Bridging gaps in health information systems: a case study from Somaliland, Somalia

Reliable and timely health information is fundamental for health information systems [HIS] to work effectively. This case study aims to assess Somaliland HIS in terms of its contextual situation, major weaknesses and proposes key evidence-based recommendations. Data were collected through national level key informants' interviews, observations, group discussion and scoring using the HIS framework and assessment tool developed by World Health Organization Health Metrics Network [WHO/HMN]. The study found major weaknesses including: no policy, strategic plan and legal framework in place; fragmented sub-information systems; Poor information and communications technology [ICT] infrastructure; poorly motivated and under-skilled personnel; dependence on unsustainable external funds; no census or civil registration in place; data from private health sector not captured; insufficient technical capacity to analyse data collected by HIS; and information is not widely shared, disseminated or utilized for decision-making. We recommend developing a national HIS strategic plan that harmonizes and directs collective efforts to become a more integrated, cost-effective and sustainable HIS

Clinical features and outcome of infective endocarditis in Yemeni patients treated with empirical antibiotic therapy

Infective endocarditis is a common disease in Yemen. Although the incidence of rheumatic valvular disease and uncorrected congenital heart disease in adults is high in Yemen, there are few data regarding the pattern, characteristic features and outcome of infective endocarditis in Yemen. The aim was to study the characteristic, clinical features and diagnostic criteria of infective endocarditis in Yemeni patients and the outcome in patients treated with medical therapy. Seventy-two consecutive patients admitted to Kuwait teaching hospital in Sana'a with suspected infective endocarditis between June 1, 2005 and June 1, 2007 were included in this study. A questionnaire including history, clinical findings, and result of requested investigations, treatment, complications and outcome was used. The diagnosis was based on Dukes criteria, which proposed two major or five minor criteria. In our study, we included raised erythrocyte sedimentation rate [ESR] as a minor criteria. The patients were classified as definite, possible and rejected cases. All patients received empirical antibiotic therapy. The mean age was 28.56 +/- 14.5 years. Men were 30 [42.2%] while women were 42 [57.7%]. 59 [81.9%] of the patients had been admitted due to fever. Past history of rheumatic heart disease was positive in 38 [53.3%] of the patients. Mitral regurgitation was the commonest form of valvular affection 54 [82.1%] of patients followed by aortic regurgitation in 45 [63%]. Anemia was present in 53 [74%] while raised erythrocyte sedimentation rate was high in all patients. Vegetations were detected by transthorasic echocardiography in 51 [70.83%] of the patients while blood culture was positive in only 7 [9.6%]. After adding high ESR to the criteria, definite infective endocarditis were found in 34 [47.2%]; possible in 38 [52.7%] and no rejected patients. Sixty-two [87.5%] of the patients improved and were discharged in good general condition. Nine patients died, an In hospital mortality of 12.5%. Patients with IE in Yemen were younger than those patients in western countries, RHD is the commonest predisposing factor. Duke's criteria in addition to high ESR as minor criteria improved the diagnostic possibilities and using empirical antibiotic therapy improves the outcome

Neurological and psychometric evaluation of children with chronic renal failure

Various neurological and psychological disturbances in children with chronic renal failure [CRF] were reported, the quality of life and psychological adaptation of these children became of increasing interest as the prognosis of this condition improves and mortality decreases. It is recognized, however, that medical advances in nutritional support, pharmacotherapy and dialysis techniques will only finally pay off if the patient adapts to the chronic disease and if the optimal rehabilitation is achieved. The aim of the present work is to evaluate children with CRF on regular hemodialysis [HD] as regards neurological and psychological abnormalities and the correlation with the clinical, as well as, biochemical changes present in these children. The study included 25 children with CRF on regular HD as well as 25 apparently healthy children of matching age and sex as controls. All cases and control children had full clinical assessment Laboratory investigations included complete blood count, complete urine analysis, urine culture, blood urea, and serum creatinine [S.Cr] and serum electrolytes. Creatinine clearance was calculated according to Schwartz formula. Electroencephalogram [EEG] was also done. intelligences quotient [IQ] was estimated. The results showed that the incidence of convulsions and alteration of consciousness Were found significantly higher when duration of CRF is > one year or associated with hypertension, blood urea is > 25 mmol/L, and creatinine clearance is [10 ml/min/1.73 m2. Headache and irritability were significantly higher when CRF is associated with hypertension. Depression was significantly higher when duration of CRF is > one year, blood urea is > 25mmol/L. EEG abnormalities in CRF children included slow background rhythm [52%], abnormal discharge [44%] and bilateral spike and wave complex [20%]. Slow background rhythms was significantly higher when duration of CRF is > one year, blood urea is > 25 mmol/L, and creatinine clearance is

