Open Access Original Research Article

Electrolytic Status in Meningitis of Children in Chittagong Region: A Clinical Survey

Sangjukta Das Gupta, Md. Mohaiminul Islam, Mohammad Rashedul Hasan, Farhana Nasrin, Talha Bin Emran, Arif Ahmed Khan, Abul Kalam Azad, Chowdhury Mohammad Monirul Hasan

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/JAMMR/2017/33822

Aims: Electrolyte of different body fluid is one kind of important parameter to determine the severity of meningitis. Therefore we aimed to investigate electrolytic status in different types of meningitis together with detailed medical history in children.  We wanted to make a comparison of CSF electrolytes between pyogenic and tubercular meningitis in male and female patients.
Place and Duration of the Study: The study was conducted in the Biochemistry, Microbiology laboratory of ChattagramMaa-O-Shishu General Hospital, Chittagong, Bangladesh.
Methodology: A total of 100 subjects were investigated in this study. CSF obtained from the selected patient by the process of lumbar puncture done in the hospital ward by the doctor by maintaining sterility and aseptic condition from the pathology laboratory for electrolytes estimation.
Results: We observed that the Na+ level was increased (>145 mmol/L), Cl- level was increased (>107 mmol/L), Klevel was increased (>5.1 mmol/L) and HCO3- level was increased up to (>28 mmol/L) in 16%, 21%, 26% and 7% patients respectively. Furthermore, lymphocytes and neutrophils were also detected in the CSF and blood of the patients. Interestingly, in pyogenic meningitis, the neutrophil count was very high compared to that in viral meningitis. In both cases the correlation of Na+, Cl-, K+ and HCO3- were tested among patients.
Conclusion: Our survey and experimental observations reveals that the abnormality is not due to a combined deficiency of sodium, chloride, and potassium. Biochemical parameter such as electrolytes level in CSF might be a potential tool for determining pH, acid-base balance, and hormone secretion.

Open Access Original Research Article

The 13 UN Life-saving Commodities for Maternal, Newborn and Child Health: Knowledge, Attitudes and Practices in Uganda

Gloria Seruwagi, Catherine Nakidde, Gerald Pande, Monica Okuga, Joseph Akuze, Esther Nasikye, Geoffrey Babughirana, Peter Waiswa

Journal of Advances in Medicine and Medical Research, Page 1-18
DOI: 10.9734/JAMMR/2017/35067

Background: Life Saving Commodities (LSC) are medicines, medical devices and health supplies that effectively address leading avoidable causes of death during pregnancy, childbirth and childhood. In 2012 the United Nations put priority on globally promoting 13 priority LSC across the reproductive, maternal, newborn and child health (RMNCH) continuum of care.  We assessed barriers to demand, access and utilization of these 13 LSC.
Methods: This was a mixed methods cross-sectional study using both quantitative and qualitative approaches. The quantitative component was a health facility survey while the qualitative one was community-based. A blend of simple random and purposive sampling was undertaken to recruit study participants in four regions of Uganda. A total of 125 health facilities were surveyed and 513 people interviewed. Descriptive and bivariate analysis was done for quantitative data while the qualitative strand employed thematic analysis. This paper presents descriptive findings on knowledge, attitudes and practices (KAP) pertaining to the 13 LSC.
Results: There was a variation in knowledge of LSC. Knowledge on child health commodities (ORS and Zinc) was higher among community members compared to the other commodities which are largely hospital-based (injectable antibiotics, antenatal corticosteroids, chlorhexidine, oxytocin, misoprostol and magnesium sulphate). Although health workers were knowledgeable on most LSC they also demonstrated limited comprehensive knowledge some, particularly those relating to reproductive and newborn health (48% and 42.4% respectively). For instance only 37.6% had comprehensive knowledge on management of preterm labour; only 44.8% health facilities had health workers knowledgeable on use of antenatal corticosteroids for preterm labour and only 30.4% reported to give antibiotics. Perceptions on some commodities, particularly the female condom and emergency contraception, were largely negative and health workers practiced selective recommendation or use.  Explanatory factors for this could be traced at individual, household, community, facility and macro levels. Constrained by system-related issues like medicine stock-outs, majority of health workers were improvising and using available alternatives to LSC.
Conclusion: The concept “lifesaving commodities” for maternal, newborn and child health was not well understood by both health workers as caregivers and community as service users. As a result they have not been demanded for, made available or utilized as originally intended. Alongside improved LSC availability, their overlooked, complementary nature and efficacy should continuously be emphasized to the various stakeholders for optimum results.

