linical Audit of Stillbirths at a Faith-Based Secondary Health Centre in Ibadan, Nigeria: A Six-Year Review

Objective:The determine the prevalence of stillbirth and identify associated factors among parturients in a faith-based secondary health centre.Method:This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at the Our Lady of Apostle Catholic Hospital at Oluyoro, OkeOffainIbadan, Nigeria,betweenstst1January2010, and 31December, 2015. Data was extractedfromhospitalrecordsforsociodemographiccharacteristics, obstetricfactors,complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05. Results:The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of still birth rate among the booked and unbooked parturients was 1:21. The commoncausesofstillbirthswerehypertensivedisordersinpregnancy (24.9%), anaemia in pregnancy (20.4%); while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.

Quest to Improve Management of Prostate Cancer in West Africa Development of a Clinical Audit Tool

In 2010 and during the following decade, two guidelines werepublished for the management of prostate cancer in West Africa.A key recommendation of the guidelines was the need for thedevelopment of a Clinical Audit Tool which should helpsurgeons and institutions to identify the gaps between therecommended standards and current practice. In this paper, aClinical Audit Tool, WAPCAT, was developed to facilitate andimplement the audit process for the management of Prostatecancer in a West African healthcare institution

Clinical staff knowledge and awareness of point-of-care-testing best practices at Tygerberg Hospital, South Africa

Background: Point-of-care testing (POCT) is defined as testing done near or at the site of patient care with the goal of providing rapid information and improving patient outcomes. Point-of-care testing has many advantages and some limitations which affect its use and implementation. Objective: The aim of the audit was to determine the current practices, staff attitudes and training provided to hospital clinical staff. Methods: The audit was conducted with the use of a questionnaire containing 30 questions. One hundred and sixty questionnaires were delivered to 55 sites at Tygerberg Academic Hospital in Cape Town, South Africa, from 21 June 2016 to 15 July 2016. A total of 68 questionnaires were completed and returned (42.5% response rate). Results: Most participants were nursing staff (62/68, 91%), and the rest were medical doctors (6/68, 9%). Most participants (66/68, 97%) performed glucose testing, 16/68 (24%) performed blood gas testing and 17/68 (25%) performed urine dipstick testing. Many participants (35/68, 51%) reported having had some formal training in one or more of the tests and 25/68 (37%) reported having never had any formal training in the respective tests. Many participants (46/68, 68%) reported that they never had formal assessment of competency in performing the respective tests. Conclusion: Participants indicated a lack of adequate training in POCT and, thus, limited knowledge of quality control measures. This audit gives an indication of the current state of the POCT programme at a Southand highlights areas where intervention is needed to improve patient care and management

Audit of delayed presentation in breast cancer from a tertiary centre in the Niger Delta, Nigeria

Context: Breast cancer is the most common cause of cancer-related morbidity and mortality in women in developing countries, compounded by delayed presentation. Determining the contemporary reasons for delayed presentation in our environment, is necessary to properly guide enlightenment campaigns, enhance their effectiveness and improve patient survival. Subjects and Methods: A 1-year audit of consecutive histologically-confirmed breast cancer patients presenting to University of Benin Teaching Hospital was done. Socio-demographic data, time to presentation with reasons, stage at presentation were obtained in a proforma and analyzed. Results: 92% of patients had delayed presentation. 270 patients with complete records were included in the study. Mean age of patients was 47.6±11.0years, most were between 40 ­ 49 years (32.2%). Most patients in the study were married (75.6%), of lower class (52.2%) and had tertiary education (55.9%). Delay of 12 ­ 15months occurred most (54.8%) with advanced stage disease (Stages 3/4; 73%). Use of alternative medicine accounted for most of the delay (48.9%) while fear of mastectomy (30.4%), financial (6.7%) and referral problems (6.7%) were other common reasons. Conclusion: Delay in presentation is common in our breast cancer patients. Use of alternative medicine, fear of mastectomy, financial issues were common reasons for delay. There should be proper regulation of alternative medical practice to forestall bogus claims of cancer treatment. More affordable and accessible screening centres, insurance coverage of cancer care, alongside enlightenment about effect of delayed presentation and appropriate cancer care in religious houses, amongst traditional rulers and other custodians of cultural practices are required to help mitigate negative beliefs resulting in delayed presentation