Conclusion: the risk factors for neurological complications in children with CRF are multifactorial and complex. When duration of CRF is > one year, blood urea is > 25 mmol/L, creatinine clearance is < than 10 ml/min/1.73 m2 or hypertension is developed, the frequency of encephalopathy and convulsions is higher. The presence of slow background rhythm in EEG records gives attention to duration of CRF and biochemical disturbances. Psychiatric disturbances and intellectual impairment should be considered as a part of the pediatric handling of children with CRF and need an expertise to be available in the pediatric nephrology team for dealing with both problems. IQ test is recommended to be done regularly as intellectual impairment shows significant correlation with duration of CRF

Fecal occult blood and iron status in cow's milk- fed infants

The present study included fifty apparently healthy infants attending the outpatient pediatric clinic of Assiut University Hospital for preventive medicine. They were 25 breast-fed infants [15 males and 10 females], aged 6-12 months with mean age 9.1 +/- 1.73 months and 25 cow's milk-fed infants [12 males and 13 females], their age ranged from 6-12 months, mean age 8.46 +/- 1.76 months. Infants with protein energy malnutrition [PEM] and chronic diseases were excluded from the study. Peripheral hemogram, serum iron, serum ferritin, transferrin saturation percentage and fecal occult blood testing were done for all studied infants. The mean hemoglobin [Hb] and hematocrit [Hct] values were significantly lower in cow's milk-fed infants than in breast-fed ones. At a cut-off value of 11 gm/dl for Hb and 34% for Hct, significantly higher number of infants showed lower Hb [< 11 gm/dL] and lower Hct [<34%] in cow's milk- fed group than in breast-fed one. Furthermore, at a cut-off value of 70 fL [femtolitre] for mean corpuscular volume and 23 pg/cell for mean corpuscular hemoglobin [MCH], the number of infants with lower levels was significantly higher in the former than in the latter group. Serum iron, ferritin and transferrin saturation percentages were significantly lower in cow's milk feeders than in breast-fed ones. At a cut-off value of 22 micro g/dL for serum iron, 10 ng/ml for ferritin and 16% for transferrin saturation percentage, significantly larger number of cow's milk-fed infants showed lower values than breast-fed ones. On the other hand, high total iron binding capacity [> 400 micro g/dL] was more frequent in the former than in the latter group [P<0.1]. Occult blood in stools was detected with significantly higher frequency in cow's milk than in breast milk-fed group

Conclusion: iron deficiency is more common in cow's milk-fed infants than in breast-fed ones and it may be attributed to increased occult blood loss and decreased iron bioavailability in cow's milk group. If non-mother milk is mandatory to be given before 1 year of age for any reason, it is to be fortified with iron

Technological studies on low calorie apricot nectar

The processing of low calorie apricot nectar by using a mixture of non-nutritive sweeteners [aspartame and acesulfame-K] and fructose as well sorbitol had been subject to study for selecting the suitable formula. Data indicated that the best sensory characteristics of apricot nectar-was found by using a mixture of fructorse and acesulfame-K with a ratio of [50%: 50%] which has a 50% calorie reduction. On the other hand the results appeared that an acceptable product having a very low calorie content could be obtained by using a mixture of aspartame and acesulfame-K with ratio of [75%: 25%]