Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways

Factors affecting dairy production in peri-urban areas of Kampala

The number of small holder dairy farms in the peri-urban areas of Kampala are increasing. This could be due to the high demand for dairy products by the increasing urban population and the need to provide an alternative source of income especially for the resource poor urban population. The farmers rear both improved breeds and local breeds. However, no detailed study has been carried out to address the factors that affect peri-urban dairy production. A survey was carried out in the peri-urban areas of Kampala to find out how these factors affect production. Specifically the study aimed at investigating how socio-economic factors affect dairy production. The econometric model (Cobb-Douglas production function) and descriptive statistics were used. The results showed that the breed of the cows, experience in dairy farming, purchased feeds and labour were the biggest vAriables affecting dairy farming in the peri-urban areas of Kampala city.lt was therefore recommended that if milk production in the peri-urban areas of Kampala is to be increased, farmers should be encouraged to rear improved breeds.Key words: Dairy production, peri-urban, Kampal

Analysis of profit inefficiency in rice production in eastern and northern Uganda

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