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

Cancer of the breast: 5-year survival in a tertiary hospital in Uganda

The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22–85 years, with a median of 45 years and peak age group of 30–39 years. Twenty-three percent had early disease (stages 0–IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was ‘not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan–Meier) for early disease were 74 and 39% for advanced disease (P=0.001). The overall 5-year survival was 56%, which is lower than the rates in the South African blacks (64%) and North American whites (82–88%)

Verification of Wegelin\'s design criteria for horizontal flow roughing filters (HRFs) with alternative filter material

Wegelin\'s design criteria founded on the “1/3 – 2/3” filter theory are still to date the most comprehensive models applied in design of roughing filters. This study aimed at verifying these criteria based on gravel as a filter medium and two other possible alternative filter media, namely broken burnt bricks and charcoal maize cobs. Gravel was used as a control medium since it is one of the most commonly used roughing filter media and also because it was used in developing these criteria. The per cent reduction in raw water suspended solids (SS) concentration was compared against the expected model prediction. SS was used as a parameter of choice since the “1/3 – 2/3” filter theory is based on SS reduction. A pilot plant study was undertaken to meet this objective. The pilot plant was monitored for a continuous 85 days from commissioning till the end of the project. Results showed that in general, filters filled with charcoal maize cobs and broken burnt bricks were off model prediction by 13% compared to gravel\'s 15%. The performances also varied in both low- and high-peak periods. It is concluded that the Wegelin\'s design criteria should be used as a guideline step followed by actual field and laboratory tests to establish the actual filter design parameters in line with the filter media in use and the quality of the raw water to be treated. Water SA Vol 32(1)pp:105-10

Best Fit and Selection of Probability Distribution Models for Frequency Analysis of Extreme Mean Annual Rainfall Events

<p>Frequency analysis of extreme low mean annual rainfall events is important to water resource planners at catchment level because mean annual rainfall is an important parameter in determining mean annual runoff. Mean annual runoff is an important input in determining surface water available for water resource infrastructure development. In order to carry out frequency analysis of extreme low mean annual rainfall events, it is necessary to identify the best fit probability distribution models (PDMs) for the frequency analysis. The primary objective of the study was to develop two model identification criteria. The first criterion was developed to identify candidate probability distribution models from which the best fit probability distribution models were identified. The second criterion was applied to select the best fit probability distribution models from the candidate models. The secondary objectives were:</p

Anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin g antibody seroprevalence among truck drivers and assistants in Kenya

In October 2020, anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G seroprevalence among truck drivers and their assistants (TDA) in Kenya was 42.3%, higher than among healthcare workers and blood donors. Truck drivers and their assistants transport essential supplies during the coronavirus disease 2019 pandemic, placing them at increased risk of being infected and of transmitting SARS-CoV-2 over a wide geographical area