Texila International Journal of Public Health, 2020
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the... more Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. A number of factors are attributable to this delay. Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV. Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers). Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%). Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV. Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).
Introduction: Globally every day, about 830 women die due to complications of pregnancy and child... more Introduction: Globally every day, about 830 women die due to complications of pregnancy and child birth. Of these deaths, 99% occur in low-resource settings, and most could be prevented. Use of Modified Early Obstetric Warning System (MEOWS) would be appropriate. MEOWS is a monitoring chart intended to identify mothers at risk and initiate the right action, at right time by the appropriately skilled clinicians, at a time when treatment might make a difference to reduce maternal mortality and morbidity. Objectives: To determine the sensitivity, specificity and predictive values of Modified Early Obstetric Warning System (MEOWS) in correctly identifying women at risk of developing obstetric morbidity in St. Francis Hospital_Nsambya between January and February, 2016 Methods: The study was a prospective cohort study conducted at St. Francis Hospital Nsambya, maternity ward, from January to February 2016. MEOWS monitoring tool was used alongside with questionnaires. Result: 502 respondent mothers were enrolled in the study. 160patients (31.9%) triggered and of which: 11.5% of them had obstetric morbidity which included postpartum haemorrhage-35.5%, preeclampsia-26.3%, suspected infection-22.4%, third degree perineum tear-5.3%, anaesthetic complications-4% and prolong hospital stay-7%. MEOWS was 81.7% sensitive (95% CI 80-94%), 76.3% specific (95% CI 74-81%), with a positive predictive value 36.3% (95% CI 31-44%) and negative predictive value of 96.2% (95% CI 94-99%). Conclusion: MEOWS chart is even effective for use in low resource setting, like Uganda.
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the... more Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. Many factors attribute to this; shortage of staff, insufficient training, antibiotic unavailability and equipment among others. Objectives: The purpose of the study was to ascertain the preparedness of Arua regional referral hospital to handle referred emergency obstetrics cases. Methods: A qualitative contextual descriptive phenomenological design was used. A sample of six (6) carefully selected mothers and four (4) midwives were used. Triangulation of methods was used to enhance quality. Transcriptions of the interviews was analyzed using descriptive thematic analysis Findings: As per WHO criteria, Arua Regional Referral Hospital was rated as a fully functional EmOC facility. Out of the 6 respondent mothers, two had received Emergency Obstetric Care three times from the facility while the rest of them received EmOC more than 5times. When asked about history of having been referred out, non of them was referred out. Again, when asked about the outcome of all their deliveries, four out of 6 had good maternal outcomes whereas 2 had bad maternal outcomes. Conclusion: Arua RRH remains an EmOC Health Facility, falling in keeping with the World Health Organization standard as well as the Uganda national standard, although some improvements are still wanting. Recommendation: The hospital needs to embark on training other surrounding health facilities on EmOC.
