KNOWLEDGE, ATTITUDES AND PRACTICE AMONG HEALTHCARE WORKERS TOWARDS COVID 19 PREVENTIVE MEASURES AT WOMEN AND NEW BORN HOSPITAL OF THE UNIVERSITY TEACHING HOSPITALS IN LUSAKA ZAMBIA

Objective: To assess the knowledge, attitude and Practices among healthcare workers towards covid 19 preventive measures at Women and New-born Hospital of the University Teaching Hospitals in Lusaka. Methods: Cross-sectional study conducted at WNH-UTH, Lusaka. Convenient sample of 264 frontline healthcare workers responded to self-administered questionnaire to determine their knowledge, attitudes and practices on COVID 19 preventive measures. Results: Majority (31.9%) of the respondents were aged 25 : 29 years. The study revealed that 63.4% had a good knowledge, 60.3% had positive attitudes and 59.9% had a good practice. Attitude was positively related with practice (r = 0.524, p < 0.001) and knowledge (r = 0.469; p < 0.001). Further, knowledge was positively correlated with practice (r = 0.51; p < 0.001). Bivariate analysis results showed that only high knowledge score (75.6%; p < 0.001) and high attitude score (77.6%; p < 0.001) was associated with an increase in good practice among healthcare workers towards Covid 19 preventive measures. Conclusion: The study showed the need for continued assessment of Knowledge Attitude and Practice among healthcare workers towards Covid 19 preventive measures. It further showed the need of designing interventions aimed at encouraging sustained compliance to preventive measures among healthcare workers to prevent COVID 19 transmission.

CHALLENGES FACED BY PHYSIOTHERAPY PRACTITIONERS AND PATIENTS REGARDING CONTINUITY OF CARE AT THE UNIVERSITY TEACHING HOSPITALS LUSAKA, ZAMBIA.

Continuity of care is a fundamental dimension of quality of care and patient satisfaction, because it leads to quality and coordinated health care delivery, increased patient trust and condence. To explore the challenges that patients and Physiotherapy practitioners face regarding continuity of care at the University Teaching Hospitals in Lusaka, Zambia. The study employed a phenomenological qualitative design, using in-depth interviews with eight physiotherapy practitioners and six patients with varying medical conditions, aged 18 years and above. This study used a purposive sampling technique based on the researcher’s judgment of the subjects. This is a form of non-probability sampling in which decisions concerning the individuals to be included in the sample were taken by the researcher, based upon a variety of criteria, including specialist knowledge of the research issue, or capacity and willingness to participate in the research. All patients reported having multiple Physiotherapy service providers, which sometimes led to uncoordinated treatment sessions. In addition, ve out of six patients cited the high cost of transport fares from their homes to the hospital and work schedules clashing with hospital appointments as most critical factors that led to discontinuity in physiotherapy care. On the other hand, physiotherapy practitioners reported difculties following up on the progress of patients due to the functional design of the Physiotherapy department which requires them to operate from both the passive and active areas of the department. High physiotherapy practitioners’ turnover per patient, long distance from patients’ homes to the hospital as well as the physical demarcation of the department of Physiotherapy into active and passive treatment areas hinder continuity of care at the University Teaching Hospitals.

Partial upper median sternotomy for anterior aortopexy for innominate artery compression syndrome: Our preferred technique.

Objectives: Innominate artery compression syndrome (IAS) is caused by an anterior compression of the trachea by an abnormally originating innominate artery. One option to relieve such a compression is an anterior aortopexy (AA). In this paper we describe our technique of an AA via a partial upper median sternotomy. Methods: A retrospective review of a prospectively maintained database of patients with IAS (July 2017 to November 2020) treated with AA via a partial upper median sternotomy at University teaching hospitals in the US was done. Results: Nine consecutive patients underwent AA for IAS during the study period. The median age was 9 months (IQR 3- 16.5). The male to female ratio was 1.25. All patients had > 70% compression by flexible bronchoscopy. 2 patients had previous surgeries. The follow-up was a median of 6 (IQR 4- 8.5) months. The indications for the operation were: reflex apnea (4/9 patients), recurrent intubation (4/9 patients), and severe stridor (1/9). IAS was a technical success (defined as ≤ 20 % residual stenosis) in 78 % (7/9) of the patients. Complete symptom resolution after an AA was seen in 71% (5/7) of the patients. 2 patients had an unsuccessful AA, requiring a tracheal resection and an innominate artery reimplantation, respectively. Conclusion: An upper partial sternotomy approach provides a very versatile approach to an AA for IAS. Besides facilitating an adequate AA, it provides options for direct tracheal surgery or an innominate artery reimplantation in case an optimal result is not obtained by an AA.

