CONSOLATA HOSPITAL IKONDA founded in 1963

P.O.Box 700 Njombe, tel 0752 41161, email: [email protected]

Annual Report 2014

CONSOLATA HOPITAL IKONDA

Annual Report 2014

THEME OF THE YEAR 2015

“Every patient is our main concern”

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

THE HOSPITAL AND ITS ENVIRONMENT The Consolata Hospital Ikonda is located in the Southern Highlands of Tanzania, 2050m above sea level (9°22’10’’S, 34°14’22”E), in Njombe Region. It is one of the three hospitals of Makete District with the Lutheran Hospital of Bulongwa (50 km far) and Makete District Hospital (30 km far). The Consolata Hospital of Ikonda is a private, no-profit, catholic institution that belongs from its origin (1963) to Consolata Missionaries. The mission of the Hospital is to provide general quality health care to the population of the area and to promote access to health care for the needy with a special attention for children, women and people affected by chronic diseases. It is registered since 1997 with the Ministry of Health (reg.no.115002), it’s recognised by NHIF (National Health Insurance Fund) and is member of CSSC (Christian Social Services Commission) . Today the hospital has 322 beds and receives every day an average of 250-350 outpatients, coming from different districts and regions. The presence of the hospital has produced important changes in Ikonda village and in the area around moving from an economy of subsistence farming to commerce with an increased number of buses and minibuses (13 daily), taxis, motorbike taxis, shops, guest houses and restaurants. The hospital itself is the biggest contributor of Tanzania revenue Authority (TRA) and National Social Security Fund (NSSF) of Makete District. Ikonda village has been connected to electricity from National Grid starting from August 2014.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

A SHORT HISTORY The history of Consolata Hospital of Ikonda started on 25th February 1961 when Bwana Kiluswa, Executive Officer, Ukinga Chiefdom wrote a letter to the Missionary i/c, Benedictine Fathers, R.C.M Sunji, Lupila asking for a New Mission Hospital in Ukinga. This is part of the letter of Bwana Kiluswa: “Reverend Sir, on behalf of the Wakinga I am writing this letter to ask your Mission to establish a Mission Hospital in the Ukinga Chiefdom. Ukinga, within the last thirty years has experienced a very small increase in population…. This has been caused by medical deficiencies in the Chiefdom. A great number of deaths both of infants and grown-ups have taken place…. The Wakinga will highly be thankful to your Mission if this request is met with cordial thought.” The parish priest of Sunji sent the letter to Abbot-Bishop Eberhard Spiess OSB, of Peramiho who wrote (18th March 1961) a letter to the Bishop Beltramino of Tosamaganga explaining to him that the right place to build a hospital will be Kisinga Mission that it is more in the centre of the Ukinga. Because of the heavy expenditure of establishing a proper hospital, the Bishop Beltramino and the Consolata Fathers Superior asked help to the General Superior of Consolata Fathers in Turin asking for support. The answer from Turin was positive and the Executive Officer of Ukinga Chiefdom was informed by Fr. Pagani, parish priest of Kisinga. On 4th October 1963 the Right of Occupancy of 60 acres of land for the construction of the Consolata Hospital of Ikonda was approved and the construction of the hospital started. At the end of the 1968 the Consolata Hospital had 60 beds, houses for fathers, sisters and doctors. The Consolata Hospital of Ikonda was inaugurated by the President of Tanzania, Julius K. Nyerere on 7th October 1968. Since then the Consolata Hospital experienced different collaborations with many Organizations and volunteers doctors.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

