The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report

Gadama, Yohane; Kamtchum‐Tatuene, Joseph; Benjamin, Laura; Phiri, Tamara; Mwandumba, Henry C.

doi:10.4314/mmj.v31i4.6

Cited by 7 publications

(5 citation statements)

References 29 publications

(24 reference statements)

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“…These meetings are essential because they provide an opportunity to harmonize management decisions, respond to patient concerns, allay their fears, and plan long-term rehabilitation and follow-up. The hospital length of stay of 7 to 20 days reported in this survey is comparable to reports of 10 days on average from previous studies in sub-Saharan African countries [ 36 , 37 ].…”

Section: Discussionsupporting

confidence: 87%

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Stroke units in Nigeria: a report from a Nationwide organizational cross-sectional survey

Arabambi¹,

Oshinaike²,

Ogun³

et al. 2022

Pan Afr Med J

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Introduction stroke is one of the leading causes of death and disability in Nigeria. Stroke unit care is crucial for reducing mortality and morbidity in stroke. This study describes the stroke units' structure, organization, and care process in Nigerian tertiary hospitals. Methods this study is a cross-sectional descriptive organizational survey-based study using an online structured questionnaire to collect information on the stroke units. Results five (8.6%) out of 58 hospitals had a stroke unit. The number of beds ranged between 10 and 27 with the coverage of hospital stroke patients ranging from 24% to 100%. All the centers had a multidisciplinary team for their unit. The basic required investigations like computerized tomography and electrocardiography were available in the centers. Thrombolytic therapy coverage was suboptimal in all the centers due to prolonged onset-to-arrival times and inaccessibility of thrombolytic medications. Conclusion there has been some progress in stroke unit availability since the country´s first stroke unit was established over a decade ago. However, there is still the need to create more stroke units in Nigeria and improve reperfusion therapy coverage.

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Section: Discussionsupporting

confidence: 87%

“…The use of thrombolytic therapy remains a significant challenge. Inaccessibility of thrombolytic treatment has also been reported in other developing countries [ 33 , 36 ]. Known reasons for lack of thrombosis include cost [ 33 ] and delayed presentations, with prolonged onset-to-arrival and door-to-needle time [ 43 ].…”

Section: Discussionmentioning

confidence: 75%

Stroke units in Nigeria: a report from a Nationwide organizational cross-sectional survey

Arabambi¹,

Oshinaike²,

Ogun³

et al. 2022

Pan Afr Med J

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“…The adherence to guidelines for Zomba Central Hospital was higher than the results of a study conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre district in 2018, which found 84% adherence to antibiotic prescriptions to treatment guidelines [ 42 ]. The QECH is one of the four major referral and teaching hospitals in Malawi [ 45 ]. Adherence to MSTG was sub-optimal for both Machinga and Nsanje District Hospitals (54.2% and 73.2% respectively).…”

Section: Discussionmentioning

confidence: 99%

Effect of antibiotic medicines availability on adherence to standard treatment guidelines among hospitalized adult patients in southern Malawi

