Clinical governance and quality of health services in public health facilities: evidence from three councils in Tanzania

Objective: Our objective was to assess clinical governance and the quality of health services in public primary health facilities in three councils of Arusha Region. Participants: We conducted a study involving 270 clients from 19 primary health facilities in three councils in Arusha Region. Methods: We conducted a cross-sectional study. The clients were selected using multistage-cluster sampling. Data were collected using exit interview and observation. A descriptive statistical method was used to analyse data. Results: We found that health facilities had the key policies and structures for quality improvement and limited governance for quality of health services. In total,109(43%) of the clients reported receiving all the prescribed medicines and 230 (85%) of the clients had a positive experience with care processes. Also, 181(72%) of the clients were satisfied with the health services and 230 (85%) of clients had confidence and trust in public primary health facilities. Conclusion: This research has generated valuable evidence on governance and the quality of health services offered in public primary health facilities in three councils of the Arusha Region. Our research has indicated that: facilities had limited governance for quality of health services and clients had limited access to essential medicines; the majority of clients had a positive experience with the processes of health care; the majority of clients were satisfied with health services offered and had confidence and trust in public primary health facilities. The empirical evidence of this study should inform quality improvement efforts in the studied councils and Tanzania

Real-time three-dimensional echocardiographic left heart parameters in healthy indian adults

Objective Cardiac chamber dimensions are race and anthropometry dependent. We determined the age and gender specific 3-Dimensional echocardiographic (3DE) reference values for dimensions and function of left ventricle (LV) and left atrium (LA) in normal Indian adults. Methods This single center prospective study enrolled 133 adult Indians free of heart disease and/or hypertensions, subjecting them to 3DE measurements of left atrial (LA) & left ventricular (LV) volumes, function and left ventricular mass (LVM). The higher limits of normal cut-offs were determined for these parameters and their dependency on age, gender and anthropometry were analyzed. Results The body surface area (BSA) corrected higher limit cut-offs were: 59.37 ml/m2 for LV end diastolic volume (59.19 ml/m2 and 59.61 ml/m2 for men and women, respectively; P = NS); 23.48 ml/m2 for LV end systolic volume (23.27 ml/m2 and 23.11 ml/m2 for men and women, P = NS). Mean LVEF was 64.79% ± 7.26 (62.99% ± 6.51 and 67.05% ± 7.58 in men and women, P = NS). Men had higher LVM than women (119.79 g±23.95 vs. 103.26 g±23.76, P < 0.001), this difference disappeared after BSA indexing. The higher limit cut-offs for normal LA volumes were 20.49 ml for minimum volume (21.18 ml and 19.46 ml for men and women, P = NS) and 39.76 ml for maximum volume (39.60 ml and 40.03 ml in men and women, P = NS). The parameters were smaller compared to western populations but the differences attenuated after BSA indexing. Conclusions The study reports normal 3DE parameters of size and function of left heart chambers in Indians.

Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex

Objectives To investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS. Methods 143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB). Results Frequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments. Conclusions 3DE confirmed significant dyssynchrony in > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.

Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population‑based study.

Context: Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India. Aims: To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India. Settings and Design: Door‑to‑door population survey in suburban town of South India in May 2013. Materials and Methods: A 30‑point questionnaire was prepared and the data were collected and analyzed to determine statistically the knowledge, attitude, and practice (KAP) scores of the general and diabetic population and also to determine significant demographic associations. Results: In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 ± 11.7 years (range 21–98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001). Conclusions: Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow‑ups.

Heat cramps in a hot desert work-site

To determine whether the increased numbers of patients attending the field clinics of an Arabian oil company in summer and complaining of limb and abdominal pains for which no apparent cause was found could have been suffering from heat cramps. The study was a prospective field study carried out in the desert work-sites of the Abu Dhabi onshore oil company The complaints were responsible for much discomfort, loss of working time and of efficiency in the work-force. All patients attending the desert clinics during the month of July 1997 and complaining of abdominal or limb pain were subjected to careful examination to determine the cause. In 132 cases no cause was found. The occupational and recreational history was taken and the electrolytes were measured. During the following equally hot month [August, 1997] the entire work force was given 60 mg of sodium chloride each day and the same surveillance took place at the clinics. During this month, only six patients presented to the clinics. When these six were questioned it seemed that four had not taken the salt tablets from fear of developing hypertension. It was concluded that the likely cause of the symptoms was heat cramps and during the following year [1999] when the same dose of salt was given during summer there were no complaints of heat cramps in the work-force. A secondary cause was the acceptance of health education material from a temperate zone and applying it directly to a hot work-site