HOSPITAL DESCRIPTION The actual bed capacity of the Hospital is 322 beds distributed in rooms of three bed maximum, with one toilette and one shower every six beds. IPD (In Patient Department) consists of these wards: Male Ward, Female Ward, Paediatric Ward, Maternity, Premature Unit, Annex/Isolation, Private Ward, Orthopaedic Ward, Surgical Ward and Antenatal. The Hospital has the following units: - O.P.D.(Out Patient Department) - First Aid - 2 Dental Units - Ophthalmic Department - X-Ray - CT scan - Ultrasound - Endoscopy - Laboratory - Dressing Room - POP Room - Physiotherapy and Gym - 4 Theatres - 2 Delivery rooms - 3 Pharmacy stores - Infusion Unit - 2 Sterilization rooms - R.C.H. and PMTCT - C.T.C./ V C.T. Unit (HIV clinic) - F.P.A. (Food Program Ass.) - Mortuary - Laundry The Hospital also runs outreach clinics and Counselling services (P.M.T.C.T.) and H.B.C. (Home basic care). Ambulance services are available. The Hospital runs for his own needs a garage, a workshop and a small carpentry. Electricity is available 24h. The Hospital has its own hydroelectric power station. Electrical generators are used when there is shortage of water. Since August 2014 hospital is connected also with Tanesco. Hospital water main is feed by 4 springs (registered) on the mountains around. A central water heating provides hot water to the whole hospital and the laundry. The hospital has its own implant for purifying black water. The hospital has a small incinerator for garbage. An Oxygen Generator provides oxygen feeds to all the hospital wards.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

A compound called “Kampini” gives free accommodation to relatives who assist their patients admitted in the hospital: it consists of 12 big rooms, toilettes and showers and a large cooking area. Inside the hospital compound there is a restaurant, a grocery and two shops run by private people. This shopping centre has been opened in order to help people who are coming to hospital to get food at very easy price. The hospital has 53 single houses and 6 hostel for nurses and workers. In May 2014 we have started the implementation of a new software, Hospital Management System developed by Power computers. This system will help to manage hospital activities with increased number of patients. The implementation will go on in 2015 gradually involving all the departments.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

PERSONNEL The number of hospital staff has been increased from 225 employees in 2013 to 245 in 2014 in order to sustain the growing number of patients and activities. They are paid as follows: PAID BY

Number of staff (2013)

Number of staff (2014)

Consolata Hospital Ikonda

180

196

Central Government

36

36

Makete District

9

13

225

245

TOTAL

Despite the increased number of patients treated in our hospital, the financial support from Ministry of Health of Tanzania has not increased: 36 workers only are paid by central government, and not 73 as promised on basis of nominal number of beds. Makete District sent 13 health workers as a compensation for the different services that the hospital is providing to the population of the district, according to the service agreement signed on 17th November 2014 between the Hospital and the District Council.

Physician

2008 0

2009 0

2010 0

2011 0

2012 0

2013 1

2014 1

Medical Doctors

1

3

5

5

2

4

7

A.M.O.

4

5

6

6

5

7

6

Clinical Officers

7

6

4

3

6

7

8

Nurse

48

52

55

57

59

60

67

Medical attendant

24

23

23

27

23

36

36

Laboratory tech.

4

4

3

3

4

5

4

Laboratory ass.

1

1

1

2

3

3

7

Radiographer

1

1

1

1

1

1

2

Pharmacy, Dental & Physiotherapy

9

11

11

9

11

12

11

Admin. Staff

9

9

11

12

10

13

16

Drivers

5

5

5

4

4

5

5

Support Staff

50

52

65

71

75

72

75

Total

163

171

190

200

203

225

245

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

In the following table is compared the number of hospital employees with the estimated required workforce for each department. Est. Req.: Estimated Requirement aligned with national government policy Actual: Number of employees at 31st December 2014 MEDICAL Physician Paediatrician Obstetrician./Gynaecologist Surgeon Ophthalmologist Anaesthesiologist Dermatologist Medical Officer General AMO. Anaesthesiology Assistant Medical Officer General Assist. Medical off. Ophthalmic Anaesthetic Technician Clinical Officer Orthopaedic Technician Medical Total

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Est. Req

Actual

Gap

1 1 1 1 1 1 1 6 2 6 1 1 5 1 29

1 0 0 0 0 0 0 7 1 5 0 0 8 0 22

0 -1 -1 -1 -1 -1 -1 +1 -1 -1 -1 -1 +3 -1 -7

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

NURSING & MEDICAL ATTENDANTS Officer Supervisor (Matron/Patron) Nursing Officer General Nursing Officer Paediatrics Nursing 1 Psychiatry Ass. Nursing officer Nurse I Nurse II Nurse I (Anaesthetic) Nurse II (Anaesthetic) Medical Attendant Nursing & Medical Attendants Total X-RAY Radiographer Radiographic Assistant X-Ray Total LABORATORY Technician (Diploma) Assistant Technicians Laboratory Total PHARMACY Pharmacist Pharmaceutical Technician Pharmaceutical Attendant Pharmacy Total DENTAL Dental Surgeon Assistant Dental Officer Dental Technician Dental Therapist Dental Total PHYSIOTHERAPY Physiotherapist Occupational Therapist Physiotherapy Total ADMINISTRATION Administrator Health Secretary/Admin. Personal Secretary Records Officer Assistant Rec. Assistant accountant Chief accountant

