Comparing influenza positivity rates by real-time rt-pcr, elisa and viral culture methods in Cote d'Ivoire, West Africa, in 2009

Detection of circulating influenza strains is a key public health concern especially in limited-resource settings where diagnosis capabilities remain a challenge. As part of multi-site surveillance in Cote d'Ivoire during the 2009 influenza A(H1N1) pandemic; we had the opportunity to test respiratory specimens collected from patients with acute respiratory illness (ARI). We analyzed and compared the percentage of specimens testing positive using three laboratory methods (rtRT-PCR; ELISA; viral culture). From January to October 2009; 1;356 respiratory specimens were collected from patients with acute respiratory illness and shipped at the WHO NIC (Institut Pasteur) Cote d'Ivoire; and 453 (33) tested positive for influenza by one or more laboratory methods. The proportion of positive influenza tests did not differ by the sex or age of the patient or presenting symptoms; but did differ depending on the timing and site of specimen collection. Of the 453 positive specimens; 424 (93.6) were detected by PCR; 199 (43.9) by ELISA and 40 (8.8) by viral culture. While seasonal influenza A(H1N1) virus strains were prominent; only four 2009 pandemic influenza A(H1N1) cases were detected. Use of molecular biology method (rtRT-PCR) increased sensitivity and diagnosis capabilities. Among all three methods used; rRT-PCR was the most sensitive and rapid method. More capacity building is still required for viral culture. Need to collect denominator data in order to have an accurate estimate of the burden of influenza. There was delayed introduction of pandemic influenza A(H1N1)2009 in Cote d'Ivoire

An Evaluation of the Triage Early Warning Score in an Urban Accident and Emergency Department in KwaZulu-Natal

Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission. As this triage tool has only been evaluated to a limited extent; this study assessed its effectiveness in identifying patients at risk of early deterioration to enable timely medical intervention.Design and setting: This was a retrospective study of medical records within the accident and emergency department of an urban public hospital. Outcome measures: The calculated TEWS was compared to one of four possible outcomes viz. discharge within 24 hours; admission to the ward; admission to the intensive care unit (ICU); or death in hospital. Pearson's chi-squared tests and cross-tabulation was used to determine the statistical significance of the association. Results: Of the 265 patient records analysed; 233 (87.9) had a TEWS of 7. Of patients with a TEWS of 7; 53.7were discharged; compared to 18.7with a score ? 7; who were discharged. The average score of the four patients who died was 9.5; and 8.2 for the three admitted to ICU. Higher TEWS were significantly associated with increased admission to hospital and in-hospital deaths (p-value 0.032). Conclusion: An effective triage scoring system ensures that those requiring emergency care are appropriately categorised. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the appropriate service level; including ICU

Evaluation of analgesic and anti-inflammatory activity of Diospyros Cordifolia Extract

Abstract: In this study we evaluated the analgesic and anti- inflammatory activities of the methanol extract of stem bark of Diospyros cordifolia (MEDC) Roxb. The analgesic effects of the stem bark of the plant was assessed in mice using the tail-flick method while carrageenan, histamine and dextran induced paw oedema was used to study the antiinflammatory effects in rats. The MEDC exhibited significant (p<0.01) analgesic effects comparable to the reference drug diclofenac sodium. MEDC also was evaluated for its anti-inflammatory potential against carrageenan, histamine and dextran induced rat paw edema. The methanol extract (25 and 50 mg / kg body weight) exhibited significant (p<0.01) activity against all phlogistic agents used in a dose dependent manner. All these effects were compared with reference drug phenylbutazone (100 mg/kg body weight)

Preparedness for Mass Casualties of Road Traffic Crashes in Uganda: Assessing the Surge Capacity of Highway General Hospitals

