuric pre-eclampsia. There was a non-significant difference in the frequency of end-organ dysfunction in women with non-proteinuric and proteinuric pre-eclampsia, p=0.309.Conclusion: Non-proteinuric preeclampsia is common, especially among primigravidae. End-organ dysfunction occurs similarly in women with non-proteinuric and proteinuric preeclampsia. Obstetrics care providers should emphasize laboratory testing, beyond proteinuria, among all women with hypertensive disorders of pregnancy to optimally diagnose and manage non-proteinuric preeclampsia.

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Early Malaria Diagnosis and Treatment Seeking Behavior Among Clients Attending Outpatient Department Sekou-Toure Regional Referral Hospital in Mwanza, Tanzania; A Cross-Sectional Study

10.20944/preprints202112.0387.v1 ◽

2021 ◽

Author(s):

Samson Mvandal ◽

Godfrida Marandu

Keyword(s):

Health Facility ◽

Early Treatment ◽

Malaria Diagnosis ◽

Cross Sectional Study ◽

Referral Hospital ◽

Treatment Seeking ◽

Sectional Study ◽

Cross Sectional ◽

Regional Referral Hospital ◽

Seeking Behavior

Early diagnosis of malaria and treatment seeking behavior play key role in controlling and preventing further complication related to malaria disease. Aim of this study was to determine the responses on early malaria diagnosis and treatment seeking behavior among outpatient clients attending at Sekou toure regional referral hospital in Mwanza, Tanzania. Methods: A cross-sectional study was conducted among outpatient client at Sekou-Touré regional referral hospital, convenient simple random sampling used and self-administered questionnaire were used to collect data and data was entered into Microsoft excel and then exported to SPSS version 25.0 for further analysis and presented on the percentages and table. The analysis of strength of relationships between categorical variables was conducted using the Chi-square test. A p-value of ≤ 0.05 was considered to be statistically significant. Results: A total of 192 respondents completed the study with a response rate of 97.6%. The study revealed that Most of the respondents about 90.6% stated they would seek treatment from health facility when symptoms appear. However, only 6.3% seek treatment within 24 hours of onset of illness (p= 0.017). Half of respondents (50.5%) experienced malaria symptoms in the past six months and only 30% seek for treatment at health facility. Preference of health facility, (51%) respondents were going direct to pharmacy to buy medicine for self-treatment. Overall, cost of service, time consumed and distance of health facility especially health center shows significant with such delay. Conclusion: A low proportion of malaria-suspected patients sought treatment within 24 h of fever onset compared to the national target. Distance from the health facility, cost of service and time consumed were found to be predictors of early treatment-seeking behavior for malaria. Strengthening strategies tailored to increasing awareness for communities about malaria, importance of going hospital and early treatment-seeking behavior is essential.

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Post Caesarean Wound sepsis and associated factors among patients attending a rural regional referral hospital in Western Uganda: A cross-sectional study

10.21203/rs.2.24374/v1 ◽

2020 ◽

Author(s):

Ismael Muhumuza ◽

Abdulrahman Zeinul Lavingia ◽

Bekson Tayebwa ◽

Ahmed Abdulhussein Ahmed ◽

Farhiya Mohammed Koriow ◽

...

Keyword(s):

