Presentation on Kenya Mobile Clinics Aug 2011

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A short presentation describing the mobile clinics held in Kitale, Kenya, Aug 2012 - focussing mainly on clinical data and implications.

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Presentation on Kenya Mobile Clinics Aug 2011

  1. 1. Mobile Clinics in Kitale district, Kenya – July-Aug 2011 Key lessons from collection of clinical dataMyer Glickman MFPH FHRIM FBMISHead of Life Events Modernisation, UK Office for National StatisticsDirector & Consultant Statistician, Development & Health Informatics LtdSecretary of the Board of Trustees, UK-Africa Health Partnership - AEMRN(UK)
  2. 2. Data collection• One clinic (out of three) in Kitale district• Clinical records were kept by hand on A5 plain paper• Key data items were abstracted manually on site for later analysis: – sex, age, place of residence, weight, blood pressure, symptoms and diagnoses, medications prescribed, referral to hospital• Data were collected for 307 patients out of an estimated 504 (61%)• Catchment population mainly local area but not clearly defined
  3. 3. Clinic attendance by age and sex 40 35 30 25Number 20 15 10 5 0 <1 1-04 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 + Male Female
  4. 4. Key points on demographicsStatistics• 65% of patients were female• 53% were children <15 years• 20% were aged 1-4 years• 78% of patients (estimated) came in a family groupLessons• Paediatric expertise especially valuable• Ensure sufficient supplies of common paediatric formulations, tonics and wormers• Opportunity for health promotion to women but not men• Alternatives needed to approach men’s health issues?
  5. 5. Most common medical conditions Number 0 5 10 15 20 25 30 35 40 Upper respiratory infection, m isc. sym ptom s Dermatitis, m isc. skin problem s of body Chest pain, palpitations Eye and vision problem s Non-specific headaches, dizziness Diarrhoea, m isc. gastrointestinal sym ptom s Dermatitis, m isc. skin problem s, head or face Abdom inal pain, distension, ascites Back pain, neck pain Ear problem s, deafness MalariaAsthm a, bronchitis, m isc. respiratory problem s Fever, unspecified Other m usculoskeletal
  6. 6. Key points on medical conditionsStatistics• 13% of all conditions diagnosed were upper respiratory tract infections• 12% were dermatitis of trunk or limbs, allergic or other• 18% of patients had a potentially serious or life-threatening condition• At least 4% of patients were referred to hospitalLessons• The clinics provide mainly primary care for common diseases, especially of childhood• Most patients do not have regular access to healthcare and conditions are often multiple and chronic• Conditions seen may suggest health promotion opportunities• A significant minority need potentially life-saving treatment
  7. 7. Most common medications Percent 0 2 4 6 8 10 12 14 ASAQ Amoxicillin Paracetamol Ibuprofen Albendazole Multivitamin Ampicillin CetirizineMetronidazole (Flagyl) Iron, Folic acid
  8. 8. Key points on medicationsStatistics• An estimated 1,120 courses of medicine were prescribed altogether• Artesunate/amodiaquine was 13% of all prescriptions• Amoxicillin was 11%, paracetamol 11% and ibuprofen 8%• 36% of patients received a broad spectrum antibiotic• 28% were prescribed ASAQLessons• Use of broad spectrum antibiotics may be excessive: on-site testing and written prescribing guidelines might help• On-site testing might also reduce use of antimalarials• Prescribing practice was inconsistent: written guidelines might improve practice• Triage could possibly reduce burden on doctors e.g. multivitamins/wormers could be given without prescription
  9. 9. Clinic utilisation study• Reason for attending clinic• How heard of clinic• Means of travel to clinic• Time taken to travel• Cost of travel• Family group composition• Could be linked to medical record
  10. 10. Needs assessment study• Household membership• Educational level• Type of accommodation• Source of water, toilet facilities• Recent illness in family• Contact with healthcare services• Subjective view on health impacts, priorities
  11. 11. Final points• Thanks to local colleagues who helped with translation and data collection• Valuable clinical and social information, supporting evidence- based practice, can be derived from very basic record- keeping• Quality of record-keeping could be improved by structured forms (since designed) or even electronic records• Potential for integrating studies into clinic process e.g. needs assessment, health knowledge• Full report is available at http://www.ukahp.org/resources/Kipsongo%20clinic%202011 %20report.pdf• Email me on myer.glickman@yahoo.co.uk

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