atacho report
TRANSCRIPT
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CHAPTER 5
5.1 HEALTH SERVICES OFFERED IN THE DISTRICT
PRIMARY HEALTH CARE (PHC) ACTIVITIES AND SERVICES OFFERED BY THE
HEALTH WORKERS AT THE DISTRICT LEVEL:
The PHC activities and services offered by the health workers at the District level had 4
characteristics, i.e. they were; affordable, acceptable, and reliable and had full
community participation. The PHC Services included;
o Water and sanitation: Sanitation and Water Quality is a big challenge within Kisii
municipal I participated in piped water mapping and its contaminants within Kisii
municipal and Bacteriological water quality testing for household’s workshop that was
conducted by the UN habitat for 3 days at St Stephens Catholic hall in Kisii. 4
classification of water related diseases were discussed:
1. Water borne diseases: Diseases caused by ingestion of contaminated water by
human or animal or urine containing bacteria or viruses.
2. Water washed diseases: Caused by poor personal hygiene as a result of poor access
to water
3. Water based diseases: Diseases caused by parasites found in the intermediate
organism leaving in water.
4. Water related diseases: Transmitted by insect’s vectors which breed in water
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Whereby in Kisii Central District the following were found to be the most common
diseases In terms of prevalence Malaria is the highest in prevalent then typhoid,
dysentery, Amoeba, Tungiasis Water supply in Kisii Central District is divided in to two:
1. Piped water: Kegati water treatment plant that supplies The lager Kisii was visited
where conventional ways were used to treat water, The following Chemicals were used
in the following stages:
Presumptive test- where Aluminum Sulphate is used to suspend dirt in water
Confirmed test –Where Chlorine is used to disinfect and leave residue for further
decontamination.
Completed test – Where sodium carbonate is used to neutralize the water that has been
treated by Aluminum sulphate.
- treated water entering the distribution system
-Untreated water entering the distribution.
2. Un piped water: any other water not entering the distribution system which some are
protected some not is unprotected like:
-Springs
-Streams
--Wells
-Bore holes
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-Rivers
-Rainwater.
Possible sources of water contaminant in Kisii central District are: Industrial waste e.g.
from slaughter houses, Chemicals from agricultural practices, Soil erosion, Poor
disposal of waste, Poor storage or handling of domestic water, Run offs e.g. leachates
from dump sites, Underground contamination. Existing sanitation facilities in KMC are
not well planned hence the greatest water contaminants: Latrines, Dump sites,
sewerage system, septic tanks and most of this existing sanitation were down streams
hence contribute a lot in water contamination.
o Waste management services: Kisi Central District has waste from the level five
hospitals and the Municipal waste.
Medical waste: Classified in to three categories 1. Highly infectious put in a red
polythene bag then collected every morning and taken for incineration.
Infectious waste: put in a yellow polythene bag and collected every morning for
incineration too.
Non Infectious waste: Put in black polythene and taken to the hospital dump site. The
main ways of managing hospital waste at Kisii level five hospitals are damp sites for non
infectious waste, open drains for rain water disposal, pits e.g. placental pits, sewage
drains for liquid infectious waste and safety boxes for syringes and vials, they are all
kept in a strategic point for collection for disposal.
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Municipal waste: it has both solid and liquid wastes; municipal mainly uses sewerage
system and septic tanks for liquid wastes and damp sites for solid wastes.
o Immunization: This was also done in the Mother Child health clinic different vaccines
were learnt, their doses; routes use to administer them and participated in
administering them at Oresi health center, discussed KEPI diseases i.e.
Poliomyelitis, Pertusis/whooping cough, Tetanus, hepatitis B, Heamophilus Influenza
type B.For example we have the BCG vaccine for Tuberculosis given at birth or at
first contact with the child dose is 0.05 cc under one year and 0.1cc above one year,
route of administration is intradermal.There is also oral polio vaccine aganaist
poliomyelitis2 drops given at birth, fast polio given after 6 weeks, second polio given
at 10 weeks, and third polio given at 14 weeks. There is pentavalent vaccine given
aganaist Diptheria,Pertusis/whooping cough,Tetanus,Hepatitis B,and hemophilus
influenza type B this vaccine is given at 6 weeks in the thigh muscle the dose is
2.5cc.at 6 months or 9 months Vitamin A vaccine is given and at 9 months measles
vaccine is administered intra muscle with a dose of 0.5cc in the right hand in some
places like some parts of Rift valley yellow fever vaccine is administered so there is
a total of 8 Kepi diseases but 9 with the inclusion of yellow fever..
o Learnt Cold chain process: Keeping vaccines safe from the manufacturer to the
patient potent according to manufacturer’s instructions. They arrive at the
headquarters in Nairobi they are confirmed by the experts then transported to
Regional stores example Kisumu for Nyanza province vaccines and they are
transported by use of special vehicles purposely made for transporting vaccines this
is done by Kenya Medical Supplies Agency(KEMSA) who also confirms their safety
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and potency at this level from the region level cool boxes and ice parks are used to
transport them to District level e.g. Kisii district then to health centers, dispensaries
and to some Non Governmental Organizations offering the services. During
transport and use health workers are required to record batch numbers of vaccines
in the ledger book for control and references. At the facility level all vaccines must be
kept at +2 and +8 degrees centigrade.
