Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Effect of the Health Extension Program and other Accessibility Factors on Care-Seeking Behaviors for Common Childhood Illnesses in Rural Ethiopian

Background:In January 2011; Health Extension Workers (HEWs) of Ethiopia's Health Extension Program (HEP) began providing pneumonia case management for children less than five years of age through the integrated Community Case Management (iCCM) strategy. Objective. To report the effect of HEP; following the introduction of iCCM; and other accessibility factors on care-seeking behaviors for common childhood illnesses (acute respiratory infection [ARI]; diarrhea; and fever). Methods. Three possible care-seeking outcomes for childhood illnesses were considered: not seeking appropriate care; seeking care from HEP sources; or seeking care from other appropriate sources. The baseline care-seeking outcomes from the Ethiopian Demographic and Health Survey; 2011; were compared with the care-seeking out-comes in a follow-up iCCM survey in December 2012. The effects of the HEP intensity and other factors on care-seeking outcomes were estimated using regression analyses. Results. Appropriate careseeking for children with acute respiratory infection; ARI; diarrhea; or fever increased two-fold; from 19 at baseline to 38 at follow-up; mainly due to an increase in seeking care for common child-hood illnesses from HEWs. Higher intensity of the HEP and other accessibility factors were associated with higher care-seeking for childhood illnesses from HEP sources. Conclusion. Incorporating iCCM within the HEP service package significantly improved the appropriate care-seeking behaviors for childhoodillnesses in rural Ethiopia

Programmatic Correlates of Maternal Healthcare Seeking Behaviors in Ethiopia

Background: Considerable improvement in maternal healthcare use has been observed since the inception of the health extension program (HEP) in Ethiopia in 2003. Objective: This paper evaluates the influence of HEP outreach strategies on maternal healthcare use. Method: Cross-sectional survey of 2;916 women with children 0 to 11 months from Amhara; Oromiya; Southern Nations; Nationalities and People's; and Tigray regions; obtained between December 2008 and January 2009; were analyzed using regression models to assess the impacts of HEP strategies on maternal health outcomes. Result: The analyses found that communities (i.e.; kebeles) with relatively high prevalence of model families; higher rate of household visits by health extension workers; and higher rate of household visits by voluntary community health workers were associated with improved antenatal care use; tetanus toxoid vaccination coverage; and receiving postnatal care visits; but the strategies were not associated with deliveries attended by health professionals. Conclusion: Although the impacts of HEP strategies on maternal healthcare use were statistically significant; they were not optimum to reach the maternal mortality reduction targets of the government of Ethiopia. The HEP needs to review and strengthen its community based strategies in order to reach its goals

Responding to the Maternal Health Care Challenge: the Ethiopian Health Extension Program

Background: Responding to challenges in achieving Millennium Development Goals (MDG); the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive; promotive and select curative health interventions through paid community level health extension workers. Objective: To explore Ethiopia's progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program. Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP. Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32skilled birth attendant use by 2010 but only about 12use was found in the four most populated regions of the country in 2009. Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions; such as misoprostol for active management of third stage of labor; immediate postpartum visits; and improved coordination from community to referral level

Knowledge, practices and perceptions which affect acquiring malaria in man-made malarious area in Khartoum State, Sudan

A cross- sectional descriptive study was carried out among people of ElAzergab area. This area was chosen as a model to study Sudanese malaria knowledge attitude and practices (KAP) in man-made malarious areas. This area is situated along the eastern bank of the River Nile north of Khartoum North; in Khartoum State. The aim is to determine risk factors associated with malaria. Data were collected from 167 households. The survey deals with sociodemographic characteristics; history of malaria; knowledge; attitudes; practices; preservation measures and treatment seeking behaviour. Ninety one percent of household heads reported malaria attack among household members in the previous year. Risk of malaria attack was significantly associated with family grade of education; occupation of household head; water and electric supply; economic status of the family; number of rooms; expenses of treatment; treatment seeking behaviour. About 76.6of household heads reported delayed treatment seeking behaviour for malaria. Knowledge; attitude and practice have no association with malaria attacks except for a 2- fold increased risk of malaria in people obtaining water from irrigation canals

Problem-based learning in distance education: a first exploration in continuing medical education

The Wellcome Tropical Institute has assisted countries in the tropics to establish viable systems of continuing medical education; particularly for young doctors practising in rural areas. As part of this strategy the Institute has developed material for use in distance learning. The first attempt to apply the problem-based learning approach to written material for use by an individual learner in the absence of a tutor led to a trial in Ghana; Kenya and Pakistan to compare a conventionally designed module with a problem-based learning module on the same topic for their respective acceptability; effectiveness and efficiency. The design; implementation and results of these three comparative trials are presented