Medical audit on problem analysis and implementing changes at the Health Unit level

Background: Decentralization is one of the reforms the Uganda government adopted to improve public services delivery. However, human resource numbers and capacities in local governments remain below the required level and this coupled with severe resource constraints make it increasingly difficult to deal with enormous workload in public health units. The authors responded to these human resource demands and needs in health service delivery by introducing hospital medical audit on problem analysis and implementation of changes through continuing medical education to health care workers. The main objective of this study was to introduce hospital medical audit on problem analysis and implementation of changes in health units in order to reduce morbidity and mortality.Methods: A feasibility study was done to find out the effects of decentralization on the health service delivery and to assess the need for continuing medical education. Twelve problematic clinical areas were identified, modules developed, tested and eventually used to train selected health care workers on hospital medical audit to improve health service delivery.Results: A total of 270 health care workers and 400 paramedical students were trained on hospital medical audit by identifying causes of complications associated with common clinical procedures done in their health units and then provide solutions that can be implemented. On prevention of HIV/AIDS and malaria spread, three different levels at which the two could be prevented from spreading were identified and discussed. Infection control and continuing medical education committees were formed where they did not exist.Conclusion/Recommendation: Hospital medical audit on problem analysis and implementation of changes in health units is highly effective in stimulating and empowering health care workers and hospital administrators to analyze their own situations and provide implementable solutions to their health care problems. There is need to introduce hospital medical audit in all the districts in Uganda to improve health services delivery

The accuracy of self monitoring blood glucose meter systems in Kampala Uganda

Background: Many blood glucose self-monitoring systems are privately and publicly used by people in Uganda and technical and human errors may occur during their operation. Many patients were referred to Kololo polyclinic laboratory to have their blood glucose checked because the values obtained on the patients' glucose meter systems did not tally with familiar clinical signs and symptoms. This prompted an experimental set up to check glucose meter systems using a larger number of patients. Objective: The objective was to collate the technical conditions and standing operational procedures of four common glucose meter systems; observe the time, ambient temperature and humidity at which the meter systems operate locally; and compare the performance of three meter systems A, B, and C with the Sensorex glucose meter system on a number of capillary blood samples. Setting: Kololo polyclinic laboratory – a privately run facility in Kampala, Uganda. Design: An experimental set up to compare four glucose meter systems. Methods: Instruction manuals of the four glucose monitoring systems were studied and used to familiarize with the meter operations. One hundred and fourteen capillary blood specimens were assayed for blood glucose. Blood glucose values were instantly read off the four randomly set meter systems A, B, C, and Sensorex, noting the time, ambient temperature and humidity. Results from meter systems A, B, and C were regressed against those of Sensorex using Epi-Info computer program. Results: Blood glucose concentration levels on meter system A tallied with those on Sensorex meter system. However, those on meter system B and C were significantly lower and different. Temperature and humidity adversely affected the analytical performance of meter systems B and C in the Kampala environ. Conclusion: Some of the blood glucose monitoring systems in Kampala, Uganda are poor performers and may lead to the mismanagement of patients. There is need for a system to ensure national quality control of blood glucose monitoring systems. African Health Sciences 2003; 3(1): 23-3