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African Health Sciences
Makerere University Medical School
ISSN: 1680-6905 EISSN: 1729-0503
Vol. 3, Num. 3, 2003, pp. 144-145

African Health Sciences, Vol. 3, No. 3, August, 2003, pp. 144-145

Abstracts presented at the Uganda Medical Association Annual Scientific Conference November 2002

Code Number: hs03026

African Health Sciences brings you some abstracts of the papers presented at the above conference courtesy of the Uganda Medical Association.

1. Economic effect of irrational use of drugs

W. Tumwikirize, ENT Department, Mulago Hospital, P.O. Box 7051, Kampala, Uganda.

Results from studies conducted in several countries, including Uganda, show that there is a high degree of irrational drug prescribing. The importance of irrational drug use is that it frequently results in unsafe use of drugs, waste of the scarce resources, poor patients compliance, and preventable resistance of organisms of commonly used antibiotics. This Paper gives results of a pilot study, conducted in Mulago Hospital, to determine the amount of avoidable cost that resulted from irrational prescribing.
Prescription charts of 4 patients were reviewed. Three categories of irrational prescription were identified. These were poly-pharmacy, prolonged medication and use of more costly drug instead of a cheaper but equally effective drug was available. Only direct costs resulting from cost of excess or unnecessary drug was determined, and all figures are given in Uganda shillings.
Poly-pharmacy, as a result of irrational treatment of a case of malaria, lead to waste of Shs. 1,900 due to prolonged duration of medication. Prescribing of a more expensive drug, exemplified by two cases, resulted into a waste to Shs. 4,200 in one case, and Sh.450 in another. The total wastage for the 4 cases was 16,350 Uganda Shillings.
Mulago Hospital incurs a big loss as a result of irrational drug prescribing.

2. HIV- related behaviour and psychological disorder among taxi drives in Uganda

E. Kinyanda, Butabika Mental Hospital, P.O. Box 7051 Kampala, Uganda

Taxi drivers in Uganda are believed to be a highrisk group for HIV/AIDS. A study was therefore undertaken to assess high HIV risk behaviour and associated psychological disorder taxi drivers in Kampala.
A cross sectional descriptive study design was employed and involved a two-stage procedure. In the first stage, 231 randomly selected respondents were interviewed with a screening questionnaire while 147 respondents were subject to a second stage psychiatric diagnostic interview. Epi info version 6.0 and SPSS were used to enter the data and in subsequent analysis.
Of the 231 respondents 88.3% were married, and 52.4% were in the 25-34 year age group. Significant psychological distress was reported in 97(41.9%) of the taxi drivers assessed. The psychiatric disorders reported depression 35(23.8%), anxiety 33(22.4%), somatoform disorder 19(12.9), alcohol abuse 17(11.6%) and suicidal ideation 4(1.8%). A number of respondents 92(39.8%) used substances of abuse: alcohol 54(23.4%), cigarettes 34(7.3%), marijuana (0.8%) and khat (1 0.4%). High HIV- risk behaviour was reported in 88 (40.4%) and included: having more than one wife 14 (6.4%), sex with commercial sex workers 106 (48.6%) and a history of genital ulcers/discharge.
Although 123 (53.3%) reported that the job exposes them to the risk of contracting HIV they assessed their personal vulnerability to contracting HIV over the next few years as minimal. Factors associated with high HIV risk behaviour included: age of respondent (p<0.02), regular use of condoms (p=0.02), and psychological distress score on the GHQ-J 2(p=0.000).
The taxi driver occupation in Uganda is associated with high level of psychological distress and high HIV risk behaviour. There is need for psychological and psychosexual interventions among taxidrivers.

3. An audit for the management of severe pre-eclampsia

G. Alia, Department of Obstetrics and Gynaecology, Makerere Medical School, P.O. Box 7072 Kampala, Uganda.

Severe pre-eclampsia is a major cause of maternal and infant mortality and morbidity. Good management practice is important in reducing this burden. Criteria-based audit is being used in the developed world to identify deficiencies in practice and reduce mortality and morbidity.
To improve the management of severe preeclampsia through criteria-based audit.
This study was conducted in Mulago hospital, which is a large teaching hospital in which more than 14000 deliveries are conducted annually. An expert panel developed guidelines and standards for the management of severe pre-eclampsia.
Management practices were then evaluated against set standards by evaluating 43 case files. Results of the audit were presented to those offering care and recommendation were developed and implemented. A re-audit of management practices was done 6 months later to assess whether there was an improvement
The initial audit showed that most standards were rarely achieved. As a result of the audit a number of changes were made. Additional equipment and drugs were purchased following a fundraising effort, guidelines were produced, procedures in labour suite were streamlined, and staffing was increased on labour suite, There were improvements in all areas: initiation of anti-hypertensive therapy within 20 minutes improved from 30% to 58% (odds ratio 3.21; 95 CI[I.26-8.16];P<0.0520). The number of women in whom urinalysis was done within the first 2 hors increased from 33% to 63% (3.45;[1.40-8. 52],p<0. 005). Monitoring of fetal heart improved from 0% to 26% (p<0.005). The number of women with adequate monitoring of BP improved from 7% to 45%(11.01; 2.94-41.28;p<0.0005) and there was an improvement in the prescription and administration of steroids in preterm pregnancies from 9% to 1 00%(P<0.05)
Audit helps to improve the quality of care, promotes the development of innovative solution and optimises the use of limited resources.

4. Mental health as a basic right for prisoners in Uganda

M. Mungherera, Butabika Hospital, P. O. Pox 7019 Kampala, Uganda

To assess the magnitude and nature of psychological distress found among prison population in Uganda.
In June 2000, seventy six prisoners in Rukungiri south-western Uganda were interviewed using the Goldberg’s General Health Questionnaire for psychological distress (GHQ-12). Those scoring more than 5 were further subjected to the ICD-1 0 PCP checklists for depression, anxiety. somatoform disorders and substance abuse and then a DSM-IV based PTSD questionnaire.
Physical and psychological torture of prisoners by the general public, prison authorities and other law enforcement agencies was a common experience. A significant proportion (39%) of the participants were experiencing significant psychological distress with depression, anxiety and PTSD being the common psychiatrist presentations.
There is need for prisons medical services to have a service component specifically designed to address the psychosocial problems of prisoners. In addition, psychiatry needs to play a more visible role in the efforts to end discrimination and violation of basic human rights of this particular vulnerable and severely disadvantaged group.

5. Economic challenges in quality care in New Mulago Hospital

M. Lugemwa, Private Patients Department, Mulago Hospital, P.O. Box 7051 Kampala, Uganda

Background: The HIV/AIDS pandemic, apart from having had immeasurable medical, social and economic consequences on the patients, family and friends, has had enormous financial drain on most institutions that undertake to treat the sick. Objective: To establish the impact of financial costs such as incurred in investigations, drugs and sundries for the HIV/AIDS patients. The study also aimed at establishing the cost of burial expenses of hospital staff with HIV/ AIDS.
In a retrospective study, 415 patients files between 1999 and 2000 and a list of deceased staff between the same years were carried out. Private patients and non-directly monetized services such as consultation, food utilities, lodging and anti-retroviral drugs (ARVs) were excluded.
HIV / AIDS patients impact on the hospital treatment costs for commonly pathology is 6 times that of non HI V/A IDS patients.
Health institutions should be prepared to increase their budgets in bid to meet treatment costs for HIV/AIDS patients even for simple common diseases if quality care in health systems has to be consummated.

Copyright © 2003 - Makerere Medical School, Uganda

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