In Uganda; increase in human and vehicular populations against a non-expanding road infrastructure; breakdown in enforcement of traffic regulations and poor vehicle quality contribute to the high rate of casualties from road traffic crashes on highways; with over 2000 deaths per year. Highway hospitals should be the vanguard of preparedness to manage mass surgical casualties; to minimize road crash mortality. Objectives: To determine the capacity of Uganda's highway hospitals to manage mass surgical casualties. Methods: A descriptive; cross-sectional study of emergency surgical services of ten key highway general hospitals. Results: The hospitals had adequate capacity to manage uncomplicated solitary cases of injury. However; they had severe shortage of essential surgical equipment (9.6of expected). Staffing was poor (64.3of the recommended) and the staff lacked the life-saving surgical skills needed in a frontline hospital. There was perennial shortage of essential supplies e.g. blood; surgical gloves; intravenous fluids; oxygen and medicines. There was inadequate space for emergency surgery and only few staff members reside within easy reach for quick mobilization. Overall surge capacity was rated at below 50of what is required. Conclusion: Ugandan highway hospitals lack the technical and infrastructural capacity to handle mass casualties resulting from road traffic crashes. Surge capacity is below 50of that required to manage mass casualties. Recommendations: The key recommendations of this paper are: re-organisation of the outpatient departments to cater for mass emergency surgical cases; deployment of qualified surgeons in highway hospitals; training of hospital staff in life-saving surgical skills; targeted supervision of highway hospitals; training of managers in disaster preparedness; and improved funding for highway hospitals. THEME TWO: HOSPITALS

Evaluation of the Capacity to Appropriately Diagnose and Treat Malaria at Rural Health Centers in Kabarole District; Western Uganda

Setting: Malaria has remained the leading cause of morbidity; responsible for 47of the total causes of ill health at the outpatient department; in Kabarole District for over ten years. In Uganda; the malaria treatment policy changed the first-line treatment from chroloquine and sulfadoxine/pyrimethamine (SP) to artemisinin-based combination therapies in 2005; necessitating building new technical and infrastructural capacities. Objective: This study evaluated the status of the capacities and practices to appropriately manage malaria in a rural setting following the new guidelines.Methods: A stratified random sample of 16 heath facilities was selected from public and private not for profit health centres. We used a pre-tested interviewer-administered questionnaire to interview 26 health workers; and observation checklists to assess essential equipment; supplies; anti-malarial medicines; human resources and treatment practices. Data analysis was done with Epi-Info soft ware. Procedure observations made were coded according to the emergent themes and frequencies calculated. Results: More than 75of the respondents had little knowledge on basic facts about malaria and 54did not know the new malaria treatment policy. Over 50health workers did not understand the rationale for intermittent preventive treatment and 65had never had refresher training about malaria management. At least 65mentioned AL as the first-line anti-malarial treatment and 73mentioned parental quinine as a drug of choice for complicated malaria. Over 80health facilities had experienced stock-outs of artemether/lumefantrine (AL) and SP within the 3 months prior to the study. Only one health centre had 80of the minimum required staff. Malaria treatment policy guidelines lacked in 86health facilities; microscopes in 50; while 100lacked insecticide-treated bed nets. All clinicians spent inadequate time i.e. less than (10-19 minutes) with malaria patients; 82never conducted physical examination; 92never checked for anemia and 67never weighed patients. Conclusion: The district has very low capacity to manage malaria correctly according to the guidelines. The study recommends regular refresher training of health workers on malaria policy and additional support to health facilities to improve their capacity to manage malaria

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria

Aim: With increasing urbanization of lifestyle; cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have ypertension. Each participant's blood pressure was measured and any value =140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI =30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value =102 cm for males and =88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2). Females were more aware than the males. The prevalence of HBP was higher in males (49.3) compared with their female counterparts (42.3); whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2; global: 14.8) compared with the males (abdominal: 14.5; global: 10.1). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus; the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP

Assessment of Occupational Injuries in Tendaho Agricultural Development S.C; Afar Regional State