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Est. Req

Actual

Gap

2 13 3 3 2 13 56 4 3 23 122

2 1 0 1 12 15 31 4 1 36 103

0 -12 -3 -2 +10 +2 -15 0 -2 +13 -19

Est. Req

Actual

Gap

2 2 4

0 2 2

-2 0 -2

Est. Req

Actual

Gap

6 2 8

4 7 11

-2 +5 +3

Est. Req

Actual

Gap

3 1 5 9

1 1 6 8

-2 0 +1 -1

Est. Req

Actual

Gap

1 1 1 1 4

0 0 0 1 1

-1 -1 -1 0 -3

Est. Req

Actual

Gap

2 2 4

0 2 2

-2 0 -2

Est. Req

Actual

Gap

1 1 1 1 1 1 1

1 1 0 0 2 1 0

0 0 -1 -1 +1 0 -1

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

Data clacker Administration Total SUPPORT STAFF Launderers Kitchen Attendant Mortuary Attendant Electrician Plumber Carpenter Tailor Cleaners Driver Security guard Support Staff Total

GRAND TOTAL

5 12

11 16

+6 +4

Est. Req

Actual

Gap

9 5 2 1 1 1 3 31 5 12 70

7 6 2 2 2 1 2 39 5 14 80

-2 +1 0 +1 +1 0 -1 +11 0 +2 +11

Est. Req

Actual

Gap

262

245

-17

TURNOVER OF MEDICAL PERSONNEL Although the Hospital took the step since many years ago to align salary levels to those of the Tanzanian Government, nursing staff and junior medics have been leaving for NGOs, government hospitals and other institutions. This high turnover has been an obstacle to maintaining quality health services and management building. The reasons causing clinical officers and nurses to leave the Hospital might be found in the poor environment and distance from big towns. The following table clearly shows the high level of turnover in the medical staff (Medical Officers, AMOs, Clinical Officers, Nurses, Medical Attendants, Laboratory Technicians and Assistants and Radiographers). NEW MEDICAL STAFF EMPLOYED IN 2014

55

MEDICAL STAFF LEAVING THE HOSPITAL IN 2014

26

The hospital has tried to retain the medical personnel by several means, as for example:    

Almost free of charge provision of house with full free of charge water supply 24 hours a day Free of charge shamba (piece of land for cultivation) Access to salary advance 40 million for loans

Nevertheless, as figures above clearly prove, the results have been very poor and it has been not possible to get proper commitment by medical staff. We do not believe any more that these are really means to retain personnel. Mobility of personnel has other reasons: this is a problem all over Tanzania and not only in our hospital.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

tTRAINING During 2014 the Hospital supported 3 people in school as shown in the table below. CARDE MEDICAL OFFICER

NUMBER 2

SPECIALIST DOCTOR TOTAL

1 3

PLACE IMUTU BUGANDO

NOTE:  The 3 medical employees listed above under training have not been counted in the staff table at beginning of chapter 0. Since 2003 the hospital has funded training for 90 medical employees. Unfortunately the results are not reassuring at all since 41 of them have left mostly without completing the contract with the Hospital. For this reason it is no more policy of the hospital to sponsor personnel for study. CONTINUOUS EDUCATION The Hospital continues the program to train the personnel. Training on job was done in Ikonda by many specialists:        

Orthopaedics: dr. Roberto Tormen, dr. Roberto Plazzi, dr. Francesco Vasciaveo, dr Giuliano Novaretti, dott. Giuseppe Bonomi, dr.Silvio Galvagno Anaesthesist: dr.Giuseppe Tormen Dentist: dr.Giuseppe Vasta Cardiologists: dr. Marco De Marco, dr.Gaetano Povolo Gynecologist: dr. Giovanni Crestani, dr. Giovanni Scozzari Paediatrician: dr. Giovanni Cecchini, dr.Patrizia Stasi Plastic surgeon: dr.Francesco Bellezza Surgeons: dr.Aldo Infantino, dr.Alessandro Testa, dr.Pietro Iani, dr.Bruno Compagnoni