Audit of medical records keeping at a Nigerian geriatric clinic

BACKGROUND: A medical record also known as health chart is the written health information about a patient or clients and is always opened whenever a patient or client visits a health facility. There are different types of medical records and it may be problem based or patient based; paper based or electronic. It enhances continuity of care; source of communication between healthcare professionals, as aides de memoire and it is a legal document. OBJECTIVE: To compare the medical records keeping with reference standards. METHOD: This is a prospective clinical audit, was conducted in a Nigerian Nursing Home for the elderly. The medical record keeping was compared with the generic standards of medicalrecordkeepingofthehealthinformatics Unitof the Royal College of Physicians. Two clinical audit cycles were performed. results: At the first clinical audit cycle only the third standard was 50%, others were zero. At the second clinical audit cycle there was improvement and 100% increase in standard 1, 3, 4 and 5, with 10% increase in standard 2. Paper based medical records are kept at the nursing home. Most of the residents do not know their age as their birth dates was not recorded. There were 30 residents at the nursing home when the clinical audit was conducted. CONCLUSION: Initially, the medical record keeping was below standard but with the clinical audit there was improvement. Clinical audit is important in medical practice in comparing the practice with standards

A five year audit of cases admitted in maxillofacial surgery wards in a Nigerian teaching hospital

Objective: Admissions of Maxillofacial surgery patient's are on the rise. However, search of English literature shows that there has not been any audit on pattern of maxillofacial admission done in any Nigerian hospital. The objective of the study was to review the indications and pattern of maxillofacial surgery admission in a Nigerian Teaching hospital over a 5-year period. Methods: A retrospective review of the pattern of maxillofacial admissions in a Teaching Hospital in North-West Nigeria from January 2011 to December 2015. Sources of information included maxillofacial ward admission records; patients' case files, accident and emergency records and patients discharge registers. Results: One thousand one hundred and thirty (1,130) patients were admitted into the maxillofacial ward during the study period with an overall gender ratio of 1:1.25. 260 patients were admitted as emergencies while 870 patients were admitted on elective basis. Review of treatment given showed that reduction and immobilization/ arthroplasties had the highest frequency (29.38%) while sequestrectomies had the lowest frequency of 0.80%. Conclusion: A progressive increase in the number of admission of patients into maxillofacial surgery wards shows that there is need for advocacy to improve the practice of the specialty in this region in terms of resources allocation and manpower development

An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Objectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth.Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre.Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described.Results: Many patients (32%) booked after 24 weeks' gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0­14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks.Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks' gestation may lower the number of stillbirths

An audit of chemical pathology laboratory investigation request forms received at a private tertiary hospital in Nigeria

Context: Laboratory testing constitutes an integral part of patient management and has an extensive influence on medical decision-making. The completion of laboratory investigation request forms is a vital aspect of the highly variable pre-analytical phase of laboratory testing.Aim: We aimed to assess the adequacy of completion of investigation request forms received at our laboratory.Methods: An audit of systematically selected laboratory investigation request forms received over a six-month period at our laboratory was performed to assess the degree of completion of these forms by requesting clinicians. Data was analysed using Microsoft Excel®.Results: Two hundred and fifty four request forms were reviewed. None of the reviewed forms was adequately completed. The clinician's contact number was missing in all the request forms. About two-thirds of the request forms did not have the patient's hospital number (66.1%) and the referring clinician's signature (66.9%) available on them. The clinical diagnosis of the patient was not stated in 18.9% of the request forms. The patient's name, gender and age were the most frequently completed parameters in 100.0%, 98.4% and 97.2% of the request forms respectively.Conclusion: Basic information required for the accurate interpretation of laboratory results are missing in several request forms. This may have deleterious impact on laboratory turn around time, healthcare costs and patient management as most medical decisions are influenced by laboratory results