Background: The status of occupational injuries in workplaces in general and agriculture sectors in particular is ill defined in Ethiopia. Pocket studies in developing countries indicate that occupational injury due to an unsafe working environment is increasing. Objectives: To determine the magnitude of occupational injury and describe factors affecting its happening among workers of Tendaho State Farm located in Afar Region. Methods: Cross-sectional study design was employed to assess occupational injuries among randomly selected 810 workers in August; 2006. A structured questionnaire based interviews; work environment observation; physical examination of study subjects for injury; and reviewing medical records for injury were used to collect the data. Results: The overall occupational injury prevalence rate was 783 per 1000 exposed workers per year. Seventy (11) injured workers were hospitalized. Most (90) of hospitalization was for more than 24 hours. Only one death was reported in the preceding 12 months prior to the study. A total of 6153 work-days were lost; at an average of 11.4 days per an injured worker per year. Working more than 48 hours per week [AOR: 8.27; 95CI:(4.96-13.79)]; absence of health and safety training [AOR: 2.87; 95CI: (1.02-8.06)]; sleeping disorder [AOR: 1.64; 95CI: (1.12-2.41)]; alcohol consumption [AOR: 1.72; 95CI: (1.06-2.80)]; job dissatisfaction [OR: 1.83; 95CI: (1.30-2.58)] and absence of protective devices [OR: 3.18; (1.40-7.23)] were significant factors that contributed to the prevailing occupational injuries. Conclusion: Multiple factors related to the work organization and employee's behavior increased the risk of occupational injuries. Continued on the job training; sustained work place inspections and proving occupational health and safety services should get emphasis in work places. [Ethiop. J. Health Dev. 2010;24(3):167-174]

Adaptation of the Rapid Estimate of Adult Literacy in Medicine Revised (REALM-R) to the South African Context: Part 1

Literacy levels are increasingly important in health care because professional nurses and other health care professionals often use written health education materials as a major component in patient education. In South Africa; no current instrument is available to assess the literacy levels of patients in the primary health care setting; though several instruments have been developed and validated internationally. The purpose of this paper was to adapt and validate the Rapid Estimate of Adult Literacy in Medicine Revised (REALM-R) to the South African context. The REALM-R is a short instrument that is designed to rapidly screen clients in the primary health care setting for low health literacy. A modified Delphi-technique was used to measure the judgement of a group of experts for the purpose of making a decision. Eight experts in the field of Nursing Science were selected purposively to obtain the most reliable consensus. Data was collected by means of a self-report whereby participants responded to a series of questions posed by the researcher. Descriptive statistics was used for analysing data. The REALM-R was adapted to the South African context to ensure that the literacy level of South African clients is measured with an appropriate instrument

Evaluation of the Clinical Management of HIV-Infected Patients by Private Sector Doctors in the eThekwini Metro; KwaZulu-Natal

Background: Although private sector doctors are the backbone of treatment service in many countries; caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients; in the private sector in developing countries; have highlighted some problems with management. In South Africa; two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken; few have been done in the private sector in terms of the management of this disease. Therefore; a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors. Methods: A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal; South Africa; with 190 private sector doctors who; in the first phase of the study; indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors. Results: Eighty-five doctors (54.5) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8) to initiate therapy. Of the doctors; 134 (78.5) initiated therapy at CD4 count 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p 0.001). At initiation of treatment; 68.5of the doctors saw their patients monthly and 64.3saw them every three to six months; when stable. Conclusion: The majority of private sector doctors were compliant with current guidelines for HIV management; hence maintaining an acceptable quality of clinical healthcare

Evaluation of the mechanical and physical properties of a posterior resin composite in posterior adult teeth

