Knowledge of cervical cancer among women of reproductive age in Ibadan north lga, Oyo State, Nigeria

Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is a deadly disease claiming the lives of many women in developing countries due to late presentation which might be influenced by a lack of knowledge of the disease and its prevention. Method: This descriptive study examined the knowledge assessment of cervical cancer among women of reproductive age (15-49), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 426 women in Ibadan North Local Government Area of Oyo State, Nigeria. Women voluntarily completed a structured questionnaire. Result: Results showed that women who participated in the study were aware of cervical cancer (77%; n=328) but many (62.9%; n= 268) were unaware of Pap smears as the screening tests for cervical cancer. Although 41.3% (n=176) were knowledgeable about cervical cancer, risk factors and prevention, only 9.4% (n=40) had Pap smear tests done. Conclusion: Health care professionals, need to intensify efforts to increase awareness about cervical cancer screening, and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

Patients' perception of service quality in a healthcare not-for-profit organisation

Service organisations should be aware of those elements that are perceived as excellent quality and incorporate these as part of their service offering. However, a not-for-profit (NPO) healthcare organisation consists of a diverse group of stakeholders who have different perspectives and interests. Service quality therefore requires a multidimensional definition that comprehends all their needs and expectations.Methods: Perceived service quality experienced by patients was measured by completion of the Service Performance (SERVPERF) questionnaire. A total of 111 patients completed the questionnaire across three mobile clinics supported by an NPO.Results: The research results suggested that service quality at the mobile clinics was of a very high standard, with no meaningful differences between clinics, age groups or gender. However, the responses had very little variance and could have been subjected to response bias or extreme bias. The absence of a comparator organisation could also have had an influence on responses given by respondents. Conclusion: Healthcare service organisations should strive towards maintaining high standards and engage in continuous measurement and improvement of their service quality as part of their quality management process. By measuring the current level of service experienced by patients, insights have been identified where adjustments might have a positive effect on perceived value. Future research recommendations include suggestions to increase the sample population, taking the service setting into account and further studies to confirm the validity and reliability of solicited service quality questionnaires in a NPO setting.

Rapid, remote education for point-of-care ultrasound among non-physician emergency care providers in a resource limited setting

Introduction : Access to high-quality emergency care in low- and middle-income countries (LMIC) is lacking. Many countries utilise a strategy known as "task-shifting" where skills and responsibilities are distributed in novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly improve emergency care in LMICs.Methods:POCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback. Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.Results:Over the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently, but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95% CI, 3.32­4.32) to 4.68 (95% CI, 4.35­5.01) on an eight-point scale. The sensitivity and specificity of FAST exam during the initial training period was 77.8 (95% CI, 59.2­83.0) and 98.5 (95% CI, 93.3­99.9), respectively. Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.Conclusions : Remotely delivered quality assurance feedback is an effective educational tool to enhance provider skill and foster continued and sustainable use of ultrasound in LMICs

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

Background. Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition.The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal.Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system.Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively.Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4%) and patients who should have been in orange were most commonly demoted (35.0%). Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%), followed by numerical miscalculations (21.5%). The leading omitted discriminators were 'abdominal pain', 'chest pain' and 'shortness of breath'.Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED

Assurance qualite dans le service de radiotherapie de l'hopital general de Yaounde

But : Evaluer le programme d'assurance qualite applique dans le service Radiotherapie de l'Hopital General de Yaounde. Materiels et methodes : Nous nous sommes proposes de mener une etude retrospective; transversale et qualitative du programme d'assurance qualite applique pendant une periode de 25 annees dans notre service. Toutes les donnees en rapport avec le circuit du malade; le plateau technique; la simulation; la dosimetrie et le traitement des patients ont ete recherchees grace a une analyse des differents comptes rendus des document medicaux des patients; puis relevees a l'aide d'une fiche technique preetablie et testee.Resultats : Aucun indicateur d'assurance qualite n'a atteint le score normatif ideal de 100%; l'indicateur lie aux ressources humaines notamment specialisees detient le score le plus bas de 42.10%. les indicateurs en rapport avec les equipements; les tests de controle qualite des equipements; l'organisation des locaux; le circuit des malades et la documentation technique arrivent avec un temps de conformite aux normes de 66%; 70%; 81%; 87% et 90% dans cet ordre. Conclusion : Notre programme d'assurance qualite a ete globalement satisfaisant jusqu'en avril 2012; date a laquelle des insuffisances aux plans des ressources humaines et surtout des equipements susceptibles de le compromettre se sont progressivement installees et identifiees a l'occasion de la presente etude

