effect of dietary counselling on the health status of end-stage renal failure patients

Chronic renal failure is becoming one of the most impacting diseases on the Egyptian population, alongside with cardiovascular and hepatic diseases, diabetes mellitus and cancers. Studies support the importance of dietary management on different aspects related to end-stage renal failure [ESRF] and other studies also suggest that active nutritional counselling can improve certain important biochemical parameters and fluid overload problems in patients on maintenance haemodialysis [HD]. To assess the effect of dietary counselling on the overall health status of ESRF patients subjected to haemodialysis, particularly their renal functions. A pretest-posttest study was conducted through several phases; Phase 1: Pre-intervention assessment using; an interview questionnaire to collect socio-demographic, nutritional knowledge and dietary pattern data; Malnutrition Inflammation Score [MIS]; Karnofsky Performance Scale [KPS] and anthropometric measurements. Phase 2: Implementation of nutritional counselling sessions communicating evidence-based practices. All patients were given one-to-one nutritional counselling over a six-month period. Phase 3: Post-intervention reassessment of patients using phase one tools. A sex-stratified random sample of about 50% of all patients attending El-Harem Centre for Dialysis [82] during the period from October, 1[st] 2008 till March, 31[st] 2009 were included. Intervention participants totalled 41 ESRF patients. In this study, 97.5% of patients were considered mildly to moderately malnourished. Multiple malnutrition problems detected among these patients were protein-energy malnutrition, hypocalcaemia, anaemia and hyperphosphataemia. Nutritional counselling sessions resulted in statistically significant changes in the Malnutrition Inflammation Score [MIS] and Karnofsky Performance Scale [KPS] of the patients, the patients' nutrition related knowledge and to some extent their dietary practice. Providing one-to-one nutritional counselling is an effective intervention that can improve the ESRF patients' nutrition related knowledge and practice as well as their compliance to the dietary guidelines for the dialysis patients, which in turn can improve their health status and daily performance

Assessment of laboratory services in PHC units and first referral level hospitals in 5 governorates, Egypt 2002

Parallel to the development in the promotive, preventive; curative services in primary health care are expected to achieve more specially with the concomitant implementation of the referral system and family health record. Aim of this study is to assess the laboratory services in PHC and district hospitals and to evaluate the referral link as regards laboratory services between the two levels. This was across sectional descriptive study during 2002. In this study, all laboratories either in PHC units or hospitals in the five districts assigned for the Health System Upgrading Project II. A pre-designed pre-tested questionnaire form including data about the laboratory workers, their qualifications, and training experience. In addition, data about laboratory basic sanitary requirements, equipments, supplies and its logistics was collected. Referral system between the two levels will be investigated among a sub-sample of PHC laboratory in each district to explore the aspects of strengths and weakness if it is actually exists. Manpower was mainly laboratory technicians who were evenly distributed in different districts. The 2[nd] majority was assistant laboratory technician and they were mainly in Dyrute and Somosta [upper Egypt] 51/62 [82.3%]. Unqualified laboratory worker comes third. Doctors were only 8, and there was one District hospital [somosta] laboratory without a clinical pathologist. Although the mean duration of work as a laboratory Personnel was 13.3 +/- 9.6 years for PHC workers and 11.9 +/- 9.5 years for hospital laboratory personnel, the percentage of those not attending any training course was 54.2% [116/214]. A declining percentage for attending one course, two courses and three courses among PHC personnel and still lower of hospital personnel. Basic sanitary needs: were almost satisfactory except for few PHC units in Dyrute and kantara Gharb. Laboratory equipment and laboratory materials: PHC laboratory and hospital laboratory are generally satisfactory. Some vital equipment are deficient in some hospitals. The need for maintenance besides is vital training of available personnel to use such equipment. Materials for its proper utilization are essential. Needs for redistribution of some materials between hospital laboratories is recommended. Laboratory registration forms: Registration book is the only format we can consider satisfactory. Other format is either not available or available and neglected in some PHC and Hospital lab. The need for maintenance is vital, training of available personnel to use such equipment. Materials for its utilization are essential. Need for redistribution of some materials between hospital laboratories is recommended. Foundation for referral link is vital

Congenital malformations in primary health care in Al-Qassim region

The objective of this predesigned research was to determine the prevalence, sociodemographic correlates, and pattern of congenital malformations [CM[s]] in a population less than 20 years of age. From January 1991 to December 1991, the extensive examination of family health files coupled with door-to-door survey identified 1736 patients with CM[s]. The results showed that the prevalence of CM[s] was 6.9/1000 population. The male to female ratio was 1.3:1. The patient's age, sibling order, co-morbid disorders of CM[s], parental age, chronic maternal diseases, and the family history of CM[s] were significantly associated with groups of arbitrarily classified CM[s]. The most frequently encountered CM[s] were of central nervous system [39.2%] followed by cardiovascular [22.3%], alimentary [13.1%], musculoskeletal [6.85%], urogenital [6.16%], communicative and audiovisual [5.5%], and miscellaneous [6.9%]. Further one-way ANOVA found significant differences among CM categories and age of patients and parents. Unlike Western trends, our study tentatively concludes that overall the inheritance rather than socioenvironmental factors contributes significantly in the etiology of different congenital malformations. We further suggest that the basic information of this research might be useful foundation data in future analytic studies on congenital malformations

seroepidemiological study of measles: Some practical implications for measles immunization program, Kingdom of Saudi Arabia

