Traditional remedies in children around eastern cape, South Africa

Objective: To gauge the views of mothers and other caregivers on the use of traditional remedies in the community. Design: Descriptive study. Setting: Five health centres affliated to the UNITRA, Faculty of Health Sciences. Methods: Medical students administered a questionnaire to mothers and other caregivers. Areas covered included how commonly traditional remedies are used, experience with traditional remedies in children, reasons for use, how administered, and problems encountered. Results: There were 103 respondents, 7.8% rated use of traditional remedies non-existent, 20.4% rated it as rare and the rest said it was common. 57.3% of the respondents had used these remedies in their children, and 83.1% of them said they would use them again. Only 20.7% of respondents reported problems with these remedies, including diarrhoea, vomiting, fever and death. The preparations used were known by only 40.7% of respondents. The remedies were administered by the mother and grandmother in 82.8% of cases; and were mainly given orally, by enema or by scarification. The amount administered varied from spoonful(s) up to 2.5 l. Children of all ages were given traditional remedies, usually for diarrhoea, fevers and constipation, or as prophylactics. These remedies were used because they are effective, available and safe, or due to customary beliefs and pressure from others. Conclusion: The use of traditional remedies in children is common in communities around Umtata. There is need to study the composition and activity profiles of commonly used preparations so as to develop appropriate management protocols in case of toxicity. East African Medical Journal Vol.80(8) 2003: 402-40

Efficiency Estimates of Public Health Center II Facilities in Southwestern Uganda

The study estimates the efficiency of public health centre II (HCII) facilities in Southwestern Uganda. Specifically, it determines the level of technical efficiency (TE), scale efficiency (SE) and estimates the economic savings required to make inefficient public health facilities efficient. An output-oriented Data Envelopment Analysis (DEA) is employed in the estimation of TE and SE. It was found out that 73 % of the HCIIs were technically inefficient while 27% were technically efficient. Mean TE stood at 72.3% implying that an average HCII could potentially improve its efficiency by increasing its outputs by 27.7%. In addition, 77% of the facilities were SE implying that they obtained the most productive scale size given the input-output combination. 23% of the facilities were scaled inefficient implying that they have more input waste attributable to their size. There is great potential for economic savings shown by different magnitudes of input reductions and output augmentations required to make inefficient facilities efficient. The study has important policy implications. The health sector should embark on rigorous periodic research and development to enhance healthcare delivery efficiently. Since the health units are small, there is a need  to augment their scale sizes and improve on their management practices so as to enhance their overall productivity and efficiency. Stakeholders should scale up efforts to attract, align skills with needs and improve retention and motivation of the health workforce. Holistic investment in resource inputs is essential. A comprehensive monitoring and evaluation plan with key verifiable indicators to monitor the overall health sector performance is required. &nbsp

Factors Influencing Farmers’ Decision to Adopt Apple Management Practices in Southwestern Highlands, Uganda

Worldwide apples account for fifty (50) percent of the world’s deciduous fruit tree production. Despite the benefits that come with apple production, adoption has been slow especially among smallholder farmers in Southwestern Highlands. This present study was therefore conducted to identify apple management practices (AMPs) and also examine the factors influencing farmer decision to adopt AMPs. A multi-stage sampling procedure was employed to select 52 apple growing households in the districts of Kabale, Kisoro, Kanungu and Rukungiri that form Southwestern Highlands. Probit regression model was employed and the estimation procedure followed Maximum Likelihood Estimation (MLE) approach. Results from the descriptive statistics indicated that the most applied management practices included weeding, bending and staking, pesticide application and defoliation among others.  Probit regression results showed that sex of the farmer, average number of fruits per tree, household labor force, farm size and access to credit had a positive and statistically significant effect on farmers’ decision to adopt AMPs (p<0.05) while age of the farmer, orchard location, obstruction by birds and off-farm income source had a negative and statistically significant influence on farmers’ decision to adopt AMPs (p<0.05). In view of the above, there is need to identify and address gender differences in terms of engagement in apple production targeting more women. Research needs to come up with an effective but affordable remedy against pests especially birds, strategies of attracting and maintaining youth into apple farming need to be explored and implemented since apple farming is labor intensive and is dominated by aging farmers, research and extension need to explore appropriate and cost effective avenues for farmers to access credit, accurate and quality agricultural information. Keywords: Adoption, Apples, Probit model, Orchard, Southwestern Highlands DOI: 10.7176/JESD/10-2-14