Introduction: Medical incident reporting is a key tool for improving patient safety in healthcare... more Introduction: Medical incident reporting is a key tool for improving patient safety in healthcare, hence improved quality of care. The better the knowledge, attitude and practice of this concept, the better the quality of care. The perceived knowledge, attitude and practice are still low in many Uganda healthcare facilities. Many of the healthcare providers have, therefore, limited their scope to maternal death audit and reporting or perinatal death reporting and to a greater extent Adverse Event Following Immunization (AEFI). This problem of perceived low knowledge, attitude and practice of incident reporting is coupled with the poor institutional culture to persistently and inadequate support healthcare professionals to report incidents. Medical incident reporting is, therefore, the single most powerful tool for developing and maintaining an awareness of risks in healthcare practice, hence a cornerstone to improved patient safety and improved quality of service delivery. Objectives: The study objectives were as follow; to assess the level of knowledge about medical incident reporting among healthcare professionals, by April, 2016 and determine their attitude towards medical incident reporting. The researcher also set out to ascertain the practice and the extent to which medical incident reporting is practiced in Midigo Health Centre IV, as well as, establishing the factors affecting medical incident reporting in the said healthcare facility. Methods: The study was a cross sectional study of knowledge, attitude and practice of medical incident reporting among Healthcare Professionals in Midigo health centre IV. It was both qualitative and quantitative; with a sample of 44healthcare professionals interviewed using structured questionnaires. The questionnaire was pre-tested. Analysis of result was done using computer packages called Statistical Package for Social Sciences (SPSS) and Microsoft excel. Ethical considerations in research were observed. Results: The cadre of the respondents were; Medical officers-4.5%, Clinical officers-6.8%, Nurses-43.2%, Midwives-11.4%, Theatre staffs-9.1%, Laboratory staffs-6.8% and other staffs-18.2%. The response rate was 100%. The level of knowledge about medical incident reporting among healthcare professionals in Midigo HC IV was at 84.1%, by April 2016. Much as there was no statistical significance between cadre of staffs and extent of knowledge, p-value >0.39, the only cadres that had excellent knowledge on medical incident reporting were nurses (75%) and clinical officers (25%). The rest of the staffs either had average knowledge or fair knowledge or no knowledge at all. The healthcare professionals had strong positive attitude towards medical incident reporting and this was at 97.7%. By April, 2016, the practice of medical incident reporting was at 72.6% with the majority of these respondents (up to 50%), having participated in reporting three times or more for the last 5years. The major factors that facilitated the respondents to report were; Strong positive feeling to participate and improve patient safety and respondents were knowledgeable (educated) about medical incident reporting. Other minor factors like ability of respondents to get feedback on reported incidents and strong institutional culture of reporting did not make strong contribution towards the practice of reporting. However, the major barriers were; respondents didn't know where and how to report, coupled with weak institutional culture of reporting incidents. Surprisingly, fear of consequence of reporting did not in any
Introduction: The delivery of health care is known to involve potential safety risks for the pati... more Introduction: The delivery of health care is known to involve potential safety risks for the patients who are supposed to benefit from medical treatment and care. Over the years, efforts have been put in place to reduce the occurrence of safety risks and improve on patient quality of care. Both the health care providers and patients have their respective roles to play. Bringing on board patients in efforts to minimise safety risks, also known as patient engagement, proved effective. Objectives: The objectives of the study were; to ascertain the level of awareness about patient safety in healthcare among patients and health workers, to determine the level of health workers engagement in patient safety in healthcare, assess the level of patient engagement in patient safety, as well as to determine the factors affecting patients and health workers engagement in patient safety in health care in Kitgum General Hospital. Methods: This was a descriptive, cross sectional study of patients and health workers' engagement in patient safety in healthcare in Kitgum General Hospital (KGH). The study took both qualitative and quantitative dimensions. A probability sample of 384 patients was interviewed using structured questionnaires and 103health workers were studied by observation and key informant interviews. Documentation review of previous patient files (50files) was carried out to assess the depth of patient identification, as a measure to minimize medical errors. Pre-testing of the questionnaires and training of research Assistants were done prior to the study to ensure quality of the research. Ethical considerations in research were strictly adhered to. Results: The level of awareness about patient safety among patients and health workers was found to be 46.5% and 51% respectively. The level of health workers engagement in patient safety was found to be 51.4% while engagement of patients in patient safety was at 52.1% The factors affecting patients and health workers engagement were mainly demographic factors such as age and level of education, among others. Conclusion: In conclusion, health workers in KGH were 4.5% more aware about patient safety than the patients. However, patients in KGH are 0.7% more engaged in patient safety than the health workers.