Non –K
UNIVERSITY OF EASTERN AFRICA BARATON
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF BUBLIC HEALTH
REPORT ON PROFFESSIONAL PRACTICE IN KAPTUMO DIVISION
ASSIGNMENT DONE IN PARTIAL FULFILMENT OF THE COURSE;
PHHC 420: PROFESSIONAL PRACTTICE
PRESENTED BY: WANGECI FAITH KIRAGU
ID: SWANKI0731
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COURSE COORDINATOR: Ms ASENATH NYANTIKA BARONGO
OCTOBER - DECEMBER
AcknowledgementFirst and foremost I give thanks to my God for enabling me to successfully go through
the professional practice at kaptumo division. To the entire faculty in the department for
giving us the right knowledge in the different courses. To the course coordinator,
madam Asenath, for taking her time to prepare us by giving us the right counsel on how
to conduct ourselves and also visiting us during the period. To all the PHOs who helped
us attain our objective in addition to giving us an opportunity to take part in the different
activities. To my colleagues for being so supportive and finally to my dear friend Brenda
who accommodated me during the entire period.
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DeclarationI hereby truthfully declare that this report is my own work and it has not been presented
by any other person.
Student name: Wangeci Faith Kiragu
Id: SWANKI0731
Sign:……………………………
Instructors name: Ms Asenath Barongo
Sign:……………………..
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List of abbreviationsPH – public health
PHO – public health office/public health officer
DPHO –district public health office/officer
TB - tuberculosis
VCT –voluntary counseling test
PMTCT – preventive mother-to-child transmission
HAART-highly active anti-retroviral therapy
IRS- indoor residual spraying
EPI – extensive program of immunization
MOH –Ministry of health
PPE – Personal protective equipment
KEMSA –Kenya extended medical supplies association
BMI – Body mass index
KSDH –Kaptumo sub-division hospital
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HACCP – hazardous critical control point
ContentsAcknowledgement.........................................................................................................................2
Declaration.....................................................................................................................................3
List of abbreviations.......................................................................................................................4
Chapter 1.......................................................................................................................................6
Introduction................................................................................................................................6
Objectives..................................................................................................................................8
Methodology...............................................................................................................................8
Chapter 2.......................................................................................................................................9
Organization of health services..................................................................................................9
Water and sanitation................................................................................................................11
Waste management.................................................................................................................12
Immunization services.............................................................................................................13
Nutritional services...................................................................................................................15
School health services.............................................................................................................17
Food quality..............................................................................................................................18
Meat Inspection........................................................................................................................20
Maternal health services..........................................................................................................21
Laboratory services..................................................................................................................22
Clinical care services...............................................................................................................24
Pharmacy and treatment services.,.........................................................................................27
Filter clinic................................................................................................................................27
Occupational health.................................................................................................................28
Communicable disease control................................................................................................30
Chronic disease control...........................................................................................................32
Health education and promotion..............................................................................................34
Building inspection...................................................................................................................34
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Record services.......................................................................................................................35
Chapter 3.....................................................................................................................................36
Conclusion...............................................................................................................................36
Chapter 1
IntroductionKaptumo division is an area of about 137.4km2 with a population of approximately
26,782 people projecting to 35,000. It comprises of 4,980 households with a projection
of 5,300 households. There are four locations, 14 sub locations and 82 villages/estates.
Looking at the level of education, there are26 established primary schools and 5
secondary schools. In addition there are also 7 established markets.
The division has an altitude of about 1860m, temperature range of 130c- 300c, and a
rainfall of 2100mm average p.a.
Looking at the organization of health services, the division has one health center and
three dispensaries. In addition, they have 9 major M.B sites and 8 spray teams.
There are several types of public health activities. Some of them include:
1. Pit latrines
Auditing old latrines and pegging/sitting new ones
Health education on the importance of pit latrines
2. Disease control and community strategy
Formation of community units
Mobilization for EPI
Defaulter tracing
Enhancing condom distribution
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Enhanced surveillance and reporting
Internal residual spraying.
3. Water quality control
Mobilization of community spring protection
Treatment of drinking water
Water sampling
Intersectoral collaboration
4. Revenue
Comprehensive inventory of businesses
Procure adequate official and legal forms and receipts
5. Food quality control
Enhance routine inspection/sanitation
Medical examination of all food handlers
6. School sanitation
Inspection of schools per term
Formation of health clubs
Improvement of disaster preparedness
Improving student personal hygiene practices
7. Good housing
Enhance approval of building plans
Building site inspection
Improving lighting and ventilations
Enhance routine inspection and education
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Improve structural aspects
Objectives1. To describe the organization of health services from the ministry of health to the
community level.
2. To participate in the community health services offered by the public health
officers and health center staff.
3. To describe the primary health care activities and services offered by the health
workers at the community.
Methodology Having discussions with the in charge of the different departments in the hospital.
