Informatics Publishing Limited

Abstract

Background: There is variable utilization and in some cases non-utilization of 3D/4D ultrasound imaging, even when the application is available in equipment. The reasons of non-utilization of 3D ultrasound given the high amounts of money invested in purchase of equipment with such technology in Kenya remain largely unknown. 

Objectives: The aim of this study was to evaluate the competence of sonographers in 3D/4D ultrasound imaging in Nairobi County in Kenya. The main outcome measures were knowledge, skills, and attitudes of sonographers in the use of 3D/4D ultrasound imaging.

Methodology: This was a cross-sectional descriptive survey in which self-administered questionnaires were utilized to gather data regarding utilization of 3D/4D ultrasound imaging among practicing sonographers in both public and private imaging facilities within Nairobi County.

Results: The majority, 60% of the respondents worked in private healthcare facilities. In terms of gender distribution, 52% of the respondents were male. The professional inclination of the majority of the respondents, 60% had a radiography background. None of the participants had a radiology inclination while one respondent (4%) had an obstetrics inclination. However, it is noted that 24 %( n=6) of the respondents did not respond to the question on their professional inclination and it is probable that those respondents were uncomfortable with the question. The majority, 76 % ( n=19) of the respondents had an experience of between zero and four years in sonography. The highest professional qualification of the majority of the respondents was diploma level while only 8% (n=2) of the respondents had a bachelor’s degree and above. A significant number of the respondents, 68 %( n=17) did not have formal training in 3D/4D ultrasound imaging. The majority, 68 % of the respondents did not practice 3D/4D ultrasound imaging. The majority of the respondents, 52% had regular access to 3D/4D equipment. The majority of the respondents, 64% did not undergo continuing education in 3D/4D. Most respondents, 80% believe that 3D/4D ultrasound imaging is clinically useful in obstetrics. The majority, 48 % of the respondents thought that performing 3D/4D examinations was cumbersome  The majority, 68% of the respondents thought that 3D/4D ultrasound imaging was good for patient entertainment and as a commercial gimmick. The majority of the respondents, 64 % had never recommended 3D/4D ultrasound imaging to a clinician. The majority, 92 % held that 3D/4D added information in medical diagnosis. This correlates well with the participants’ majority opinion that 3D/4D was useful. The majority, 96 % of respondents was of the opinion that showing 3D/ 4D images to patients was re-assuring and it enhanced patient’s confidence in the sonographer. Some respondents also opined that 3D/4D gives detailed images, as one is able to project images in several dimensions.

Conclusion: There is a generally low level of knowledge and utilization of 3D/4D ultrasound imaging among sonographers in Nairobi County and much equipment with 3D/4D functionalities remain under-utilized despite the fact that use of 3D/4D options adds value in ultrasound imaging. A number of respondents thought that 3D/4D ultrasound imaging was for patient entertainment or simply a commercial gimmick. 

This suggests precedence of the push factors that vendors use to achieve a sale of new equipment while neglecting the clinical supremacy of the clinical application.

Recommendation: Purchase of ultrasound equipment should be strategic rather than passive so that equipment are  not purchased expensively with in-built state of art technology like 3D/4D that is left to lie idle while other priorities are denied funding. In case there is purchase of ultrasound equipment with 3D/4D capability, there should be regular continuing medical education workshops or seminars by the dealers on user application training in order to achieve optimal utilization of the functionalities. The curriculum for training of sonographers should incorporate aspects of 3D/4D imaging to harness the benefits of using this technology as an adjunct to the routine 2D ultrasound imaging.

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Cartwright (1964:11) asserts that patient care involves all the activities carried out before, during and after medical, radiological, or therapeutic examinations to make the condition of the patient better.

This study was aimed at evaluating the level of patient care at the Cancer Treatment Centre, Kenyatta National Hospital. The study was a cross-sectional survey type that targeted 118 adult patients. The data collection instrument was a self-administered questionnaire, which was designed in line with the objectives of the study. The data was analyzed using statistical package for social scientists (SPSS).

The study revealed that the overall patient care was adequate. However, various aspects of patient care were perceived to be sub-optimal. These were patients waiting area and waiting time, privacy during treatment and comfort at the waiting area. Hygiene in the female patients’ toilets was also suboptimal. The female patients were the majority seeking radiotherapy services and were satisfied with the services rendered while the male patients constituted of 37% and 20% of them found the care given to be poor. Eighty eight percent of the respondents were satisfied with the care given to them at the reception of the radiotherapy department with 29% of them being very satisfied. However, it is of importance to find out the reasons why the other 12% were dismally satisfied with the care at the reception yet it is the area that the patients are first served. About 63% of the patients had to wait for more than one hour (standard deviation of 1.364) before they are called in for treatment. Seventy three percent (73%) of the respondents were given explanation of the expected treatment side effects satisfactorily, 10% were poorly explained to while 17% were not given any explanation at all.