The hospital sponsored also a AMO who attended a training course in Echocardio in Ospedale Molinette, Torino, Italy.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

ACTIVITIES SUMMARY OF THE MAIN HOSPITAL STATISTICS Trends in the service output and number of employed staff are shown in the table below. Year

2008

2009

2010

2011

2012

2013

2014

Number of beds

210

222

305

305

310

310

322

Admissions

7,734

9,522

11,202

11,549

12,292

13,052

14,499

Major surgical operations

774

1,019

1,336

1,695

2,088

2,560

2,921

Minor surgical operations

491

567

534

1,040

1,234

907

1,602

Deliveries

881

1,027

1,157

1,406

1,410

1,646

1,697

OPD visits

31,320

37,878

41,771

46,249

51,699

59,369

74,228

HIV Clinic visits

17,875

19,118

20,526

20,682

23,634

22,141

21,155

R.C.H.visits

9,642

48,778

41,965

35,098

13,884

15,498

14,832

Dental treatments

1,849

1,997

2,235

2,197

2,406

2,387

2,170

Laboratory examinations

50,842

53,029

70,860

75,358

97,188

117,951

143,212

X-RAY

2,313

2,831

4,392

5,051

5,832

11,348

14,862

Hospital deaths

279

440

272

515

566

626

595

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

LABORATORY EXAMINATIONS AND BLOOD TRANSFUSION Laboratory services are available every day from 8 a.m. to 8 p.m. and also during the night in case of emergency. In the table below a resume of the activities performed in 2014, compared with 2013. MICROBIOLOGY

2013

2014

WIDA TEST

18,804

22,996

H. PLYLORI

7,227

8,582

VDRL/RPR

11,296

6,335

ASOT

4,998

5,526

RF

4,265

5,348

ZN

1,408

1,361

HEPATIRIS B

224

519

HEPATITIS C

214

513

CULTURE

548

498

G/STAIN

283

290

CSF

56

83

FULL BLOOD PICTURE

15,429

24,975

HAEMOGLOBIN

3,724

4,288

CD4

3,637

3,961

CELLS MORPHOLOGY

16

46

SICKLING TEST

30

37

BLOOD BLEEDING FACTOR

29

29

BLOOD CLOTTING FACTOR

29

25

ALT

5,033

4,711

BLOOD SUGAR*

5,228

5,400

CREATINE

2,577

4,445

UREA

2,567

4,381

AST

833

1,662

URIC ACID

489

1,321

CHOLESTEROL

201

660

BILIRUBIN TOTAL

152

279

BILIRUBIN DIRECT

151

251

HAEMATOLOGY

BIOCHEMISTRY

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

K+

186

219

TG

58

52

URINE ANALYSIS

11,534

14,937

STOOL ANALYSIS

8,154

10,048

BLOOD SLIDES

2,045

3,472

628

2,150

BLOOD GROUPING

1,501

2,304

CROSSMATCHING

886

1,508

PARASSITOLOGY

URINARY PREGNANCY TEST BLOOD TRANSFUSION UNIT

Laboratory activities have grown if compared with previous year following the growth of number of patients.

Laboratory examinations

2009

2010

2011

2012

53,029

70,860

75,358

97,188

2013

2014

117,951 143,212

* This is the number of blood sugar tests done in laboratory and it refers to OPD patients only. Blood sugar tests done in the wards are not included.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

BLOOD TRANFUSION UNIT The blood bags supplied from Zonal BTS Mbeya are insufficient compared with the demands of the wards and the theatre. For this reason since long the hospital has started a transfusion unit equipped with Elisa machine. Laboratory staff visited some schools around to promote blood donation: the schools involved are TTC Tandala, Lupaseco Secondary School, Ukwama Secondary School and Mang’oto Secondary School.