Health Workers ◽

Bacterial Pathogens ◽

Cross Sectional Study ◽

Referral Hospital ◽

Vaginal Examination ◽

Sectional Study ◽

Wound Sepsis ◽

Cross Sectional ◽

Regional Referral Hospital ◽

Antibacterial Susceptibility

Abstract Background : Post-caesarean wound sepsis is among the most common problem for patients who undergo caesarean section. It remains a common and widespread problem contributing to morbidity and mortality; this could be due to an increase in antimicrobial resistance. Determining the burden of wound sepsis and common bacterial pathogens can provide solution to prevent incidence and establish microbiological mapping. Aim: To determine prevalence, identify factors, common bacterial pathogens from post-caesarean wounds and antibacterial susceptibility pattern at Hoima Regional Referral Hospital. Methods : A cross-sectional study was conducted among post-caesarean mothers attending Hoima Regional Referral Hospital. Consecutive enrolment of 303 participants who consented to participate was done. Structured questionnaires were used to collect data on associated factors and wound swabs were done prior to bacterial culture. Antibacterial susceptibility pattern of isolated bacterial pathogens was determined by Kirby Bauer disc diffusion method. Data was analyzed using Stata 14.2. Results : The wound sepsis rate was 16.8%. Being educated, multiple vaginal examination, hygiene, previous caesarean sections and HIV seropositivity were all significantly and positively associated with post-caesarean wound sepsis (p<0.05). The most implicated bacteria was Staphylococcus aureus and was most susceptible to ciprofloxacin. Resistance was most exhibited against ciprofloxacin, gentamycin, ceftriaxone and cotrimoxazole especially by coliforms. Conclusions. The rate of caesarean wound sepsis is high at Hoima Regional Referral Hospital . Being educated, multiple vaginal examination, hygiene, previous caesarean sections and HIV seropositivity are possible risk factors for the condition. Staphylococcus aureus is the commonest organism isolated from exudates of septic wounds after caesarean section. Awareness amongst health workers and patients about these major factors is necessary so that management can be directed. Rational use of antibiotics by health workers is paramount to combat resistance in this setting.

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Nutritional Knowledge and Practice among Patients with Non-communicable Diseases Attending Mbale Regional Referral Hospital in Eastern Uganda: A Cross Sectional Study

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2019/v37i130154 ◽

2019 ◽

pp. 1-11

Author(s):

Esther Nambala ◽

Jayne Byakika-Tusiime ◽

Yahaya Gavamukulya

Keyword(s):

Cross Sectional Study ◽

Nutrition Knowledge ◽

Referral Hospital ◽

P Value ◽

Nutritional Knowledge ◽

Sectional Study ◽

Cross Sectional ◽

Regional Referral Hospital ◽

Adequate Knowledge ◽

Eastern Uganda

Aim: To determine nutritional knowledge and practices among patients with Non-Communicable Diseases (NCD) attending Mbale Regional Referral hospital, in Eastern Uganda. Study Design: A mixed methods cross sectional study design was used. Place and Duration of Study: Mbale Regional Referral Hospital among patients attending the NCD clinic from May to July 2017. Methodology: Two hundred sixty clients were recruited for the study. Quantitative data was collected through structured administered questionnaires. Quantitative data was analyzed at univariate, bivariate and multivariate levels. Chi square test and logistic regression were used to determine the association between nutrition knowledge and utilization. Qualitative data was coded first and summarized according to the themes. Results: The mean age of the respondents was 55 years (SD= 14) and hospital was the main source of nutrition information (n=156, 60%). Most respondents (n=156, 60%) had a high level of nutrition knowledge, however only 48.8% (n=127) were utilizing the knowledge. Those who had attained secondary level of education were 2.308 more likely to utilize the nutrition knowledge than those who had never studied P value of .028, 95CI (1.093-4.874). Those with tertiary education were even 9.261 times more likely to utilize the knowledge P value <.001 95CI (2.721-31.522). Those with adequate knowledge were about 1.6 times most likely to utilize the nutrition knowledge compared to those with inadequate knowledge level, however, with the adjusted odd ratio of 1.573 at 95% CI (0.923- 2.868) the results were not statistically significant (P value .098). Conclusion: NCD patients had adequate knowledge, with a few of them utilizing the knowledge. High education level was associated with better nutrition practices.

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Knowledge and Practices of Post Cesarean Section Mothers Towards Self-Care After Delivery at Mbarara Regional Referral Hospital.

10.51168/sjhrafrica.v2i3.23 ◽

2021 ◽

Author(s):

◽

Solomon Atuhaire

Keyword(s):

Cesarean Section ◽

Self Care ◽

Cross Sectional Study ◽

Study Data ◽

Referral Hospital ◽

Postpartum Woman ◽

Postpartum Women ◽

Microsoft Excel ◽

Cross Sectional ◽

Regional Referral Hospital

ABSTRACT Background: It is recommended to all mothers to undergo post-cesarean section self-care after delivery up to six weeks. However, many mothers return to Mbarara Regional Referral Hospital as a result of getting some complications related to cesarean section. The reasons why these mothers develop these complications are not clear and possible other practices performed by delivered mothers to solve their post-delivery challenges are not yet documented. Methods: The design of this study was a descriptive cross-sectional study design and a semi-structured questionnaire was used to collect quantitative data from the participants. Data were collected from 150 mothers admitted to the Maternity ward of Mbarara Regional Referral Hospital who formed the inclusion criteria and accepted to participate in the study. Data was captured using Microsoft excel and analyzed using Statistical Package for social sciences (SPSS). Results: The response rate in this study was 100%. The knowledge of post-cesarean section self-care among postpartum women at MRRH in Mbarara was poor as the majority of the participants 90(60%) reported to have never heard about Post Cesarean self-care while only 60 (40%) reported having ever heard about Post Cesarean self-care and no postpartum woman was fully aware of all the aspects of PCS and only 26% could talk of more than 2 aspects of the PCS. The findings of the study also revealed that 22% (33) of the postpartum women don't perform PCS at all. This shows a low practice of PCS among postpartum women. Conclusion and recommendations: Generally, in this study, the knowledge of post-cesarean section self-care among postpartum women at MRRH in Mbarara was poor, suggesting that these postpartum women are unaware of the value of this personal health promotion tool.