Chiumia,

Muula,

Chimimba

et al. 2023

PLoS ONE

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Background Antibiotic resistance is a global public health problem. High and inappropriate use of antibiotic therapy exacerbate the risk of antibiotic resistance. We assessed the effect of availability of antibiotic medicines on adherence to standard treatment guidelines among hospitalized adult patients in Southern Malawi. Methods A cross-sectional study was done to assess the availability of 16 antibiotics among the first-line recommended treatments for common bacterial infections in Malawi. Data for up to six-month duration was extracted from stock card records in Machinga and Nsanje District Hospitals and Zomba Central Hospital. This was complemented by a retrospective review of 322 patient management files from medical wards to assess adherence to the Malawi Standard Treatment Guidelines (MSTG). Investigators abstracted data such as patient demographics, diagnoses, and prescribed therapy using a data collection form that resulted in analyzing 304 patient files. Data was entered into Microsoft excel and analyzed using STATA 14.1. Point availability, stock-out duration and adherence to treatment guidelines were presented in terms of frequencies and percentages. Chi-square test or Fisher’s exact test was applied to assess the association between variables and adherence to treatment guidelines. Results Point availability of antibiotics was 81.5%, 87.7%, and 42.8% for Zomba Central, Machinga and Nsanje District Hospitals respectively. Over a period of six months, 12.5% of antibiotic medicines were stocked out for at least one day at Zomba (Median stock out days = 0, (IQR 0–0 days), while 64.3% were stocked out at Machinga (Median stock out days = 21, IQR 0–31 days) and 85.7% were stocked out at Nsanje District Hospital (Median stock out days = 66.5, IQR 18–113 days). Overall, adherence to MSTG was 79.6%, (95% CI, 73.3–84.9%). By facilities, adherence to guidelines at Zomba Central Hospital was 95.9% (95% CI, 89.7–98.9%) while at Nsanje and Machinga District Hospitals was 73.2% (95% CI, 59.7–84.2%) and 54.2% (95% CI, 39.2–68.6%) respectively. Adherence to treatment guidelines was associated with health facility, presence of laboratory test results, antibiotic spectrum, and WHO-AWaRe category of the medicine, p<0.005. Adherence was lower for antibiotics that were stocked out than antibiotics that were not stocked out during the study period (63.8%, 95% CI 48.5–77.3% vs 84.4%, 95% CI 77.7–89.8%), p< 0.002. Conclusion We found unstable availability of antibiotic medicines in hospitals which might contribute to the sub-optimal adherence to standard treatment guidelines. This is a setback to efforts aimed at curbing antibiotic resistance in Malawi.

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“…Hospital B is another referral and teaching hospital which is located in the country's southern region which has a population of 7.7 million 22 . The hospital has a bed capacity of 1350 and receives referred patients from surrounding district hospitals, health centres, and private healthcare facilities 23 . At the time of data collection, there were three adult high dependency units (HDU) and a five bedded general intensive care unit (ICU) at Hospital A; six adult HDUs and four-bedded general ICU at Hospital B.…”

Section: Methodsmentioning

confidence: 99%

Effect of an educational programme on critical care nurses’ competence at two tertiary hospitals in Malawi

Gundo

Chirwa

et al. 2021

Mal. Med. J

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BackgroundCritical care specialty deals with the complex needs of critically ill patients. Nurses who provide critical care are expected to possess the appropriate knowledge and skills required for the care of critically ill patients. The aim of this study was to assess the effect of an educational programme on the competence of critical care nurses at two tertiary hospitals in Lilongwe and Blantyre, Malawi.MethodsA quantitative pre- and post-test design was applied. The training programme was delivered to nurses (n = 41) who worked in intensive care and adult high dependency units at two tertiary hospitals. The effect of the training was assessed through participants’ self-assessment of competence on the Intensive and Critical Care Nursing Competence Scale and a list of 10 additional competencies before and after the training.ResultsThe participants’ scores on the Intensive and Critical Care Nursing Competence Scale before the training, M = 608.2, SD = 59.6 increased significantly after the training, M = 684.7, SD = 29.7, p <.0001 (two-tailed). Similarly, there was a significant increase in the participants’ scores on the additional competencies after the training, p <.0001 (two-tailed). ConclusionThe programme could be used for upskilling nurses in critical care settings in Malawi and other developing countries with a similar context.

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The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report

Cited by 7 publications

References 29 publications

Stroke units in Nigeria: a report from a Nationwide organizational cross-sectional survey

Stroke units in Nigeria: a report from a Nationwide organizational cross-sectional survey

Effect of antibiotic medicines availability on adherence to standard treatment guidelines among hospitalized adult patients in southern Malawi

Effect of an educational programme on critical care nurses’ competence at two tertiary hospitals in Malawi

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