Is it possible to write a scientific paper in an African language?

Objective: To explore the ability of ChiShona to express the formal categories of reporting scientific information. This would guide and enable authors to write abstracts of their work for formal presentations or as appendices to publication.Design: Document analysis of selected Medical Journals in EnglishSetting: Medical Library, College of Health Sciences. University of Zimbabwe.Results: The vocabulary and terminology to structure a scientific report is available or can be constructed from available vocabulary.Conclusion: The writing or translating of an original research paper is technically demanding. Other forms of communicating scientific information are more flexible and may be used more readily to develop scientific text in ChiShona, at least in the beginning. This will probably be the case with other African languages

Obstacles faced when conducting a clinical audit in Botswana

Background: A clinical audit is a method of addressing the clinical  environment to bring about change and improvement. This paper describes the obstacles encountered while carrying out a clinical audit in a national referral teaching hospital in Botswana.Method: A record was kept over a period of three months of reasons for the referral and admission of patients to the intensive care unit (ICU) and of major obstacles that could not be overcome during a clinical audit. This paper discusses the obstacles that may be faced in this regard.Results: The following obstacles were found when carrying out the clinical audit. The medical records were difficult to find, both in the unit and in the medical records department. This led to abandonment of a retrospective pilot of the audit. When the medical records were available, the  documentation was poor and unsatisfactory for the purposes of the study. Lack of local criteria and guidelines for ICU admission resulted in  inappropriate referrals. Proposed guidelines had still not been adopted after 10 years. There was a fear by the many departments that refer patients to ICU of being “audited”, which resulted in reluctance to  participate in the audit without assurance from hospital management.Conclusion: Although the problems that were faced during our audit are not novel to the auditing process, it is important that they are resolved in order to develop an audit culture

A national survey of oxytocin use during caesarean section in Zimbabwe

Background: Post-partum haemorrhage is the leading cause of mortality for labouring women in Zimbabwe. Current literature supports the use of low dose oxytocin to prevent bleeding during Caesarean section. Internationally, clinical practice has been slow to change and the use of potentially harmful, higher than recommended dose is common.Objective: To describe the current clinical practice in Zimbabwe.Design: A self-administered questionnaire survey. Descriptive statistics were used to report the study results.Setting: In 2013 a national survey was conducted on the use of oxytocin by different types of clinicians, who provide either anaesthesia or surgery for Caesarean section.Results: Of a total of 221 (61%) questionnaires returned, 170 (80%) were completed fully. Only 23% of respondents would give an intravenous dose of 5.0 IU or less of oxytocin for elective Caesarean section. The majority of clinicians (77%) would administer more than 5.0 IU of oxytocin at elective. A significant number of nurse anaesthetists 16/59 (27%), and a non-negligible number of specialist anaesthetists 3/48 (6%) would even give 20 IU of oxytocin in elective cases rising to 30% and 13% respectively for emergency cases. In case of persistent bleeding due to uterine atony, oxytocin was more likely to be repeated (45%), rather than using misoprostol (25%) or ergometrine (19%).Conclusion: Most clinicians in Zimbabwe use oxytocin doses well above current internationally recommended. This illustrates the urgent need for updated national guidelines for the prevention of post-partum haemorrhage during Caesarean section

Duramazwi reurapi neutano

No Abstract

Comparison between MMed Anaesthesia programmes in the SADC

Objectives. There are 19 physician anaesthesia training programmes within the 16 Southern Africa Development Community (SADC) region countries, all based in 7 countries. With a new MMed Anaesthesia programme starting in Botswana, the study sought to compare the curricula of these programmes, identifying the similarities and differences.Design. Course programme directors were contacted for information, other information was sought from the Internet and following up literature references. Follow-up telephone and email conversations were used to fill in gaps where possible. Document analysis and tabulation of results were done.Results. Of the 19 programmes there was little or no information on 6 (2 in the Democratic Republic of the Congo (DRC) and 4 in Madagascar). Of the remaining 13 programmes, 8 are in South Africa. The South African and Botswana programmes use competency-based training (CBT) and use both the college Fellowship and the MMed simultaneously. The remaining programmes in Zimbabwe, Malawi and Tanzania use a traditional curriculum and are entirely MMed programmes. In general the faculties are small, resulting in small trainee intakes. Programme duration is generally 3 years in East Africa (including Tanzania – a SADC member) and 4 years in Southern Africa. Entry requirements are generally similar but internal organisation of the courses differs. This is important for meeting regional harmonisation policies.Conclusions. This paper adds to the literature and discusses some of the key issues facing training programmes in the region. A mixture of College Fellowship- and university-based MMed programmes with new thinking on curriculum will be required to grow the specialty’s role in service delivery.AJHPE 2012;4(1):22-27. DOI:10.7196/AJHPE.15

Severe airway obstruction from goitre during pregnancy relieved by Thyroidectomy at Caesarean Section: A case report

