Indications and Complications of Limb Amputation in Tamale, Ghana

Background: Amputation is the removal of whole or part of a limb or any body part by cutting through a bone, a joint or that body part. The permanent loss of these body part(s) exert stress physically, emotionally, psychologically and economically on the patient, his family and the society at large. The incidence and indications of limb amputations varies. The objective of this study was to determine and high-light the indications and complications of limb amputations in Tamale, Ghana. Methods: a retrospective study covering a 5-year period, from January 2007 to December 2012, involving 160 patients was undertaken, in Tania specialist hospital, Tamale, Ghana. Patients medical records were retrieved and examined, considering demographic factors including age and gender, Level of amputation, indications for amputation, complications after amputation and the final outcomes were also determined. The post-operation follow-up schedule was as follows; end of first week, end of first month, end of third month and end of sixth month. The inclusion criteria of all participants were; all cases referred or not referred to Tania specialist hospital from January 2007 to December 2012 who had limb amputations performed in Tania specialist hospital. Also those with previous amputation(s) done elsewhere qualified for the study if there was a written referral letter indicating the indications for that amputation and if the reasons for that referral (complications) were clear to us. Results: a total of 160 patients were recruited for the study. These patients were between the ages of 2 and 70 years, with a male to female ratio of 4:1. There were 160 unilateral limb amputations. The sites of amputation were lower limb 131 patients (81.88%) and upper limb 29 patients (18.14%), the main indications for amputation were severe trauma, 50 (31.25%), gangrene, 32 (20.0%), compartment syndrome 25 (15.63%). Of the other indications, malignant tumors were 12 (7.5%), The commonest complications after amputation were wound infections 10 (6.25%) and depression 5 (3.13%). There were no deaths or tetanus cases recorded. Conclusion; males were four times at risk of been amputated and lower limb to upper limb amputation ratio was 4:1. The main indications for limb amputations were severe trauma, gangrene and compartment syndrome. Councelling services should be provided to patients both pre-operatively and post-operative to help prevent and/or manage the depression

The Role of Community-Based Education and Service (COBES) in Undergraduate Medical Education in Reducing the Mal-Distribution of Medical Doctors in Rural Areas in Africa:A Systematic Review

Purpose Community-Based Education and Service (COBES) and rural outreach programmes are increasingly being used in the delivery of undergraduate medical education in rural communities to address the disparity of health workers across the world, especially in the developing countries. This systematic review describes whether COBES as part of the undergraduate medical training, aids in addressing the maldistribution of doctors in Africa. Method A critical literature search through key data sources identified studies that focused on COBES as an educational intervention which addressed recruitment and retention challenges in Africa. Data are presented as a narrative synthesis due to the varied methodological designs adopted by the various studies reviewed. Results This review reveals that relatively few medical schools are so far using innovative curricula incorporating COBES and rural outreach programmes to train medical students with the hope that they will opt for rural practice after graduating. Given the gaps in human resources for healthcare especially in the rural areas and lower levels of service delivery in Africa, students’ contributions to health delivery at facilities and in communities are expected to bridge the gaps in services delivery at the primary health care level. Some medical schools from African countries, have consequently scaled up their rural components in the undergraduate curricula, thus responding to changes in health and making medical education more relevant to the needs of rural communities. There is now increasing evidence that COBES and rural outreach programmes are indeed making an impact on health services delivery in the rural areas. Graduates of institutions that incorporate COBES and rural outreach programmes have testified that their present practice location in the rural communities was influenced by the undergraduate rural exposure through COBES. There is growing evidence that exposure of health professions students, especially medical students, to the rural areas influences their eventual choice to work in the rural areas after graduation. Conclusion Based on this review, it is strongly recommended that COBES/rural outreach programmes should be made part of the undergraduate medical curricula in all health training institutions in Ghana in particular, and the sub-Saharan African sub-region in general

Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study

Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients

The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices

BACKGROUND: Community Based Education and Service (COBES) are those learning activities that make use of the community as a learning environment. COBES exposes students to the public and primary health care needs of rural communities. The purpose of this study was to investigate students’ perceived usefulness of COBES and its potential effect on their choice of career specialty and willingness to work in rural areas. METHOD: A mixed method cross sectional study design using semi-structured interviews, questionnaires, and focus group discussions were used for health facility staff, faculty and students and community members. RESULTS: One hundred and seventy questionnaires were administered to students and 134 were returned (78.8 % response rate). The majority (59.7 %) of students were male. Almost 45 % of the students indicated that COBES will have an influence on their choice of career specialty. An almost equal number (44 %) said COBES will not have an influence on their choice of career specialty. However, 60.3 % of the students perceived that COBES could influence their practice location. More males (64.7 %, n = 44) than females (57.8 %, n = 26) were likely to indicate that COBES will influence their practice location but the differences were statistically insignificant (p = 0.553). The majority of students, who stated that COBES could influence their practice location, said that COBES may influence them to choose to practice in the rural area and that exposure to different disease conditions among different population groups may influence them in their career choice. Other stakeholders held similar views. Qualitative data supported the finding that COBES could influence medical students’ choice of specialty and their practice location. CONCLUSION: Medical students’ ‘perceptions of the influence of COBES on their choice of career specialty were varied. However, most of the students felt that COBES could influence them to practice in rural locations

Working among the rural communities in Ghana - why doctors choose to engage in rural practice

Background: An unequal distribution of health personnel, leading to unfavourable differences in health status between urban and rural populations, is a serious cause for concern globally. Part of the solution to this problem lies in attracting medical doctors to rural, remote communities, which presents a real challenge. The present study therefore explored the factors that influence medical doctors' decision to practise in rural Ghana. Methods: We conducted a cross-sectional descriptive study based on questionnaires. Participants were doctors working in health facilities in the districts and rural areas of the Northern Region, Ghana. The qualitative data analysis consisted of an iterative process of open, axial and selective coding. Results: We administered the questionnaires to 40 doctors, 27 of whom completed and returned the form, signalling a response rate of 67.5%. The majority of the doctors were male (88.9%) and had been trained at the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS) (63%). Although they had chosen to work in the remote areas, they identified a number of factors that could prevent future doctors from accepting rural postings, such as: a lack of social amenities, financial and material resources; limited career progression opportunities; and too little emphasis on rural practice in medical school curricula. Moreover, respondents flagged specific stakeholders who, in their opinion, had a major role to play in the attraction of doctors and in convincing them to work in remote areas. Conclusions: The medical doctors we surveyed had gravitated to the rural areas themselves for the opportunity to acquire clinical skills and gain experience and professional independence. Nevertheless, they felt that in order to attract such cadre of health professionals to rural areas and retain them there, specific challenges needed addressing. For instance, they called for an enforceable, national policy on rural postings, demanding strong political commitment and leadership. Another recommendation flowing from the study findings is to extend the introduction of Community-Based Education and Service (COBES) or similar curriculum components to other medical schools in order to prepare students for rural practice, increasing the likelihood of them accepting rural postings

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students' perspectives on barriers and strategies

Abstract Background The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students’ perspectives on doctors’ role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. Methods A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. Results Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. Conclusion Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education