ABSTRACT
Background:Diabetic foot is one of the chronic consequences of diabetes mellitus and isresponsible for about 50of non-traumatic lower limb amputations.It is thus associated with social devastation to the patients and their families;both emotionally and economically.This study aimed at determining the pattern and the surgical management of patients with Diabetic Foot at Muhimbili National Hospital; from March to December 2008. Methods: All in-patients with diabetic foot who were admitted in the hospital during the study period were included into the study.Results: A total of 67 patients presented with diabetic foot during the study period of 10 months 4.5had Type 1 Diabetes Mellitus and 95.5had Type 2.The mean age of the patients was 52.4 years with a range of 21-75 years.The mean hospital stay was35.5 days.Most patients had a positive family history of Diabetes Mellitus (59.7).Majority of them lacked the known risk factors for foot ulceration such as hypertension;elevated cholesterol levels;trauma and duration of Diabetes Mellitus for longer than 10 years.Wagner Grade 4 and 5 were the most common ulcers encountered and major amputation was done in 44.8of the patients.The mortality rate was relatively high (25.4). Mortality was significantly higher in those with Wagner's Grade ulcers 3 (p-value = 0.0322). Conclusion:Diabetic foot ulceration was found to be a significant cause of morbidity and mortality in our setting.These patients stay in the surgical ward for a prolonged period of time.This causes a significant strain to the provision health services in the hospital.Designing a diabetic foot management protocol and initiating a diabetic foot unit for admission of these patients could reduce the associated morbidity and mortality and improve outcome
Subject(s)
Diabetic Foot/complications , Diabetic Foot/mortality , Risk Factors , Surgical Procedures, OperativeABSTRACT
Objectives: Patients are the primary beneficiaries of the services and care that hospitals provide. The Patient Satisfaction study examined the extent to which patients at the Muhimbili National Hospital (MNH) were satisfied with the services and care they received at MNH. This was part of a baseline study that sought to determine the level of performance of the hospital before massive restructuring; reform; and renovations were undertaken. Methodology: Exit interviews were the main research method used to determine patient satisfaction. Patients were interviewed as they were leaving the OPD clinics; laboratory; X-ray; pharmacy and inpatient wards. Results: The study found that most patients were satisfied with the services and care they received. This high level of satisfaction must be viewed within the context of a hierarchical public health care delivery system; with MNH at the apex. The services and care MNH provides can only be excellent compared to that provided by lower level health facilities. Indeed; patients covered by this study perceived the services provided by MNH as superior; and this was reflected in the high level of satisfaction they reported. Some patients expressed dissatisfaction with specific aspects of the services that they received. They were particularly dissatisfied with long waiting times before receiving services; the high costs of treatment and investigations charged at MNH; poor levels of hygiene in the wards; and negative attitudes of staff towards patients. Conclusion: Although only a small proportion of patients expressed dissatisfaction with these aspects of the services provided; they are significant in that they constitute a call for action by the MNH management to encourage the health personnel to embrace a new staffpatient relationship ethos; in which the patient is a viewed as a customer
Subject(s)
Health Care Reform , Patient Satisfaction , Referral and ConsultationABSTRACT
Objective: To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. Methods: A checklist of key information items was used to get facts and figures about the organization of the MNH and management situation. Interviews with MNH and MUCHS leaders; and documentation of existing hospital data were done to gather the necessary information. Results: The survey reveals that there are a number of organizational; managerial and human resource deficiencies that are impinging on the smooth running of the hospital as a national referral entity. The survey also revealed a complex relationship existing between the hospital and the college (MUCHS) that has a bearing on the functioning of both entities. Conclusion: In order for the hospital to function effectively as a referral hospital with a training component inbuilt; four basic things need to be put in place among others: a sound organization structure; adequate staffing levels especially of specialist cadre; a functional information system especially for inpatient services and a good working relationship with the college
Subject(s)
Health Care Reform , Management Service OrganizationsABSTRACT
A 30 year old male patient presented with an umbilical mass that was excised at a peripheral hospital. This recurred five months later. Excision of the recurrent mass and exploratory laparotomy at a consultant hospital revealed multiple intraabdominal metastases and a pelvic tumour. Histological studies revealed features consistent with adenocarcinoma of the rectum