Participating in the carrying out inspections in the food premises, slaughter slab,
market, schools, buildings under constructions and building maps before
approval
Visiting the DPHO for a short briefing on the organization of health services.
Visiting factories for the purposes of learning more on occupational health, tea
factory and two different mala factories.
Participating in drafting of statutory notices and issuing medical examination
certificates to food handlers.
Participating in health talks both in the hospital and schools.
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Chapter 2
Organization of health servicesThere are six levels of health services:
National hospital
Provincial hospital
Sub-division/division hospital
Health center
Dispensaries
Community level
There are two ministries dealing with health issues:
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MINISTRY OF HEALTH
MINISTER FOR MEDICAL SERVICES MINISTER FOR PUBLIC HEALTH
ASSISTANT MINISTER FOR PUBLIC HEALTH
ASSISTANT MINISTER FOR PUBLIC HEALTH
PERMANENT SECRETARY FOR PUBLIC HEALTH
DIRECTOR OF MEDICAL SERVICES (DMS)
PROVINCIAL HEALTH MANAGEMENT BOARD
(PHMB)
PROVINCIAL MEDICAL OFFICER OF
HEALTH (PMOH)
PROVINCIAL DIRECTOR OF PUBLIC
HEALTH (PDPH)
PROVINCIAL HOSPITAL
MANAGEMENT TEAM (P-HMT)
PROVINCIAL HEALTH MANAGEMENT TEAM
(PHMT)
SUB-DISTRICT HOSPITAL MANAGEMENT BOARD (SD-HMB) chaired by the DISTRICT MEDICAL OFFICER OF HEALTH
DISTRICT HOSPITAL MANAGEMENT BOARD (D-HMB)
DISTRICT HEALTH MANAGEMENT BOARD
(DHMB)
DISTRICT HEALTH MANAGEMENT TEAM
(DHMT)
DISTRICT HOSPITAL MANAGEMENT TEAM (D-
HMT)
1. Ministry of medical services
2. Ministry of public health and sanitation
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Discussion
Kaptumo sub division hospital was ideally supposed to be a at level 3 but due to the fact
that it is the largest in the division and serves all the facilities near it, it has been
upgraded to level 4.
Challenge
Being the central point of all other facilities in the division it requires more recourses of
which it doesn’t have. It has limited personnel and equipments e.g surgery equipments.
Water and sanitationA big percentage of people at kaptumo get their water from the springs. A spring is a
place where water appears from the ground. The springs are of different kinds;
protected springs, unprotected springs, gravity schemes and hydram springs. The
public health departments have the responsibility of protecting the unprotected springs
to ensure that people not only get water but safe water.
Discussion
The gravity schemes have been established in places with high gravity gradient i.e. eye
from top to bottom, while the hydram springs have been erected where the eyes are in
the low lands and there is need to reach people in the high lands.
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For any spring to be protected, there are two things that should be of concern; the
history of the spring, from the people around the spring, and the positioning of the
spring eyes. After the excavation of the eyes, an embankment wall is constructed and a
collection point provided for. The area is later surrounded by a fence to keep off humans
and animals from the site in addition to protecting the spring from any pollution at the
source. Trees are finally planted around to provide shade preventing it from drying out.
Blue gum trees are discouraged since they take in more water.
Springs are protected to; increase spring water yield and reliability, protect the spring
from pollution as well as water contamination during water drawing and facilitates
improved access to the spring.
Critique
There being reasons as to why springs should be protected; some people especially the
children insert various objects in the collection pipe with an excuse of wanting to
increase water pressure.
Waste managementDisposal of human waste is very important and a crucial area to be attended to.
Kaptumo divisions being an area with no much water VIP latrines have the biggest
coverage. Solid waste is disposed in compost pit and a soakage pit for the liquid waste
that is later used as manure in the farms.
Discussion
There is a certain criteria used in construction of VIP latrines to ensure that they serve
the right purpose. It should have a floor space of 4” by3” with an allowance of 2-4”
outside. The hole should be trapezium shaped with the floor sloping towards the hole.
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The vent pipe should be placed outside and should be 4” wide and 30m above the
highest point of the roof. It has several functions; passage for fowl smell, with the fly trap
present it helps control flies and thermal effect that ensures continuous suction of air.
The door should open outwards so as to maintain the inner space and also it should
have a 2” space at the bottom and no space at the top. No ventilation is required; the
latrine should be dark in the Inside.
Critic
Being in haste of providing the VIP latrines, the people at kaptumo division end up
constructing improper VIP latrines, some having their vent pipes outside, holes being
bigger than required, providing ventilation etc.
Immunization servicesAdministration of vaccines is a major way of preventing diseases. Children are given a
maximum of five compulsory vaccines; BCG vaccine, DPT vaccine, polio vaccine,
measles vaccine and yellow fever vaccine.
In case of any outbreak or introduction of a new vaccine, it is administered appropriately
e.g H1N1 vaccine.
