Factors Associated with Pulmonary Tuberculosis Outcomes among Inmates in Potchefstroom Prison in North West Province

Tuberculosis is the leading cause of death among the world's prison populations. Prisons are reservoirs of tuberculosis and threaten inmates; prison staff; visitors and the surrounding community. This study was carried out to explore the associated factors with pulmonary tuberculosis treatment outcomes at Potchefstroom Prison. A retrospective record review of 202 inmates with tuberculosis; whose treatment outcomes as of March 2010 were known; was conducted. Data on sex; racial group; level of education; weight; smoking habits; existence and type of co-morbidity; diagnostic classification; treatment regimen; initiation date; completion date and outcome; use of directly observed treatment; allergy and hospitalisation were captured. The majority of the inmates (142; 70.3) were aged 21-37 years; while 48 (23.8) were aged 38-53 years. There were 198 (98) male and 4 (2) female inmates. Fifty-five inmates (27.3) had attained Grade 6 and lower; 71 (35.1) grade 7-9; 68 (33.7) Grade 10-12; and 8 (3.9) above grade 12. One hundred and fifty-eight (78.2) received occasional visitors. There were 121 (59.9) smokers. The adverse outcomes for tuberculosis were significantly increased by an age 37 years; human immunodeficiency virus co-infection; smoking; a lack of support and an absence of directly observed treatment. Inmates who received fewer visits and less social support must be supported by community volunteers; counsellors and psychologists in order to motivate them and enhance favourable treatment outcomes. Smokers need to stop smoking. Younger inmates require peer support groups

Care-Seeking Behaviour and Implications for Malaria Control in Southern Malawi

Abstract:Although malaria is a controllable and preventable disease; it remains among the leading causes of mortality and morbidity in southern Malawi. The importance of early diagnosis and prompt treatment with hospital prescribed drugs and effective home management to control malaria is well established; however; these in part depend on how households make their decisions when family members have suffered from malaria. This study examines the behaviour of households with regard to decisions they make in managing malaria illness. Using hierarchically built data from a survey of 1;400 mothers nested within 33 communities; a series of two-level logistic regression models with Bayesian estimation was used to determine predictors of care-seeking behaviour towards malaria when a family member or a child was perceived to have malaria. The results show that most families normally visit or use medication prescribed at health facilities for both adult (80) and child (86) members when they are perceived to have malaria. The main obstacle to accessing the nearest health facility was distance and transport costs (73) and the main problems encountered at health facilities were long waiting time or absence of health workers (73) and shortage of drugs (35). Among the main predictor variables for choices of treatment for childhood malaria was the absence of a health surveillance assistant for those that visited hospitals [?=0.56; 95 CI:-0.86;-0.26]; bought medication from open markets [?=0.51; 95 CI:0.20;0.82]; and those that used other traditional methods or did nothing [?=0.70; 95

Necropsias de neonatos, fator da melhoria da qualidade nas UTIs neonatais / Neonatal necropsies as a factor in quality improvement of the neonatal ICUs

Neste estudo foram estudados 552 casos de necropsia de neomortos provenientes de unidades de terapia intensiva neonatais (UTINs). Desses, 265 apresentaram algum tipo de enfermidade ou lesão não esperada conseqüentes (direta ou indiretamente) a seu manuseio diagnóstico e/ou terapêutico. Os casos foram agrupados por tipo de enfermidade, em seus respectivos órgãos ou sistemas, que ressaltou a prevalência de lesões pulmonares, como membrana hialina, enfisema intersticial, displasia broncopulmonar e alterações graves em nível de sistema nervoso central (SNC), sinalizando o prognóstico quanto à qualidade de vida. Como parte das medidas terapêuticas, devem ser analisados os acessos arteriais e venosos dos vasos umbilicais, com suas complicações, e o acesso venoso profundo, propriamente dito, para nutrição parenteral total, com graves complicações fatais para o lado do coração, como endocardite fúngica e tamponamento cardíaco por "Intralipid". Foram discutidas as resultantes multissistêmicas dos quadros de hipotensão e choque: enterocolite necrotizante e necroses corticomedular, renal, hepática e miocárdica. Este trabalho ressalta o valor da necropsia na melhoria da qualidade das UTINs, bem como apresenta várias situações em que o diagnostico só foi conhecido devido à necropsia ou, então, o resultado modificou, de certa forma, a abordagem terapêutica futura. A consulta e a análise da literatura demonstram a virtual inexistência de metodologia adequada para desenvolver e estabelecer um comportamento que propicie o exercício sistemático de aferição do desempenho organizacional, e que reduza sensivelmente as possibilidades de efeitos indesejáveis relacionados com rotinas e procedimentos operacionais nesse campo da prática assistencial. As principais causas de insucesso parecem ser creditadas à tecnologia de máquinas e substâncias, cuja adequação à biologia dos organismos em desenvolvimento não é plenamente conhecida no que se refere à influência...

The present study emphasizes the necropsy value in the development of the neonatal ICU. We present many situations where the diagnostic was possible solely because of the necropsy, as well, many diagnosis were changed based on the necropsies results. The literature compilation shows no evidence of a systematic procedure concerning the mitigation of the problems related to the avaliable routines in this matter. The lack of a more scientific investigation related to the neonatal deaths is a enormous barrier to the improvement of those organizations (ITU's). Apparently, these failure is connected to machines and products thecnology not well know in terms of their suitability concerning under biological development organisms. Also, the necropsies appears to be a useful tool when the death results, directly or indirectly, from therapeutical process. The conception of a quality development process strategy represents a major issue, even more when you face new political decisions in health field, including cost reduction and higher complexity. Also, we need to pay special attention to science and research ethical principles.