Introduction: The delivery of health care is known to involve potential safety risks for the pati... more Introduction: The delivery of health care is known to involve potential safety risks for the patients who are supposed to benefit from medical treatment and care. Over the years, efforts have been put in place to reduce the occurrence of safety risks and improve on patient quality of care. Both the health care providers and patients have their respective roles to play. Bringing on board patients in efforts to minimise safety risks, also known as patient engagement, proved effective. Objectives: The objectives of the study were; to ascertain the level of awareness about patient safety in healthcare among patients and health workers, to determine the level of health workers engagement in patient safety in healthcare, assess the level of patient engagement in patient safety, as well as to determine the factors affecting patients and health workers engagement in patient safety in health care in Kitgum General Hospital. Methods: This was a descriptive, cross sectional study of patients and health workers' engagement in patient safety in healthcare in Kitgum General Hospital (KGH). The study took both qualitative and quantitative dimensions. A probability sample of 384 patients was interviewed using structured questionnaires and 103health workers were studied by observation and key informant interviews. Documentation review of previous patient files (50files) was carried out to assess the depth of patient identification, as a measure to minimize medical errors. Pre-testing of the questionnaires and training of research Assistants were done prior to the study to ensure quality of the research. Ethical considerations in research were strictly adhered to. Results: The level of awareness about patient safety among patients and health workers was found to be 46.5% and 51% respectively. The level of health workers engagement in patient safety was found to be 51.4% while engagement of patients in patient safety was at 52.1% The factors affecting patients and health workers engagement were mainly demographic factors such as age and level of education, among others. Conclusion: In conclusion, health workers in KGH were 4.5% more aware about patient safety than the patients. However, patients in KGH are 0.7% more engaged in patient safety than the health workers.
Texila International Journal of Public Health, 2020
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the... more Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. A number of factors are attributable to this delay. Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV. Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers). Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%). Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV. Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).
Introduction: Globally every day, about 830 women die due to complications of pregnancy and child... more Introduction: Globally every day, about 830 women die due to complications of pregnancy and child birth. Of these deaths, 99% occur in low-resource settings, and most could be prevented. Use of Modified Early Obstetric Warning System (MEOWS) would be appropriate. MEOWS is a monitoring chart intended to identify mothers at risk and initiate the right action, at right time by the appropriately skilled clinicians, at a time when treatment might make a difference to reduce maternal mortality and morbidity. Objectives: To determine the sensitivity, specificity and predictive values of Modified Early Obstetric Warning System (MEOWS) in correctly identifying women at risk of developing obstetric morbidity in St. Francis Hospital_Nsambya between January and February, 2016 Methods: The study was a prospective cohort study conducted at St. Francis Hospital Nsambya, maternity ward, from January to February 2016. MEOWS monitoring tool was used alongside with questionnaires. Result: 502 respondent mothers were enrolled in the study. 160patients (31.9%) triggered and of which: 11.5% of them had obstetric morbidity which included postpartum haemorrhage-35.5%, preeclampsia-26.3%, suspected infection-22.4%, third degree perineum tear-5.3%, anaesthetic complications-4% and prolong hospital stay-7%. MEOWS was 81.7% sensitive (95% CI 80-94%), 76.3% specific (95% CI 74-81%), with a positive predictive value 36.3% (95% CI 31-44%) and negative predictive value of 96.2% (95% CI 94-99%). Conclusion: MEOWS chart is even effective for use in low resource setting, like Uganda.
Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the... more Introduction: The third delay is the delay in receiving adequate and appropriate treatment at the healthcare facility by mothers during and after pregnancy. Many factors attribute to this; shortage of staff, insufficient training, antibiotic unavailability and equipment among others. Objectives: The purpose of the study was to ascertain the preparedness of Arua regional referral hospital to handle referred emergency obstetrics cases. Methods: A qualitative contextual descriptive phenomenological design was used. A sample of six (6) carefully selected mothers and four (4) midwives were used. Triangulation of methods was used to enhance quality. Transcriptions of the interviews was analyzed using descriptive thematic analysis Findings: As per WHO criteria, Arua Regional Referral Hospital was rated as a fully functional EmOC facility. Out of the 6 respondent mothers, two had received Emergency Obstetric Care three times from the facility while the rest of them received EmOC more than 5times. When asked about history of having been referred out, non of them was referred out. Again, when asked about the outcome of all their deliveries, four out of 6 had good maternal outcomes whereas 2 had bad maternal outcomes. Conclusion: Arua RRH remains an EmOC Health Facility, falling in keeping with the World Health Organization standard as well as the Uganda national standard, although some improvements are still wanting. Recommendation: The hospital needs to embark on training other surrounding health facilities on EmOC.