A 39yr old woman P5G6 presented to hospital where a diagnosis of airway obstruction secondary to goitre was made. At anaesthetic review, she had severe inspiratory stridor and expiratory wheezing. Adecision was made to proceed to CS urgently under GA and perform a thyroidectomy at the same sitting. Zimbabwe is considered iodine adequate because over 90% of households have access to iodine, but 14.8% have urinary iodine excretion below 100mcg/L, the threshold for iodine inadequacy. In Zimbabwe developing a policy for antenatal management of patients with goitre should always be considered

Metabolic effects of Carbon Dioxide (CO2) insufflation during laparoscopic surgery: changes in pH, arterial partial Pressure of Carbon Dioxide (PaCo2) and End Tidal Carbon Dioxide (EtCO2)

Background: Acid base alterations occur during laparoscopy with carbon dioxide insufflation. The purpose of this study was to investigate the effects of low tidal volume ventilation on acid base status during pneumoperitonium.Materials and Methods: 30 patients undergoing laparoscopic surgery under General Anaesthesia were ventilated with tidal volume of 6 ml/kg and respiratory rate of 12 breaths/minute. Arterial blood gas analysis was done before, during and after C02 pneumoperitoneum. Arterial haemoglobin oxygen saturation by pulse oximetry (SPO2) and EtC02 were monitored continuously throughout the laparoscopy. Respiratory adjustments were done for EtCO2 levels above 60mmHg or SPO2 below 92% or adverse haemodynamic changes.Results: low tidal volume ventilation during pneumoperitoneum resulted in a significant elevation in PaCO2 (p<0.001) and a fall of pH (p <0.001), ion bicarbonate (HCO3-) (p = 0.011), and base excess (ABE) (p <0.001). A correlation was found between the EtCO2 and PaCO2 during pneumoperitoneum. Oxygenation was well maintained during pneumoperitoneum. No ventilatory adjustments were instituted on any of the patients as they maintained EtCO2 below 60mmHg throughout pneumoperitoneum.Conclusion: Ventilation with low tidal volume during pneumoperitoneum causes a mixed respiratory and metabolic acidosis. EtCO2 is still a good non-invasive monitor for estimation of PaCO2 during low tidal volume ventilation during pneumoperitoneum

Comparison of haemodynamic effects of a bolus of five units of oxytocin versus a bolus of ten units of oxytocin on parturients undergoing caesarean section at Parirenyatwa and Harare hospitals, Zimbabwe

Objectives: This study was done to compare the haemodynamic effects of an intravenous bolus of 5 IU oxytocin versus a bolus of 10 IU.Study Design: A prospective randomised clinical trial.Setting: The study was conducted at Harare Central Hospital Maternity Unit and Mbuya Nehanda Maternity hospitalStudy Subjects: The study was conducted in 86 ASA 1 and 2 parturients undergoing spinal anaesthesia for elective and emergency caesarean sectionMethods: The 86 patients were randomized to receive either five IU or ten IU of oxytocin post-delivery. Noninvasive monitoring of Heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) was done. Blood loss was also measured.Results: There was a statistically significant greater increase in mean Heart rate in patients who received 10 IU than in those who received 5 IU of oxytocin (p=0.028). There was a larger decrease in Mean Arterial Pressure, Diastolic blood pressure and Systolic blood pressure in patients who received 10 IU of oxytocin than in patients who received 5 IU of oxytocin (p<0.0001). There was no difference in blood loss between the two groups.Conclusions: During caesarean section, a bolus of 5 IU oxytocin results in less haemodynamic change than a bolus of 10 IU of oxytocin with no difference in the blood loss

Postoperative Outcomes Associated With Procedural Sedation Conducted by Physician and Nonphysician Anesthesia Providers: Findings From the Prospective, Observational African Surgical Outcomes Study.

BACKGROUND: There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Nonphysician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by nonphysicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death. METHODS: A secondary analysis of a prospective cohort of inhospital adult surgical patients representing 25 African countries was performed. The primary outcome was a collapsed composite of inhospital severe postoperative complications and death. We assessed the association between receiving procedural sedation conducted by a nonphysician (versus physician) and the composite outcome using logistic regression. We used the inverse probability of treatment weighting propensity score method to adjust for potential confounding variables including patient age, hemoglobin level, American Society of Anesthesiologists (ASA) physiological status, diabetes mellitus, urgency of surgery, severity of surgery, indication for surgery, surgical discipline, seniority of the surgical team, hospital level of specialization, and hospital funding system using public or private funding. All patients who only received procedural sedation for surgery were included. RESULTS: Three hundred thirty-six patients met the inclusion criteria, of which 98 (29.2%) received sedation from a nonphysician provider. The incidence of severe postoperative complications and death was 10 of 98 (10.2%) in the nonphysician group and 5 of 238 (2.1%) in the physician group. The estimated association between procedural sedation conducted by a nonphysician provider and inhospital outcomes was an 8-fold increase in the odds of severe complications and/or death, with an odds ratio (95% confidence interval [CI]) of 8.3 (2.7-25.6). CONCLUSIONS: The modest number of observations in this secondary data analysis suggests that shifting the task of procedural sedation from physicians to nonphysicians to increase access to care may be associated with severe postoperative complications and death in Africa. Research focusing on identifying factors contributing to adverse outcomes associated with procedural sedation is necessary to make this practice safer