HIV-positive patients in the intensive care unit: A retrospective audit

Background. The indications for and outcomes of intensive care unit (ICU) admission of HIV-positive patients in resource-poor settings such as sub-Saharan Africa are unknown.Objective. To identify indications for ICU admission and determine factors associated with high ICU and hospital mortality in HIV-positive patients.Methods. We reviewed case records of HIV-positive patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, Cape Town, South Africa, from 1 January 2012 to 31 December 2012.Results. Seventy-seven HIV-positive patients were admitted to an ICU, of whom two were aged <18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during the study period. HIV-positive patients had a median CD4 count of 232.5 (interquartile range 59 - 459) cells/µL. Respiratory illness, mainly community-acquired pneumonia, accounted for 30.7% of ICU admissions. ICU and hospital mortality rates were 25.3% and 34.7%, respectively. Predictors of ICU mortality included an Acute Physiology and Chronic Health Evaluation ΙΙ (APACHE II) score >13 (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1 - 1.7; p=0.015), receipt of renal replacement therapy (RRT) (OR 2.2, 95% CI 1.2 - 4.1; p=0.018) and receipt of inotropes (OR 2.3, 95% CI 1.6 - 3.4; p<0.001). Predictors of hospital mortality were severe sepsis on admission (OR 2.8, 95% CI 0.9 - 9.1; p=0.07), receipt of RRT (OR 1.9, 95% CI 1.0 - 3.6; p=0.056) and receipt of inotropic support (OR 2.0, 95% CI 1.4 - 3.2; p<0.001). Use of highly active antiretroviral therapy (HAART), CD4 count, detectable HIV viral load and diagnosis at ICU admission did not predict ICU or hospital mortality.Conclusions. Respiratory illnesses remain the main indication for ICU in HIV-positive patients. HIV infection is often diagnosed late, with patients presenting with life-threatening illnesses. Severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and RRT, rather than receipt of HAART, CD4 count and diagnosis at ICU admission, are predictors of ICU and hospital mortality

Electrophoresis test prevalence, requesting patterns, yield and related bone marrow biopsy findings at a South African tertiary hospital: A 5-year retrospective audit

Background. Studies of electrophoresis testing (serum protein electrophoresis (SPE), urine protein electrophoresis (UPE), immunofixation electrophoresis (IFE)) in a South African (SA) pathology laboratory setting are limited. Objectives. To evaluate the prevalence, testing pattern and yield of electrophoresis tests performed over a 5-year period in a tertiary academic laboratory and to relate these findings to bone marrow biopsy findings in a few selected cases.Methods. This was a retrospective audit of all SPE, UPE and IFE tests performed on new and follow-up adult patients (aged ≥18 years) from 2010 to 2015, using data from the Tygerberg Academic Hospital (Cape Town, SA) National Health Laboratory Service hospital information system database. A subgroup analysis of all patients with negative serum (SIFE) and/or urine immunofixation (UIFE) tests who had concurrent bone marrow biopsies close to the time of IFE testing was also performed.Results. A total of 5 086 SPE tests were performed (44.3% were follow-up tests, and of these patients 13.8% had SIFE tests); 1 299 UPE tests were performed (23.3% were follow-up tests, and of these patients 33.6% had UIFE tests). The mean ages of patients who had SIFE and UIFE tests were 59 years (standard deviation (SD) 14.2) and 60 years (SD 15), respectively. The female-to-male ratio was 1.1:1 for both SIFE and UIFE. The negative test yields for SIFE and UIFE were 31.3% and 52.1%, respectively. Bone marrow biopsy findings for patients with negative SIFE tests identified 8 out of the 20 biopsies (40.0%) as positive for myeloma.Conclusion. This audit provides baseline data on the prevalence of test requests, their source and the yield of electrophoresis testing in our laboratory. An increasing trend in SIFE and UIFE was evident

An audit of the Day-of-Surgery Cancellation of Scheduled Surgical Procedures in Sagamu, Nigeria

Background: Timely performance of scheduled surgical procedures may be an indirect method of assessing the quality of surgical services in a hospital.Objective: This study aimed to determine the rate and the reasons for day-of-surgery cancellation of elective surgical procedures.Methods: A prospective study was conducted at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria to audit the type of surgery and the reasons for the cancellation of procedure among patients scheduled for elective surgical procedures.Results: A total of 1,324 patients were scheduled for elective surgeries during the period of audit and 268 (20.2%) were cancelled on the day of surgery. One hundred and seventy-four of the 268 (65.0%) cancellations were avoidable while 94 (35.0%) cancellations were unavoidable. The reasons for the cancellation of surgeries included patient-related factors (35.0%), unfavourable pre-operative clinical evaluation (31.0%), facility-based factors (28.0%) and surgeon-related factors (6.7%).Conclusion: The day-of-surgery cancellation rate was 20.2%, and the three leading causes of cancellation of elective surgeries in Sagamu included patient-related factors, unfavourable pre-operative clinical evaluation and inadequacies of hospital resources

