S. Ogendo

Appropriately designed elearning programmes (including Best or School for Surgeons) may allow more efficient use of consultant teaching time. Using funding from Irish Aid, we piloted these existing elearning tools in a sub-Saharan African country (Zambia) where low specialist numbers and limited Consultant time for teaching limits expansion of surgical training programmes. Eight MMed trainees preparing for the Membership (COSECSA) examination in the University Department of Surgery, Lusaka acted as the study group and four from elsewhere served as controls. Each trainee was supplied with BeST (an RCSI elearning basic knowledge course) on a hand held computer and weekly online case based discussions were arranged using the RCSI School for Surgeons platform. Structured feedback, following an initial eight cases previously developed for Irish trainees, identified trainee preference for local cases and faculty involvement. Eight cases appropriate to the healthcare context of the region ...

............................................................................................................................ 5 INTRODUCTION ..................................................................................................................... 6 AIMS OF THE STUDY .............................................................................................................. 6 REVIEW OF THE LITERATURE ................................................................................................. 6 RESEARCH QUESTION. ........................................................................................................... 8 JUSTIFICATION/ RATIONALE .................................................................................................. 8 PARTICIPANT SAMPLE ........................................................................................................... 9 DATA COLLECTION METHODS ............................................................................................... 9 DATA ANALYSIS METHODS .................................................................................................. 10 ETHICAL ISSUES ................................................................................................................... 10 FINDINGS ............................................................................................................................ 10 CONCLUSION ...................................................................................................................... 22 RECOMMENDATIONS. ......................................................................................................... 24 REFERENCES ........................................................................................................................ 24 APPENDIX .......................................................................................................................................... 27

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. T...

To determine the incidence of valve morbidity associated with post-operative valve patients at the Kenyatta National Hospital, Nairobi. A combined retrospective and prospective study. Restrospective period from 1973 to 31st July 1977 and prospective period from there on to 31st July 1998. Cardiothoracic outpatient clinic at Kenyatta National Hospital, Nairobi. All valve replacement patients attending the cardiothoracic outpatient clinic on follow up following discharge from the ward. Morbidity was assessed by incidence of: stroke, thromboembolism, valve thrombosis, bleeding episodes, valve endocarditis and re-operation for valve failure. For all valve surgery combined the overall follow up rate equalled 476.3 patient years. The linearised occurrence rate for thromboembolism for all valves was 1.04% per patient year. For the mechanical valves this incidence was 1.32% per patient year. The stroke free rate at one year and five years was 97.7% and 95.9% respectively. The linearised inc...

In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy among patients following open heart surgery for valve replacement, in view of the adverse effects of warfarin. To review the occurrence of pregnancy in open heart patients following discharge from hospital, and to compare the incidence with national figures. Retrospective and prospective. Kenyatta National Hospital, Nairobi. Of the 239 female patients operated upon at the cardiothoracic unit of the KNH during the period June 1973 and September 1998, 108 met the inclusion criteria; 56 of them had valve replacement surgery. At the time of surgery, 31% of all the female patients were in the reproductive age group of 14 to 45 years. Only two per cent were older than 45 years. Follow up was 490 patient years for the entire group, and 318 patient years for all with valvulopathy. For the whole group, irrespective of age, pregnancy rate was 6% and 15% at five and ten years of follow up respectivel...

To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta National Hospital. The study analysed the postoperative attendance of heart patients to the surgical outpatient clinic at the KNH. Data on clinic attendance was collected over a one-year period from patient files and from clinic attendance. A total of four hundred and seventy-five open heart operations have been performed at the Kenyatta National Hospital over the last twenty-five years. The patients' mean age is 18.0 years. Clinic follow up rate over this period is 85% at one-year, 62% at five-years, 32% at ten-years and 13% at fifteen-years. A number of patients who had since fallen out to clinic follow up were traced during the study period, when included into the analysis the revised figures are 85%, 70%, 40% and 24% respectively. The difference is statistically significant (p = 0.019). There was no significant statistical difference in the follow up between males and females (p =...

On average, for every 100 patients with malignant dysphagia admitted into the Kenyatta National Hospital (KNH) in Nairobi, 28 will have their tumour resected. Seven in the tumour resected group will die during the postoperative period while there will be 12 deaths occurring in patients before surgery.

A 50-year-old female presented with a five months history of recurrent attacks of dizziness, sweatiness, tremors and fainting with loss of consciousness. These were found to be due to hypoglycaemic episodes with blood sugars less than 1 mmol/l and were treated as such. A diagnosis of insulinoma was initially considered, but the patient turned out to have fibrosarcoma of the lung, a rare lung tumour. She also had finger and toe clubbing and features of hypertrophic pulmonary osteoarthropathy.

Eighty random patients were examined over a 9-month-period to determine the incidence of asymptomatic haemorrhoids at the Kenyatta National Hospital (KNH). The incidence of asymptomatic was found to be 21% all being first degree haemorrhoids, while in the age group 50 years and over, 29% had asymptomatic haemorrhoids. The mean age calculated as 44.3 years (+/- 18.3), with no statistical difference between the ages of the two sexes. Males however had a significant greater incidence of asymptomatic haemorrhoids than females.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseas...