Læknaneminn - 01.04.2007, Page 127

Verkefni 3. árs læknanema
af 15 þátttakendum í Scopoderm hópnum fundu fyrir ógleði
(p=0.03). Einnig var marktækur munur á því hversu mikil-
li ógleði þátttakendur í hópunum fundu fyrir (p=0.03), en
miðgildið (median) í placebo hópnum var 2 (bil 1-5) á
meðan miðgildið (median) í Scopoderm hópnum var 1 (bil
1-4). Munur á tíðni uppkasta á milli hópanna var ekki töl-
fræðilega marktækur (6 af 17 í lyfleysuhópnum en 1 af 15
í Scopoderm hópnum, p=0.051) en hér getur verið um
týpu 2 villu að ræða. Ekki var marktækur munur á milli
hópanna í tíðni fylgikvilla (munnþurrks, sjóntruflana,
þreytu og húðertingar). Endanlegar niðurstöður munu
fyrst liggja fyrir þegar búið er að innrita alla sjúklinga í
rannsóknina.
Ályktun: Scopoderm forðaplásturinn virðist gagnlegur
sem fyrirbyggjandi meðferð við ógleði í tengslum við kvið-
arholsspeglanir. Kostir þessarar meðferðar eru að hún er
langvinn, ódýr, auðveld í notkun og þolist vel. Miðað við
óbreyttar niðurstöður mælum við með notkun scopolamin
forðaplásturs sem fyrirbyggjandi meðferð við ógleði/upp-
köstum hjá konum sem undirgangast kviðarholsspeglanir.
Implementation of U5-clinics in the Monkey Bay
area in Malawi
Björg Jónsdóttir, stud.med.1, Geir Gunnlaugsson, Dr.Med.
Sc., MPH1'2
^University of Iceland Faculty of Medicine, 2Centre for
Child Health Services, Reykjavík.
Introduction:
Annually about 10,6 million children die before they
reach five years of age (U5s). Most deaths occur in low-
income countries, especially sub-Saharan Africa. Common
causes of death after the neonatal period are acute
respiratory infections, diarrhea, measles and malaria,
compounded by malnutrition in about half of the cases.
There are known simple evidence-based preventive meas-
ures that includes also e.g. immunization and vitamin A
supplementation. The delivery of preventive services is
growth monitoring with weighing of U5s. In many places
access to such services is limited. Outreach programs that
aim to reach U5s in rural areas are an important service
component to facilitate access for the population.
Since 2000, the Iceiandic International Development
Agency (ICEIDA) has been giving support to strengthen
the health services in the Monkey Bay area in southern
Malawi. There are five health facilities in the area. All
implement outreach programs aimed at U5s but include in
some cases antenatal (ANC) and family planning (FP)
services. In addition, U5s can attend so-called static
sessions at each of the health facilities. The aim of this
study is to describe and analyze implementation of U5-
clinics in the Monkey Bay area with particular emphasis on
the outreach services.
Methods:
The study was conducted in March-April 2006. Outreach
and static sessions were observed. Data was extracted
from attendance books to specially designed forms for the
study for the period January 2005 to March 2006. Attending
mothers were interviewed to get their opinion of the
services. Data was computerized in FileMaker Pro and
analyzed in Excel.
Results:
All health facilities had fixed schedules for static and
outreach U5-clinics; two of the facilities included ANC and
FP. For the observed period, 355 (74%) outreach sessions
were conducted out of the 480 planned (range 71-93%) in
all five facilities. Reasons given for missed sessions were
e.g. iack of transport, rainy season with difficult access,
bad roads and lack of staff. In total, 50,612 children
attended the sessions and 36,321 (72%) were less than
one year of age (Uls). Health talks were given in all
observed sessions and engaged the mothers in songs that
promoted the health of the child and the mother. A total of
45,686 vaccination doses were given to Uls in the research
period and 2427 of vitamin A supplementation. About nine
out of 10 children weighed had normal weight; however, in
observed sessions the weighing was done with the children
in their cloths. During the study period, 910 women
attended ANC and 1797 FP sessions during outreach.
Registration of each U5-clinic was incomplete in many
cases, e.g. weight or sex of children was not registered.
Mothers appreciated the opportunity to attend outreach
services, in particular health education, growth monitoring
and immunizations.
Conclusion:
U5-clinics in the Monkey Bay area are appreciated and
reach many children. The sessions include evidence-based
preventive services and the outreach brings such
interventions to where people live, in rural villages with
difficult access. There are fixed schedules for the
implementation of U5-clinics; however, these are not
always followed through. To improve implementation,
transport of staff needs to be guaranteed and stock of
vaccines sufficient for estimated number of attendees.
Weighing routines should be revised in order to make
growth monitoring more effective.
Key words:
Outreach clinics, preventive health services, maternal-
and-child health, sub-Saharan Africa.
Þéttnimælingar í mjúkum innanæða og veg-
glægum kransæðaþykkildum hjá einstaklingum
sem hafa farið í tölvusneiðmyndarannsókn.
Brynja Vala Bjarnadóttir1, Birna Jónsdóttir2
1 Læknadeild Háskóla íslands, 2 Læknisfræðileg
myndgreining
Læknarieminn 2007 1 27