The Influenceof Parallel Reporting SystemsonData Quality and Information Use in Northwest Ethiopia: Qualitative Study

Background:Ethiopia utilisesthedistrict health information systemfor health information management. However,the lower level health structure seems inaccurate in comparisonto theparallel reportingsystem, withlimited evidence on its effect ondata quality and information use.Therefore,the present study aimed to assess the influence of a parallel reporting system on data quality and information use at the lower level structuresof the Amhara region, Northwest Ethiopia.Methods:The study was conducted in five districts of the Amhara region using an explanatory case study design. Twenty respondents were interviewed from the 1st­30thApril 2021,usinga semi-structured key informant interview(KII)guide with multiple probes to explore relevant information. The data was transcribed into English and transferred to the Open-Code 4.02 software for analysis. Textual data werecoded, and themes were identified from the synthesis. Inductive thematic analysis was applied to identify the relationships among the emerging themes in order todraw a relevant conclusion. Results:Five themeswere emerged fromthe analysis, includingthe current practice of parallel reporting, a program area of parallel reporting, the influence of parallel reporting, reasonsfor parallel reporting,and means to avoid parallel reporting.Likewise, parallelreportingwasdone at the district level and at the point of service delivery. The respondents described maternal and child health programs often usingparallel reporting. Parallel reporting was described as havingundesirable impacts on routinely collected health data quality and use. Moreover, it increases the work burden; andaffects service quality,the the satisfactionlevelsof clients and staff, and the overall efficiency. The main reasons for practicingparallel reporting were:missing important data elements in DHIS2, single language, varying stakeholders' interests, and lack of conductinga partnerforum.Conclusion and implication:Against the national health information system'sguiding principlesand vision, parallelreporting is practicedat the lower health system levelsfor various programs. Therefore, a corrective measure should be taken to achieve the country's information revolution (IR) agenda. To avoid parallel reporting mechanisms, it is recommended that regular partner forums at the district level must be strengthened, important data elements should beincorporated into the DHIS 2, and additional language platforms should be be included in theDHIS2 system.

Faible performances diagnostiques de l'IPS cheville de repos par rapport au doppler artériel des membres inférieurs dans le diagnostic de l'AOMI chez le patient coronarien: à propos d'une série hospitalière / Weak diagnostic performance of resting ankle ABI compared with lower limb's arterial Doppler in the diagnosis of PAD in coronary patients: about a hospital serial study

Introduction. L'index de pression systolique (IPS) est considéré comme un outil indispensable, pour la prise en charge de l'artériopathie oblitérante des membres inférieurs (AOMI), cependant un complément d'exploration par les autres testes physiologiques, IPS au gros orteil et IPS effort s'impose afin de réduire le nombre des faux négatifs. Objectif. Démontrer le faible apport de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs dans le diagnostic de l'AOMI. Matériels et méthodes. Sur une série de 300 malades coronariens consécutifs durant l'année 2016 hospitalisés dans le service de cardiologie de l'hôpital universitaire de Constantine, un dépistage de l'AOMI a été réalisé par les investigations suivantes : Mesure de l'IPS à la cheville, compléter par la mesure de l'IPS a l'orteil si incompressibilité artérielle et par la mesure de l'IPS d'effort si l'IPS de repos est limite. Un échodoppler artériel des membres inférieurs a été réalisée par un échographe vividE9 General Electric pour l'ensemble de nos malades, en utilisant une sonde à balayage linéaire 12L, destinée à l'exploration vasculaire périphérique permettant d'obtenir un dépistage ciblé, Le traitement et l'exploitation des données ont fait appel au logiciel SPSS22. Résultats. Une sensibilité modérée de l'ordre de 50%, face à une spécificité élevée avoisinant 100% de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs. Sensibilité nettement améliorer après complément par les autres testes physiologiques qui sont la prise de l'IPS cheville effort et la mesure de l'index de pression systolique au gros orteil. Conclusion. L'examen vasculaire des membres inférieurs associe à la mesure de l'IPS cheville couplée aux autres testes physiologique (IPS au gros orteil et IPS effort) assurent une bonne sensibilité et spécificité diagnostiques de l'AOMI

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology:A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor

Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon

Introduction: low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause.Methods: this was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded.Results: we analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3rd and 4th decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries.Conclusion: in view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision

