Migrants' admissions to hospital: a retrospective study in Como from 1994 to 1998

BACKGROUND: International migrants represent only 4.5% of the world's population, but they may become a challenge for host countries. The aim of the study was to assess the impact of this population on health parameters in Como county, on the northern border of Italy. METHODS: A retrospective analysis of migrants' admissions at Sant'Anna Hospital in 1998 was done, and compared to data from 1994. RESULTS: Of 47,378 total admissions at our hospital, 268 involved migrants (0.5%), mostly from the former Yugoslavia, with a slight preponderance of females; 22 out of 268 migrants were admitted in the Infectious Diseases Department (8.2%), mainly from Africa. Most admissions were classified as Drug Related Group (DRG), but an increasing number of miscellaneous DRGs are reported, including obstetric ones. CONCLUSIONS: The emergence of a female population among migrant admissions, and the relevance of delivery DRGs in 1998, may suggest that, after a first immigration wave of rather healthy men in search of good job opportunities during the first years of the 90s, we are now observing a second wave of migrants: their families. The increasing number of patients from the former Yugoslavia reported in 1998, could suggest that a third wave is expected in the near future: these will be irregular migrants and refugees.     

Drug-related visits to a district hospital emergency room

The role of adverse drug reactions (ADRs) as a cause of hospital visits varies depending on the type of hospitals. Our aim was to determine the incidence of drug-related emergency department visits to a district hospital, and to identify the drugs and patient groups involved. All patient visits to the emergency department of a Finnish district hospital were evaluated prospectively for 6 months. The physician on duty and a clinical pharmacologist selected all possibly drug-related visits for further scrutinising. The causality assessment (drug-related or not) was judged according to WHO criteria, based on the patients' files, including laboratory and other data. Of the 7113 evaluated visits, 167 (2.3%) were "certainly" or "probably" drug-related; 102 (1.4% of all) were related to ADRs and 65 (0.9%) to intentional overdoses. The most common ADRs were gastrointestinal symptoms (n=17) caused by antibiotics, opioids, nonsteroidal antiinflammatory or cytostatic drugs. The International Classification of Disease (ICD-10) codes on patients' files were insensitive to disclose ADRs. The ADR patients were older (mean age 57 years) than the intentional overdose patients (38 years; P<0.001). Males predominated in the intentional overdose group (38 males, 27 females) but not in the ADR patients. The majority of intentional overdoses was caused by psychotropics. The ADRs lead to hospitalisation in a higher frequency (51%) than did the intentional overdoses (35%). In conclusion, the incidence of "certainly" or "probably" drug-related visits to the district hospital emergency room was relatively low. The ICH-10 codes on patients' files were found to be insensitive to disclose the ADRs, even when they lead to hospital admission, casting doubts on the usefulness of ICH codes alone in ADR evaluation.     

Situation analysis of obstetric care services in a rural district in Zimbabwe

OBJECTIVE: To conduct a situation analysis of obstetric services in a rural district of Zimbabwe. DESIGN: Observational study. SETTING: 13 primary health care centres in Murewa district in Zimbabwe. MAIN OUTCOME MEASURES: Number of maternity beds, antenatal attendance, deliveries per month, availability of antenatal, intrapartum and neonatal care equipment, intrapartum monitoring and neonatal resuscitation skills. RESULTS: 13 of 15 primary health care clinics providing obstetric care in Murewa district were surveyed in 1995. Median number of maternity beds were nine (Q1 = 0, Q3 = 11) per clinic, median number of first ANC attenders per month was 15 (Q1 = 3, Q3 = 18), median number of deliveries per clinic per month were eight (Q1 = 0, Q3 = 16). While all clinics had laboratory facilities, 6/13 could estimate haemoglobin, 5/13 syphilis serology, none of the clinics sent blood to district hospitals for blood grouping and there were no microscopes at clinics for malaria parasite determination. Only 6/13 clinics used partographs for monitoring labour, 10/13 had suction machines for neonatal resuscitation while only 3/13 had ambu bags, 3/13 had oxygen and 2/13 had heaters. Correct methods for neonatal resuscitation were used in 3/13 clinics. Clean water supply, reliable power supply and the referral system were not optimal. CONCLUSION: Basic equipment for antenatal, intrapartum and neonatal care was inadequate. Essential laboratory facilities for obstetric care were lacking. Skills for intrapartum monitoring and neonatal resuscitation were inadequate. The referral system was poor. There is need for more strategic planning at primary health care level in this district which is known to have high perinatal and neonatal death rates. More emphasis should be placed on strengthening basic laboratory back up service for obstetric care, strengthening infrastructural and referral systems as well as training in areas of lost or no skills.     

