Umbilical Cord Care Among Postnatal Mothers in Kibungo Hospital Catchment Area, Rwanda

Background Infections contribute to 30% of the 2.5 million neonatal deaths that occur globally every year. A newly cut umbilical cord can be a pathway for bacteria to enter the vulnerable neonate and cause neonatal sepsis. Most infections are preventable with evidenced-based cord care. Objective To assess postnatal mothers’ knowledge and practice of umbilical cord care in the Kibungo Hospital catchment area in Rwanda. Methodology A descriptive cross-sectional study design and purposive sampling strategy was used to recruit 224 postnatal mothers. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data. Results A third of mothers (33%) had adequate knowledge, and a half (54%) had good umbilical cord care practice. The majority (70%) reported dry cord care practice, though many applied substances including Vaseline (23%) and Movit ointment (15%). There was a negative correlation between knowledge of cord care and substance applied to cord (R2=0.224, p=0.001), and days applied (R2=0.167, p=0.012). Conclusion The study population had low cord care knowledge. Health care providers need to educate mothers on the practice of allowing the cord to dry naturally, and discourage the use of harmful substances that delay cord separation and increase risk of sepsis and subsequent neonatal mortality. Rwanda J Med Health Sci 2020;3(2):167-180

Insights into the Epidemiology of the First Wave of COVID-19 ICU Admissions in South Wales – the Interplay between Ethnicity and Deprivation

On the 9th March 2020, the first patient with COVID-19 was admitted to ICU in the Royal Gwent Hospital, Newport, Wales. We prospectively recorded the rate of ICU admissions of 52 patients with COVID-19 over 60 days, focusing on the epidemiology of ethnicity and deprivation. Patients were 65% (34 of 52) male and had a median (IQR) age of 55 (48-62) years. Prevalent comorbidities included obesity (52%); diabetes (33%), and asthma (23%). COVID-19 hospital and ICU inpatient numbers peaked on days 23 and 39, respectively – a lag of 16 days. The ICU mortality rate was 33% (17 of 52). Black, Asian and Minority Ethnics (BAME) population represented 35% of ICU COVID-19 admissions (18 of 52) and 35% of deaths (6 of 17). Within the BAME group, 72% (13 of 18) were found to reside in geographical areas representing the 20% most deprived in Wales, versus 27% of Caucasians (9 of 33). Less than 5% of the population within the hospital catchment area are of BAME descent, yet they represent a disproportionately high proportion of patients with ICU admission and mortality suffering from COVID-19. The interplay between ethnicity and deprivation, which is complex, may be a factor in our findings. This in turn could be related to an increased prevalence of co-morbidities; higher community exposure; or genetic polymorphisms.

Assessment of a Rainwater Harvesting System for the Volta Regional Hospital in Ghana

Rainwater harvesting is the art and science of capturing rain for human use. This study analysed rainfall data for the Regional Hospital's catchment area to ascertain potential harvestable rainfall. Assessment of the buildings and their respective roof areas were also done to determine the possible roof catchment areas. The potential rainwater that could be harvested from the different blocks within the hospital range between 3,306.18 -9,943.45m3. The potential total average rainwater that could be harvested from the different blocks within the hospital catchment area of 51,939.11m2 is 53,524.29 m3 per annum. According to data collected from the GWCL, the monthly and yearly demand of water by the hospital are 3,146 m3 and 337,752m3 respectively, which is lower than the total potential rainwater that could be harvested per annum of 53, 524.29m3 . This implies that there would be an excess water of 15,772.29m3 . Theoretically, it means that harvested and stored rainwater could meet the water needs of the hospital. Keywords: Rainwater harvesting (RWH); Water storage; Organizational water usage

Determination of true patient origin through motorcycle mapping: design and implementation of a community-defined geographic infrastructure surveillance tool in rural Sierra Leone

Background Village-level geographic infrastructure data are often insufficient in low-resource settings, despite accurate patient origin determination being essential for surveillance and outbreak management. We detail a novel and seemingly reliable method for the determination of true patient origin with proof of concept in rural Sierra Leone. Methods Potential villages (n=2263), identified within a 7800 km2 hospital catchment area from satellite imagery, were accessed by motorcycle and surveyed in person, capturing village name and community-defined section/chiefdom/district. Results A survey established 1740 inhabited villages and a village of origin determination tool (gazetteer) was produced. Recording the district/chiefdom/section/village at hospital registration allowed Global Positioning System patient origin determination in 2277/2344 (97.1%) attendances. Conclusions Our proof of concept reports a substantial and sustained record of true patient origin in a low-resource setting.