East African Journal of Public Health

Assessment of educational environment using Dreem Scale: are different domains needed revisiting?

Indranil Saha — 2020-02-12

Introduction: DREEM stands for Dundee Ready Education Environment Measure is an internationally accepted checklist for assessment of educational status in medical schools.

Objective: To find out the reliability of DREEM scale and its different domains like Students' Perceptions of Learning (SPL), Students' Perceptions of Atmosphere (SPA), Students' Perceptions of Teachers (SPT), Students' Academic Self- Perceptions (SASP), and Students' Social Self-Perceptions (SSSP).

Methods: The study was conducted at IQ City Medical College, Durgapur, West Bengal from April–September, 2018 among 407 students with a response rate of 72.5%. Reliability analysis was evaluated by the Cronbach’s alpha, corrected item total correlation and Cronbach’s alpha if item deleted values by SPSS software.

Results: Overall DREEM scale had excellent reliability with Cronbach’s α value 0.905. Regarding different sub domains SPL, SPT and SPA had acceptable reliability with a score more than 0.7 and less than 0.8. SASP had questionable reliability with a value of 0.674 and SSSP had poor reliability with a score of 0.518. Apart from the DREEM questionnaires following are the suggestions from the students’ - more practical exposures, patient exposure, integrated teaching, more interactive sessions, seminars, workshops, quizzes, increased number of academic cases in the college, good canteen facilities, recreational environment for relaxation, good senior – junior interaction, more attention to mediocre & slow students, extra doubt clearing classes, correct way of writing answers to get good marks in examinations etc.

Conclusion: Although overall reliability of the scale was excellent but different domains was not found to be consistent as other studies, which needs revisiting.

Keywords: DREEM, educational environment, reliability, Cronbach’s α

Patients’ and providers’ perceptions of the Swahili words of msongo (stress) and sonona (depression): implications for treating mood disorders among people living with HIV/AIDS, Dar Es Salaam, Tanzania

Hellen N. Siril — 2020-02-12

Objectives: People living with HIV/AIDS (PLH) in resource-limited settings have high and often unrecognized prevalence of mood disorders, with adverse implications for medication adherence and engagement in transmission risk reduction behaviors. Working in HIV treatment and care provision, we observed lack of common understandings between PLH and health care workers (HW) of the words msongo and sonona (Swahili) intended to mean stress and depression, respectively. This gap in psychosocial health communication may result in missed opportunities for depression management, which can contribute to altered immune functioning, poor self-care practices, accelerated HIV disease progression, and poor clinical outcomes among PLH. We explored perceptions and experiences in use of the terms msongo and sonona among PLH, to better inform the management of mood disorders among PLH

Methods: A two-phased study which included exploratory mixed methods study including focus group discussions (FGDs), indepth interviews (IDIs) with PLH and HW, and a cross-sectional pilot survey with PLH in Dar es Salaam, Tanzania was conducted from 2012 to 2013. Only the data for phase I was included in this manuscript. Thematic analysis of qualitative data from 86 participants explored PLH and HW experiences with the use of terms msongo and sonona. From these findings, we developed scale items based on PLH’s descriptive idioms for a structured survey questionnaire administered to 318 PLH. Through Principal Component Analysis (PCA) we identified meaningful dimensions for the msongo and sonona scales

Results: Predominant meanings for PLH with mood disorder of the terms included troubling thoughts, emotional and physical symptoms. There were gender and age differences in meanings given to both words. For older PLH, msongo and sonona had similar meanings; the former representing higher severity of sonona. In contrast, younger women perceived sonona as a worse form of msongo, while for some young men sonona was understood as kisonono (gonorrhea). Among PLH with mood disorder, 60% and 80% requested help from a health worker for managing sonona and msongo, respectively. PLH without a mood disorder articulated msongo as normal thoughts not requiring hospital treatment; while sonona was a new word, the meaning of which they did not know. This group reported they did not seek care from a health worker for these concerns. The HW interchanged meanings and symptoms of msongo and sonona, while some thought sonona was a type of psychosis. PCA of the data from PLH revealed five dimensions for the combined sonona and msongo scale, with Cronbach’s alpha estimates of 0.92, a unidimensional msongo scale with Cronbach’s alpha estimates of 0.77 and four dimensions for the sonona scale with Cronbach’s alpha estimates of 0.90