Obstructed labor at a district hospital

A retrospective analysis of all deliveries that occurred at Jimma hospital, south western Ethiopia from September 1990 to May 1999 was conducted to determine the incidence, maternal and perinatal outcome, sociodemographic and clinical characteristics of mothers with obstructed labor. Seven percent (945/13,425) of the deliveries were complicated with obstructed labor with an overall increasing trend noted during the study period. Sixty seven percent of the cases were primigravida and grand multiparous mothers. Fourteen percent of obstructed labor occurred among teenage pregnant mothers. Forty four percent of the cases had no antenatal care while 35.1% had antenatal care. Cephalopelvic disproportion (CPD) was responsible for 80.6% of the cases, malpresentations accounting for the remainder, shoulder presentation being the commonest (11.5%). Fifty eight percent of the CPD cases were among the primigravida but para two to four mothers were not immune accounting for 25.7% of the cases, the rest being grand multipara, (15%). Fifty seven percent of the ruptured uterus cases were para two to four mothers while primigravids accounted for 7.2%. Maternal mortality was 9.1% while 62.1% of the perinates died with only 12.5% of the neonates having normal first minute apgar scores. Obstructed labor was the commonest cause of maternal and perinatal mortality at the hospital during the study period responsible for 45.5% and 37.4% of the deaths respectively. Any attempt to reduce maternal mortality at the hospital must comprehensively address the issue of obstructed labor, identify risk groups of mothers for this peripartum complication and design preventive strategies.     

Aids is now the commonest clinical condition associated with multilineage blood cytopenia in a central referral hospital in Zimbabwe

OBJECTIVE: To describe the clinical features and diagnosis of patients hospitalised and found to have multilineage peripheral blood cytopenias. DESIGN: Prospective cross sectional study. SETTING: Parirenyatwa Hospital, a central referral hospital in Harare, Zimbabwe. SUBJECTS: 231 consecutive patients whose blood parameters revealed bi- or trilinneage cytopenia during a five month period in 1996. MAIN OUTCOME MEASURES: 1. Blood cytopenia was described as: (a) Haemoglobin concentration = or < 100 g/L (b) Total leucocyte count = or < 3.5 x 10(9)/L (c) Platelet count = or < 100 x 10(9)/L 2. Other clinical and diagnostic features. RESULTS: The highest percentage of multilineage blood cytopenia was in the age bracket 30 to 44 years and the male to female ratio was 1.4:1. Pancytopenia was found in 32.5% of patients, while bilineage cytopenia occurred in 67.5%. The commonest bilineage pattern was the combination of anaemia and thrombocytopenia occurring in 46.3% of all study cases or 68.5% of bilineage cytopenias. Anaemia was the most frequent cytopenia; it was found in 95.2% of all study cases. CONCLUSION: The commonest condition with which multilineage blood cytopenia was associated was AIDS which was diagnosed in 25.1% of the study cases.     

Drug use before hospital admission in Zimbabwe

Summary Drug use before hospital admission was studied prospectively in 284 consecutive patients admitted to general medical wards in Zimbabwe.Drugs were used by 84% of patients. Self-medication was used by 143 (50%) patients, aspirin (54%) and chloroquine (17%) being the most commonly used drugs. Traditional medicines were used by 55 (19%) patients. Drugs dispensed from orthodox medical sources were taken by 128 (45%) patients. Analgesics (22%), antibiotics (18%), and chloroquine (13%) were the commonest drugs dispensed. Urine screening tests were performed and were positive for aspirin in 37% of cases, chloroquine (33%), and antibiotics (20%).Adverse drug reactions requiring hospital admission occurred in 14 patients (10 orthodox medicines, 4 traditional medicines).Drug use before hospital admission, which is often poorly documented, is a source of potential drug toxicity and may obscure a diagnosis of infective illness.     

Perinatal mortality in Marondera district

In an attempt to identify factors associated with stillbirths and those occuring in the 1st week of life, perinatal deaths in infants born in health facilities in Marondera Districts occurred during a 7 months period 1986 were recorded and analyzed. 66 such deaths out of a total of 1900 births, giving a perinatal mortality rate of 35/1000 total births. The largest groups with identifiable cause were intrapartum asphyxia (14 deaths) and severe prematurity (birthweight 1500 gm) (8 deaths). The other associated causes of perinatal deaths were antepartum hemorrhage, code prolapse, toxemia of pregnancy, ruptured uterus, severe congenital abnormalities and intrauterine infections.     

Noxythiolln-resistant organisms in a district general hospital.

Twelve strains of Pseudomonas aeruginosa, three strains of Klebsiella aerogenes, and two strains of Escherichia coli were found to be resistant to noxythiolin. Some of the pseudomonads were isolated from patients in the same ward, not all of whom were on noxythiolin treatment. The strains from these patients were indistinguishable from each other on phage typing, which suggested cross-contamination. No Gram-positive organism was found to be resistant to noxythiolin. Noxythiolin should not be used before a disc diffusion sensitivity test has been performed to determine whether the organisms are sensitive to it. This is particularly important when pseudomonads are the offending organisms.     