The vaccines should be kept at a given temperature to maintain their potency thus the
cold chain regime/schedule should strictly be followed,
Discussion
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The immunization schedule for all children in Kenya and that followed at kaptumo
division in all health facilities is as follows;
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BCG VACCINES: at birth
Intra-dermal left fore arm
Dose; 0.5mls for children below 1 year
;0.1mls for children above 1 year
DPT + Hep B/Hi b
Intra muscular outer thigh
Dose;0.5mls
1st at 6 weeks
2nd at 10 weeks
3rd at 14 weeks
Oral polio vaccine Dose; 2 drops orally
Birth dose: birth/ within 2weeks OPV0
1st dose at 6 weeks OPV1
2nd dose at 10 weeks, OPV2
3rd dose at14 weeks,OPV3
Measles vaccine
Subcutaneously right upper
arm
Dose; 0.5mls: at 9 months
Yellow fever vaccine: 9
months
Intra muscular left upper
arm
Dose 0.5mls
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Vaccines in stock are maintained at a temperature of +20c to +80c either in a deep
freezer or in a normal refrigerator. When the vaccines are being transported from one
facility to another, they are carried using the ice box (have ice packs inside). They are
also stored temporarily in the cold box before being administered.
In the deep freezer, the vaccines are arranged in a specific format starting with the most
sensitive on trays of different colors;
Tray5 Red DPT +Hep B/ Hi b
Tray 4 Orange Tetanus
Tray 3 Yellow BCG
Tray 2 Green measles/ yellow fever
Tray 1 Blue polio
Critique
The yellow fever vaccine is not administered at kaptumo sub-division hospital.
Despite the notification of the next day of return for their child’s immunization to the
parents, some of them forget and come at a later date.
Nutritional servicesThe nutritional services offered at kaptumo sub-division hospital majorly favors the
HIV/AIDS patients from every category; mothers, youths, old and children.
The BMI of a HIV/AIDS patient guides the nutritionist on what kind of advice is to be
given. MUAC is also used for children, pregnant mothers and that bed ridden.
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Those living near sources of water, spring, also benefit by acquiring some knowledge
from the PHOs on their mission to inspecting protected and unprotected springs on how
they can use the runoff water for nutritional purposes such as irrigation or fishing in
manmade fish ponds.
Discussion
Normal BMI ranges between 18.5-24.9 and those below 18.5 need supplements and
those above 24.9 need advices on how to watch their diet. Those with a BMI of below
16 are considered to severely malnourished and should be admitted and given
therapeutic feeds. These feeds are of different kinds;
On admission,
F 75, given from day one to day three, helps to catch up growth.
F 100, given from day3 to day5, its dense in calories and helps boost weight
gain.
For children,
F 75;
Day 1………11ml per kg body weight
Day2……….16ml per kg body weight
Day3………. 22ml per kg body weight
For adults,
F75;
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70-80ml per kg body weight
Note: for those admitted and they can not easily eat they are given;
Pedisure - for children
En-sure –for adults
On discharge, they are given the following supplements to use at home:
Fast food – for children
Foundation plus – 11years- 50years
Advantage – for pregnant and lactating mothers.
Critique
Nutritional services should not only be for those with HIV/AIDS but also for those
without for healthy life is a right to every person.
School health servicesThe PH departments at kaptumo division are required to offers the following health
services to schools:
Deworming and dispensation of vitamin A tablets
Assist and encourage the formation of school health clubs and committees.
Health talks on basic hygiene and other matters that may benefit the pupils in
regard to their health.
Routine inspection of schools.
Discussion
School health is considered to be one of the best ways to help make a difference in
the society. This is because, the target population, students are still willing to learn
and have a greater capacity of changing unlike the grownups or old.
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Deworming and administration of vitamin A drugs from in schools ensures that even
those not readily accessible to these health services benefit, with an aim of bringing
up healthy children.
The existence of health clubs or committees in a school greatly help both the
students and stuff to make it a personal initiative to take care of their health and not
wait to become sick and get treated.
Health talks on hygiene and importance of hand washing was given much emphasis
in schools in addition to providing hand washing tins with an objective to help reduce
fecal-oral diseases.
The routine inspection are done to ensure that ;the buildings are safe to the
occupants, staff and students, the sanitary facilities are adequate and well
maintained, there are proper methods of both solid and liquid waste management,
the source of water is sufficient and safe for use etc.
Critique
Deworming should be done after every three months which is not the case at
kaptumo division. There is also some reluctance in routine inspection of schools
which has led to poor running of schools with evidence of unfit structures e.g.
existence of dilapidated toilets and classrooms
Food qualityIt refers to the quality characteristics of food that is acceptable to consumers i.e
both external factors (size, shape, color) and internal factors (ingredients). Cap 254,
Food and Drug Act is the relevant tool used.
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The PHOs at kaptumo are responsible of issuing medical examination certificates to
food handlers, disposal of ceased food, seizure of unfit foods supplied to hospitals or
other institutions especially for tender cases and inspection of food eating premises
and trade premises.
Discussion
Medical examination certificates are only issued to those food handlers who have
been examined, laboratory tests – BS WIDAL, urine, stool, to be fit to handle food.
This practice helps greatly in the control of communicable diseases especially the
fecal oral infections.