Conclusions: Though PLH overall had a limited understanding of the psychological health implications of msongo and sonona, those with mood disorders understood these words as meaning stress and depression, respectively. HW should raise their awareness and be alerted to possibilities of depressive disorders when PLH express concerns about msongo or sonona or have symptoms in order to facilitate the identification and management of depression in such settings

Keywords: HIV, PLH, msongo, sonona, depression, stress scale, Swahili, Tanzania

Bacillus Calmette Guerin immunization coverage and the accuracy of the reported immunization data in Wanging’ombe District, Njombe Region, Tanzania

Linda Chatilla — 2020-02-12

Background: Inaccuracy of the reported administrative immunization data and the corresponding coverage has been a concern for stakeholders and users of immunization data. Apart from coverage estimation, the number of doses administered for Bacillus Calmette Guerin (BCG) vaccine is primarily used as a baseline for computing immunization indicators like dropout rate.

Objectives: To estimate BCG coverage and determine the accuracy of the reported number of doses administered to children less than one year for the calendar year 2018.

Methods: A quantitative descriptive cross- sectional study was conducted at 23 selected health facilities in Wanging’ombe district. Abstraction forms were used to collect data on the number of doses administered to children less than one year, number of reported doses in monthly summary forms and live births for the calendar year 2018. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20 software.

Results: The estimated coverage was 177%. Of the 15 health facilities that were assessed for accuracy, seven had accurate data, five over reported and three under reported.

Conclusion: The overall estimated coverage was unusually high. Though, the reported number of doses administered can be relied for decision making. Establishing and strengthening countrywide Civil Registration and Vital Statistics system (CVRS) may be a sustainable solution to the outstanding challenges in denominators. Standard Operating Procedures (SOPs) with clear instructions for recording and reporting should be emphasized.

Keywords: BCG, coverage, data quality, immunization, Tanzania

Renal echogenicity predicting renal dysfunction in patients with chronic kidney disease at Muhimbili National Hospital

Joel J. Bwemelo — 2020-02-12

Objective: Chronic kidney disease (CKD) is a slow progressive loss of kidney function over the span of years. Many studies have been done on correlating sonographic renal changes with renal function by using serum creatinine as a functional mark of renal failure but less is reported on correlation of eGFR with sonographic findings. The aim of this study was to determine the role of renal sonography in predicting renal function among patients with chronic kidney disease (CKD).

Method: This was a cross-sectional study which evaluated 145 patients with CKD who underwent both kidney sonography and renal function test based on estimated glomerular filtration rate (eGFR). This study was conducted at Muhimbili National Hospital from June to December 2009. We evaluated three variables; cortical echogenicity, cortical volume and Renal function. These variables were compared by using correlation, sensitivity, specificity, positive and negative predictive values and Likelihood Ratio.

Results: The regression correlation between renal cortical echogenicity and renal function (eGFR) revealed a correlation coefficient of r² = 0.622, p<O.OO. The sensitivity of echogenicity as predictor of renal function was 74.7% (95% Confidence Interval (CI): 0.68 - 0.78), specificity was 93.5% (95% CI: 0.85 - 0.99). Positive Likelihood Ratio (LR) +11.6; p<O.OOI), hence echogenicity proved to be a strong prediction sign.

Conclusions: Renal cortical echogenicity sign was potentially useful as surrogate marker of the renal function.

Keywords: CKD, Ultrasonography, cortical echogenicity, eGFR

The impact of oral health education for caregivers on school children’s utilization of dental services: a school dental screening intervention study at Ibadan, Nigeria

Omolola T. Alade — 2020-02-12

Objective: To test the impact of oral health education for caregivers on children’s utilization of dental services.