UNITS OF BLOOD RECEIVED FROM MBEYA

665

UNITS OF BLOOD RECEIVED FROM DIFFERENT DONORS

376

TOTAL UNITS OF BLOOD TRANSFUSED UNITS NOT TRANSFUSED FOR DIFFERENT REASONS

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1,041 65

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

RADIOLOGY DEPARTMENT X Ray

2009

2010

2011

2012

2013

2014

Bones

1,035

1,487

2,070

2,528

6,933

8,177

Chest

1,690

2,789

2,823

3,092

3,349

5,960

Abdomen

56

59

76

120

320

272

Others

50

57

82

92

746

453

TOTAL

2,831

4,392

5,051

5,832

11,348

14,862

Total Number of X-Ray 16,000

14,000

12,000

10,000

8,000

6,000

4,000 2010

2011

2012

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2013

2014

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

OTHER INVESTIGATIONS 2013

2014

Ultrasound

3,889

7,1861

ECG

2,407

4,667

Echo Cardio

186

114

Gastroscopy

1

17

Note 1: The number refers to the tests done in OPD only. The ultrasound done in the wards are not included

CT SCAN At the end of November 2014 a CT Scan machine (Siemens 6 Slice) started working in Ikonda. CT scan of brain, abdomen and bones can be performed.

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

ADMISSIONS Beds

Admissions

Days

Deaths

Occupancy

Male General

42

2,080

8

180

113%

Female General

42

3,315

6

148

125%

Paediatric

33

1,909

7

56

118%

Annex/Isolation1

36

1,684

7

97

91%

Surgical

42

978

17

41

138%

Orthopaedic2

33

927

10

13

85%

Maternity/ Gynaecology

27

2,227

9

28

156%

Premature

8

83

16

16

45%

Private

14

299

9

16

51%

Antenatal

45

997

17

0

101%

Average length of stay per admission: Number of in patients days / Number of admissions Bed occupancy rate: (Number of in patient days X100) / = (Number of beds x 365) The number of in patients days is calculated as follows: every day, at midnight, the number of patients present in each ward is counted. When a patient is discharged and the same day another patients is admitted in the same bed, only one in patient day is counted.

Note 1: Annex and Isolation wards moved in February 2014: Isolation entered in a new building while Annex occupied the building of old Isolation. Note 2: Orthopaedic ward has been opened in February 2014 only. Before that, the orthopaedic patients were accommodated in different wards.

The diagram below shows that for many days during the year the actual daily bed occupancy was bigger than the total hospital bed capacity. That means that many patients were accommodated in the corridors and ward TV room.

Hospital Bed Occupancy 2014 450 400 350 300 250 200 150 100 50 0 Daily Bed Occupancy

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Num ber of Beds

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

Hospital Admission Trend 16,000

15,000

14,000

13,000

12,000

11,000

10,000 2010

2011

2012

Page 17

2013

2014

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

SUMMARY OF MAIN IN-PATIENTS DIAGNOSIS N.

I- INFECTIOUS AND PARASITIC DISEASES

5

Death

1

Clinical AIDS

22

1

528

100

2

Bacterial diseases

62

2

210

14

3

Enteric inf.

5

0

214

8

4

Amoebiasis

2

0

18

3

5

Other Diarrhoea dis.

191

5

309

5

6

Hepatitis

3

0

17

4

7

Intestinal Worms

2

0

3

0

8

Leprosy

0

0

1

0

9

Cerebral Malaria

79

7

112

12

10

Other Malaria

244

9

406

19

11

Schistosomiasis

0

0

5

0

12

Tuberculosis

9

0

438

57

13

Genital Discharge Syndrome

0

0

9

0

14

Genital Ulcer Diseases

0

0

22

0

N.

II-NEOPLASM

5

Death

15

All Neoplasm

21

0

370

11

N.

III- ENDOCRINE DISEASES

5

Death

16

Thyroid diseases

0

0

144

0

17

Diabetes Mellitus

0

0

208

16

N.

IV-NUTRITIONAL DISORDERS

5

Death

18

Protein Energy Malnutrition

43

5

19

0

19

All others nutritional disorders

1

0

1

0

N.

V- BLOOD DISEASES

5

Death

20

Sickle cell anaemia

2

0

4

1

21

All other anaemia

116

13

350

52

22

Other haematological diseases

0

0

5

0

N.

VI- MENTAL DISORDERS

5

Death

23

Neuroses

0

0

48

0

24

Psychoses

0

0

92

0

N.