The ceased foods from the trading premises are disposed specifically by the PHOs
themselves or persons strictly appointed by the officers by incineration or burial to
ensure no villagers or person get access to the foods that could actually cause harm
to them.
All foods supplied by tender contracts to be inspected to prevent mass supply of
unfit food to a larger group of people that might cause harm. The unfit foods are
seized and a seizure form issued to the supplier.
Routine inspection of both food and trade premises are done using a certain criteria
and below is a step – to – step guidance on how to do it:
Surrounding; this include the general environment, waste around the premises,
fencing etc
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Structural aspects; both externally and internally i.e walls – presence of cracks,
paint; window openings – for ventilation and lighting; roofing – paint, condition of iron
sheets; floor – easy to clean with no potholes.
Liquid waste management; drainage system, from source of waste to the end point
(soakage pit)
Solid waste management; presence of dustbins or improvised containers and sitting/
design of the compost pit.
Ventilation and lighting; especially in kitchen, overcrowding should also be
discouraged.
Water supply; the source of water used should be safe. If spring, preferable a
protected spring. There should be storage tank(s), hot/cold water supply for
washing utensils and a hot water supply with provision of a detergent for hand
washing outside or inside the eating premises.
Excreta disposal; clean and well maintained latrines should be present. To test if a
latrine is full one should through a stone inside and listen to the variation of sound.
Facilities/Equipment for Food Preparation; they should not be plastic but galvanized.
Plastic equipment is not easy to wash and they retain oil.
Personnel; they should have adequate and appropriate PPE. i.e clean
overalls/aprons , footwear and headscarf. They should posses a medical
examination certificate to certify ones physical health.
NOTE: The inspections are done in stages, first, there is verbal warning, then a
written warning and failure to comply, the premise is closed.
Critique
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Follow-ups are not done effectively as stipulated in the statutory notices issued. This
is as a result of limited staff in the PHO department.
Meat InspectionIt includes both ante mortem and postmortem. Irrespective of the animal being
inspected, the slaughter slab/ slaughter house should also be inspected to ensure it
is well cleaned and maintained. The carriage containers should also be inspected
before putting in any meat. At the end of the inspection the carcass that has been
passed should be stamped before dispatching it.
Discussion
Every slaughter slab or house should have a holding area where ante mortem is
carried out. The animal is carefully examined by the vetenary doctor and treated
when necessary before slaughter. The animal is also given time to relax to prevent
hyperglycemia which affect the quality of meat. Inspection should ideally be done at
every stage to ensure no contamination at the critical points. This stages include;
stunning – a humane way should be used, bleeding, flaring, evisceration, and
splitting. The personnel should be well protected with adequate and appropriate
PPEs.
Critique
The kaptumo slaughter slab has no holding area, the animals are slaughtered as
they come thus being exposed to risks of getting hyperglycemia which leads to
rigomotis of the meat. They use the crude method of stunning the animals that
recurrently leads to hemorrhages of the carcass. Despite having the provision of
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separate drainage, there is sometimes mixture of blood and liquid waste which is
later released to the farms as manure.
The vetenary department having taken up the responsibility of meat inspection, the
PHOs have failed in carrying out routine inspection of the slaughter slab.
Maternal health servicesUnder the maternal health services at kaptumo sub-division hospital the following
services are offered to the mothers; antenatal care, delivery care and postnatal care
and family planning inclusive. In addition there is also distribution of nets during
antenatal and postnatal care.
Discussion
Antenatal care is given to pregnant mothers from time of conception. During this
period the mother makes regular visits to the hospital for checkup purposes to
ensure that the development of both the baby and the mother is fine. It involves;
weighing, measuring BP, palpation of the mother to determine the stage of the baby
in development, administration of TT vaccine, malaria prophylaxis (IPT),
supplements of FeSo4, folic acid and provision of LLITN under the PH department.
For delivery services, KDSH has a delivery room. After the onset of labor pains, the
mother reports to the hospital for close monitoring and vaginal examination after
every four hours until birth.
Postnatal care begins immediately after birth. The mother should be well cleaned
and given the baby for breastfeeding within the first 30minutes – 1hour after birth.
She then leaves the hospital after 10 – 12 hours of close observation by the nurses.
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Family planning is also a service given to the mothers after proper counseling for
every beginner. They are then left to make a decision of which method they would
prefer to use.
Critique
There are cases of dropout of mothers from attending the regular visits during
antenatal care. In addition, some mothers end up giving birth at home instead of
doing it in hospital. Minimal or no advice is given to mothers on the expected
postnatal outcomes.
Children do not get the BCG immunization at birth since it always take place on
Friday during immunization hours.
Uncooperative mothers during delivery which is as a result of labor pains leading to
hostility of nurses as they struggle to perform their duty.
Despite its importance, most mothers lack support from their husbands concerning
FP issues.
Laboratory servicesThe lab services are quite important since they confirm clinical diagnosis of patients
with an aim of ensuring appropriate management of the patients is administered.
Some of the tests doe at the KSDH include; blood sugar test, HB test WIDAL test,
urinalysis, pregnancy test, malaria test and TB test.
