Morbidity profile of admissions to GF Jooste Hospital; Manenberg; Cape Town

BackgroundSecondary hospitals play an important; yet overlooked; role in reflecting public health status; both locally and nationally. Relatively few reports analysing the causes of secondary hospital admissions exist; which is especially unfortunate in the case of developing countries; considering the huge numbers of admissions and people at risk. In developing countries like South Africa; the quality of records varies among institutions. Some hospitals have computerised data; while others may keep no records whatsoever. A major problem facing the quality of hospital records is the constant shortage of staff in rural and urban hospitals. Thorough documentation is essential in providing an invaluable database for researchers; but morbidity statistics are unfortunately scarce.GF Jooste Hospital in Manenberg is the busiest hospital in Cape Town - serving 1.1 million people; with 224 beds and over 12 000 admissions annually. Budgetary constraints in the South African public health sector means that providing healthcare services at higher levels than necessary is too costly. Because hospitals consume the largest share of the public healthcare budget; they have been the focus in cost cutting. In particular; the budgets of referral (tertiary or teaching) hospitals have been trimmed in order to promote primary and secondary care. It is imperative to identify those services that are required most at secondary hospitals in order to improve budgeting and; more appropriately; train doctors and medical students for the job at hand. Identifying the morbidity profile of the population for which the hospital caters can aid the optimal utilisation of the available resources; as well as focusing the continuing medical education of hospital physicians. We determined disease patterns of admissions over a three-year period (2001-2003); primarily as insight towards optimal hospital resource management.MethodsA retrospective study examined ward records; totalling 36 657 admissions; from which a random sample (N=608) was selected. A stratified sample (N=462) was constructed; considering the relative proportions admitted to the wards. The International Statistical Classification of Diseases (ICD) directed diagnosis sorting. Disease prevalence was expressed as the percentage of patients allocated to each ICD category among those admitted to the hospital and respective wards and; additionally; the percentage of diagnoses for each ICD subcategory among patients assigned to each major category.ResultsTrauma (represented by ICD categories S/T 23and V/X/Y 16); specifically assault-related; was most prevalent. This was followed by circulatory diseases (22) and infectious diseases (19); dominated by HIV (61) and associated diseases like TB (57). The age of the patients ranged from 13 to 87 (mean: 40 years); with the 20 to 30-year-olds predominating. Surgical patients were younger (mean: 35 years) than medical (mean: 45 years). In the medical wards; infectious (39in men; 38in women) and circulatory aetiologies (39and 41in men and women respectively) dominated. In the surgical wards; the trend varied according to sex: assault (43) and other injuries (61) for males; pregnancy-related (42) for females. ConclusionThe morbidity distribution reflects the ills affecting South African urban society; with young trauma admissions predominating. The hospital's budget is insufficient; considering its population's demands

Finger nail plate shape and size for personal identification­a possible low technology method for the developing world-Preliminary report

There is much documented information on abnormal fingernail shapes- acquired or congenital. There is a dearth of information on the shapes of the clinically healthy fingernail in medical textbooks and scientific journals. A study was carried out to determine the possible shapes of the healthy fingernails and the prevalence of each shape in the locality, i.e. in Ibadan, south-western Nigeria and to consider if there would be enough diversity in the shapes and sizes and their distribution on the different fingers to merit consideration for personal identification. The population included 496 consenting individuals, four family units and four sets of monozygotic twins. The latter two population samples were studied to assess the combinations possible within families and in monozygotic twins. Seven gross fingernail shapes were identified in the study population. Examination showed variations within members of the families i.e. no two members had identical shapes in the pair of hands. Examination of 4 sets of identical twins showed no difference in the shapes and sizes of the fingernails on each finger. It would appear that the finger nail plate shapes /sizes of the hands show diversities similar to finger prints and therefore can be considered and developed further for personal identification in developing countries such as Africa

Why is charting necessary?

Charting information becomes an indication of the quality of care a nurse is giving. A simple model started by Dr L. Weed referred to as SOAP is given as an example that could be adopted in Malawi

Growth monitoring and nutrition: a manual for health workers in Malawi

This manual is designed to help health workers develop and utilize growth charts and to give effective nutrition education presentations to mothers

An investigation to identify ways in which primary care records can be used more effectively as a source of data on the Harare urban health centres

Nursing records in the Harare City primary health care centres are not effective as a source of data for continuity of nursing care in that; information on client management is only recorded on the card which the client takes home. The nurses therefore; remain with no information on how the client was managed. The study was undertaken to identify ways in which client records kept at the health centre could be made more effective as a source of data. The study findings indicated that 48;4pc of the newly employed nurses in the Harare City health centres were not receiving formal orientation on records management. The major findings of the study were that there was no format in the heath centres on which the nurses could base their history taking by neglecting the psycho-social aspects of the client and absence of recording clients' management in the health centres which inhibited continuity of care. The recommendations from the study suggest that there should be a duplicate card at the health centre for each client; which is updated on each visit; that the client's heatlh record card should be structured to include family history; psycho-social data; clients managements and recommended follow up care