Introduction: Medical incident reporting is a key tool for improving patient safety in healthcare... more Introduction: Medical incident reporting is a key tool for improving patient safety in healthcare, hence improved quality of care. The better the knowledge, attitude and practice of this concept, the better the quality of care. The perceived knowledge, attitude and practice are still low in many Uganda healthcare facilities. Many of the healthcare providers have, therefore, limited their scope to maternal death audit and reporting or perinatal death reporting and to a greater extent Adverse Event Following Immunization (AEFI). This problem of perceived low knowledge, attitude and practice of incident reporting is coupled with the poor institutional culture to persistently and inadequate support healthcare professionals to report incidents. Medical incident reporting is, therefore, the single most powerful tool for developing and maintaining an awareness of risks in healthcare practice, hence a cornerstone to improved patient safety and improved quality of service delivery. Objectives: The study objectives were as follow; to assess the level of knowledge about medical incident reporting among healthcare professionals, by April, 2016 and determine their attitude towards medical incident reporting. The researcher also set out to ascertain the practice and the extent to which medical incident reporting is practiced in Midigo Health Centre IV, as well as, establishing the factors affecting medical incident reporting in the said healthcare facility. Methods: The study was a cross sectional study of knowledge, attitude and practice of medical incident reporting among Healthcare Professionals in Midigo health centre IV. It was both qualitative and quantitative; with a sample of 44healthcare professionals interviewed using structured questionnaires. The questionnaire was pre-tested. Analysis of result was done using computer packages called Statistical Package for Social Sciences (SPSS) and Microsoft excel. Ethical considerations in research were observed. Results: The cadre of the respondents were; Medical officers-4.5%, Clinical officers-6.8%, Nurses-43.2%, Midwives-11.4%, Theatre staffs-9.1%, Laboratory staffs-6.8% and other staffs-18.2%. The response rate was 100%. The level of knowledge about medical incident reporting among healthcare professionals in Midigo HC IV was at 84.1%, by April 2016. Much as there was no statistical significance between cadre of staffs and extent of knowledge, p-value >0.39, the only cadres that had excellent knowledge on medical incident reporting were nurses (75%) and clinical officers (25%). The rest of the staffs either had average knowledge or fair knowledge or no knowledge at all. The healthcare professionals had strong positive attitude towards medical incident reporting and this was at 97.7%. By April, 2016, the practice of medical incident reporting was at 72.6% with the majority of these respondents (up to 50%), having participated in reporting three times or more for the last 5years. The major factors that facilitated the respondents to report were; Strong positive feeling to participate and improve patient safety and respondents were knowledgeable (educated) about medical incident reporting. Other minor factors like ability of respondents to get feedback on reported incidents and strong institutional culture of reporting did not make strong contribution towards the practice of reporting. However, the major barriers were; respondents didn't know where and how to report, coupled with weak institutional culture of reporting incidents. Surprisingly, fear of consequence of reporting did not in any
Introduction: The delivery of health care is known to involve potential safety risks for the pati... more Introduction: The delivery of health care is known to involve potential safety risks for the patients who are supposed to benefit from medical treatment and care. Over the years, efforts have been put in place to reduce the occurrence of safety risks and improve on patient quality of care. Both the health care providers and patients have their respective roles to play. Bringing on board patients in efforts to minimise safety risks, also known as patient engagement, proved effective. Objectives: The objectives of the study were; to ascertain the level of awareness about patient safety in healthcare among patients and health workers, to determine the level of health workers engagement in patient safety in healthcare, assess the level of patient engagement in patient safety, as well as to determine the factors affecting patients and health workers engagement in patient safety in health care in Kitgum General Hospital. Methods: This was a descriptive, cross sectional study of patients and health workers' engagement in patient safety in healthcare in Kitgum General Hospital (KGH). The study took both qualitative and quantitative dimensions. A probability sample of 384 patients was interviewed using structured questionnaires and 103health workers were studied by observation and key informant interviews. Documentation review of previous patient files (50files) was carried out to assess the depth of patient identification, as a measure to minimize medical errors. Pre-testing of the questionnaires and training of research Assistants were done prior to the study to ensure quality of the research. Ethical considerations in research were strictly adhered to. Results: The level of awareness about patient safety among patients and health workers was found to be 46.5% and 51% respectively. The level of health workers engagement in patient safety was found to be 51.4% while engagement of patients in patient safety was at 52.1% The factors affecting patients and health workers engagement were mainly demographic factors such as age and level of education, among others. Conclusion: In conclusion, health workers in KGH were 4.5% more aware about patient safety than the patients. However, patients in KGH are 0.7% more engaged in patient safety than the health workers.