VII- NEUROLOGICAL DISEASES

5

Death

25

Ear diseases

8

0

14

0

26

Epilepsy

6

0

59

1

N.

VIII – CARDIOVASCULAR DISEASES

5

Death

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

27

Cardiac Failure

4

0

258

42

28

Hypertension

2

0

523

52

29

Rheumatic Fever

0

0

18

0

30

Other cardiovascular diseases

2

0

296

42

N.

IX – RESPIRATORY DISEASES

5

Death

31

Upper Respiratory tract infections

.28

0

12

1

32

Obstructive pulmonary diseases

0

0

0

0

33

Pneumonia

368

19

514

46

34

Other respiratory diseases

11

0

218

0

N.

X – DIGESTIVE DISEASES

5

Death

35

Liver diseases

1

0

99

15

36

Peptic ulcers

0

0

196

14

37

Other non-infectious gastric-intestinal

53

0

264

20

N.

XI – GENITOURINARY DISEASES

5

Death

38

Non-infectious kidney diseases

2

0

261

2

39

Pelvic inflammatory diseases

0

0

45

0

40

Urinary Tract Infectious

41

0

226

0

41

Other gynaecological diseases

0

0

324

0

N.

XII – SKIN DISEASES

5

Death

42

Infective skin diseases (non viral)

38

0

79

0

43

Non infectious skin diseases

58

0

100

0

N.

XIII – MUSCULOSKELETAL AND CONNECTIVE DISEASES

5

Death

44

Osteomyelitis

2

0

108

1

45

Non-infectious rheumatic or joint diseases

2

0

198

0

N.

XIV – CONGENITAL DISORDERS

5

Death

46

Congenital disorders

80

1

46

0

N.

XVI- MISCELLANEOUS

5

Death

47

Ill defined symptoms, no diagnosis

0

0

123

0

48

Snake and insect bites

0

0

11

0

49

Burns

54

2

41

1

50

Fractures

62

0

845

4

51

Poisoning

6

0

13

0

Page 19

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

TOP TEN CAUSES OF HOSPITAL DEATHS (YEAR 2014)

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CONSOLATA HOSPITAL IKONDA

Annual Report 2014

THEATRE The hospital has four operation theatres: one for General Surgery, one for Maternity/Gynaecology, one for Orthopaedic Surgery and another one for emergencies. Planned surgery procedures are done from Monday to Friday but theatre is open for emergency operations everyday 24 hours. In the table below is listed the work done in 2014. TOTAL MAJOR OPERATIONS: 2,921 ABDOMINAL SURGERY Inguinal hernia Umbelical hernia Acute appendicitis Epigastric hernia Intestinal resection+anastomosis Peritonitis Incisional hernia Exploratory laparatomy Adesiolisis Bowel obstruction due to volvulus Gastro-jejunostomy Burst abdomen resuturing Splenectomy Perforated peptic ulcer Colostomy &ileostomy closure Tubercolosis peritonitis drainage Re-opening post laparatomy Gastric resection NON-ABDOMINAL GENERAL SURGERY Subtotal thyroidectomy Lumpectomy Mastectomy Thyroglosal cyst Parotid tumor excision UROLOGICAL SURGERY Prostatectomy Hydrocelectomy Orchidectomy Soprapubic cystostomy Re-opening post prostatectomy Urethral dilatation Bourgenage Penis amputation Nephrectomy Testicular cyst Page 21

509 118 75 65 41 35 34 31 25 21 19 11 10 10 5 4 2 2 1 176 94 66 7 6 3 209 115 46 20 10 8 4 3 1 1 1

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

ANO-RECTAL SURGERY Haemorrhoidectomy Anal fissure Anal fistulae Thiersch’s procedure for rectum prolapse Eua PLASTIC SURGERY Skin graft Release/excision of scar and post burn contractures Keloid OBSTETRIC AND GYNAECOLOGY Caesarian section Total abdominal hysterectomy Annexectomy (Ovariectomy/Salpingectomy) Tube surgery Ectopic pregnancy Miomectomy Pelvic abscess Subtotal hysterectomy Molar pregnancy evacuation Imperforated hymen ORTHOPAEDIC & TRAUMA SURGERY ORIF Chronic osteomyelitis sequestrectomy External fixation Amputation External fixation removal Contracure release Traction skin (skeletal) Re-ORIF Re-amputation Plastic surgery (slap) Hip protesis Tendon repair Arthrodesis Nerve release Bone grafting Radial head resection

