Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and Inter VA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making

Renal replacement therapy (RRT) in Rwanda: benefits, challenges and recommendations

Worldwide, non-communicable diseases (NCDs) are a global health problem as they contribute to approximately 60% of deaths. There is limited data on the management of NCDs including kidney diseases at all levels of health care delivery in Rwanda. Yet renal replacement therapy (RRT), which seems to be the only option to provide an acceptable quality of life to patients with end stage renal disease (ERSD), is yet to be well established in Rwanda. Although there are policies and guidelines on renal replacement modalities in Rwanda, inadequate human and financial resources in the area of nephrology care remains a challenge. The purpose of the paper is to document an overview of kidney diseases and Renal Replacement Therapy (RRT) in Rwanda and highlight the benefits, challenges and recommendations to provide future directions for nephrology care. Improved knowledge about renal conditions and their risk factors is the initial step to create major interventions for improved kidney quality of life (KQoL) among patients with end stage renal disease. Notwithstanding, the Government of Rwanda has established several dialysis centers intended to provide services and for maintenance of the health status of patients with renal conditions. Further studies are necessary to provide evidence on the outcomes of RRT

Infection control recommendations for radiology departments in Malawi

Background: Guidelines for radiographers contain recommendations related to standard infection control precautions for healthcare-associated infections (HAIs) which are a major cause of mortality and morbidity in hospital settings. However, the implementation of these recommendations has proven to be a challenge in the Malawian radiology departments, as there are no national guidelines or radiology policies for infection control.Aim: This article outlines the development of infection control recommendations that could facilitate sound knowledge and practices of radiographers regarding infection control.Setting: Radiology departments in hospitals in Malawi.Methods: The recommendations were developed based on data from a questionnaire that measured the knowledge and practices of 62 radiographers regarding infection control as well as data from the literature. The Florence Nightingale environmental theory was used as the conceptual framework for the recommendations, while its development was based on steps of the National Institute for Health and Care Excellence. For the format of the draft recommendations, an adapted version of the Appraisal of Guidelines for Research and Evaluation II tool was used.Results: Issues identified from the responses to the questionnaire and literature resulted in seven sets of recommendations: hand hygiene, personal hygiene, personal protective gear and the use of appropriate equipment, safe handling of sharps and sharp containers, decontamination and cleaning, housekeeping and routine infection control practices.Conclusions: The recommendations can be further reviewed and implemented to improve the implementation of infection control and to reduce HAIs in resource-constrained settings

Evaluation du respect des mesures d'asepsie en salle d'opération et antibioprophylaxie en milieu rural. A propos d'une cohorte de 42 interventions chirurgicales réalisées à Moba (République Démocratique du Congo)

Introduction : La prévention des infections du site opératoire demeure une préoccupation pour tout système de santé. Cette étude avait pour objectif d'évaluer le niveau de respect des mesures d'asepsie au bloc opératoire et la pratique d'antibioprophylaxie chez les opérés. Méthode : Il s'agit d'une étude observationnelle de cohorte prospective. Elle a été effectuée au service de chirurgie de l'hôpital général de référence de Moba d'avril à juin 2018. Les variables d'étude concernaient les opérés et les chirurgiens. Dans le but de supprimer tout jugement a priori pouvant entraîner les biais de suivi, l'observation était en double aveugle. Résultats : Quarante-deux interventions chirurgicales avaient été retenues et évaluées chez les patients en majorité de sexe féminin (n = 36 ; 85,7 %), avec un âge moyen de 27 ans. La chirurgie pelvienne a été la plus pratiquée (n = 30 ; 71,4%). Les résultats montrent un écart considérable entre ce qui est fait et ce qui devrait être fait. Il en va de la disposition du bloc opératoire aux fautes d'asepsie (présence des téléphones portables et radiocassette dans la salle d'opération pendant l'intervention chirurgicale ; ports incorrects des bonnets, masques et gants ; gestes non-aseptiques dans l'exécution des actes ; discussions non-utiles, etc…) et à l'antibioprophylaxie à des doses usuelles et uniquement en post-opératoire. La conséquence a été que les infections du site opératoire représentaient 40,5% (n = 17). Néanmoins, pour être complet dans l'amélioration des conditions de travail et de satisfaire nos attentes, ces résultats devraient être corrélés par une étude similaire au service de chirurgie (soins post-opératoires et qualité de stérilité du matériel, hygiène des opérés). Conclusion : Le risque infectieux en milieu chirurgical constitue une préoccupation à laquelle il faudrait rapidement trouver solution pour inverser la tendance des infections du site opératoire. La solution passe obligatoirement par le respect strict des mesures d'asepsie, l'antibioprophylaxie en pré-opératoire et à double dose lors de son initiation, et les études épidémiologiques sur les infections en chirurgie