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Simultaneous Evaluation of Diagnostic Assays for Pharyngeal and Rectal Neisseria gonorrhoeae and Chlamydia trachomatis Using a Master Protocol

Clinical Infectious Diseases ◽

10.1093/cid/ciz1105 ◽

2019 ◽

Cited By ~ 3

Author(s):

Sarah B Doernberg ◽

Lauren Komarow ◽

Thuy Tien T Tran ◽

Zoe Sund ◽

Mark W Pandori ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Reference Method ◽

Likelihood Ratios ◽

Anatomic Site ◽

Transmitted Infection ◽

Cross Sectional ◽

Predictive Values ◽

Sexually Transmitted ◽

Percent Agreement

Abstract Background Pharyngeal and rectal Neisseria gonorrhoeae and Chlamydia trachomatis play important roles in infection and antibacterial resistance transmission, but no US Food and Drug Administration (FDA)–cleared assays for detection at these sites existed prior to this study. The objective was to estimate performance of assays to detect those infections in pharyngeal and rectal specimens to support regulatory submission. Methods We performed a cross-sectional, single-visit study of adults seeking sexually transmitted infection testing at 9 clinics in 7 states. We collected pharyngeal and rectal swabs from participants. The primary outcome was positive and negative percent agreement for detection of N. gonorrhoeae and C. trachomatis for 3 investigational assays compared to a composite reference. Secondary outcomes included positivity as well as positive and negative predictive values and likelihood ratios. Subgroup analyses included outcomes by symptom status and sex. Results A total of 2598 participants (79% male) underwent testing. We observed N. gonorrhoeae positivity of 8.1% in the pharynx and 7.9% in the rectum and C. trachomatis positivity of 2.0% in the pharynx and 8.7% in the rectum. Positive percent agreement ranged from 84.8% to 96.5% for different anatomic site infection combinations, whereas negative percent agreement was 98.8% to 99.6%. Conclusions This study utilized a Master Protocol to generate diagnostic performance data for multiple assays from different manufacturers in a single study population, which ultimately supported first-in-class FDA clearance for extragenital assays. We observed very good positive percent agreement when compared to a composite reference method for the detection of both pharyngeal and rectal N. gonorrhoeae and C. trachomatis. Clinical Trials Registration NCT02870101.

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Delays in diagnosis and treatment of pulmonary tuberculosis in patients seeking care at a regional referral hospital, Uganda: a cross sectional study

BMC Research Notes ◽

10.1186/s13104-019-4616-2 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Winters Muttamba ◽

Samuel Kyobe ◽

Alimah Komuhangi ◽

James Lakony ◽

Esther Buregyeya ◽

...

Keyword(s):

Health Facility ◽

Cross Sectional Study ◽

Patient Delay ◽

Referral Hospital ◽

Cross Sectional Survey ◽

Total Delay ◽

Cross Sectional ◽

Treatment Unit ◽

Regional Referral Hospital ◽

Tb Treatment

Abstract Objective A cross-sectional survey involving 134 pulmonary TB patients started on TB treatment at the TB Treatment Unit of the regional referral hospital was conducted to ascertain the prevalence of individual and health facility delays and associated factors. Prolonged health facility delay was taken as delay of more than 1 week and prolonged patient delay as delay of more than 3 weeks. A logistic regression model was done using STATA version 12 to determine the delays. Results There was a median total delay of 13 weeks and 110 (82.1%) of the respondents had delay of more than 4 weeks. Patient delay was the most frequent and greatest contributor of total delay and exceeded 3 weeks in 95 (71.6%) respondents. At multivariate analysis, factors that influenced delay included poor patient knowledge on TB (adjOR 6.904, 95% CI 1.648–28.921; p = 0.04) and being unemployed (adjOR 3.947, 95% CI 1.382–11.274; p = 0.010) while being female was found protective of delay; adjOR 0.231, 95% CI 0.08–0.67; p = 0.007). Patient delay was the most significant, frequent and greatest contributor to total delay, and factors associated with delay included being unemployed, low knowledge on TB while being female was found protective of delay.