A retrospective study of lower limb cellulitis in a regional hospital in Ghana

Background: Cellulitis is a non-necrotizing inflammation of the dermis of skin and subcutaneous tissues. Lower limb cellulitis is a common cause of hospitalization in Ghana but scarcely reported. Objective: To document management and outcomes of lower limb cellulitis at the Ashanti Regional Hospital in Ghana. Materials and Methods: Retrospective review of patients admitted to the Ashanti Regional Hospital with a diagnosis of lower limb cellulitis from November 2016 to October 2018. We reviewed patients' clinical records for data on patient demographics, risk factors, clinical presentation, treatment modality and outcome of cellulitis. A p-value of less than 0.05 was considered to be statistically significant. Results: Eighty two (82) patients with lower limb cellulitis were admitted over the study period. There were 47 (57.3%) females and 35 (42.7%) males. The mean age of patients was 38.8 years (standard deviation 21.6065). Among females, the majority, 10 (21.3%) were in the 6th decade whilst the majority, 9 (25.7%) of males were in the 4th decade. All the patients presented with swelling of the lower limb involving the left lower limb in 38(46.3%) and right in 44(53.7%) cases. The leg was the most common location involved 60 (73%). The mean duration of swelling prior to admission was 5. 2 days (SD 3.196). Antibiotics treatment resulted in complete resolution in 29 (35.4%) cases and complications in 53 (54.5%), cases requiring surgical treatment in 31(58.5%) patients. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy

Reconstruction par la technique de la membrane induite des pertes de substance osseuse du membre inferieur: résultats préliminaires

Introduction: La reconstruction des pertes de substance osseuse étendue du membre inférieur fait appel à plusieurs techniques. L'objectif de cette étude était d'évaluer les résultats préliminaires de la technique de la membrane induite. Matériels et méthodes: Cette étude rétrospective a concerné 20 patients qui avaient une perte de substance osseuse primaire (n=5) et une perte de substance osseuse secondaire (n=15). La longueur moyenne du défect était de 7,6 cm (2-13cm). Selon la classification de la SOFCOT, les lésions étaient de type 1 (n=5), type 3 (n=3), et type4 (n=2). La reconstruction concernait le tibia (n=14) et le fémur (n=6). Lors du premier temps, la contention a été assurée par une attelle plâtrée postérieure (n=2), le fixateur externe (n=14) et les broches (n=4). Le délai moyen entre le premier et le deuxième temps était de 5,23 semaines (4- 44 semaines). Des greffons iliaques cortico-spongieux ont été utilisés. L'évaluation des patients revus au contrôle a été réalisée selon les critères de l'ASAMI. Résultats: Avec un recul moyen de 2 ans (8mois-4 ans). La consolidation a été obtenue chez 15 patients dans un délai moyen de 9 mois (4 - 24 mois) au prix d'une seule intervention de greffe osseuse. Le résultat anatomique était excellent (n=10), bon (n= 3), moyen (n= 3)cas et mauvais (n=3). Le résultat fonctionnel était excellent(n=10 ), bon (n= 3), moyen (n= 3) cas et mauvais (n=3). Conclusion: La technique de reconstruction par membrane induite représente une méthode de choix dans l'arsenal thérapeutique des reconstructions osseuses malgré un délai assez long de consolidation en partie lié au retard de la réalisation du premier temps

Artériopathie oblitérante asymptomatique des membres inférieurs chez un groupe de patients avec des facteurs de risque cardiovasculaire à Yaoundé

INTRODUCTION. L'artériopathie oblitérante des membres inférieurs (AOMI) évolue chez près de 70% des malades de manière asymptomatique. Le but de notre étude était de décrire les aspects épidémiologiques, cliniques et diagnostiques de l'AOMI chez un groupe de patients consultant à l'Hôpital Général de Yaoundé. METHODOLOGIE. Il s'agit d'une étude transversale, descriptive qui s'est déroulée d'Octobre 2012 à Avril 2013 dans l'unité de Cardiologie de l'Hôpital général de Yaoundé. Nous avons recruté 42 sujets ayant au moins un facteur de risque cardiovasculaire majeur. Pour chaque sujet, nous avons collecté des données cliniques, anthropométriques. Puis nous avons mesuré l'Indice des pressions systoliques(IPS) et l'épaisseur intima média (EIM) fémorale. RESULTATS. La moyenne d'âge des sujets était de 54,3 ± 10,3 ans avec un sex-ratio (H/F) de 3,2. Une AOMI (IPS < 0,90) a été retrouvée chez 16,7% des sujets, tandis que 7,1% avaient un IPS > 1,30. L'EIM fémorale moyenne était de 0,82 ± 0,19 mm et 26,2% des sujets avaient une EIM augmentée (> 1 mm). CONCLUSION. L'AOMI asymptomatique est fréquente chez les patients présentant plusieurs facteurs de risque cardiovasculaire à Yaoundé