Risk factors and mortality associated with Clostridium difficile-associated diarrhoea at a VA hospital

The objective of this study was to evaluate the risk of certain patient co-morbidities and antibiotics in the development of Clostridium difficile-associated diarrhoea (CDAD). Hospitalized patients developing CDAD during a specified period were compared with a cohort of patients, matched by age, without a diagnosis of CDAD, who were hospitalized during the same time period. Data collection included demographics, hospital ward, co-morbid conditions, antibiotics received, and mortality. Gender and age were similar in both groups. Co-morbid conditions significantly associated with the case group included cancer and COPD. The most commonly prescribed antibiotics in the case versus control group included levofloxacin, intravenous vancomycin, clindamycin, and piperacillin/tazobactam. The case group was associated with a higher mortality rate.     

Risk factors for contracting plague in Nkayi district, Zimbabwe

OBJECTIVE: To identify risk factors for contracting plague among the three to 16 year old age group. DESIGN: A matched case control study, carried out in two parts. SETTING: Nkayi District--a plague endemic area in Zimbabwe. SUBJECTS: A total of 86 cases were randomly selected from a line listing of all reported plague cases in the district. Two neighbourhood controls were selected from households at least 500 m on either side of the case household. MAIN OUTCOME MEASURES: Maximum likelihood estimate of the odds ratio (OR) for the 17 risk factors studied (grouped as personal, environmental, domestic animals and rat reports). RESULTS: Risk factors which were significantly associated with contracting plague were having a sick cat in the household (OR 3.4, 95% CI 1.1 to 13.0), herding cattle (OR 1.7, 95% CI 1.0 to 3.0), and age 10 years or older (OR 2.2, 95% CI 1.2 to 4.1). In a logistic model, only having a sick cat was found to be independently associated with being a case (OR 3.9, 95% CI 1.3 to 12.2). CONCLUSION: The presence of a sick domestic cat was identified as a risk factor for acquiring bubonic plague during this outbreak. Communities should be informed that sick cats may act as a warning of potential plague, and that if cats become sick they should be removed from the household.     

Tuberculous meningitis in a district hospital from Southern Ethiopia

In order to describe the clinical presentation, immediate outcome and risk factors associated with Tuberculous meningitis (TBM), 28 children with TBM were analyzed. The male to female ratio was 1.5:1. The mean age of the cases was 8 years (range 5 months-14 years). Nineteen (67%) of the patients were not vaccinated for Tuberculosis (TB). Nineteen (67%) patients had exposure to adults with pulmonary TB of which 14 (50%) were family members. Among these were four children who were vaccinated and their age range was from 7 month to 8 years. Thirteen (40%) were seen by health professionals with in three months before symptoms related to TBM, the mean duration of symptoms before seeking medical advice was 3.2 months. Using the weight height percentage of median, sixteen (57%) had malnutrition. Twenty (71%) patients were in stage three of TBM at presentation. Eleven (38%) had positive reaction to Mantoux test and 25 (89%) had abnormal chest radiography the most common finding being hilar lymphadenopathy. CSF (Cerebro Spinal Fluid) total cell count showed pleocytosis of < 200 in all but two cases (71%), and raised protein level on quantitative determination. Acid Fast Bacilli (AFB) test done in seven patients, was positive in two (29%) cases. One (4%) direct sputum smear and gastric aspirate culture were positive. Thirteen 13 (46%) patients died despite treatment and 9 (64%) had severe neurological complications. Delay at presentation advanced stage of TBM and unvaccinated state for tuberculosis were closely associated with poor outcome (P<0.05). Hence health workers who treat children should maintain high index of suspicion at all times and evaluate for TBM. The value of prophylaxis for children who have close contact with infectious cases should be evaluated in Ethiopia.     

Use of packed red cells in a major hospital in Harare, Zimbabwe

OBJECTIVES: To document the current pattern of packed red cell (PC) usage and the crossmatch to transfusion ratio (C/T ratio) in a major city teaching hospital in Harare, Zimbabwe. DESIGN: Restropective, (audit). SETTING: Harare Central Hospital, a 1,200 bed multidisciplinary hospital located in Harare, Zimbabwe. MAIN OUTCOME MEASURES: Amount of PC ordered and proportion collected for the year 1995. Quantity of PC used by different medical specialties. RESULTS: In 1995 a total of 8,292 PC were collected from Harare Hospital blood bank. This translates to an average PC usage for a 1,200 bed hospital of seven units per hospital bed per year. Only 48.5% of PC crossmatched was collected with a C/T ratio of 2.1:1. Revenue loss of Z$478,434 is estimated to have occurred due to expired units and resource wastage from uncollected crossmatched units. The largest consumer of PC was the Department of Gynaecology, followed by Surgery and Paediatrics. CONCLUSION: Regular auditing of blood usage is recommended to promote the efficient use of PC in accordance with accepted international standards and local guidelines and practice.