Introduction: The delivery of health care is known to involve potential safety risks for the pati... more Introduction: The delivery of health care is known to involve potential safety risks for the patients who are supposed to benefit from medical treatment and care. Over the years, efforts have been put in place to reduce the occurrence of safety risks and improve on patient quality of care. Both the health care providers and patients have their respective roles to play. Bringing on board patients in efforts to minimise safety risks, also known as patient engagement, proved effective. Objectives: The objectives of the study were; to ascertain the level of awareness about patient safety in healthcare among patients and health workers, to determine the level of health workers engagement in patient safety in healthcare, assess the level of patient engagement in patient safety, as well as to determine the factors affecting patients and health workers engagement in patient safety in health care in Kitgum General Hospital. Methods: This was a descriptive, cross sectional study of patients and health workers' engagement in patient safety in healthcare in Kitgum General Hospital (KGH). The study took both qualitative and quantitative dimensions. A probability sample of 384 patients was interviewed using structured questionnaires and 103health workers were studied by observation and key informant interviews. Documentation review of previous patient files (50files) was carried out to assess the depth of patient identification, as a measure to minimize medical errors. Pre-testing of the questionnaires and training of research Assistants were done prior to the study to ensure quality of the research. Ethical considerations in research were strictly adhered to. Results: The level of awareness about patient safety among patients and health workers was found to be 46.5% and 51% respectively. The level of health workers engagement in patient safety was found to be 51.4% while engagement of patients in patient safety was at 52.1% The factors affecting patients and health workers engagement were mainly demographic factors such as age and level of education, among others. Conclusion: In conclusion, health workers in KGH were 4.5% more aware about patient safety than the patients. However, patients in KGH are 0.7% more engaged in patient safety than the health workers.
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Papers by Kizito Omona
Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV.
Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers).
Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%).
Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV.
Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).
Aim: To identify factors that led to internal delay in management of obstetric emergency, to identify measures to address them and determine the lived experiences of mothers who received obstetric emergency care in Midigo HC IV.
Methods: Purely descriptive cross-sectional design; both qualitative and quantitative in nature. Sample size was 36 participants (33 health workers and 3 mothers).
Results: Factors like long hours of work due inadequate staffing (80%), inadequate refresher training on EmONC (66.7%), poor referral system, poor lighting system, inadequate blood transfusion services and hostility of the community led to delays. Qualitative analysis from mothers confirmed these factors. Measures that could be used to address them were; use of Workload Indicator of Staffing Needs (WISN) to adequately allocate staffs – 90%, holding periodic refresher training on EmONC -93.3%, availability of full-time doctors and anaesthetists (93.3%). Other measures were revamping referral system (93.3%).
Conclusion: Third delays in accessing Emergency Obstetric Care (EmOC) are still a huge challenge in Uganda _ Midigo HC IV.
Keywords: Workload Indicator of Staffing Needs (WISN), Emergency Obstetric Care (EmOC), Emergency Obstetric and Neonatal Care (EmONC).