Patients’ Attitudes Towards Involvement of Medical Students in Their Care at Three Selected University Teaching Hospitals in Uganda: A Cross Sectional Study

BackgroundThe acceptance of medical students by patients during care is important and promotes appropriate clinical reasoning, competence and skills development among students. The attitudes and comfort of patients attending care at the medical and obstetrics/gynecology specialties was studied in teaching hospitals of three public universities in Uganda.MethodsThis was cross sectional study conducted among patients getting care at teaching hospitals for three public universities; of Mbarara University of Science and Technology (MUST), Makerere and Gulu Universities. Logistical regression was used to determine the magnitude of associations between independent and dependent variables. Two-sided p<0.05 was considered statistically significant.Results855 patients participated in the study. Majority (54%, n=460) were aged 18 — 39 years, female (81%, n=696) and married (67%, n=567). Seventy percent (n=599) of participants could recognize and differentiate medical students from qualified physicians, and had ever had involvement of medical students (65%, n=554) during earlier consultations. Regarding attitudes of patients towards presence of medical students during their consultations, most participants (96%; n=818) considered their involvement in patients’ care as an essential ingredient of training of future doctors/ health professionals. Most participants prefer the training of medical students to take place in the tertiary public hospitals (80%; n=683). Participants who were single/never married were 68% less likely to recognize and differentiate medical students (aOR = 0.32, 95%CI: 0.22 — 0.53) from other members of the healthcare team ,compared to married participants. Participants with university education had 55% lower odds of being comfortable with presence of medical students during consultation compared to those with primary education (aOR= 0.45, 95%CI: 0.21 — 0.94). Participants from MUST teaching hospital had 2-fold higher odds of being comfortable with presence of medical students compared to participants from Mak teaching hospitals (aOR = 2.01; 95%CI: 1.20 — 3.39).ConclusionPatients are generally comfortable with medical students’ involvement in their care; they prefer to seek care in hospitals where medical students contribute to their care. There is a need for disseminating clear messages to the public regarding the presence and roles of medical students in the university teaching hospitals in order to promote and inform patients’ autonomy and informed decisions.

Medication omissions in the first 48 hours after admission: failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children’s Hospital in Lusaka, Zambia

Background: The first few days of in-patient care are possibly the most significant in a patient’s recovery and any omitted medications during this period may harm the patient or increase their hospital length of stay. Therefore, our study aimed at assessing the frequency of medication administration omission errors and their reasons for the omission in the paediatric wards after admission at University Teaching Children’s Hospital.Methods: This was a descriptive study in which 259 patient files and drug charts were reviewed. Admission prescription charts were studied in detail over a period of four weeks and all drugs prescribed but then not given in the first 48 hours were recorded as omitted medications, along with the reason given for their omission.Results: From the 259 drug charts, a total of 1598 doses of drugs were ordered within 48 hours of admission. However, from this, only a total of 1132 doses were administered with the remaining 466 doses omitted, which accounted for a frequency of 29.2%. When the frequency of medication omission errors was compared, parenteral drugs (70.8% vs. 25.3%, [p=0.0001]), afternoon shift (48.5% vs. 15.8%, [p=0.0001]), and anti-infective medications (69.1% vs. 39.4%, [p=0.0001]) were found to be the most frequently omitted medications. There were also considerably more medication omissions in patients prescribed with more medications (median number: 4, I QR [2, 6] vs. median number: 2, IQR [2, 4], [p=0. 0.001]). The most common reason for the omission was medication unavailability (89.3%), followed by work overload (71.4%), and the patient is off the ward (71.4%).Conclusions: This study revealed that medication omissions are a continuing problem and this may result in increased morbidity and mortality rates. There is a need to put in place specific strategies to reduce this problem.