It was hypothesized that the recent outbreaks of measles in a geographically defined area of Al-Qassim might reflect significant changes in the epidemiology of measles and cast doubt upon the real protective value of measles vaccines. Therefore, the two objectives of this research were to study some epidemiological parameters of cases of measles [n=993] and the current immunological status of immunized children [n=2810]. The crossmatched data about measles patients were collected on an official proforma and 3 mL of blood were extracted from each child for determining the measles IgG and IgM antibodies. The results showed that female patients were significantly overrepresented [51.3%]. The majority of patients encountered at primary health care centers [PHCC[s]] [81.3%] were more than five years of age [76.5%]. Among nonvaccinated measles cases, 54.9% [n=402] were from rural/desert areas. The measles vaccine failure rate was 26.3%. The results of the surveyed children showed that 2% of them were not vaccinated. The measles IgM levels were detected significantly in recently vaccinated females [n=29/51, 56.9%]. The measles IgG positivity unaffected by age, sex, and residence was found in 87.4% of children. A significant portion of children from rural/desert areas were not vaccinated [n=44/57, 77.2%]. Though there were apparently high seroconversion rates in children under two years of age following Edmonston-Zagreb vaccine, overall it did not achieve any statistical significance when compared with seroconversion rates in all children following Schwartz vaccine. We conclude that besides at age six months, and MMR containing measles vaccine at 12 months, children at school entry [six years] should also be considered for measles vaccination

Utilization pattern of immunization services at primary health care centres: a 6-year study from Al-Qassim region

The timely delivery of immunization services to infants and children by medical personnel is essentially one of the most important components of the entire medical services meant for the infant population. The two objectives of this research were to determine the utilization of immunization services by infants and children over a period of 6 years, through 1987 to 1992, and also to assess whether their residential styles influence the utilization of these immunization services.The relevant recorded data about infants and children was collected on a pretested proforma by physicians attached to 60 primary health care centres of AI-Qassim region, Saudi Arabia, which were randomly selected to represent the main four types of residential strata. It was shown that sparing the second and third dose of poliomyelitis and DPT [diphtheria, pertussis, tetanus] [p>0.05], led to significant successive enhancement in the utilization of other immunization services [p< 0.001]. Furthermore, there was a significant improvement during the study period in the utilization of these services across different residential styles [p< 0.0001]. However, in each year the immunization services were more or less equitably utilized by infants and children belonging to different subgroups of residential zones [p>0.05]. Evidently there is further need to monitor the timely delivery of immunization services to this sector of the population by better implementing the computerized information system at each primary health care centre which will not only reduce the attrition rates but ensure the cost-effectiveness and quality of delivery of infants and child health services

Some characteristics of mental patients admitted to a psychiatric hospital

We retrospectively reviewed the randomly selected case files of 195 Saudi patients who were admitted to a mental health hospital and relevent data were recorded on a semistructured proforma and ICD -IX definitions were applied for diagnostic purpose. It was found that mean age of patients was 30 +/- 10.85 and male subjects [58.97%] as compared to female gender [41.23%] utilized more indoor services. Both family constellation and employment were significantly associated with a variety of mental diseases among which the commonest diagnosis was of schizophrenia [56.92]. Multiple admissions, high rates of relapse, family history of mental illnesses, poor drug compliance and presence of precipitating factors were other features of these patients. In addition, physical diseases were found in 74 patients [37.95%] who were referred to different specialists' clinics. The polypharmacy of psychotropic drugs and prophylactic use antiparkinsonian agents were the mainstay of treatment. The different aspects of this study were discussed and relevent recommendations were suggested

Rose Bengal screening test for community diagnosis of avitaminosis a among children in a high density area of Cairo

320 Children of both sexes aged from 2 months to 10 years were randomly selected from attendants to Misr Elkadema MCH centre. Conjunctival xerosis caused by avitaminosis A was detected by Rose Bengal Test in 20.9% of children [prevalence rate: 209/1000], while clinically by the professor of ophthalmology 6.2% of children were diagnosed [prevalence rate: 62/1000], with a statistically significant difference of P < 0.001. Rose Bengal Test proved to be highly sensitive and specific, valid, reliable, harmless, cheap, available, simple and practical screening test to be used by paramedical personnel as well as it is the only sure single method for pre symptomatic community diagnosis of conjunctival xerosis. The study showed that the most vulnerable age group for avitaminosis A was one year of age and over [P < 0.001]. There was no significant sex difference regarding prevalence of avitaminosis A [X2 = 1.039 < d.f. =1 P > 0.05]. Dietary supplementation by vegetables and/or vitamin A capsules played a major role in the prevention of vitamin A deficiency