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- ItemRestrictedAfrican Surgical Outcomes Study in Paediatric patients (ASOS-Paeds)(Kamuzu University of Health Sciences, 2022-06-15) Mulwafu, WakisaTYPE OF STUDY Multi-centre prospective observational cohort study. PROBLEM Access to safe surgery is a basic human right. This is highlighted by the work of the Lancet Commission on Global Surgery.There is a burden of surgical disease in the paediatric surgical population with a large need. In Africa, children comprise a significant proportion of the population with approximately 50% of the population being ≤19 years old. Limited Limited data from Africa suggests the risk factors for, incidence and outcomes associated with paediatric surgical complications differ from HICs. The African Surgical Outcomes Study (ASOS) has described surgical outcomes in adult patients in Africa. There is a need to determine the burden of the complications in paediatric surgical patients in Africa, and the risk factors for and the type of complications experienced. STUDY OBJECTIVES The main objective of this study is to confirm the incidence of in-hospital postoperative complications up to 30 days post-surgery in paediatric surgical patients aged < 18 years in Africa. In paediatric surgical patients < 18 years in Africa: 1. To determine the in-hospital postoperative complications including mortality up to 30 days post-surgery, 2. To evaluate the incidence of intraoperative critical incidents, 3. To assess the association between pre-operative, intra-operative and facility factors with postoperative complications including death. METHODS An African multi-centre prospective observational cohort study of All consecutive paediatric patients aged < 18 years admitted to participating hospitals undergoing elective and non-elective surgery . The primary outcome measure is in-hospital postoperative complications. Obstetric surgery will be excluded. The primary outcome measure is in-hospital postoperative complications censored at 30 days post operatively. This study is expected to start in March 2022. EXPECTED FINDINGS AND DISSEMINATION We expect the outcomes to be potentially worse in Africa, because firstly, there is a limited workforce, and secondly there are limited intensive care facilities and critical care resources across Africa to provide sufficient care. A report of the research findings will be submitted to the College of Medicine Research and Ethics Committee, the College of Medicine Library, the Health Sciences research committee, the University research and publication committee, the Lancet Commission and the Ministry of Health 2. Summary Short title ASOS-Paeds Methodology A prospective international, multi-centre, African observational study Research sites Hospitals undertaking paediatric surgery in participating African Objective To confirm the incidence of in-hospital postoperative complications up to 30 days post-surgery in paediatric surgical patients aged < 18 years in Africa. Number of 7000 patients Inclusion All consecutive paediatric patients aged < 18 years admitted to criteria participating hospitals undergoing elective and non-elective surgery Exclusion Obstetric surgery
- ItemRestrictedThe relationship between Caeserian section and development of Endomyometritis leading to Hysterectomy(Kamuzu University of Health Sciences, 2020-10-16) Chewale, Owen; Mankhwazi, Kossam; Lipenga, AlfredThis study has been designed to bring to book the relationship between caesarean section deliveries and the development of endomyometritis that results into removal of uteruses. It will be both a qualitative and quantitative retrospective study that will be done at QECH, southern Malawi. The study shall mainly focus on estimating the prevalence of post caesarean section endomyometritis that leads to hysterectomies at QECH, exploring the risk factors contributing to the development of endomyometritis and finally it will focus on finding out the experiences of women who had their uteruses removed. It will involve collection of both primary and secondary data whereby primary data will be collected using questionnaires and secondary data will be collected from medical registers. The measures were reinforced at QECH in the years of 2018 and 2019 in order to reduce post caesarean section endomyometritis and hysterectomy cases[1]. The impacts of such measures will be also known through our objectives. A copy of final report of the research findings shall be submitted to The College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library, The Health Sciences Research committee, and The University Research and Publication committee (URPC), through COMREC secretaria
- ItemRestrictedPsychosocial care for road traffic injury patients: An exlporation of service provision to patients attending orthopaedic clinic at Queen Elizabeth Central Hospital in Blantyre(Kamuzu University of Health Sciences, 2020-06-05) Chingwalu, MacleanThis is a qualitative study employing a phenomenological design as it examines human experience through the descriptions that are provided by the participants. Annually, an estimated 1.2.million people worldwide are killed in road crashes and as many as 50 million are injured, occupying 30 to 70 percent of orthopedic beds in developing countries’ hospitals. In 2013, over 85% of all deaths and 90% of disability adjusted life years lost from road traffic injuries occurred in low and middle-income countries which have only 47% of the world’s registered vehicles. Biopsychosocial models where psychosocial factors are assessed and treated along with medical care have become standard of care in the treatment of many medical conditions including cancer but have not been incorporated in most orthopaedic practices. This happens because the health workers do not have time to probe more on psychosocial issues and others feel that the patients will feel stigmatized if asked this. Kohler et al did a research on quality of life after lower extremity trauma which was conducted at Kamuzu Central Hospital in Lilongwe and found that apart from having physical disabilities, work performance, school performance and overall quality of life is affected, but he did not look at factors that prevent health workers from providing the psychosocial care to these patients. Apart from determining mechanism of injury, assessment of patient’s social and professional status to identify potential problems that might affect treatment and rehabilitation, is