Suspected Down Syndrome in one of non-identical twins in Ile-Ife: A case report

Nigerian women of southwest extraction have the highest rate of dizygotic twinning worldwide, with a reported incidence as high as 49 per 1000 deliveries. Among the risk factors for dizygotic twinning is advanced maternal age, which is also an independent risk factor for Down syndrome (trisomy 21). Down syndrome is the most common chromosomal disorder affecting live born neonates. It occurs very rarely in twins, seen in 14-15 per million non-identical twins. Down syndrome in one of non-identical twins was first reported in Nigeria by Otaigbe in Port Harcourt, in 2007. Herein, we report another case of suspected Down syndrome in one of non-identical twins born to a 41-year-old grand multiparous woman at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun state, Nigeria. Keywords: Down Syndrome; dizygotic; fraternal; dichorionic; diamniotic.

Fertility-preserving Management of Cervical Ectopic Pregnancy in a Nigerian Teaching Hospital

Cervical Ectopic Pregnancies (CEPs) are commonly associated with adverse outcomes due to diagnostic and treatment challenges. This report describes the successful management of an initially misdiagnosed CEP. A 30-year-old G4P2+1(Alive 2) presented to the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, with vaginal bleeding following 11 weeks amenorrhea. The patient was haemodynamically stable, with minimal bleeding per vaginam, and ultrasonography had previously diagnosed complete miscarriage. However, transvaginal ultrasonography demonstrated classical hour-glass uterus. The ballooned cervix contained a gestational sac and foetal node without cardiac activity. The patient was managed with a single dose of intramuscular methotrexate injection. Her serum B-HCG concentration declined from 460.8mIU/ml at presentation to <5mIU/ml on the 10th day post-methotrexate injection, with a complete clinical and ultrasonographic resolution of the features. A high index of suspicion and appropriate ultrasonographic skills are necessary for prompt diagnosis of a CEP. Medical management could minimise the risk of intractable haemorrhage and hysterectomy.

1385 “Pre-Op Fasting Times Audit in Colorectal Surgery at A University Teaching Hospital”

Aim Hull University teaching hospitals NHS trust has guidelines for patient fasting times prior to major elective surgery. We aimed to assess the compliance of pre-op fasting times for patients undergoing elective colorectal surgery. Method An initial and later re-audit was undertaken, prospectively, of 20 consecutive patients admitted for elective colorectal surgery at Castle Hill Hospital. Data was collected on a structured proforma and was completed following patient’s interview, ORMIS (operation room system) and Lorenzo (hospital intranet). Results Initial audit demonstrated 10% (2 out of 20) and 5% (1 out of 20) compliance with liquid and solid fasting times, respectively. Following implementation of changes, re-audit demonstrated 60% (12 out of 20) and 0% (0 out of 20) compliance with liquid and solid fasting times respectively Conclusions We concluded that liquid fasting times can be improved further by communication between theatre staff and ward. Whilst solid fasting times can be improved but at an expense of losing a theatre space. A further re-audit [planned in a month period.

Obstructed labour in a Nigerian tertiary health facility: a mixed-method study

Background: Obstructed labour remains a leading cause of maternal and perinatal mortality and morbidity in sub-Saharan Africa. This study aimed to determine the incidence, causes, complications and outcomes of obstructed labour at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria.Methods: A mixed methods approach was employed for this study. A 10-year retrospective review of all cases of obstructed labour managed at the OAUTHC, between January 1, 2008, and December 31, 2017, was done. Ten in-depth interviews were conducted for some selected patients. The quantitative data was analysed using SPSS version 24, while the qualitative data was analyzed with NVivo version 12.Results: The incidence of obstructed labour was 1.99%. Most of the patients were unbooked (217, 90.4%), primigravid (138, 57.5%), and either had no formal or only primary/secondary education (120, 50%). Cephalopelvic disproportion (CPD) was the commonest cause of obstructed labour (227, 94.6%). The most common maternal complication was wound infection (48, 20%). There were three maternal deaths, giving a case fatality rate of 1.25%. The most common foetal complication was birth asphyxia (85, 34.7%). The perinatal mortality rate was 18.8 %. From the qualitative arm of the study, reasons given by parturients who suffered obstructed labour, for avoiding hospitals for delivery, included religion, finance, fear of hospitals, faith/belief in mission homes/maternity houses, and proximity.Conclusions: Obstructed labour remains an important obstetric problem in our environment, contributing significantly to the burden of maternal and perinatal mortality and morbidity.