Haematological values in a healthy adult population in Yaoundé, Cameroon

Background: Haematological values derived from local populations are useful in laboratories to improve diagnoses for local patients. In Cameroon, these data are not yet available. Moreover, there is great variation in baseline parameters pertaining to full blood cell count among medical laboratories.Objectives: This study aimed to determine values for the complete blood cell count of a healthy adult Cameroonian population for use in locally derived ranges in our medical laboratories.Methods: A cross-sectional study was conducted among blood donors attending three blood banks in Yaoundé from November 2015 to September 2016. We expected to obtain at least 120 venous blood samples from both men and women. Tests were performed for (1) HIV, (2) complete blood cell count, (3) hepatitis B virus, (4) malaria, (5) syphilis, (6) C-reactive protein and (7) hepatitis C virus.Results: We enrolled 294 healthy participants (161 men, 133 women) aged 18 to 55 years. The median haemoglobin concentration was 135 g/L in men and 114 g/L in women (p < 0.001). The median reticulocyte count was 60 × 109/L in men and 40 × 109/L in women (p < 0.001).Significant variation by sex was observed for the platelet count. The median white blood cell count was 4.1 × 109/L in men and 4.6 × 109/L in women (p = 0.008). Conclusion: This study provides locally derived ranges for complete blood cell and reticulocyte counts for a healthy adult population in Yaoundé, Cameroon. These results can be used pending larger studies

Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa

Background: Costly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.Aim: This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments. Setting: The study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa.Methods: An exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators ­ one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes.Results: Co-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes' function.Conclusion: Unavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments

Irrigation endodontique à l'hypochlorite de sodium : Types de solutions et modalités de préparations dans 102 cabinets dentaires de la ville d'Abidjan (Côte d'Ivoire)

Introduction : L'hypochlorite de sodium (NaOCl) représente à ce jour le "gold standard" pour l'irrigation endodontique. L'objectif de cette étude était d'identifier les solutions de NaOCl utilisées comme irrigant canalaire et les modes de préparations dans les cabinets dentaires. Matériels et méthodes : Une étude prospective a été réalisée dans 102 cabinets. Par la suite, les teneurs en chlore actif (c.a.) des solutions de NaOCl ont été évaluées par titrage iodométrique. Les analyses statistiques ont été effectuées par le logiciel SPSS version 22 sous Windows (SPSS Inc., Chicago, IL, USA). Résultats : Les sources commerciales de solution de NaOCl étaient utilisées à 72,5% pour l'irrigation endodontique. Ces solutions étaient concentrées à 2,53% c.a. ou 3,80% c.a. selon l'emballage. Dans l'ensemble, les titrages iodométriques ont révélé des rétrogradations en c.a. des solutions mères. Les dilutions au 1/5ième étaient généralement réalisées, ce qui signifiait une concentration à 0,5% c.a. pour l'irrigation endodontique. Une solution de NaOCl stabilisée à 0,5% c.a. et disponible en officine était principalement utilisée dans les cabinets privés. Discussion : Les concentrations des solutions de NaOCl pour l'irrigation en endodontie se situe entre 0,5% et 6% d'après la littérature. Cependant un compromis semble être trouvé autour des valeurs situées entre 2,5% c.a. et 3% c.a. Dans ce cadre, les solutions de NaOCl issues du commerce dans cette étude peuvent être considérées comme prêtes à l'emploi. Il faut cependant tenir compte de leur instabilité qui suggère des préparations finales à teneur en c.a. inférieure à la minimale préconisée en endodontie (0,5% c.a.). Conclusion : cette étude montre l'intérêt de l'usage de solutions de NaOCl stabilisées et conçues spécifiquement pour l'irrigation endodontique. Ce sont elles qui sont considérées comme dispositif médical par les autorités sanitaires

