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  Reports
 
  Masanga Hospital
 


Report on Clinical activities

By Abu Balkarr Tarawali

Chief Health Officer

Executive summary

This report summarises  clinical activities at Masang a Hospital clinic in the first half
year of opening,  a p eriod from July to Dec 2006:

  • Just under 10,000 patients were treated in the first six months
  • Of those ab out 14% were leprosy patients
  • Malaria, Diarrhoea, Dysentery, ARI/Pneumonia and STIs are the most
    commonly occurring diseases.
  • Malaria accounts for 70% of patient morbidity
  • Under 5’s and antinatal clinics have been given sp ecial attention. They
    represent two of every ten patient seen at the clinic.
  • The clinic was served by a resident senior Chief Health Officer in the p eriod
    reported on.
 
 

Introduction:

Masanga Leprosy Hospital (MLH) is situated at Masanga village in Kholija Rowallah chiefdom in Tonkolili district. Masanga village is located ten miles away from, and on the North-East of Magburaka, the headquarters town of Tonkolili district. Tonkolili d istrict lies in the Northern region of Sierra Leone. This district shares border with seven other districts within Sierra Leone as follows: On the North by Port Loko, Bombali and Koinadugu districts. On the south by Bo and Moyamba districts. On the East by Kono and Kenema districts. Tonkolili d istrict is so strategically located that everyone moving from the extreme North-west to the extreme South-East passes through it. This district is centrally loc ated in Sierra Leone. The center of the circumference of Sierra Leone is loc ated in Gbonkolenken Chiefdom at a town called Mab arr Polie, all of which are found in Tonkolili d istrict. This being the case, Tonkolili district can be therefore described as being highly prone or vulnerable to infections/ communicable diseases like HIV/AIDS, TB, Leprosy, Diarrhoeal Diseases (cholera, Typhoid Fever), Measles and other STIs, to mention a few.

A Clinic: This is simply a place where bedside observation and treatment of patients take place. Morbidity simply refers to a disease condition (sick). A Clinic is next to a hospital in hierarchy of Health Facilities in Sierra Leone. The nomenclature of a health facitlity depends on the personnel head ing that facility in Sierra Leone. Thus, a Maternal and Child Health Post (MCHP) is headed by a MCHA nurse, a c ommunity health post is head ed by a State Enrolled Community Health Nurse (SECHN), or an Endemic Disease Control Unit (EDCU), assistant, a Community Health Center (CHC) by a Community Health Officer (CHO) or a Nursing Sister (NS), a clinic by a medical doctor or senior CHO or a Senior NS, and a Hosp ital by a medical doctor only.

In effect, minor, intermed iate and major surgery can by done in a clinic by a medical doctor depending on his/her competence and on the equipment of the clinic in terms of personnel and instruments of the clinic. A senior CHO or a Senior NS c an do minor Surgery in a clinic also depending on his/her competence and equipment of the clinic. A medical d octor in a clinic can do admission of patients. A senior CHO or a senior NS can only observe patients for seventy-two hours in a clinic. Monitoring and supervision of any of the above procedures can be done by a specialist doctor or a district medic al officer (DMO) to ensure that standards are maintained.

Clinical Attendance
The table below shows the patient attendance pattern, from 17th of July to 31st December 2006. It is a summary of daily registration from the clinical reg ister

 
Date TB Leprosy Non-Leprosy ANC UFC Total
17/7-31/7/06 7 207 554 24 299 1091
1/8-31/8/06 2 239 1295 52 331 1919
1/9-30/9/06 4 327 1224 89 422 2066
1/9-30/9/06 8 241 970 75 310 1604
1/10- 31/11/06 4 220 1247 68 357 1896
1/11- 31/11/06 5 170 858 39 151 1223
1/12- 31/12/06 30 1404 6148 347 1870 9799
   