The effectiveness of clinician education on the adequate completion of laboratory test request forms at a tertiary hospital

Background: Inadequately completed laboratory test request forms contribute to preanalytical errors and limit the advice of pathologists when interpreting laboratory test results. Educating clinicians about this has been proposed by several studies as a strategy to reduce the occurrence. Aim: We aimed to determine the effectiveness of such education on the prevalence of adequately completed laboratory test request forms. Subjects and Methods: This was a quasi-experimental study conducted at the chemical pathology laboratory of the Lagos University Teaching Hospital; Nigeria. Incoming laboratory request forms were audited for a period of 1 month looking out for eight data variables. Subsequently; intensive clinician education was undertaken via seminars; publications; and orientation programs on 670 clinicians for 6 weeks duration. After that; a repeat audit for the same data variables was conducted for another period of 1 month. A Z-test of significance for the comparison of independent proportions was conducted for form errors pre- and post-intervention. Results: Error rates for missing variables pre- and post-clinician education were: Name pre = 0 (0%); post = 0 (0%); age pre = 330 (21.6%); post = 28 (1.9%); P 0.001; gender pre

A Clinical Audit of Female Urinary Incontinence at a Urogynaecology Clinic of a Tertiary Hospital in Durban; South Africa

Background. Urinary incontinence (UI) is a common condition with an increasing prevalence worldwide. Although it is not a life-threatening condition; it can be very disabling.Objective. To describe the clinical profiles; risk factors; diagnosis; treatment and clinical outcomes of women with different subtypes of UI who attended a tertiary hospital in Durban; South Africa.Methods. A retrospective chart review was performed. A structured data form was used to obtain the relevant information.Results. Seven hundred and fifty-eight of 945 charts with a diagnosis of UI were analysed. Stress urinary incontinence (SUI) was the most common subtype of UI (30). The mean (standard deviation (SD)) age was 50.9 (15.2) years; mean (SD) parity 2.8 (1.4) and mean (SD) body mass index 29.2 (5.3) kg/m2. Indians (n=366; 48.3) were the predominant racial group; black Africans constituted 32.7 (n=248). Mid-urethral tape was the preferred surgical treatment for SUI (n=134; 62.0). Urge UI was treated mainly with pharmaceutical agents (n=138; 74.2) with physiotherapy as adjunctive therapy. Urogenital fistulas were repaired via laparotomy (n=42; 53.9) and vaginally (n=25; 32). Mid-urethral tapes and Burch colposuspension had success rates of 97 and 83.3; respectively. Both laparotomy and vaginal fistula repairs had success rates of 95.Conclusions. Stress UI was the most common subtype of UI observed in this study. Patients were predominantly Indians and overweight or obese. The majority of patients with urogenital fistulas were black Africans. Surgical outcomes at our centre were in keeping with those in international reports

A Clinical Audit of the Utilisation of Red Cell Products in Elective Total Hip Replacement Surgery

Background. Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery.Objective. To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG).Methods. The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age; sex; clinical observations; indications for surgery; pre- and postoperative haemoglobin (Hb) values; comorbidities; length of hospital stay and transfusion history was recorded.Results. The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p0.05); and the mean age of transfused patients was significantly greater than that of untransfused patients (p0.005). Although patients with comorbidities had a higher transfusion rate than those without; this did not reach statistical significance. Of 120 patients with complete data; 113 (94.2%) had a blood bank order; of which the vast majority; 102/113 (90.3%); were group-and-screen (GetS) requests; 29/113 (25.7%) were converted to a full crossmatch.Conclusions. Overall; the transfusion rate for both hospitals was 25.8%; which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines; with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary; and a GetS order is sufficient

Surgical Inpatient Mortality in a Nigerian Tertiary Hospital

Background: There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore; there is a great disparity and dearth in apportioning health care services appropriately. Aim: The determination of the pattern of mortality in a surgical unit helps in planning; provision of quality surgical care and prioritizing of limited resources in developing countries. Methods: This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards; the emergency unit; surgical outpatients; and theater records. Results: A total of 527 deaths occurred among the 8230 patients admitted during the 6-year period giving a mortality rate of 6.4%. Three hundred and forty-five (65.5%) were male; while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%); general surgery (5.5%); neurosurgery (7.9%); urology (6.0%); orthopedics (3.8%); pediatric surgery (3.4%); and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows; respectively: 2007 (7.1%); 2008 (6.0%); 2009 (4.5%); 2010 (6.5%); 2011 (7.2%); and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20- and 70-year-old. Conclusion: Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required

