The magnitude of perinatal mortality rate and associated risk factors among deliveries at Dilla University Referral Hospital, Southern Ethiopia: A case-control study

The perinatal mortality rate is the sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration. In Ethiopia, the death rate was 33 deaths/1000 total births in 2016. We aimed to identify the perinatal mortality rate and associated risk factors among deliveries in Dilla University Referral Hospital; January, 2016 - December, 2018. A hospital based retrospective case-control study was conducted using subgroup binary logistic regression analysis including 138 cases and 296 control group. The proportion of hospital perinatal deaths was 30% with 90% of the deaths were occurred as a result of stillbirths and antepartum hemorrhage. Adjusted odds ratios revealed that history of still birth, very low birth weight, short interval and nonuse of partograph found to be independent predictors of both stillbirths and early neonatal deaths besides to pregnancy induced hypertension and antepartum hemorrhage. The risk of perinatal mortality may be increased by not treating chronic illnesses, obstetrics complications and risk factors causing low birth weight as well as short birth intervals and not using partograph during labour.

Attitude of the first year medical students towards medicine as career: Motivations and apprehensions of being a doctor

The choice of a career as a doctor is a complex personal decision influenced by a multitude of factors. These include family background, role models, media, and personal experiences. The present study was done with the objectives to know the reasons for first-year medical students for joining MBBS and their apprehensions. A cross-sectional study carried out among first-year students of batch 2018, 2019, and 2020 of a Medical College of North India. The data was collected within 10 days of admission in MBBS. A total of 278 students were given pre-designed and pre-validated questionnaire after informed consent. Out of multiple reasons for being doctor respect in society was the largest, i.e. 83%, while 72% joined because of high earning by the doctor. More than 80% had a professional image of the doctor as a calm, helping and well-groomed person, while 60% thought doctors don’t listen properly, and 57% had a perception that doctors are not much concerned about the problems of patient. Sixtyeight percent (68%) thought media doesn’t portray a good image of doctors. According to students outrage in the community and lack of trust for doctors were the major reasons for violence against doctors. Munnabhai MBBS, Anand and Patch Adams, Sanjeevani and House MD were the movies and series motivated most students to be a doctor. Respect in society was the prime motivator to be a doctor among students still they feel media doesn’t justify the image of doctors. Movies and television series can be used to keep the students high in morale and excitement.

Computed tomography severity scoring of COVID 19 infected young patients: Is the second wave affecting the young lungs more than the first wave in India?

We evaluated the High Resolution Computed Tomography (HRCT) findings in young patients (< 40 years) infected with the COVID 19 virus and tried to find out any difference in the severity of lung involvement between the first and second wave of the pandemic and whether the notion of young population being more severely affected by the second wave holds true.Two-hundred (200) young patients (<40 years) with RT PCR documented COVID infections undergoing HRCT chest at our institute were included. Group A included young patients infected in the first wave (up to 28 February 2021) while Group B included patients beyond this date. Demographic and clinical data was obtained from the medical records department. HRCT scans were retrieved from the archive and were assessed by two radiologists or CT severity scoring. The mean severity scores were calculated and any statistical difference between Group A and B was sought. CT scans of four fully vaccinated patients were also evaluated.The age and gender distribution among the two groups was comparable. A greater number of patients in group B required hospital admission compared to group A (74% VS 53%). In group A, the mean severity score was 10.1±2.1 with 34 patients (34%) in mild category, 46 patients (46%) in moderate group and 20 patients (20%) in the severe group. In group B, the mean CT severity score was 12.6±2.3 with 20 patients (20%) in mild category, 42 patients (42%) in moderate group and 38 patients (38%) in the severe group.Lung involvement in young patients in the second wave is more severe requiring more hospital admissions. Vaccinated population may well have a milder form of the disease.

Health service delivery for type 1 diabetes during the lockdown in Uganda following the coronavirus disease 2019 pandemic

Lockdown measures to reduce the spread of coronavirus disease 2019 (COVID-19), may adversely impact on diabetes supplies and metabolic control, especially in type 1 diabetes in low-resource countries. To address this, we conceptualized a service delivery model that incorporated a digitized tool. The digitized tool (UT1D-HIMAS) maintained electronic health records, monitored clinic supplies, patient clinic visits and admissions, and sent automated SMS messages. Delivery of supplies was by motor vehicles, motorcycles, bicycles or patients/caregivers walking to clinics. Metabolic control was assessed by glycated haemoglobin (HbA1c). Monitoring of clinic supplies including emergency restocking, patient clinic visits and admissions, and sending automated SMS by UT1D-HIMAS were successfully achieved. A fall in clinic visits, reaching a nadir (67.9%) in May 2020 was observed. HbA1c (mean ± SD mmol/mol) significantly (p= 0.040) worsened from 79.1 ± 26.8 to 94.9 ± 39.2 and (p=0.002) from 67.1 ± 22.7 to 84.8 ± 39.4 in the rural and urban clinic respectively. The digitized health information system exhibited high practicability in tracking stocks, clinic visits and hospitalisation but failed to improve metabolic control.

COVID-19 pandemic and management on hospital length of stay: A review

COVID-19 virus is a serious threat to public health everywhere on the planet. The World Health Organization (WHO) declared the disease epidemic in December 2019 because of its rapid prevalence around the world. The disease is transferred by inhalation or contact with contaminated droplets, and the incubation period varies from 2 to 14 days. COVID-19 has led to unprecedented pressures as demand for healthcare in hospitals and intensive care units around the world increases. As the epidemic intensifies, determining the resulting needs for health care resources (beds, staff, equipment) has become a priority for many countries. Predicting future demand requires estimating how long COVID-19 patients must have access to different levels of hospital care. The length of hospitalization for these patients is one of the management priorities. It is possible to pass through the crisis only with careful planning and comprehensive cooperation.