Objective: To evaluate the mechanical and physical properties of a micro-hybrid resin composite used in adult posterior restorations Materials and Methods: A micro-hybrid; light curing resin composite Unolux BCS Composite Restorative; (UnoDent; England) was used to restore 74 carious classes I and II cavities on posterior teeth of 62 adult patients. The restorations were evaluated immediately following placement (Baseline); at 1 week; 3months; 6months and 12months using the United States Public Health Service Criteria/Modified Ryge criteria for direct evaluation. Color matching; marginal stains and adaptation; wear and surface texture were evaluated. Ranging from best to the worst; the ratings were; Alfa; Bravo and Charlie. Results: 58 restorations were available for review at the 12 th month evaluation; 15 patients bearing 21.6of the restorations were lost to recall. Colour match scores were 89.6Alpha at baseline and 74.1at 12-month review. Marginal staining were 100Alpha at baseline and 98.3Alpha at the end of the evaluation period. Marginal adaptation at baseline was 100Alpha this value dropped to 94.8by the 12th month. Anatomical wear scores were 100Alpha at baseline and scores dropped to 93.1at the 12-month evaluation. At baseline; Alpha scores for Surface texture were 100. A drop in Alpha scores to 93.1at the first week review was maintained till the 12 month. Conclusion: Carefully controlled placement of micro-hybrid resin composite using the total etch and type 2 (one-bottle) adhesive can produce satisfactory posterior restorations on permanent teeth

Evaluation of Pharmacists' Participation in Post-Admission Ward Rounds in a Tertiary Hospital in South-West Nigeria

Background: Many patients on admission have limited mobility and need physical examination by the clinical team. Ward rounds serve as an avenue for health professionals to meet and develop an integrated plan of care for the inpatients. Lack of representation for certain professional groups; including pharmacy; may adversely affect the range of opinions and therapies for patients. Objective: The study evaluates pharmacist's perception of and participation in post-admission ward rounds; at the Lagos University Teaching Hospital (LUTH). Method: All the 60 pharmacists covering various units of pharmaceutical services were administered a forty-two element structured questionnaire. Fifty (83.3) pharmacists completed the questionnaires. Descriptive statistics and chi-square were used to analyse the collated data. Results: Pharmacists had positive perception of their participation in ward rounds; some of whom were already involved in the exercise on a low scale. Peer reviews of patients' cases were frequently conducted and were usually dominated by the medical staff. The clinical role of the pharmacists is not clearly defined in respect to ward round. Their current impact in patient care activities during ward round is not significant. Conclusion: Pharmacists should be scheduled to participate actively in ward rounds; peer reviews and other professional activities; for optimum patient care. The hospital authorities should optimise the involvement of pharmacists in the paradigm shift towards pharmaceutical care; with a view to minimizing prescribing errors; cost of drugs and length of hospital stay. The use of preceptors should be explored

CT and Ultrasound in the diagnosis of orbital dermoid Cysts - A retrospective study at the University Teaching Hospital in Lusaka

Objective: To evaluate the use of Computed Tomography (CT) and Ultrasound (US) to diagnose orbital dermoid cyst and compare the characteristic features of CT and US in detection of the lesions. Design: CT and Ultrasound were used to evaluate patients with orbital dermoid cysts in 16 cases were retrospectively analysed. Result: Ultrasound features were confirmatory of orbital demoid cysts in 4 cases where as CT was effective in diagnosing the condition in 15 cases except for one case of mistaken diagnosis for mucocoele. The characteristic features as fat -floating sign on CT were revealed in 7 patients. Conclusion: Ultrasound is useful in displaying internal structures; CT is excellent in detecting the orbital demoid cyst and can more accurately confirm the diagnosis when the characteristic features as fat -floating sign is revealed

Student Evaluation of Teaching: A Case Study from School of Medicine (UNZA)

