Browsing by Author "Ochola, Emmanuel"

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    919 Routine Hospital Acquired Infection surveys are feasible in low income health care settings and can inform quality improvement interventions
    (Oxford University Press, 2014) Ochola, Emmanuel; Okello, Tom Richard; Kansiime, Jackson; Praticò, Liliana; Greco, Donato
    Background. Prevention of acquisition of infection in the health care setting is imperative for reduction in morbidity and mortality for patients and health workers and improvement health care quality. However, data is scarce on prevalence and trends of hospital acquired infections (HAI) in low income settings, unlike in developed countries. We instituted annual surveys to determine HAI prevalence and determinants in a hospital in Gulu, Northern Uganda, an area recovering from over 20 years of war. Methods. An external expert mentored local hospital staff at the request of the Board, to do HAI surveys for 2 years after which a local team continues the exercise. Using standard WHO checklists. A one-day survey is done, recruiting all patients admitted in the hospital for 48hours or more. Data is collected by doctors and nurses on demographics, new diarrhea, Urinary Tract Infections (UTI), respiratory conditions, wound infection and intravenous catheter infections that were absent during admission. Urinalysis was done to confirm UTI. Results were analysed using SPSS, reporting basic statistics and p values of chi square tests comparisons. Results. A total 1174 clients were surveyed in four years, average 293 per survey. There was a 56% decline in HAI prevalence from 28% in 2010 to 14.2% in 2011 (p < 0.0001). Prevalence of HAI was 15.1% in 2013 and 14% in 2014. In different years, the key hospital acquired infections included UTI accounting for 39% (21.5-55%) of the total HAI, intravenous line infection 27% (18.2-30.4%), respiratory tract infections, 17.5% (5.5-25.5%), and surgical wound infections, 16.0% (8.7-20%). In 2013 which had UTI at 58%, UTI was present in 53.3% of catheterized clients, compared to 14.8% in 2011. Conclusion. The HAI surveys are practical, and feasible to perform, even in poor settings. The surveys prompted the institution of the hospital infection control committee. HAI surveys can generate glaring gaps, which when intervened on, like urinary catheter overstay, poor wound care, duration of iv lines, and hand washing practices, can improve care quality. The surveys can suggest corrective actions for good care practices. Nevertheless, prevention of HAI needs continuous efforts of all health workers.
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    Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda
    (BMJ open, 2021) Alobo, Gasthony; Ochola, Emmanuel; Bayo, Pontius; Muhereza, Alex; Nahurira, Violah; Byamugisha, Josaphat
    Objectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting. Design This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants. Setting Thirteen primary healthcare centres, one general private-not- for- profit hospital, one regional referral hospital and one teaching hospital in northern Uganda. Participants Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling. Results After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and- forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional. Conclusion Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.