Open Access Original Research Article

Prevalence and Risk Factors of Depression among a Population of Economically-disadvantaged Fishermen in Teluk Bahang, Penang

Nor Izzah Marzuki, Surajudeen Abiola Abdulrahman, Abdul Rashid

Journal of Advances in Medicine and Medical Research, Page 1-20
DOI: 10.9734/JAMMR/2017/35980

Aims: To determine the prevalence and identify the risk factors of depression among a population of economically-disadvantaged fishermen in Teluk Bahang, Penang.

Study Design: The research design for this study was analytical cross-sectional design.

Place and Duration of Study: This research was conducted at five fishing villages (Teluk Bahang, Batu Feringghi, Tanjung Bungah, Tanjung Tokong and Gurney Drive) covered by Teluk Bahang Fishermen’s Association during four consecutive weekends in January 2017.

Methodology: Using simple random sampling technique, we selected 242 male fishermen from five fishing villages of Teluk Bahang, who were aged 18 to 75 years old and registered under fishermen’s association to participate in this study. An interview session using a set of pre-validated questionnaire (including socio-demographic characteristics, Patient Health Questionnaire-9, and Kendler’s Stressful Live Events) was conducted face-to-face with the respondents. We analyzed bivariate associations using chi-square test, and fitted multivariate regression models to determine predictors of depression among the study population, using SPSS version 22.

Results: The prevalence of depression in our study population was 10.7%. Multivariate logistic regression analysis revealed that the predictors of depression in this study were the level of education (aOR = 0.20, 95% CI 0.055 – 0.754, p=0.017), monthly income (aOR = 3.44, 95% CI 1.044 – 11.348, p=0.04), serious injury due to accident (aOR = 4.97, 95% CI 1.467 – 16.810, p=0.01), and serious problem at work (aOR = 0.13, 95% CI 0.041 – 0.396, p<0.001).

Conclusion: The prevalence of depression in this study was consistent with previous studies in Malaysia, and indicates that depression is a serious problem among fishermen. The findings from this study may be valuable and useful as a benchmark for the development of an effective program to raise awareness and to minimize the stigma associated with depression among the fishermen community.

Open Access Original Research Article

Maternal Deaths in a Tertiary Health Institution in Southeast Nigeria: Two Decades after Safe Motherhood Initiative

L. C. Ikeako, H. U. Ezegwui, E. C. Azuike, T. C. Okeke, J. C. Umeobika, C. C. T. Ezenyeaku, U. I. Ezebialu

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/35545

Background: Decades after several concerted efforts were made to contain the scourge, maternal deaths continue to have a devastating effect in many developing countries. Strengthening the strategies to reduce these calamitous losses is necessary to achieve a palpable decline in the commonly affected regions.

Aim: This study was undertaken to determine the Maternal Mortality Rate (MMR) in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Southeast Nigeria and to compare with rates in other similar institutions.

Methods: A retrospective analysis of all maternal deaths over a five year period, January 2012 to December 2016. Data analysis was by means of descriptive and inferential statistics including means, frequencies and X2-tests at the 95% confidence level (CL).

Results: During the 5 year period (2012-2016), there were a total of 5057 live births and 13 maternal deaths. The overall MMR was 257 per 100,000 live births.

Maternal Mortality (MM) was highest amongst women age 40 years and above, 1429/100,000 live births (P=0.047).

Leading contributors to maternal deaths were grandmultiparity (33.3%) and unbooked mothers (75%). Mothers living in the rural area, unbooked and of lower socio-economic status were 4.7, 7.8 and 5.7 times more likely to be associated with maternal death.

Major direct causes of maternal deaths were sepsis (33.4%), haemorrhage (22.2%) and ectopic pregnancy (22.2%). HIV/AIDS (100%) was the major indirect cause of maternal deaths.

MMR increased gradually at the study hospital from zero in 2012 to the highest level, 588/100,000 live births in 2016.

Conclusion: MMR, though gradually increasing in COOUTH is still lower than the national average and outcome in similar health institutions in Nigeria.

The contributions of HIV/AIDS, unbooked mothers and low socio-economic status to maternal deaths stress the need for increased counselling and testing for HIV/AIDS, antenatal care services and empowerment of women respectively.

Open Access Original Research Article

Assessment of Knowledge, Attitude, Practice, Preference and Acceptance of Mosquito Larvicidal Measures in George Town, Penang – A Cross Sectional Study

Wee Loon Chin, Surajudeen Abiola Abdulrahman, Abdul Rashid

Journal of Advances in Medicine and Medical Research, Page 1-15
DOI: 10.9734/JAMMR/2017/35981

Background: This study aimed to assess the knowledge, attitude and practice (KAP) on larvicidal measures, and to assess the level of acceptance and preference of larvicidal measures among George Town residents.