Acceptance of sugar reduction in yoghurt among Moroccan population

Introduction: Morocco has recently developed a plan of reducing sugar consumption to reinforce prevention of non-communicable diseases and to contribute to the achievement of global voluntary targets for non-communicable diseases set by ICN2 by 2025. The objective of the present study was to assess acceptance of yogurts with different percentage reduction of sugar by the Moroccan population.Methods: a total of 201 participants (age > 15 y.) were recruited to determine the level of sugar reduction in yogurt. Sucrose was added to a plain yoghurt in the following different concentrations 166.5; 149.8; 133.2; 116.5; 99; 83.2 mM/l, corresponding to the reduction of sugar of 0%, -10%, -20%, -30%, -40% and -50%, respectively, compared available yogurt in local market. Overall, the acceptability scores of the different yoghurts were based on liking, "Just About Right" (JAR) and purchase intent scales was used to score the different yoghurts.Results: yogurts containing -20% and -30% added sugar were highly accepted by 81% and 74% of respondents. Based on JAR score, yoghurt with 20% (133.2mM/l) and 30% (116.5 mM/l) reduction were considered as "just about right" by 42.7% and 44.3% respectively. Best average score of purchase intent was obtained for sucrose concentration of 149.8 mM/l. 35.8% and 40.3% for yoghurt with sucrose concentration of 133.2 mM/l and 116.5 mM/l respectively.Conclusion: the finding from this study indicated that yogurts containing -20% and -30% added sugar were most accepted by respondents. Advocacy before dairy industry to have them commit towards sugar reduction in yogurt is needed, in order to help achieving the national sugar reduction strategy in Morocco

Blood and virus detection on barber clippers

Background. Bleeding from the popular clean-shave 'chiskop' haircut was recently reported as prevalent in South Africa (SA), a country with 6.9 million HIV-infected people.Objectives. To investigate the prevalence of barber hair clipper contamination with blood and HIV and hepatitis B viruses.Methods. Fifty barbers from three townships in Cape Town, SA, were invited to participate. One clipper from each barber was collected immediately after it had been used for a clean-shave haircut. Each clipper was rinsed with phosphate-buffered saline and then submerged in viral medium. The polymerase chain reaction (PCR) was used to identify the blood-specific RNA marker haemoglobin beta (HBB), hepatitis B virus (HBV) and HIV.Results. The clean-shave haircut was the most common haircut requested by clients (78%). Of the clippers collected, 42% were positive for HBB, confirming detection of blood, none were positive for HIV, and 4 (8%) were positive for HBV. Two clippers (clippers 16 and 20) were positive on qualitative HBV PCR. HBV DNA from clipper 16 clustered with genotype A sequences from SA, India, Brazil and Martinique, while clipper 20 clustered with SA genotype D sequences. The clipper 20 sequence was identical to a subtype D sequence (GenBank accession AY233291) from Gauteng, SA.Conclusions. This study confirms that there is significant contamination of barber hair clippers with blood and blood-borne viruses. Hepatitis B was detected with enough DNA copies to pose a risk of transmitting infection. Although HIV was not detected in this small study, the risk of transmission should be quantified. Further studies to investigate barber clipper sterilisation practices and whether the clean-shave hairstyle is an independent risk factor for HIV, HBV and hepatitis C virus infections are warranted. Public education on individual clipper ownership (as is the case with a toothbrush) should be advocated for clean-shave and blade-fade haircuts

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Background. The World Health Organization (WHO) has implemented the Surgical Safety Checklist (SSCL) as part of the Safe Surgery Saves Lives campaign. This is aimed at improving surgical safety worldwide. Despite many perceived benefits of the SSCL, compliance and acceptance in many areas remain poor.Objectives. To investigate perceptions of theatre staff regarding the checklist and to identify reasons and barriers for poor compliance and implementation. Methods. Questionnaires were handed out to theatre teams across all surgical disciplines at two large hospitals in Durban, South Africa, over a 2-week period. Data collected included role in theatre, intention of the SSCL, training received, as well as questions regarding previously identified barriers and staff perceptions.Results. Questionnaires were distributed to 225 practitioners, with a response rate of 81.7% from 51 nurses, 54 anaesthetists and 79 surgeons. Rank of medical staff included 52 seniors (consultants) and 81 juniors (registrars and medical officers). The majority (95%) of respondents perceived the SSCL as intended to improve safety, prevent errors or reduce morbidity and mortality. A total of 146 respondents (79.3%) received no SSCL training. No new barriers were identified, but previously identified barriers were confirmed. Our key factors were time-related issues and lack of buy-in from team members. Surgeons were perceived as being supportive by 45.1% of respondents, in contrast to nurses (62.5%), anaesthetists (70.1%) and management (68.5%). When compared with junior staff, senior staff were 5-fold more likely to feel that staff did not need to be trained and 8-fold more likely to indicate that the checklist did not improve patient safety.Conclusions. The WHO SSCL is an important tool in the operating room environment. The barriers in our setting are similar to those identified in other settings. There needs to be widespread training in the use of the SSCL, including adaptation of the checklist to make it fit for purpose in our setting. Improving use of the checklist will allow theatre staff to work together towards ensuring a safer theatre environment for both patients and staff