Purpose: This paper presents a case study of an academic department's experience with evaluation. The purpose is to review the impact of student evaluation of teaching. The paper also introduces a new evaluation scoring method: the University of Zambia Staff Appraisal System (UNZASAS) method. Method: Anonymous 5-point Likert scale evaluation rating forms were administered to 134 third-year medical students in two consecutive years to measure students' perceptions of teaching quality of four faculty members in an academic department at School of Medicine. The rating forms were scored using the UNZASAS method. Results: The response rate averaged 83. The group average lecturer rating improved from 120 to 141.5. Individual performance of three lecturers improved while that of one declined. The UNZASAS method was effective in summarizing data to identify the areas of weakness and strength in the faculty members. The specificity and sensitivity of this method were fundamental to its success as a diagnostic tool for formative evaluation of teaching quality. Conclusions et Implications: The quality of teaching in the academic department improved after evaluation of teaching was introduced. The UNZASAS method proved to be an effective tool for scoring evaluation data and for providing faculty with useful and specific formative feedback. Health professionals training institutions can consider using the UNZASAS method for their evaluation of teaching contribution by educators

Evaluation of Antimicrobial Activity of the Stem Bark of Cylicodiscus Gabunensis (Mimosaceae)

Ethyl acetate (EA) extract of the stem bark of Cylicodiscus gabunensis (CG) was analysed phytochemically and evaluated for its antimicrobial activity against 17 pathogenic species isolated from patient: Escherichia coli; Klebsiella pneumoniae; Shigella dysenteriae; Shigella flexneri; Morganella morganii; Proteus vulgaris; Proteus mirabilis ; Salmonella typhi; Citrobacter freundii; Enterobacter cloacae; Enterobacter agglomerans; Staphylococcus aureus; Streptococcus feacalis; Pseudomonas aeruginosa; Bacillus cereus T; Candida albicans and Candida glabrata. Flavonoids; saponins; tannins; polyphenols; coumarins; triterpenes and/or sterols and reducing sugars were detected in the (EA) extract of CG. The best MIC and MBC values for the microorganisms sensitive to the extract were 0.00078 and 0.00315 mg/ml respectively. The greater and remarkable antimicrobial activity of the (EA) extract of CG was recorded with Staphylococcus aureus; Proteus vulgaris and Bacillus cereus T. These results provide a rationalization for the traditional use of this plant for the treatment of infections diseases

Faciliting Critical Thinking within the Nursing Process Framework : a Literature Review

This article intends to describe how critical thinking of learners can be facilitated or infused in clinical nursing education using the identified core cognitive critical thinking skills; their related sub-skills and the affective dispositions. The desire of the researcher to apply these critical thinking skills in clinical nursing education was in response to the recommendations made by experts in critical thinking who conducted the Delphi research project about the concept analysis of critical thinking (Facione; 1990:6; 13).The recommendations made urge educators to develop programmes and teaching and assessment instruments to facilitate or measure critical thinking using the identified core cognitive thinking skills. Nurses should be critical thinkers because they deal with the lives of patients. They are faced with challenges in their daily practice which require the ability to make rational and critical clinical decisions and also make astute clinical judgment that are logical to solve health related problems. Critical thinking is understood to be purposeful; self-regulatory judgments which result in interpretation; analysis; evaluation and inference; as well as explanation of the evidential; conceptual; methodological; criteriological or contextual considerations upon which that judgment is based (Facione; 1990:2). The core cognitive thinking skills are supported and driven by the identified affective dispositions such as inquisitiveness; analytical thinking; open- and fairmindedness; flexibility; self-confidence; being systematic; truth-seeking and a mature attitude. An exploratory and descriptive approach was used to describe how critical thinking of learners can be facilitated in clinical nursing education. Since critical thinking can not be facilitated in a vacuum; the author used the theoretical framework of critical thinking identified by critical thinking experts in a Delphi study (Facione; 1990:6; 13) within the nursing process framework (Wilkinson; 1992:29) and other relevant literature to demonstrate how critical thinking can be facilitated were used. Content validity of the study is ensured based on the two theoretical frameworks. Recommendations to apply the identified critical thinking skills and the dispositions are made