Assurance de la qualite de la chaine d'imagerie scintigraphique dans le service de medecine nucleaire de l'hopital general de Yaounde

Objectif : Comparer le programme d'assurance qualite de la chaine d'imagerie scintigraphique du service de medecine nucleaire de l'Hopital General de Yaounde (HGY) aux normes internationales admises. Materiel et Methode : L'etude etait retrospective et transversale descriptive couvrant la periode de novembre 2002 a octobre 2007. Le materiel etait constitue du personnel; des documents;des radiopharmaceutiques et des equipements. L'approche normative de l'audit a ete utilisee pour l'analyse des donnees; et les taux de conformite (Tc) ont ete calcules. Resultats : Le personnel etait bien forme et suffisant (Tc= 100 ). La documentation etait bien organisee et disponible (Tc= 90;9). Les resultats des tests de controle qualite sur l'activimetre et la gamma camera ont rassure que ces instruments fournissaient des mesures valides et fiables (Tc= 99;94 et 95;16) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87 ) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87) et ceux obtenus des tests sur les radiopharmaceutiques ont revele que les preparations administrees etaient de qualite a fournir de bonnes images a moindre dose d'irradiation (Tc= 98;87). Conclusion : Le programme d'assurance qualite de la chaine d'image scintigraphique de l'HGY etait conforme aux normes internationales admises

Evolution des prestations du service de pédiatrie de Morondava (Madagascar): morbidité et mortalité des enfants de 0 à 15 ans hospitalisé de 1986 a 1989

"La faiblesse des ressources familiales; la cherte et la penurie de medicaments entraine a Madagascar; un recours souvent tardif a l'hospitalisation des enfants. Afin de faciliter l'acces des enfants aux services de sante; le service de pediatrie de Moronava a progressivement adapte ses prestations et ses techniques de soins avec la mise en place d'hospitalisation de jour et la formation de femmes relais dans tous les quartiers de la ville qui assurent depuis un suivi hebdomadaire de tous les enfants de 0 a 5 ans. Cette evolution s'est traduite dans les statistiques hospitalieres. De 1986 a 1989; 2011 enfants ont ete hospitalises dans le service avec une mortalite de 15;7 per cent. La mortalite des enfants hospitalises originaires de la ville (10;8 per cent) est comparable a celle des malades venant de peripherie (12;1 per cent) dont 48 per cent habitent a plus de 30 km de la ville. La malnutrition represente la premiere cause de deces et d'hospitalisation des enfants de 0 a 5 ans. La letalitte des enfants malnutris est passee de 16;1 per cent a 43;4 per cent lors du cyclone ""Cynthia"" de janvier 1989. Les principales pathologies etaient par ordre chronologique: le paludisme realisant seulement la 5 eme cause de deces avec une lethalite de 4;6 per cent; les diarrhees (lethalite 8;7 per cent); les infections respiratoires 8letalite 12;5 per cent). La pathologie neonatale presente la letalite la plus forte (31 per cent) apres les intoxications (41 per cent). L'hospitalisation de jour s'est traduite par une baisse de la proportion d'hospitalisation chez les consultants ce qui accrut la disponibilite du personnel pour la surveillance des cas graves et diminue la charge que represente l'hospitalisation pour les familles. L'ouverture d'un service de tri des consultants par un infirmier a permis de poursuivre la prise en charge des pathologies simples et de repondre a la demande des familles. Plusieurs techniques originales de traitement ont ete etudiees et vulgarisees: bouillie de riz aux crevetttes sechees (koba pasta) pour les enfants malnutris; eau de riz salee sucree (Fanafody fivalana) pour la diarrhee; quinine injectable diluee en intra rectale en alternative des intra musculaires de quinine."