Effect of low-dose ketamine on post-operative serum IL-6 production among elective surgical patients: a randomized clinical trial

Background: Surgery and Anesthesia cause an excessive pro-inflammatory response. Mulago Hospital is faced with staff shortage making post-operative pain management difficult.Interleukin-6 (IL-6) drives inflammatory pain, endothelial cell dysfunction and fibrogenesis. Ketamine is cheap and, readily available. We hypothesized that its attenuation of serum IL-6 was a surrogate for clinical benefit.Materials and methods: Institutional Review Board’s approval was sought and RCT was registered at clinical trials.gov (identifier number: NCT01339065). Consenting patients were randomized to receive pre-incision intravenous ketamine - 0.5mg/kg or 0.9% saline placebo in weighted dosing. Blood samples were collected and laboratory analyzed at baseline, post-operatively in PACU, 24 and 48 hours respectively.Results: We recruited 39 patients of whom 18 were randomized to the ketamine arm and 21 in the placebo arm with follow up at 24 and 48 hours. Serum IL-6 and IL-1β levels were analyzed using ELIZA assay of pre-coated micro wells. Ketamine suppressed serum IL-6 at PACU with reduced increase at 24 hours. There was no reaction in 98% of IL-1β assayed.Conclusion: Low-dose ketamine attenuated early serum IL-6 levels due to surgical response with reduced 24 hour increase, but the difference was not statistically significant and we recommend more studies.Keywords: Ketamine, post-operative inflammation, interleukin 6, interleukin 1-

Prevalence and determinants of tobacco use amongst South African adults with mental illness in the Eastern Cape

Background: Given the physical and mental health consequences of tobacco use amongst individuals with mental illness, it was imperative to assess the burden of tobacco use in this population. Aim: This study examined the patterns and factors associated with tobacco use in individuals attending the outpatient unit. Setting: Cecilia Makiwane Hospital Mental Health Department in Eastern Cape province, South Africa. Methods: Lifetime (ever use) use and current use of any tobacco products were examined in a cross-sectional study of 390 individuals between March and June 2020. A logistic regression was fitted to determine the correlates of lifetime and current use of any tobacco products. Results: The rates of ever use and current use of tobacco products were 59.4% and 44.6%, respectively. Of the participants interviewed, lifetime tobacco use was more prevalent amongst individuals with schizophrenia (67.9%) and cannabis-induced disorders (97.3%) and lower in those with major depressive disorders (36.1%) and bipolar and related disorders (43.5%). Men were six times more likely to have ever used or currently use tobacco products in comparison to women. Also, those who had a salaried job or owned a business were over three times more likely to have ever used or currently use tobacco products compared with those receiving government social grants. Conclusions: The prevalence of tobacco use in this study was significantly higher than the general population in the Eastern Cape. Therefore, smoking prevention and cessation interventions targeted at the general population should target this often neglected sub-population in the region. Keywords: Eastern Cape province; mental health users; mental illness; South Africa; tobacco use

Clinical Study Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda's Tertiary Hospital: A Randomized Clinical Trial

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine's postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as "time to first breakthrough pain." Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178

Effect of low-dose ketamine on post-operative serum IL-6 production among elective surgical patients: a randomized clinical trial.

Background: Surgery and Anesthesia cause an excessive pro-inflammatory response. Mulago Hospital is faced with staff shortage making post-operative pain management difficult.Interleukin-6 (IL-6) drives inflammatory pain, endothelial cell dysfunction and fibrogenesis. Ketamine is cheap and, readily available. We hypothesized that its attenuation of serum IL-6 was a surrogate for clinical benefit. Materials and methods: Institutional Review Board\u2019s approval was sought and RCT was registered at clinical trials.gov (identifier number: NCT01339065). Consenting patients were randomized to receive pre-incision intravenous ketamine - 0.5mg/kg or 0.9% saline placebo in weighted dosing. Blood samples were collected and laboratory analyzed at baseline, post-operatively in PACU, 24 and 48 hours respectively. Results: We recruited 39 patients of whom 18 were randomized to the ketamine arm and 21 in the placebo arm with follow up at 24 and 48 hours. Serum IL-6 and IL-1\u3b2 levels were analyzed using ELIZA assay of pre-coated micro wells. Ketamine suppressed serum IL-6 at PACU with reduced increase at 24 hours. There was no reaction in 98% of IL-1\u3b2 assayed. Conclusion: Low-dose ketamine attenuated early serum IL-6 levels due to surgical response with reduced 24 hour increase, but the difference was not statistically significant and we recommend more studies