  From the table above, it can be seen that the patients are grouped under the
following: Tuberculosis (TB) – these are patients that have been proved from
laboratory findings to have pulmonary TB. Leprosy – these are patients with or
suspected to have leprosy. Non-leprosy – these are patients with other conditions
that are neither TB nor leprosy. ANC means antenatal clinic and UFC means under
fives clinic.
Going horizontally across the table, we have a number of the various categories of
patients attending clinic per month. Going vertically down the table, we have the
number of patients in a particular group per month.
There in, we have 30 TB, 1404 Leprosy, 6148 Non-leprosy, 347 ANC and 1870 UFC
patients seen in the clinic, totaling 9799 pts.
The number of patients seen at the clinic are as follows: 1091 in July, 1919 In
August, 2066 in September, 1604 in October, 1896 in November and 1223 in
December, totaling 9799 patients seen in the clinic from 17th July to 31st December
2006.
It is worth noting that all TB cases were diagnosed based on laboratory
investigation. All Leprosy cases were diagnosed based on clinical symptoms and
signs, and on past medical history of the patients. Typhoid fever was diagnosed
based on clinical symptoms and signs and on response to treatment.

Morbidity Pattern: Here, we look at the five commonly occurring diseases per
month. We go further to see how these diseases affect the following age groups:
Under fives and general clinic (five years and above). And then we compare this
pattern to previous month or months.
 

July from 17th -31st

Disease Under fives % General clinic % Total %
Malaria 205 24 444 51 649 75
Diarrhoea 13 1.5 7 0.8 20 2.3
Dysentry 0 0 23 2.7 23 2.7
ARI/Pneumonia 36 4.2 61 7 97 11.2
STIs 0 0 72 8.4 72 8.4
Typhoid Fever 0 0 7   7  
Onchocerciasis 0   5   5  
Others 55   219   274 100
   
  For instance, looking at the table above, Malaria, Diarrhoea, Dysentery,
ARI/Pneumonia and STIs are the commonly occurring diseases in July month. These
diseases affected more five year and above than under five children, except
diarrhoea witch affected more under fives.
Among these diseases also, Malaria occurred the highest, accounting for 75% of all
the diseases that occurred in July. Next to it is ARI/Pneumonia 11,2%, STI’s come as
3rd , 8,4%, Dysentry is 4th 2,7% and Diarrhoea is fifth with 2,3%.
The group others is left out as it is different types of diseases that are there, and
also leprosy is not considered as it includes more of prevalence than incidence
cases.
 

August from 1st -31st

Disease Under fives % General clinic % Total %
Malaria 357 21.3 808 48 1165 69.3
Diarrhoea 31 1.8 0 0 31 1.8
Dysentry 9 0.5 32 1.9 41 2.4
ARI/Pneumonia 85 5 217 12.9 302 18
STIs 0 0 140 8.3 140 8.3
Typhoid Fever 0 0 19   19  
Onchocerciasis 0 0 5   5  
TB 0 0     2  
Leprosy 0 0     243  
Others 105   418   523 100
   
  Malaria, Diarrhoea, Dysentry, ARI/Pneumonia and STI‘s are the most commonly
occurring diseases in August, as per table above. All these diseases affected more
general clinic that UFC except Diarrhoea, witch affected more UFC than General
Clinic.
Malaria ranks highest in occurrence, next is ARI/Pneumonia. Third is STI’s, fourth is
dysentry and the fifth is diarrhoea. These diseases occurred in August more than in
July, both UFC and G/clininc.
 

September from 1st -31st

Disease Under fives % General clinic % Total %
Malaria 265 16.6 860 54 1125 70.6
Diarrhoea 42 2.6 0 0 42 2.6
Dysentry 15 0.9 17 1 32 2
ARI/Pneumonia 87 5.5 231 14.5 318 20
STIs 0 0 75 4.7 75 4.7
Typhoid Fever 0 0 41   41  
Onchocerciasis 1 0 0   1  
TB 0 0 4   4  
Leprosy 0 0     327  
Others 105   418   523 100
   
  In the table above, Malaria, Diarrhoea, Dysentry, ARI/Pneumonia and STI’s are the
most commonly occurring diseases. These followed the same pattern as in August.
But the diseases occurred in August more than in September except Malaria, witch
occurred in September more than in August.
 