Evaluation de la qualité nutritionnelle des farines infantiles fabriquées et vendues au Bénin

La malnutrition chez les enfants a atteint des proportions inquiétantes dans les pays en voie de développement y compris le Bénin. Cette étude s'est inscrite dans le cadre de la lutte contre les carences en nutriments, dans la mesure où promouvoir des farines infantiles de bonne qualité nutritionnelle semble être l'une des meilleures voies d'amélioration du statut nutritionnel du jeune enfant. L'objectif était d'évaluer la qualité nutritionnelle des farines infantiles commercialisées au Bénin. Il s'agissait d'une étude transversale qui a porté sur 10 farines de 2ème âge, dont 8 locales et 2 importées, considérées comme référence. Les teneurs en nutriments ont été évaluées en suivant les méthodes de dosage de référence. Les résultats ont montré une non-conformité de la composition de ces farines aux normes du Codex Alimentarius, sauf en ce qui concerne les teneurs en énergie et en protéine. Sur le plan qualitatif, les protéines apportées par ces aliments de complément sont uniquement végétales, contrairement aux proportions recommandées de 6% d'origine végétale et 6% d'origine animale. Malgré l'ajout de compléments vitaminiques, les farines analysées sont très pauvres en micronutriments. En outre, une densité énergétique inadéquate des bouillies issues de la préparation de certaines farines les rend incapables d'assurer une alimentation suffisante pour la croissance du jeune enfant. Il ressort néanmoins, une standardisation des méthodes de fabrication de ces aliments de complément, expliquant l'absence de variation des paramètres étudiés d'un lot à un autre, à l'exception de la teneur en matières sèches. Des propositions d'amélioration de la densité énergétique des bouillies, ainsi que de la formulation des recettes et de leur préparation ont été suggérées à l'égard des entreprises productrices de farines infantiles de complément au Bénin

Demystifying writing papers for biomedical journals

This paper attempts to demystify the publication process in biomedical journals by offering simple step by step recipes on how to write and get published. The author relies on a narrative review and personal experience as a fellow student of publishing to achieve objective. Five stages in the publication process were identified: Planning, Writing, Submission, Managing editorial decisions and Post-acceptance. Planning is probably the most neglected yet the most important stage. The author begins by making sure that all necessary resources are in place, develops careful outline, decides on authorship and selects potential journal for publication. The paper will typically have three sections. The title which contains title of the paper and the list of authors and also key words is the first section. The abstract and the body of the paper are also the second and third sections. The title and abstract are critical and are usually revised many more times than the other parts of the paper. Choosing key words carefully increases the chance of the paper being read and cited. The body of the paper follows what is called the Introduction, Methods, Results and Discussion structure. Submission begins by writing a cover letter that makes the case for the article. Following all the key steps of the submission process avoids early rejection. Respond speedily and graciously and in sufficient detail to reviewers' and editors' comments. Following publication,the author should ensure that the published knowledge is disseminated widely. Overall, writing for biomedical journals is not too mysterious. However, there is no short cut: learning to write successfully takes time and practice

EMJ series on statistics and methods: variables, populations and samples

This the first article in the EMJ Series on Statistics and Methods describes "variables" which represent different demographic and clinical characteristics of several individuals in a data set. Various attributes of quantitative and qualitative variables, including type, scale of measurement and values they may take are presented. Some descriptive statistics and graphic summaries are introduced. Pertinent examples drawn from journal articles are provided. The article also defines "population" as used in statistics and epidemiology and highlights population in size and scope in the context of the research question to be answered. It emphasizes the need for explicitly defining sampling based on the research question in a particular study. In addition, the articles introduces concepts and notations related to parameter and statistic. It highlights the need for using appropriate sampling method in selecting a representative sample of the study population and to be able to make valid inferences and generalizations. It is indicated in this articles that specific issues requiring further details will be addressed in the Series articles in subsequent Issues of EMJ