Notre experience sur la traction des fractures des os des membres inferieurs chez l'enfant a partir de la botte platree

Les auteurs rapportent leur experience de la traction des fractures des membres inferieurs chez l'enfant en se servant de la botte platree. Methodes: 296 tractions ont ete appliquees a l'hopital de Ndjili/ ISTM entre l'an 2000 et 2010. Resultats : avec 12 d'escarres par compression. Ce resultat parait meilleur en le comparant a celui obtenu par traction au sparadrap (34;7 des phlyctenes); en l'absence des bandes adhesives appropriees. Les escarres apres usage de la couche d'ouate suffisamment epaisse au talon et au dos du pied n'ont pas ete rapportees

Lower Limb Injuries Arising From Motorcycle Crashes

Background: Motorcycle accidents are the second most common cause of road traffic accidents in both developing and developed countries. In this study we aim to look at the pattern and characteristics of lower limb injuries arising from motorcycle accidents and evaluate early outcome of treatment. Methods: All the patients with lower limb injuries arising from motorcycle accidents who presented in our hospital between 1st October 2006 and 30th September 2007 were reviewed. History was obtained and detailed examination was done after resuscitation to determine the site; nature and the characteristics of injuries. Definitive treatment (conservative or operative) given was based on the pattern and type of injuries. Patients were followed up in the clinic for both clinical and radiological review. Functional outcome assessment was commenced after the onset of weight bearing. The data were recorded on a designated proforma and analyzed using a statistical programme. Results: A total of 429 motorcycle accident victims were seen during this period and lower limb injuries represented the commonest type of injury(238; 55.5). Male: female ratio was 2.2:1 with a mean age of 43.1years. Fractures were the commonest lower limb injuries(73.4) and closed fractures were commoner than the open fractures. The commonest anatomical location of fractures in lower limbs was tibial shaft. Joint stiffness was found to be the commonest post treatment complication. Conclusion: Lower limb injuries represent the commonest form of injuries among the motorcycle accident victims. Fractures were the commonest type of injury seen and the most common location was shaft of tibia

Contribution a l'etude des oedemes des membres inferieurs : a propos de 339 cas colliges dans le Service de Medecine interne du CHU de Treichville

"Nous avons realise une etude de 339 cas d'oedemes des inferieurs recenses dans le service de Option : Medecine Interne du CHU de Treichville du 1o'Janvier 2003 au 30 Juin 2004. Cette etude nous a permis de definirle profil epidemiologique; clinique et etiologique des patients presentant ces oedemes. L'incidence des oedemes des membres inferieurs dans le service s'etablissait a 6.31pour cent. L'age moyen a ete de 44 ans pour l'ensemble des patients avec des extremes de 15 ans et 90 ans. Les signes fonctionnels associes etaient domines par la dyspnee (43.95pour cent); le ballonnement abdominal (29pour cent) et l'ictere (8.55pour cent). Le tableau clinique etait essentiellement celui de l'insuffisance cardiaque (35.59""pour cent); du syndrome oedemato-ascitique (29.85pour cent); le syndrome oedemateux bilateral isole (15.33pour cent) et l'arasarque (14;74pour cent). Au plan etiologique; l'oedeme generalise representait 84.66pour cent de notre population. Les principaux organes atteints etaient le cour(44.01pour cent); le foie (26.05pour cent) et le rein (18.31pour cent). L'HTA (45.16pour cent) et la myocardiopathie du post-partum (19.35pour cent) dominaient les atteintes myocardiques. L'HTA pulmonaire etait en majorite associee a l'infection a VIH (66pour cent). L'oedeme hepatique etait essentiellement du a la cirrhose post-hepatitique decompensee (63.38pour cent). Les syndromes nephrotiques (46.16pour cent); la nephropathie hypertensive (28.84pour cent) et l'insuffisance renale aigue (15.38pour cent) dominaient les causes de l'oedeme d'origine renale. Les syndromes nephrotiques etaient principalement lies au VIH (50pour cent); au diabete (27.77pour cent) et gravidique (16.67pour cent). La denutrition (76pour cent des. oedemes carentiels) etaient surtout due a l'infection a VIH (52.63pour cent) et au cancer (26.33pour cent). La denutrition (32.70pour cent) ; l'erysipele (26.92pour cent) et la phlebite (17.30pour cent) etaient les principales etiologies des oedemes localises."