The quality of care of diabetic patients in rural Malawi: A case of Mangochi district.

BACKGROUND: Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied. OBJECTIVE: The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district. METHODS: This was a cross sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 20012 and 2013. Qualitative data were also collected using semi-structured interviews with eight Key Informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients' master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data. RESULTS: Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes (40.0 % (n=30) and 22.7 (n=17) respectively. The majority of patients were taking their medicines regularly 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them left. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters. CONCLUSION: Quality of diabetes care provided to diabetic patients attended to Mangochi hospital was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education

Guidance and Its Meaning in the Light of Any Wise Mention

The word “guidance” came in the first surah of the Noble Qur’an, and God Almighty said: We guided us (إهـدِنَا الصّراطَ المُستَقِيمَ) [Al-Fatihah:6]. I wanted to highlight this noble word and its meaning, individually and in combination, and the formulas used by the Holy Book; To reveal the significance of this word - guidance - in its most uses as far as my energy, so we do not need to manage the meanings of the download; The Holy Qur’an would be the light of our life, the guidance of God, his light, and our path. Had it not been for the guidance, the wisdom of finding creation would have been dysfunctional or decaye

Showingand Confirmation in the Light of Quranic Readings

The Qur\u27an was concerned with the issue of the statement of truth pure and pure complete, and in order to reach that truth show us The Qur\u27an focused on two effective ways of identifying and verifying the news, so I liked to highlight these two verses to reach the truth of the story by integrating the meaning of the two word

Association between aortic sclerosis and coronary artery disease

Background: Although there is a recognized link between cardiovascular hazards and coronary artery disease (CAD), it is still unknown whether aortic sclerosis and CAD are linked.Objective: This study aimed to check whether if there is a link between aortic sclerosis and the existence and severity of coronary artery disease .Patients and methods: 204 individuals were enrolled in the study, transthoracic echocardiographic, and coronary angiography were done. Aortic leaflets were tested for the amount of thickness in the short axis view. The involvement of coronary arteries represented by the gensini score and the association between aortic valve sclerosis score and the degree and severity of coronary affection was investigated using the Gensini score.Results: The individuals were divided into 2 groups grounded on the severity of aortic valve sclerosis. Group A (GP A) included patients with aortic valve sclerosis (AVS) ≥ 2 and group B (GP B) included patients with AVS < 2. In GP A, the right coronary cusp was the most afflicted one, whereas the LAD was the most affected in coronaries. The degree and severity of CAD were more significant in GP A, as evidenced by a higher Gensini score value of 39.27 versus 28.84 in GP B.Conclusion: AVS has been found to be correlated with the presence and severity of CAD and could be used as a potential surrogate marker for the illness

Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years:a systematic review and analysis

Background: Epidemiology of type 1 diabetes mellitus (T1DM) among children aged 0-4 years globally is not well understood. We aim to assess the incidence of T1DM in low- and middle-income countries (LMIC) by conducting a systematic review of previous reports. We also aim to address possible contribution to child mortality and to identify any temporal trends. Methods: A systematic review was performed using a carefully designed search strategy to explore MEDLINE, EMBASE and Global Health databases. Data was extracted from all studies that satisfied the inclusion criteria -a total of 83 records extracted from 26 830 sources that were analysed. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess quality of evidence and applied meta-analysis approaches to assess global and regional incidence and time trends. Results: The overall pooled incidence of T1DM in children aged 0-4 years globally is 11.2 (95% CI = 10.0-12.3) per 100 000 child years. The regional incidence were the highest for European Region A (EUR A) at 15.5 (95% CI = 13.5-17.5) per 100 000 child years. EUR C had the incidence of 10.0 (95% CI = 6.5-13.6) and EUR B 5.8 (95% CI = 4.7-7.0), Region of the Americas A (AMR A) 11.4 (95% CI = 7.8-14.9), AMR B of 2.5 (95% CI = 0.2-4.8), Eastern Mediterranean Region (EMR B) 7.1 (95% CI = 4.2-10.0) and Western Pacific Region (WPR A) 7.0 (95% CI = 2.9-11.0) per 100 000 child years, while other regions had very low rates or no data. When data points were categorised in the study periods and re-analysed, an increasing trend of the T1DM incidence was observed, with the incidence of 20.9 (95% CI = 7.8-34.1) per 100 000 child years in the years 2010-2015, preceded by 13.2 (95% CI = 11.0-15.5) in 2000-2009 study period, 10.0 (95% CI = 8.4-11.7) in 1990-1999 and 8.3 (95% CI = 5.1-11.6) in 1980-1989, respectively. Although the data are scarce, and variation and uncertainty are large, we estimated that the number of new cases of T1DM among children aged 0-4 years in the world each year is between 100 000 and 150 000. Conclusions: The identified large variation in incidence estimates for different parts of the world, along with scarcity of information and the identified strong temporal increase in T1DM incidence suggest a clear need for further research into this subject

Stakeholder participation in greywater management in the Jordanian Badia

The aim of this chapter is to illustrate the process of stakeholder participation in greywater (GW) management in the Badia of Jordan. The work was carried out as a part of a project entitled Integrated Wastewater Management Policies and Technologies in Marginal Communities in Jordan, described more fully in Chapter 4. The objectives of the project were to improve the quality of life and well-being for rural Jordanians, strategically support GW use and improve hygienic conditions. The stakeholders participating in GW management included local people, nongovernmental organizations (NGOs), community-based organizations (CBOs), governmental authorities and scientists and experts from universities as well as research institutions. Local people were involved in different capacity-building programs, including technical field visits, a participatory rapid (or rural) appraisal (PRA) training course and awareness campaigns. Local people were also involved in data collection, community selection, GW quality and quantity assessment, treatment technology, construction and operation. Experts and governmental authorities participated in treatment technology selection and design. The study revealed that combining the strengths of different stakeholders made up for the scarce learning resources and human and financial resources that are needed to develop GW treatment technology for the Badia region. It was concluded that incorporation of inputs from different stakeholders enhanced the quality, ownership and sustainability of the project

Greywater Management in the North Eastern Badia of Jordan

This chapter looks at the feasibility of adopting non-conventional GW management policies for small, rural communities in the north-eastern Badia of Jordan. The north-eastern Badia comprises 33 small clusters (communities), all of which lack public sewerage networks. The most common wastewater collection method is the use of pit latrines and unlined cesspools. About two-thirds of the population separate GW from blackwater, but use the GW for irrigation in an uncontrolled manner and without any treatment. A local stakeholder committee (LSC) formed of and including community members and officials was engaged in all project activities, including field visits to wastewater/GW treatment-and-use projects as well as a training workshop on public participation concepts and participatory rapid (or rural) appraisal (PRA) tools and methodologies. Relevant social, economic, and environmental data and information were collected utilizing PRA tools as well as formal surveys. One of the clusters – Rawdat Al-Amir Ali – was appointed as a research site based on specific criteria set by the research team and the LSC. Greywater quality and quantities generated from different fixtures of six households at the research site were investigated during the period March–August 2005. Different cost-effective and technologically-sound alternative treatment options were assessed, taking into consideration potential reuse opportunities. Two different treatment options were considered: 1) septic tank followed by intermittent sand filter; 2) up-flow anaerobic sludge blanket (UASB). Two pilot plants were designed, installed and operated in two households at the research site