RESUMEN
The aim of this study was to evaluate the correctness of use of pressurised metered-dose inhalers and spacer devices and to determine the common errors in the inhalation technique and factors associated with incorrect technique. The descriptive cross-sectional survey took place in the Kenyatta National Hospital; Nairobi; Kenya. Eighty-two asthmatic children aged 6 months to 12 years (median age 45 months; 56males) on inhaler medications and their carers were recruited into the study and assessed for correctness of inhalation technique. Of the 82 subjects; only 37 (45.1) performed all the essential steps of the inhalation technique correctly. The commonest errors were failure to take adequate breaths after actuation of inhaler (45) and not shaking the inhaler before use (18). The characteristics of correct and incorrect users are mainly similar. It was concluded that the majority (55) of asthmatic children and their carers do not perform the inhalation technique correctly
Asunto(s)
Asma , Niño , Hormonas , Inhalación , KeniaRESUMEN
BACKGROUND: There is laboratory evidence of altered immune function in children with malaria. Bacterial infections have been documented to complicate severe forms of malaria. However, it remains unclear whether such infections are attributable to the malaria, other risk factors, or are coincidental. OBJECTIVE: To determine the prevalence of bacteraemia and urinary tract infections (UTI) in febrile hospitalised children with and without malaria. DESIGN: A cross-sectional survey. SETTING: General paediatric wards, Kenyatta National Hospital, Nairobi. SUBJECTS: Children aged between three months and 12 years admitted with an acute febrile illness, with no obvious focus of bacterial infection. MATERIALS AND METHODS: Using a standardised questionnaire, information on socio-demography, symptomatology, and nutritional status was obtained. Malaria slides, blood and urine cultures were performed on each child. RESULTS: Malaria parasitaemia was present in 158 (60%) of 264 children presenting with acute febrile illness with no obvious focus of bacterial infection. Bacteria were isolated from blood and/or urine of 62 (23%) of all enrolled children. Bacteraemia was prevalent among 11.4% of 158 children with malaria and among 13.2% of 106 without malaria. Gram-positive organisms comprised 28.1% of blood isolates, gram-negative 62.5%, and atypical bacteria 9.4%. UTI was prevalent among 13.3% of 158 children with malaria and 16.0% of 106 children without malaria. Gram-positive organisms comprised 18.4%, gram-negative 78.9%, and atypical bacteria 2.6% of the urine isolates. Presence of malaria parasitaemia was not associated with an increased risk of bacteraemia (OR 0.9, 95% CI [0.4-0.7], or UTI (OR 0.8 95% CI [0.4-1.6] in this study population. CONCLUSION: Among children hospitalised in Nairobi with fever and no obvious bacterial infective focus, there should be a high index of suspicion for malaria, followed by bacteraemia and UTI. Malaria parasitaemia does not appear to be associated with increased risk of bacterial co-infection.
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Bacteriemia/complicaciones , Fiebre/complicaciones , Malaria/complicaciones , Infecciones Urinarias/complicaciones , Niño , Preescolar , Estudios Transversales , Femenino , Hospitalización , Humanos , Lactante , Kenia , MasculinoRESUMEN
OBJECTIVE: To critically review the advantages and disadvantages of selective versus comprehensive Primary Health Care (PHC) approaches as a strategy towards improving health in the developing world. DATA SOURCES: Review of literature on PHC. DATA SELECTION: Relevant papers from western and developing world literature. DATA EXTRACTION: Search of Pub-Med, WHO/UNICEF reports, and relevant publications on PHC. DATA SYNTHESIS: Examination of principles behind PHC and practical experiences in PHC in the developing world. CONCLUSIONS: Selective PHC programs have improved specific aspects of health, frequently at the expense of other health sectors, but fail to address an individual's health in holistic manner, or the health infrastructure of countries. Selective PHC programs tend to focus only on a small subset of the community. Comprehensive PHC is expensive to implement, however addresses health of individuals more holistically, addresses both preventive and curative health care, and promotes health infrastructure development and community involvement, thereby providing more sustainable improvement of health in the whole community.