October from 1st -31st

Disease Under fives % General clinic % Total %
Malaria 257 17 828 56 1085 73
Diarrhoea 41 2.7 28 1,8 69 5
Dysentry 0 0 22 1,5 22 1.5
ARI/Pneumonia 59 4 211 14 270 18
STIs 0 0 45 3 45 3
TB 0 0     8  
Leprosy 0 0     241  
Others 67   448   515 100
   
  Here, Malaria, Diarrhoa, dysentery, ARI/Pneumonia and STI are also the most
commonly occurring diseases according to the above table. These diseases took the
same pattern as in September except diarrhoea which increased in occurrence, It
takes the third position instead of STI.
These diseases occurred more in September than in October, except Diarrhoea
which occurred more in October than in September.
 

November from 1st -30th

Disease Under fives % General clinic % Total %
Malaria 394 18.4 1127 52.6 152 71
Diarrhoea 65 3 25 1.2 90 4.2
Dysentry 0 0 22   22  
ARI/Pneumonia 125 5.8 311 14.5 436 20.3
STIs 0 0 71 3.3 71 3.3
Typhoid Fever 1 0.05 24 1.1 25 1.2
TB 0 0     5  
Leprosy 0 0     220  
Others 80   503   583 100
   
  In the table above Malaria, Diarrhoea, ARI/Pneumonia, STI and Typhoid Fever are
the most commonly occurring diseases in November. These diseases affected more
five year and above than under fives children, except diarrhoea witch affected more
under fives than general clinic.
Among these diseases, Malaria is highest in prevalence, next to it is ARI/Pneumonia.
Following ARI is Diarrhoea, then comes STI’s and then Typhoid Fever. These
diseases occurred in November more than in September.
 

December from 1st -31st 2006

Disease Under fives % General clinic % Total %
Malaria 159 13.6 621 53.4 780 67
Diarrhoea 20 1,7 3 0.3 23 2
Dysentry 0 0 3   3  
ARI/Pneumonia 56 4,8 213 18.4 269 23
STIs 0 0 58 5 58 5
Typhoid Fever 0 0 34   34 3
TB 0 0     4  
Leprosy 0 0     170  
Others 253   1168   1421 100
   
  In the table above, Malaria, Diarrhoea, ARI/ Pneumonia, STI’s and Typhoid Fever are
the most commonly occurring diseases in December. These diseases affected more
adults than children under five years, except diarrhoea, which affected more children
than adults. Among these diseases, malaria occurred highest, next is
ARI/Pneumonia. Following ARI is Typhoid Fever and finally Diarrhoea. These
diseases occurred in November more than in December. It is worth noting that
diarrhoea occurence increased in prevalence in the month of October and November
and then fell in December. Also Typhoid Fever occurrence increased in November
and December. Both diarrhoea, dysentery and typhoid fever are faecal source
diseases.
 

Now lets attempt to see the disease pattern for the past six months put
together.

  Under fives General clinic Total
Malaria 1637 4688 6325
Diarrhoea 212 63 275
Dysentry 24 96 120
ARI/Pneumonia 448 1244 1692
STI 0 461 461
Malnutrition 1 0 1
Typhoid Fever 1 65 66
Leprosy 0 1404 1404
TB 0 30 30
Others 653 3302 3955
   
  As per table above, the number of each conditions treated can be seen. All
Conditions seen at this clinic total 14329 from 17th of July to 31st December 2006.
This justifies the greater need for anti malarial drugs and the various types of
antibiotics. Sensitifation covering the 28 villages of our coverage area on STI’s,
HIV/AIDS is also justifiable looking at STI’s occurrence.
 

 

Abu Balkarr Tarawally
Chief Health Officer
Masanga Leprosy Hospital

 
         
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