These shortfalls can be improved by expanding the radiotherapy department by adding treatment machines, increasing the number of staff, availing comfortable seats for waiting patients, providing enough changing gowns and changing rooms, and providing enough and clean toilets for patients. It is therefore incumbent upon the hospital management to ensure that more facilities are acquired and more personnel trained to meet the high demand for radiotherapy services.

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Objective: This study was design to determine the prevalence of IDD by measuring urinary iodine excretion among primary school age children, to assess the effect of goitrogen on urinary iodine absorption and assess the impact of salt iodization program.

Methods: A questionnaire was given to all students participating in the study to be filled out by their families regarding whether or not they used iodized salt in the preparation of food in their homes, whether they consumed cassava, kale cabbage and sorghum including the frequency of consumptions and to bring two table spoonful of salt they use at home. The iodine in urine was determined using sadell kolthoff method while iodate in salt was analysed using iodometric titration.                                                                                                                                                                                                                                                          

Results: Of the 142 respondents who participated in the study, the overall prevalence of IDD in the study population was 3.5% (excreting less than 99 µg I₂/l) which is below the WHO value of less than 5% implying sufficient iodine in the study population. In Makina, it was 5.4% with a median urinary iodine excretion (UIE) of 215.1µgI₂/l ±57.8 while Kilimani had a prevalence of 2.4% and a median UIE of 242.2 µg I₂/l. ±67.7. In addition, 18.4% of the study subjects excrete optimum UIE (100-199 µg I₂/l) while 78.1% excrete above 200 µg I₂/l. On the consumption of salt, 82.3% reported that the salt was iodated and 63.9% knew why salt is iodated while 17.7% reported that the salt was not iodated while 36.1% did not know the reason for salt iodation. All the samples (home salt) (range 8.1-341.93 mg iodate/kg salt were analysed and had a mean of 134.88 mg iodate/kg salt (± 61.8). However, there was no significant difference between the iodate levels in the salt samples from the households of the two schools  (Makina and Kilimani having a mean of 145.1 mg iodate per Kg salt and 135 mg iodate per Kg salt respectively) (t = -0.932;p > 0.05). Analysis of the six salt brands (53  salt samples) obtained by direct purchase indicated that the brands Kay salt, Kensalt, sea salt, refined, mzuri and unknown had a mean of 159.67, 165.89, 2.02, 191.45, 150.55 and 176.58 mg iodate/Kg salt respectively.  Only Kensalt was within the recommended iodate levels of 168.5 mg/kg salts. When iodate levels in the direct purchase salt brands and home salt were paired, there were significant differences (p < 0.05).  On the association between UIE and consumption of goitrogenic foods, there was significantly increased levels of urinary iodine in non-consumers of cassava relative to the consumers (p = 0.032).

Conclusion: IDD prevalence in Nairobi is 3.5%, which is below the WHO value of less than 5% suggesting that the study community is iodine sufficient. Universal salt iodation is effective in controlling IDD among school children in the study population in Kenya. Many brands of salt sold in the Kenya have less and others high iodate levels than the Kenya Government recommended levels of 168.5 mg/kg salt. Consumption of kale (sukuma wiki), cabbage and sorghum has no effect on urinary iodine excretion except cassava since it affects iodine absorption that could put consumers at risk of hypothyroidism. Effective monitoring and surveillance by Kenya Bureau of standards should be encouraged to guard against consumption of salt preparations that do not meet the required standards. Health Education programs in schools should be conducted across Kenya to guard against IDD.

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Objective: The following study is aimed at investigating the attitude of patients towards medical students as they deliver services to them in terms of medical investigation or procedures. 

Methods: Through a questionnaire, the researcher asked patients what their preferences are as regards medical students attending them. The points of interest were the number of medical students a patient would be comfortable with, the gender of the student and the types of medical investigation or procedure that the patient would be comfortable with if attended by a student.

Results: Of the 144 patients sampled, 69.44% were male and 30.56% were female, out of which 56% consented to involvement of medical students on teaching practice, as 44.05% refused. Different patients were comfortable only with a particular number of students attending them. For example, 37.8 % of respondents who consented preferred only 1 student’s presence while 29.26% preferred 2 students. More than ¾ of the respondents wanted a student attending them to be under the supervision of a professional doctor. Different respondents had diverse opinions on the role of the student in the examination or procedure. Religion also played a role in the manner of attending to the patient, as well as the preferred gender of the attending student.

Discussion: The proportion of consenting respondents was just slightly higher than those refusing to be attended by students in medical practice. This may imply that a good number or patients are suspicious or uncomfortable with medical students attending them. Patients were also selective on the number of students to attend to them. The nature of examination also influenced consent or refusal of attendance by students.

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