Discussion
It involves collection of specimens that are then examined:
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Blood sugar test; the specimen use is blood and it is measured using an instrument
called on-call plus measuring in Mmol/Lit. Normal blood sugar is below 10Mmol/Lit.
Urinalysis; urine is the specimen. Urinalysis reagent strip is used to check the
normality or abnormality of urine content in relation of the body composition of
sugars.
WIDAL test; blood is used as the specimen. The test is for typhoid. Since serum is
used in the test, an electronic centrifuge is used to separate blood and serum. Three
reactions can be done using different reagents, hymolysis, agglutination and
neutralization.
Pregnancy test; urine is the specimen used and the pregnancy strip is the instrument
used.
HB test; blood is the specimen using the and instrument called, satili haemometer.
Malaria test; blood is the specimen. Blood smear is prepared and plasmodium
parasite observed under a microscope.
TB test; sputum is the specimen.
Critique
Despite the high reliability and validity given to results from the laboratory, there was
improper labeling specimen resulting to wrong results for different patients’ thus
wrong management. There is also failure in the use of PPEs irrespective of the risks
of being infected in the process of handling the specimens.
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Clinical care servicesThis refers to the services the patients receive in the ward from the nursing staff and
clinical doctors as done in KSDH.
Discussion
On admission, every patient is required to buy an impatient book for proper record
keeping on his/her progress. The following activities take place from morning to
evening;
6:00am-6:45am – feeding, breakfast.
6:45am –7:30am – cleaning of wards.
7:30am – 8:00am – ward round, reviewing of patients.
8:00am –9:00am - handing over to day staff.
-Bed making and changing of soiled beddings.
12noon- 12:30 – lunch break
1:00pm – 2:00pm – visiting hours
3pm and 3am – are times for observation of vital signs, temperature, BP, pulse,
respiration etc.
Note: observation and treatment takes place continuously.
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Critique
There are no restrictions on visiting hours thus leading to overcrowding of the wards at
every given time. There is also no impatient registry at the ward reception area of which
it is a very important data collection tool.
HIV/AIDS services
The HIV/AIDS services offered at KSDH include; VCT services, PMTCT services and
HAART services. They all have separate departments that care for the clients different
needs.
Discussion
At the VCT, clients voluntary visit to either get information on HIV/AIDS, to know their
status or both. There are three kind of test that are available; Determine, Bioline and
Uni-gold. Un-gold acts as a tie breaker after using the two first kits and they happen to
give different results.
PMTCT services are offered at the MCH department, as at KSDH, where women living
with HIV/AIDS are provided with appropriate counseling and support to enable them
make informed decisions about their reproductive lives. In addition, mothers are
educated on ways of preventing transmission to their infants during pregnancy, labor,
delivery and breastfeeding by use of ARVs and use of safer infant feeding practices.
Below is a dosing guide for Antiretroviral Drugs in PMTCT, program for 4 months:
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Confirmed HIV infection in a pregnant woman during ANC
Determine;
WHO clinical stage
CD4 count
WHO clinical stage 3 or 4 WHO clinical stage 1 or 2
or or
CD4 count ≤ 350 CD4 count > 350
Start on ARV therapy(ART) start on ARV
prophylaxis
(if 38 weeks or less) (at 28 weeks or anytime
after)
Start 1st line ART regime start: AZT 300mg twice daily for the during
pregnancy
AZT 300mg twice daily dispense: single dose NVP 200mg at the onset of
labor
3TC 150mg twice daily dispense: ARV prophylaxis, to infants after birth
NVP 200mg twice daily labor and delivery
Labor and delivery give preferred ARV prophylaxi
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Continue ART regime after delivery of new
born
Give ARV prophylaxis as soon as possible.
Under the HAART department, those clients having a CD4 counts of below 350 is
started on ARVs and are given comprehensive care in terms of counseling and
nutritional supplements. This comprehensive care helps greatly in minimizing the
incidence rate of opportunistic infections.
Critique
There are many defaulters and follow ups is not easy due to constrains such as harsh
climatic conditions, lack of transport means and finances.
Pharmacy and treatment services.,This department deals with dispensation of drugs, administration of injection and
dressing of wounds.
Discussion
Drugs after supply by KEMSA and are arranged in the provided shelves in a systematic
order ready to be dispensed. There is also an area designed for injection and dressing
of minor wounds.
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Critique
Every pharmacy should have a pharmacist but KSDH pharmacy lacks one thus the
nurse in charge dispenses drugs, injects and at the same time dresses wounds.
Filter clinicThis office is also called clerking office. Here the patient’s history taken and the patient
managed respectively. It is also from this office that patients are referred to the
laboratory if any tests are to be taken. In case the patient’s problem is far much
complicated, they are given referrals to higher levels of health services.
Discussion
When clerking a patient, the following procedures are followed by the clinical officer ;
Taking of demographic data
Chief complains
Duration of the chief complains
History of the present illness
Past medical history
Family medical history – for women, take gynecological history
Making an impression
Management of the patient
Note: for children, after the necessary questions based on the chief complains seek
more on; development of the child, immunization history and nutritional history.