Methods: 300 pre-validated questionnaires were administered to residents of three randomly selected dengue-sensitive areas via systematic random sampling proportionate to size, to assess KAP levels, preference and acceptance of mosquito larvicidal measures. Using Stata version 13.0, the KAP components were analyzed separately and categorized into good or poor KAP. Predictors of KAP were determined using multivariate logistic regression models.

Results: One hundred and fifty-five (51.7%) respondents demonstrated good knowledge and 154 (51.3%) respondents had good attitude while 188 (62.7%) respondents showed good practice. Majority (72.7%, 218/300) of the respondents preferred both chemical and biological larvicides. In general, less than 9.0% of the respondents had issues of concern regarding the use of chemical and biological larvicides in terms of safety, side-effects and environmental aspects respectively. There was a significant association between preferred choice of larvicides and age groups, race, marital status, education level, residence type and occupation. In multivariate regression analysis, female respondents had significantly (3.6 times) higher odds of having good practice compared to male respondents, while older age, Chinese race, higher education levels, being a housewife and living in medium-cost apartments were significant predictors of knowledge, attitude and practice regarding larvicidal measures in George Town, Penang.

Conclusion: Dengue prevention practices on larvicidal measures were higher compared to knowledge and attitude, and only a very small proportion of respondents preferred biological larvicide.

Open Access Original Research Article

Knowledge, Risk Perception, Protective Practices and Pattern of Accidental Exposures to Hazards of Healthcare Wastes among Workers in Primary Healthcare Centers in Sokoto, Nigeria

Z. Abdullahi, K. J. Awosan, M. T. O. Ibrahim, M. Yahaya, A. M. Nauzo

Journal of Advances in Medicine and Medical Research, Page 1-11
DOI: 10.9734/JAMMR/2017/35921

Introduction: Healthcare waste (HCW) includes all the waste generated within health-care facilities, research centers and laboratories related to medical procedures; it carries high risk for infection and injury than any other type of waste. Inadequate and inappropriate handling of health-care waste may have serious public health consequences and a significant impact on the environment. This study was conducted to assess the knowledge, risk perception, protective practices and pattern of accidental exposure to hazards of health care waste among health care workers in Primary Healthcare Centers in Sokoto, Nigeria.

Methods: A descriptive cross-sectional study was carried out among 248 subjects. Informed consent was obtained and information was collected using a semi-structured, interviewer administered questionnaire. Data was analyzed using IBM SPSS version 20.

Results: The mean age of the respondents was 35.0 ± 9.1.years. Majority of the respondents demonstrated good knowledge of hazardous HCW (95.2%), on the job training was poor (45.6%), and knowledge of color coded waste bins was suboptimal (ranging from 29.4% to 69.6%). Majority of the respondents (89.1%) also perceived themselves to be at risk of the hazards of improperly managed HCW. Segregation of HCW into appropriate color coded waste bins was poor among the respondents (19.4%), but a large proportion of them (83.9%) dispose sharps in safety boxes. The prevalence of accident/injury while handling HCW among the respondents was 16.5% with majority (82.9%) having needle stick injury.

Conclusion: Although, majority of the respondents had good knowledge of hazardous healthcare waste, on the job training and compliance with safe HCW disposal practices were poor; and a substantial proportion of respondents experienced accident/injury while handling HCW. It is therefore recommended that the management of health facilities should train their workers on safe HCW collection, storage and disposal, and also monitor them for compliance periodically.

Open Access Original Research Article

The Lived Experiences of Persons with Vitiligo: A Phenomenological Research

Farshid Saeedinezhad, Mohammadreza Firouzkouhi, Abdolghani Abdollahimohammad, Mozhgan Rahnama, Aziz Shahrakivahed

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2017/35870

Aims: This study was aimed to evaluate the lived experiences of vitiligo patients.

Study Design: Descriptive phenomenological approach.

Place and Duration of Study: Dermatology clinics of Zabol and Zahedan hospitals in southeast Iran, 1 years.

Methodology: Data were collected through semi-structured interviews with 15 male and female patients with vitiligo, who were selected through purposeful sampling method. Collected data were analyzed using Colaizzi method.

Results: The extracted themes were the challenging emergence of the disease; tirelessly patient in follow-up different treatments; true and false beliefs about the disease; difference in coping with disease in all patients; changes of lifestyle due psychosocial problems; stigma community gifts for patients.

Conclusion: The vitiligo patients faced with challenges that affect their lives. Enhancing knowledge and awareness of families and society as the fundamental factors in shaping the futures of these people is possible through mass beliefs changes. Moreover, healthcare providers should be aware of the suffering and experiences of these patients, and attempt to understand them when providing physical and mental health care and support.