Facility-Based Treatment of Under Five Diarrhoea in Cross River State: A Clinical Audit

Introduction: Diarrhoea is the second leading cause of under-five mortality globally and ranks second among the top 10 priority child health problems in Nigeria. The World Health Organization (WHO) has recommended some cost-effective; evidence- based interventions for diarrhoea case management. It is needful to evaluate the current practice in the treatment of diarrhoea in under-fives in health facilities in the country.Objective: To determine the extent to which current treatment practice for diarrhoea in underfives conforms to the WHO recommendation.Method: A clinical audit was conducted between May and June 2013 in 32 health facilities in the Southern Senatorial district of Cross River State; Nigeria. Trained field workers extracted information from patients' case records using a validated audit tool. Treatment was checked as appropriate; inappropriate; wrong or none; based on prescription on patients' case records.Result: Of the 370 case records audited; prescription for diarrhoea was appropriate in 40 (10.8%); inappropriate in 231 (62.4%); wrong in 82 (22.2%) and no prescription was made in 17 (4.6%).Conclusion: Treatment of diarrhoea in under-fives in health facilities in the State is suboptimum. Retraining of health workers on the current WHO and UNICEF treatment guidelines is highly recommended

An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

Introduction:The epidemic of HIV/AIDS in sub-Saharan Africa has led to significant increases in the burden of meningitis; especially cryptococcal meningitis. Morbidity and mortality resulting from meningitis occur partly due to delays in performing lumbar punctures both for diagnostic and therapeutic purposes. This study was conducted with the primary objective of exploring the attitudes and concerns that patients have with regard to lumbar puncture; and also to assess current consenting practices of doctors with regard to lumbar puncture. Methods : A descriptive cross-sectional study was conducted in medical wards of Princess Marina Hospital; a tertiary hospital in Gaborone; Botswana. Data were collected by means of a questionnaire-based survey involving patients or their next of kin; and doctors. Other relevant information was obtained from patient charts. Data collection involved 12 patients and 23 doctors. Results :Of the 12 patients interviewed; four stated that the reasons for doing lumbar puncture (LP) were explained to them. One respondent stated that LP risks were mentioned; while two stated that they were given the option to refuse LP. Most patients' possible reasons for refusal of LP was attributed to fear of pain. Five (42.7) patients/next of kin had never heard of LP before; and most of the interviewed patients associated the procedure with death and paralysis; while none associated with meningitis or HIV. Twenty-two (95.7) of 23 doctors stated that they routinely consent patients for LP; 11 (47.8) mentioned risks; and nine (39.1) stated that the patient has the option to decline the procedure. Only 26 of doctors routinely used local anaesthesia while 22 routinely asked for written consent. Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also; patients' attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications; benefits; and risks

Morbidite obstetricale grave ou near-miss au CHU de Cocody

"Contexte. La mortalite maternelle etant le point negatif ultime; de nombreux auteurs considerent qu'il serait plus judicieux; pour ameliorer la qualite des soins obstetricaux; d'effectuer les enquetes sur des femmes qui; a la suite d'une morbidite obstetricale grave; sont des "" echappees-belles "" de la mort ou "" Near-miss "". Patients et methode. Il s'agit d'une etude transversale a visee descriptive qui s'est deroulee dans le service de Gynecologie et Obstetrique du CHU de Cocody du 01 Avril 2001 au 31 Mars 2002. Resultats et discussion. Les Near-miss ont represente 11;1% des admissions. L'audit de leur dossier medical revele que 87;4% des cas etaient deja en etat de Near-miss a l'admission. Leur prise en charge a ete contrariee par les conditions financieres (32;5%); l'indisponibilite du materiel (21;9%); la patiente elle-meme et sa famille (14;2%) et le personnel (7;7%). Lorsqu'elle a ete sollicitee; l'administration a fourni le kit operatoire dans un delai moyen de 57minutes. Conclusion. La reduction du nombre de Near-miss et par consequent le nombre de deces maternels passe par l'amelioration des differents facteurs de contrariete identifies. "