EMJ series on statistics and methods: normal distribution and the central limit theorem

This second article in the EMJ Series on Statistics and Methods dwells on the basics of sampling distribution of' variables', which are presented in detail in the preceding article in this Issue of the Ethiopian Medical Journal (EMJ). The present article highlights recommended routines that need to be undertaken in order to understand information collected in a particular study before embarking on doing complex statistical analyses. It underscores the importance of descriptive statistics as a means to getting insights into data quality and learn about the scale and distribution of different variables in a data set. The article emphasizes the need for assessing the sampling distributions of variables as a prerequisite to making decide on selection of appropriate statistical techniques for in a data set. It describes salient features of a normally distributed random variable and touches on some other probability distributions commonly used in epidemiological studies. The article also describes the central limit theorem highlighting salient points on its conceptual basis in understanding sampling distributions of sample means and the implications of using normal distribution to make inference about the population based on summary measures from a sufficiently large sample

Improving voluntary medical male circumcision standards adherence and post-procedure follow-up in Uganda: A mixed methods study

Voluntary medical male circumcision (VMMC) has been demonstrated to reduce the transmission of HIV by 60%. Scaling up VMMC services requires that they be of high quality, socially accepted, and effective. We evaluated an intervention aimed at improving VMMC standards adherence and patient follow-up rates in nine facilities in Uganda. We also qualitatively explored why some men return for follow-up care and others do not. The completeness and quality of clinical documentation was poor at baseline, but significantly improved at endline. We observed significant improvements in management systems; supplies, equipment, and environment; and monitoring and evaluation. Due to the volume of missing data, results were less clear for registration, group education, and information, education and communication; individual counselling and HIV testing; and infection prevention. Significant improvements were also observed in follow-up rates at 48 hours and 7 days, and 6 weeks. Interviews revealed the importance of peers, including female partners, in deciding to get circumcised and in seeking follow-up care. Among the men who did not return for follow-up services, most reported they had no problems and did not see it as necessary. For those who did have mild or moderate adverse events, follow-up care was often sought at a facility closer to the patients' home rather than the circumcising facility. However, information systems were unable to capture this. Applying improvement approaches to VMMC services can promote improved standards adherence and follow-up rates and should be integrated into scale-up plans

Implementation of the world health organization regional office for africa stepwise laboratory quality improvement process towards accreditation

Background: The increase in disease burden has continued to weigh upon health systems in Africa. The role of the laboratory has become increasingly critical in the improvement of health for diagnosis; management and treatment of diseases. In response; the World Health Organization Regional Office for Africa (WHO AFRO) and its partners created the WHO AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) program.SLIPTA implementation process: WHO AFRO defined a governance structure with roles and responsibilities for six main stakeholders. Laboratories were evaluated by auditors trained and certified by the African Society for Laboratory Medicine. Laboratory performance was measured using the WHO AFRO SLIPTA scoring checklist and recognition certificates rated with 1-5 stars were issued. Preliminary results: By March 2015; 27 of the 47 (57%) WHO AFRO member states had appointed a SLIPTA focal point and 14 Ministers of Health had endorsed SLIPTA as the desired programme for continuous quality improvement. Ninety-eight auditors from 17 African countries; competent in the Portuguese (3); French (12) and eng (83) languages; were trained and certified. The mean score for the 159 laboratories audited between May 2013 and March 2015 was 69% (median 70%; SD 11.5; interquartile range 62-77). Of these audited laboratories; 70% achieved 55% compliance or higher (2 or more stars) and 1% scored at least 95% (5 stars). The lowest scoring sections of the WHO AFRO SLIPTA checklist were sections 6 (Internal Audit) and 10 (Corrective Action); which both had mean scores below 50%.Conclusion: The WHO AFRO SLIPTA is a process that countries with limited resources can adopt for effective implementation of quality management systems. Political commitment; ownership and investment in continuous quality improvement are integral components of the process

Mobile Hearing Testing - The Challenge to Stay SABS Compliant. Part 2 of 3- Part Series

How to ensure that your mobile audiometer is always calibrated according to SABS standards