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Prevalence and Antimicrobial Susceptibility Patterns of Neisseria gonorrhoeae among Suspected Patients Attending Private Clinics in Jimma, Ethiopia

International Journal of Microbiology ◽

10.1155/2020/7672024 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Addisu Sahile ◽

Lule Teshager ◽

Minale Fekadie ◽

Mulatu Gashaw

Keyword(s):

Neisseria Gonorrhoeae ◽

Antimicrobial Susceptibility ◽

Cross Sectional Study ◽

Gonococcal Infection ◽

African Countries ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Antimicrobial Susceptibility Pattern ◽

Susceptibility Patterns

Background. In most African countries including Ethiopia, Neisseria gonorrhoeae infections were diagnosed clinically and its antibiotic susceptibility was rarely tested. This study aimed to determine the prevalence and antimicrobial susceptibility patterns of N. gonorrhoeae among suspected patients attending private clinics in Jimma, Ethiopia. Methods. Institution-based cross-sectional study was conducted to determine the prevalence and antimicrobial susceptibility pattern of N. gonorrhoeae isolated from urogenital specimens. Urogenital samples were collected aseptically and then transported using Amie’s transport media and processed in a microbiology laboratory following the standard protocol. Results. Of the total 315 samples examined, 31 (9.8%) were confirmed to have gonococcal infection. Of these, 30 (96.7%) were females. High proportion of culture confirmed cases (18 (12.5%)) were observed in the 20–24 age group. All of the identified organisms were susceptible to ceftriaxone and had high resistance to penicillin (80.6%) and tetracycline (54.8%). Conclusion. The prevalence of gonococcal infection is high. In the current study, participants who have no information about sexually transmitted infection were more likely to be infected by N. gonorrhoeae. According to our study, ciprofloxacin is effective against gonococcal infection.

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PREVALENCE AND FACTORS ASSOCIATED WITH ROUTINE MEDICAL CHECKUP AMONG PATIENTS ATTENDING MASAKA REGIONAL REFERRAL HOSPITAL, UGANDA

International Journal of Advanced Research ◽

10.21474/ijar01/13104 ◽

2021 ◽

Vol 9 (07) ◽

pp. 97-105

Author(s):

Aremu A.B. ◽

◽

Afolabi I.B ◽

Salaam M. Awunor N.S ◽

Sulayman A.A ◽

...

Keyword(s):

Early Death ◽

Well Being ◽

Cross Sectional Study ◽

Health Check ◽

Referral Hospital ◽

Cross Sectional ◽

Regional Referral Hospital ◽

Mortality And Morbidity ◽

Medical Checkup ◽

Early Health

Globally, Routine Medical checkup is known to be a preventive medicine that opens doors for assessment of well-being status of all individual and decreases the mortality and morbidity of different ailments in communities. attending health checkups may be one of the key reasons of controlling the predisposition and cause of much of the illness, suffering and early death related to chronic illnesses and condition. Its on this ground that this current study sought to elucidate further on factors determining the adherence of people to medical checkups. A descriptive cross-sectional study was carried out among 385 adult respondents attending Masaka regional referral hospital, in Uganda. A structured questionnaire involving open-ended and close-ended questionnaire was used and data was analyzed using SPSS version 26. Overall, 61.3% of study participants have ever heard of routine health check-ups citing hospitals (25.7%) as the most used source of the information. A prevalence of 43.4% represents the percentage of those who do routine health check-up and of which majority engage in only a general examination (14.5%). Overall, more than half of the respondents (56.6%) have never participated in routine health check-ups with their reported reasons of not feeling sick (25.97%). Factors like level of education, Employment, Occupational, exercise practices and level of awareness was statistically significant to uptake of routine heath checkup among the respondent at P< (0.005). Low health check-up rates may translate into inability to detect and intervene with early health challenges among respondents, and this is whereeffort is needed in ensuring that routine health check-up is encouraged especially during times when patients are healthy. There is need to strengthen government efforts and other concerned NGOs to put across specific sensitization programs about routine health check-ups on different media platforms and also utilize other social public means.

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