also necessary. Many studies have shown that there is association between orthopaedic injuries which are secondary to road traffic accidents and psychosocial breakdown but in Malawi, especially at Queen Elizabeth’s Central Hospital no known study has explored the barriers of psychosocial care to these patients. This study sets to examine barriers and enablers in providing effective psychosocial care in road traffic injury patients. It will specifically establish the provision of psychosocial services to patients with road traffic injuries and examine influence of health workers in ensuring provision of psychosocial care to orthopaedic patients involved in road traffic injuries. The study is also exploring lived experiences of orthopaedic patients involved in road traffic accidents and to identify psychosocial factors that hinder holistic recovery of orthopaedic patients involved in road traffic injuries. The study sample is 20 people, which will include orthopaedic patients attending specialist clinic at Queen Elizabeth Hospital. Participants will be those aged 18 and above, had limb fractures due to road traffic accidents within a period of one year, were admitted and are now attending followup clinic. Guardians and health personnel will also be included. Exclusion criteria will include all patients who had limb fractures but were not admitted, those with other limb pathologies attending this clinic will also be excluded. Patients below 18 years will also be excluded. Purposive type of sampling will be used because the study participants are representative of the study phenomenon and are knowledgeable about the question at hand. An interview guide will be used for all the objectives. Ethical approval to conduct the study will be sought from COMREC and will get permission to conduct the study from the Hospital Director of Queen Elizabeth Central Hospital. Patients, guardians and nurses will provide an informed consent before engaging them on this study. Each respondent will be identified by a number which will be unique for anonymity. Data will be audio recorded, and then transcribed verbatim. Data analysis will proceed through coding and generating themes. This will be done using N vivo application. This software will help to handle and manage the data. Work overload, inadequate knowledge and lack of interest in health personnel are some of the expected findings and these can be addressed by having consultative meetings.
- ItemRestrictedA retrospective study on the burden and factors associated with motorcycle crashes in Lilongwe, Malawi(Kamuzu University of Health Sciences, 2021-12-02) Ngulinga, Flexon FresnelType of research study: A retrospective study in which the burden and factors associated with motorcycle crashes will be surveyed in order to come up with ways of reducing the burden of motorcycle crashes. The problem: Due to rapid motorization in the sub-Saharan Africa (SSA), there has been an increase in the road traffic injuries and fatalities from motorcycle crashes. However, there is no local data explaining the burden and factors associated with this increase. Therefore, there is a need to understand the magnitude and factors associated with motorcycle crashes for the implementation of public policies. The objectives: Broad objective is to estimate the prevalence and characteristics of motorcycle crashes in Lilongwe, Malawi. Specific objectives include: to identify factors that contribute to the severity of motorcycle crashes, determine the causes and trends of motorcycle crashes, estimate helmet wearing among motorcyclists, and to identify factors associated with helmet wearing. Methodology: This Retrospective study will be conducted in Lilongwe, Malawi. This study will be an analysis of retrospectively collected data from the Lilongwe road traffic police registry. The study participants will be all victims with motorcycle crash injuries between January 2018 and January 2021 who were recorded in the Lilongwe traffic road police registry. Expected findings and dissemination: We expect motorcycle crashes to have increased with respect to the rapid motorization. The results of this study shall be presented in disseminations and submitted for publication in a medical journal in order to ensure adequate outreach to stakeholders and decision makers. A copy of the findings shall be disseminated to COMREC, College of Medicine Library, the Health Sciences Research Committee and the University Research and Publication Committee.
- ItemRestrictedOutcomes of neurosurgical admissions in Intensive Care Unit at Queen Elizabeth Central Hospital(Kamuzu Univerisyt of Health Studies, 2021-10-28) Zimba, Edward, Elijah Chinguwo ThomoType of research. This will be a retrospective cross sectional study 28-Oct-2021 11 Problem. There has been an increase in the number and complexity of neurosurgical cases being done since the introduction of the neurosurgical unit. A lot more neurosurgical cases are being admitted in the main ICU of QECH. While the profile of patients admitted in other ICUs across the world and their mortality rate exist, such information is not available for QECH. We plan to find out the type and number neurosurgical cases that are usually admitted in the ICU, their outcome and factors that may lead to mortality in the unit. Methodology. We will look at a representative sample of the neurosurgical cases that were admitted to the ICU. We have calculated that we should look at 43 cases out of the 48 cases that were admitted to the ICU between 1 January 2019 and 31 December 2019. We shall extract data from various sources from the ICU and from the ward the surgical wards. Data of interested will be captured on a case report form. The data which will be captured will include; patient demographics and various admission parameters, including variables that may be associated with mortality. We will then describe the profile of patients that are admitted to the ICU, calculate the ICU mortality rate and find out if there are any factors that are associated with mortality. EXPECTED FINDINGS AND THEIR DISSEMINATION. We expect to find a high mortality of the cases compared to dedicated intensive care units since this unit is not a dedicated neuro intensive care unit, the lack of clinical staff expertise, drugs and equipment may compromise ICU care, leading to a high mortality. The results will be presented to the ICU team. We will also share our findings with the hospital management and CoMREC.