Treatment and the return date
Critique
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Not all clinical officers follow the above procedures in clerking of patients. There is also
a lot of misdiagnosis mainly due to overworking of the staff.
Occupational healthIt refers to the identification and control of the risk arising from physical, chemical and
other workplace hazards in order to establish and maintain a safety and healthy working
environment.
These services were majorly offered to those in industries and factories and incase of
any hazardous exposure, mitigation measures are recommended.
Discussion
On a visit to kaptumo tea factory, there was much to learn on occupational health. It
was installed with all kinds of machinery; those producing a lot of noise, moving
machines and also automated ones. In general, with reference to the kaptumo tea
factory, all the factories with such kind of machines, the following precautions should be
taken:
Any personnel working with noisy machines should be provided with protective gears for
the ears, ear muffs; The moving machines such as conveyers should be guarded o help
minimize on accidents; Personnel handling automated machines should be well trained;
those handling chemicals should be well protected with the appropriate PPEs from head
to foot wear. Note: for those working in noisy or vibrating environment, shifts could be a
good remedy since it reduces on the time of exposure of risk.
In addition there was a visit to a lala cottage industry which dealt with milk, a sensitive
product. With respect to any other sensitive product producing industry, especially those
dealing with foods, the concept of HACCP should be put to practice. E.g. the lala
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industry; the receiving area, pasteurization area, cooling area, culturing area and
packaging area.
Critique
Despite the management of various industries and factories having provided the right
PPEs, some of the staff have a negative attitude and end up not wearing them.
At the tea factory, due to lack of enough personnel, the staff present end up being
overloaded and thus the risk of multiple exposure.
At the lala cottage industry, repairs of damages e.g worn out floors, takes long to be
repaired hence resulting to inefficiency and contamination of the products.
Communicable disease controlA communicable disease is one due to a specific agent or its product which arises
through the transmission of the agent or its product from a reservoir to a susceptible
host. The PH department at kaptumo is greatly involved in the control of malaria,
handling dog bites and snake bite cases.
Discussion
Malaria control program
It involves a collection of intervention measures: distribution of nets to pregnant mothers
and children under 1 year, and IRS using icon and fendona chemicals. IRS is the
application of long-acting insecticides on the walls and internal surfaces in order to kill
the adult vector mosquitoes that land and rest on those surfaces. The primary effects of
IRS towards cartailing malaria transmission are: reduce the life span of vector
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mosquitoes- no longer transmit of malaria parasite, reduce the density of the vector
mosquitoes. IRS intervention involves a great deal of involvement and planning:
1. Planning for IRS operations
The operation involves people at national level, district level and community levels.
Commodities and other consumables need to be procured in advance. All these
activities need proper coordination to ensure smooth running of events.
2. Pre and post IRS surveys
Being an expensive operation, sufficient baseline information should be gathered to
facilitate appropriate planning and implementation. The surveys include among others:
epidemiological, entomological, and demographic surveys. In addition, it also provides
indicators for identifying areas that need spraying at a particular time.
3. Mapping and targeting IRS
It helps identify areas for spraying it gives a basis upon which coverage is monitored
and evaluated. It entails identification of vector breeding sites, location and type of
house structures to target. The surveys above are of importance to delineate low and
high risk areas for prioritization. For efficiency, geo-referenced maps need to be
developed to guide the process of accessing targeted spraying structures.
4. Timing and cycles of spraying
Malaria transmission is greatly influenced by climate and environmental factors,
particularly rains. Therefore the operation will be time d to take effect just before a rainy
season begins. The spray cycles depends on the transmission pattern and insecticides’
protective duration.
5. Estimation of IRS requirements
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Several factors are considered when establishing the quantities of required resources:
required information to calculate sprayable surface areas by district, IRS supplies
estimate, IRS accessories estimation.
In establishing the number of structures for spraying, population figure from the target
areas are used. The number of house units per household is determined using
population and housing census. This information gives an estimate of the total
sprayable surface area for a target area. This guides calculation of amount of
insecticide required, number of spray operators, sprayers protective clothing, transport
needs, supervisors and the spraying duration.
Note: national supervision is coordinated from DOMC, DVBD AND DEH. Before starting
the operation at the grassroots, there is mobilization.
For dog bites, the patients are given anti-rabies vaccine and those with snake bites,
anti-venom vaccine which is administered intravenously after admission under strict
supervision due to its intense side effects.
Critique
During the IRS operations, even after mobilization, some people are uncooperative and
thus this houses end up not being sprayed.
Irrespective of the life threatening situation the dog bite and snake bite patients are in,
there is inadequate supply of anti- rabies and anti-venom vaccine and can only be
bought in the private sectors at a high price.
Chronic disease controlA chronic disease is one that is long-lasting or recurrent. Chronicity is usually applied to
a condition that lasts more than three months. TB which can sometimes be classified as
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a chronic disease is a priority at the KSDH and comprehensive care is given to the
infected patients.
During a visit at kipletito primary school a referral was recommended to a suspected
case of osteoporosis.