Maximising mentorship: variations in laboratory mentorship models implemented in Zimbabwe

Background: Laboratory mentorship has proven to be an effective tool in building capacity and assisting laboratories in establishing quality management systems. The Zimbabwean Ministry of Health and Child Welfare implemented four mentorship models in 19 laboratories in conjunction with the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.Objectives: This study outlines how the different models were implemented; cost involved per model and results achieved.Methods: Eleven of the laboratories had been trained previously in SLMTA (Cohort I). They were assigned to one of three mentorship models based on programmatic considerations: Laboratory Manager Mentorship (Model 1; four laboratories); One Week per Month Mentorship (Model 2; four laboratories); and Cyclical Embedded Mentorship (Model 3; three laboratories). The remaining eight laboratories (Cohort II) were enrolled in Cyclical Embedded Mentorship incorporated with SLMTA training (Model 4). Progress was evaluated using a standardised audit checklist.Results: At SLMTA baseline; Model 1-3 laboratories had a median score of 30%. After SLMTA; at mentorship baseline; they had a median score of 54%. At the post-mentorship audit they reached a median score of 75%. Each of the three mentorship models for Cohort I had similar median improvements from pre- to post-mentorship (17 percentage points for Model 1; 23 for Model 2 and 25 for Model 3; p 0.10 for each comparison). The eight Model 4 laboratories had a median baseline score of 24%; after mentorship; their median score increased to 63%. Median improvements from pre-SLMTA to post-mentorship were similar for all four models.Conclusion: Several mentorship models can be considered by countries depending on the available resources for their accreditation implementation plan

Intern's experiences with episiotomy and its repair

Background: Episiotomy ­an incision of the perineum at the time of vaginal delivery is a common obstetric procedure. If the repair is inadequately done, it may leave the woman suffering from perineal pain and other long term conditions with serious impact on the woman's health and social wellbeing. The importance of skill in the obstetric procedure of episiotomy and its repair cannot be over emphasized. Objectives: The study aims to determine the interns' training and experience with episiotomy and its repair. Materials and Methods: A questionnaire study of medical interns' who had their houseman ship at the Federal Medical Centre Owerri, over a period of two years between 2003 and 2005. Results were analyzed with the SPSS version 10. Results: 70 (77.7%) of the 90 interns to whom the questionnaire was administered responded correctly. They had an average age of 28.81 ±3.36 years. 44 (62.9%) had a formal demonstration on episiotomy repair done at their medical training institution. 56 (80%) of the interns were comfortable with episiotomy repair while 14 (20%) were not. 10 (45.45%) of the females and 4 (8.33%) of the males were not comfortable with episiotomy repair. 30% of those who got their skill on episiotomy repair at the period of houseman ship were not comfortable with the procedure as opposed to 4.3% of those who had a formal training at their medical training institution. Discussion: A formal demonstration at the medical school of training does not appear to be a constant event in the medical schools as only 62.9% of the interns in this study accepted receiving such. However, despite the above, 80% of these interns' were comfortable with the repairs of episiotomy. Conclusions: It would be preferred if a formal demonstration is given on this procedure while a student is still in training

Enquete preliminaire sur la pratique des anesthesies chez l'adulte au Centre Hospitalier Universitaire de Toamasina

Objectif: evaluer qualitativement et quantitativement l'activite anesthesique au Centre Hospitalier Universitaire (CHU) de Toamasina afin d'identifier les problemes prioritaires et les normes a recommander pour le developpement future de l'anesthesie. Methodes: Une enquete a la fois retrospective et prospective a ete realisee du 1er Janvier 2008 a 31 Juin 2008. Resultats: 1215 anesthesies ont ete recensees. Le Centre Hospitalier Universitaire compte un medecin anesthesiste reanimateur. L'anesthesie generale a represente les 96des anesthesies. L'anesthesie generale etait suivie d'une intubation tracheale dans 71;86. Le thiopental a ete le produit le plus utilise. L'anesthesie generale n'etait pas balancee. L'anesthesie locoregionale a ete realisee dans 4des anesthesies. La morbidite et la mortalite anesthesiques etaient respectivement de 18;10et 0;49. Conclusion: Ces resultats soulevent une multitude de questions quant a la pratique de l'anesthesie; surtout concernant l'insuffisance des praticiens anesthesistes et les produits anesthesiques utilises