Barriers to dietary modifications for people living with type 2 diabetes in a rural indigenous Guatemalan community

In Guatemala, the prevalence of diabetes continues to increase with a disproportionate burden falling on indigenous rural communities. In this study, we assessed barriers to making dietary modifications for people living with type 2 diabetes in a rural indigenous Guatemalan population. Structed interviews (n=32) were conducted with participants selected from a convenience sample of adults with type 2 diabetes living in villages in and around San Lucas Tolimán, Guatemala. Frequencies were calculated for closed-ended questions and content analysis was used to evaluate open-ended questions. Most participants (81%) were women with low-levels of formal education and average daily food expenditure of just over $1 USD. The majority of participants were able to identify foods important in a diabetic diet, however, with significant barriers to making dietary modifications. Commonly cited perceived barriers included high costs of food due to travel and storage, inadequate local access to fresh fruits and vegetables and incompatibility with traditional diet. Several structural and cultural barriers exist to prevent dietary modifications for people living with type 2 diabetes in this rural indigenous population.

Menisco-ligamentous injuries of knee joint: Can ultrasonography serve as an effective screening modality?

The aim is to calculate sensitivity, specificity and diagnostic accuracy of Ultrasonography (USG) as a screening modality in evaluation of Menisco- Ligamentous injuries of knee joint with Magnetic Resonance Imaging (MRI)as gold standard for comparison.Patients with clinically suspected Menisco-Ligamentous injurieswere evaluated by USG initially followed by MRI on the same day. A total of 60 patients (50 males, 10 females) underwent USG and MRI. USG was done using high frequency probe (9-14 Hz) and all the injuries noted. USG of the normal knee was done for comparison. MRI with trauma protocol sequences was done on the same day. The accuracy of USG and MRI in diagnosis of menisco-ligamentous injuries was compared. Majority of the patients (50%) belonged to age group of 21-40 years. Most common injuries seen were medial meniscal tear followed by medial collateral ligament injury. The strength of agreement between USG and MRI was good with Diagnostic accuracy of USG ranging from 83.3% to 95% for different meniscal/ligamentous injuries.USG is an effective imaging modality with high accuracy in diagnosing menisco-ligamentous injuries. USG can act as an effective screening modality in closed knee trauma for evaluation of menisco- ligamentous injuries especially in resource constrained regions owing to its easy availability, portability and lower cost. MRI can be reserved for patients with suspicious USG and clinical findings.

Patient perceived quality of nursing care in hemodialysis: A meta-synthesis

This study was done with the purpose of clarifying the concept of patient perceived quality of nursing care in hemodialysis. In this meta-synthesis study, qualitative studies was searched in the four interntional databases from January 1st, 2000 to December 30th, 2019. The keywords used were: nursing care quality, and hemodialysis. Studies which had been done with the purpose of understanding the patient perceived quality of nursing care concept aomg hemodialysis patients were included. Two researchers were evaluate the quality of included studies separately using JBI tool, required information were extracted using the designed table. The main themes in the structure dimension include Sufficient Human resource, quality of equipment, financial support from patient and quality of the patient care environment. Process dimension consisted of continuous monitoring of the syndromes, effective patient education, efficient care, effective therapeutic relationship, and patient’s empowerment and participation in the process, and in the outcome dimension included high dialysis adequecy, patient burnout reduction, and increased patient satisfaction from services. The results of the study indicated a comprehensive, deep and interactive dimensions about the concept of nursing quality of care.

Economic contestation over user fees in low-resourced healthcare systems: A literature review

This paper reviewed the literature on economic theory and assumptions that provide the rationale for using a price system to finance health care services in developing countries. The primary case in favor of a system of user fees for financing healthcare in these countries lies in allocative efficiency results to be achieved through a price system. The assumption being that, the price system signals to consumers what they must pay for health care services hence giving them an incentive to utilize those services well. However, this assumes perfect markets, where prices reflect the true marginal benefits of consuming healthcare goods and the marginal cost of their production. All equity concerns being addressed through price discrimination, a system of user fees can then allocate health care resources efficiently. Although the application of user fees in the health sector is justified by the perfect markets, there are concerns that a perfect market is less likely to be the case in health sector. Therefore, it will not be a viable way to rely on the price system to allocate resources to the population when markets of any healthcare goods and services are not available or are imperfect. Information asymmetry and uncertainty are the major obstacles to a proper function of a price system in healthcare service provision. Due to the inelastic nature of the demand for healthcare, charging fees for healthcare services can pose hard financial catastrophes to poor and lead into poverty. This suggests the need to establish healthfinancing policies that would facilitate the creation of new markets or which can improve the performance of existing ones in developing countries.

Breaking the bottle neck to enhance pediatrics renal transplantation at Soba university hospital: Role of a non-governmental organization

High cost and limited resources of pediatrics renal transplant in low-resource countries limits the number of transplants. However, the collaboration between government and community sector provided high quality care for these patients. Here we highlight the impact of a non-governmental organization in facilitating pediatrics renal transplant. Data was collected from files of all pediatric patients withend stage renal disease who received renal transplant between January 2010 and December 2017 at Soba University Hospital (77 patients). The 8-year period was divided into 16 intervals of 6 months each. The number of patients who received renal transplant ranged from 1 to 12 patients in each interval. There was a rise in 2017 when 21 (28.7%) patients received kidney transplant. In the last 6 months in 2017 there was a significant reduction in duration of hospital stay compared to the rest of the period; it dropped from 16.36 to 9.92 days (P=0.003). Partnership between governmental and non-governmental sectors is a good strategy in low resource area to bridge some of the gaps of healthcare delivery system.