Most of the patients who visit KSDH present with cases of pulmonary problems as a
result of the cold climatic conditions of the area.
Discussion
A special department has been set up so as to well manage the TB patients. The
treatment of TB serves three main purposes: to cure the individual patient, to render the
patient rapidly non-infectious and to prevent the emergence of drug resistance.
On report of a patient presenting with signs and symptoms of TB, the patient is sent to
the laboratory for a sputum test for confirmation. If the test result is positive, treatment is
started immediately.
TB drug regime
Initial phase Continuation phase
Children 2SRHZ 4RH
Adults 2SRHZE 4RH
Note: for retreatment incase one is a defaulter, the regime is different; 2SRHZE/ RHZE/
5RHE
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TB drugs are given on the basis of ones weight i.e, >54kgs- 4tablets per day; 39-54kgs-
3 tablets per day; <30-39kgs- 2 tablets per day. All the TB patients require adherence
conseling on how to take the drugs.
For defaulters, defaulter tracing is done with an aim of reducing the mortality rate as a
resulting to TB cases. Every patient with TB is entitled to free drug supply from
whichever facility one visits only if already enrolled into the program.
Critique
Despite the urgency of defaulter tracing, harsh climatic conditions and impassable roads
are a barrier to the defaulter tracers.
Control of chronic diseases at kaptumo is not well covered. This is because majority of
those suffering are faced with the challenge of limited funds to visit the hospital thus end
up staying at home with their problem.
Health education and promotionThis refers to the creation of awareness to the members of the community on health
related issues with an aim of preventing diseases. It was well done through health talks
in the hospital premises and during school health program.
Discussion
In collaboration with the nursing department the PH department gathered all outpatients
near the clerking office and a health talk on basic sanitation, prevention of fecal-oral
transmitted infections, treatment of water and proper use of mosquito nets was given on
different days respectively. In addition a health talk on the importance and effective
hand washing was given in different schools with a goal of reducing on the incidence of
communicable diseases.
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Critque
The health talks are not regular and no evaluation is done after the talks therefore little
or no behavior change in correspondence to the information given.
Building inspectionIt involves approval of building plans, inspection of buildings under construction and
inspection of existing building with an aim of ensuring the safety of the occupants.
Discussion
On approval of building plans, the PHO is required that the plan includes a provision for
sanitary facilities, proper drainage system, adequate ventilation, adequate water supply,
exit doors in case of emergencies etc.
On inspection of buildings under construction, the inspection of proper foundation
depending on the drainage of the site is very important. This is aimed at preventing
collapse of houses and settlements of buildings.
On the inspection of already existing buildings, appropriate judgment is made
concerning the condition of the building under inspection e.g. signs of dampness in a
building- it should be demolished, poor lighting- recommend installation of translucent
iron sheets, repairs on cracked floors or those with potholes should be done to prevent
breeding of fleas. For any kind of improvement to be done by the owner, a statutory
notice should be issued and follow-ups done respectively.
Critique
Not all buildings under construction are inspected. This has greatly led to the existence
of dilapidated structures which can not be repaired but stand to be demolished. Follow
ups of statutory notices issued is not well done as a result of limited staff.
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Record services Each department at KSDH has data collecting tools that are all assembled at the District
health records and information office located in the hospital.
Discussion.
Records from any health service starting from level 3 include both inpatients and out
patient records. They include: MOH 504- monthly surveillance report form, used by the
PHO to monitor diseases on the ground; MOH 704-child health nutrition information
system, used to monitor the growth of a child; MOH 705A- for under 5 and above
5respectively.they are used for general conditions of patients i.e disease diagnosis at
the hospital; MOH 710- immunization summary sheet; MOH 702-immunization and
vitamin A tally sheet; MOH 711A- national intergraded form for reproductive health,
HIV/AIDS, TB,and child nutrition; weekly malaria reports- used for comparison for under
5 and below 5 males and females respectively; MOH 717-work load, done by every
worker and shows the number of people received in every department; MOH 105-
service delivery, first time seen during neonatal and maintenance of patient to the date
of delivery; MOH 406- postnatal register; MOH 511-child welfare clinic; MOH 240-
laboratory register; MOH 204A and 204B-outpatient register for under 5 and over 5
respectively; MOH 715- health facility inventory for equipments in the hospital;
reproductive health records- maternity services, PMTCT services and treated nets
distribution; TB reports- on TB cases and defaulter tracing; AL reports; HIV/AIDS
reports; cold chain recording; quarterly reports- after a three month interval etc.
Critique
Despite the clear display of particulars in the different record books, there is poor
recording done by the personnel in charge of recording.
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Chapter 3
ConclusionThe professional practice at KSDH displayed three important things;
Despite health being a right to every human being, it requires one to have an
understanding of what it is. Some people expose themselves to various hazards only
because they are not aware it is a hazard.
Having being empowered to enforce law concerning health on people, a PHO should be
humane with an aim of helping and not frustrating.
For theoretical knowledge to be applied practically, some improvisations and
modification have to be done i.e. the ideal is not always the real.
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