Methods: Schools were randomly allocated into control and experimental groups. The children in both groups underwent a dental screening exercise. An oral health education program was delivered to caregivers of the children in the experimental group only. Children found to have an unmet oral health need were referred for care. The outcome was the proportion of referred children utilizing dental services in both groups after 4 months. Chi square analysis was used; level of significance was set at p<0.05.

Results: A total of 622 school children (mean age 12.3 ± 1.81) years were screened. Overall, 190 (30.5%) were referred for care. After 4 months, 8 of the 94 (8.5%) referred children in the experimental group utilized dental services while only one of the 96 (1.0%) children in the control group did so. This difference was statistically significant (X₁² = 4.63, p = 0.03).

Conclusion: An oral health education programme for caregivers resulted in a statistically significant but unimportant difference in children’s dental service utilization.

Keywords: health care utilization, screening, health services need

Evaluation of the Tanzania programme on task shifting for caesarean sections

Matinhure Sheillah — 2020-02-12

Objectives: To critically examine the AMO program in terms of history, training, career progression, deployment, staffing, main tasks in the scheme of service, reporting structures and supervision, special rewards or incentives, regulatory authorities, professional associations and affiliations and to learn lessons that could inform the ongoing Tanzania health sector system strengthening reforms.

Methods: A descriptive cross-sectional survey augmented by key informant interviews was used to collect data on the Tanzania AMO programme. Data entry and analysis was through SPSS software Version 23. Thematic content analysis was done for qualitative data obtained from key informant interviews.

Results: The AMO programme was established more than 5 decades ago. The AMO deficit at district hospitals ranged between 62.5% and 68.8%. The AMO training Programme remains an in-service model that had not been upgraded to degree level. The advanced diploma awarded to AMOs is yet to be recognised by the National Council of Technical Education of Tanzania. AMOs are registered under the Medical Council of Tanganyika. There are limited advancement opportunities through the AMO grade. Continuous professional development (CPD) programme is yet to be established.

Conclusion: If Tanzania should address the HRH gap at primary and secondary level of care, then the AMO programme should be reviewed in the following domains; human resources development, career and professional advancement, practice regulations and recognition by the NACTE.

Keywords: Task shifting; task sharing; caesarean section, assistant medical officers; associate clinicians; clinical officers; nonphysician clinicians

The complementary role of digital rectal examination and prostate specific antigen for prostate cancer detection as seen Dar Es Salaam -Tanzania

Richard Thomas Mliwa — 2020-02-12

Background: Prostate cancer (PCA) is a significant public health problem. It is the most common malignancy and the second most common cause of cancer deaths among American men. In most of African countries its incidence is said to be unknown, probably because of poor quality of the medical care systems and registries which may have a substantial impact on the completeness and accuracy of the reported incidence rates. Digital rectal examination (DRE), PSA, Trans Rectal Ultrasound and needle biopsy remain standard tools for diagnosis of Prostate carcinoma worldwide. This study aimed to establish the diagnostic value of DRE and PSA among males suspected to have PCA at two Hospitals Dar es Salaam.

Methods: This was a cross sectional study which involved males suspected for PCA recruited by convenient sampling at Muhimbili national Hospital and Tumaini hospital. Data was collected by using structured questions. Each participating patient gave an informed consent. DRE findings and PSA values were sought from patient’s notes. Histopathology results were sought from Central Pathology Laboratory. Analysis was done with the aid of SPSS version 20 software.

Results: Three hundred and seventy-three patients were enrolled in the study with mean age 70.72 years and range from 45 to 102 years with a peak age of 61-70 years. The sensitivity, specificity and positive predictive value of DRE was 76.8%, 82.3% and 0.82 respectively; while for PSA respective values were 100%,29% and 0.47. Combination of DRE and PSA had a positive predictive value of 0.87making diagnosis accuracy of 87% when the two tests were combined.

Conclusion: Digital rectal examination and Prostate Specific Antigen provide good detection rate of prostate cancer when these two tests combined. In our study the diagnostic accuracy of DRE combined with PSA was 0.87. So as per WHO recommendations, these two tests should be used together since they complement each other if Trucut needle biopsy cannot be performed for any reason(s).

Keywords: Digital Rectal examination, prostate specific Antigen, prostate cancer