Page 22

134 74 31 25 2 2 84 44 31 9 1,236 854 245 63 28 15 10 9 6 4 2 573 316 66 55 29 27 23 14 14 7 6 6 4 3 1 1 1

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

TOTAL MINOR OPERATIONS: 1,602 SURGICAL NOT INCLUDED ABOVE Abscess incision and drainage Lipoma excision Cut wound stiching Soft tissue tumour Cyst excision Stitch abscess Other cist New growth Foreign body removal Ganglion cyst Malignant ulcer ORTHOPAEDIC AND TRAUMA Fracture reduction/POP immobilization Plate removal post ORIF Kirschner wire removal Nail removal post ORIF Figure of eight bandage Surgical toilette Skin grafting Tenoctomy Bone excision Screw removal post ORIF MINOR GYNECOLOGICAL SURGERY Incomplete abortion dilatation and curettage Dilatation and curettage for DUB Genital warts cauterization OTHERS Paracentesis Circumcision Under water seal drainage Thoracocentesis Keloid excision

Page 23

412 134 116 44 38 28 18 10 9 7 7 1 881 680 56 49 27 17 17 15 8 7 5 223 154 45 24 86 37 31 7 9 2

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

ANAESTHESIA Type Of Anaesthesia Spinal Anaesthesia

1,845

Intravenous without endotracheal intubation

897

Intravenous with endotracheal intubation

392

Local anaesthesia

147

Saddle

92

SURGICAL DEATHS Elective Surgery Haemorrhage

2

Others Tumour

1

Other causes

4

Emergency Surgery Pre or Postoperative sepsis

25

Pre or Postoperative sepsis + HIV

5

Peritonitis

4

Haemorrhage

1

Other Causes

10

Total surgical deaths

52

Page 24

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

MATERNITY SERVICES

2013

2014

1,646

1,697

Normal deliveries

862

843

Abnormal deliveries

784

854

27

28

Total number of new-born

1,673

1,725

Total number of live births

1,641

1,691

Fresh stillbirths

7

5

Macerated stillbirths

25

29

Born before arrival

11

13

Premature

58

83

New-born with body weight < 2.500 g

184

184

Early neonatal deaths

19

11

Total number of deliveries

Multiple deliveries

Delivery: The process leading to the expulsion of the products of conception with a gestational age of 28 weeks or more. A multiple delivery should be recorded as 1 delivery. Due to multiple pregnancies, the total number of children born is usually bigger than the total number of deliveries. Abnormal delivery: A delivery that, to take place, had to be assisted “actively“ with an outside intervention like : pharmacological induction, vacuum extraction, symphisiotomy, forceps extraction, caesarean section. A delivery where just an episiotomy has been done, has to be considered a normal delivery. Stillbirth: Any child delivered after the 28 week of pregnancy that does not afterwards breathe or show any sign of life. If the heart is beating after delivery, although there is no sign of respiration, the death should not be recorded as a stillbirth but as a neonatal death. A child born dead before 28 weeks gestation should not be recorded as a stillbirth.

ASSISTED DELIVERIES 2013

2014

Caesarean sections

784

854

Breech delivery

24

29

Induction

16

12

Vacuum extractions

3

3

Forceps deliveries

0

0

Page 25

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

CAESAREAN SECTIONS Caesarean sections are many because many mothers with previous caesarian sections or other problems are coming to our hospital even from other districts. Previous caesarean sections

262

Cephalic-pelvic disproportion

152

Foetal Distress

152

Placenta praevia

18

Big Baby

4

Mal position

113

POPP

59

Breech

31

Face

5

Transverse

18

Obstructed Labour

83

Gestosis PIH

25

Cord Prolapse

22

Bad Obstetrical History (BOH)

15

Premature rupture membrane

9

Antepartum haemorrhage

8

Prolonged Labour

7

Multiple Pregnancy

3

Abruption placenta

2

Imminent rupture

2

Warts, Condylomata

1

Uterine fibroids

1

Pregress VVF Repair

1

Page 26

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

MATERNAL DEATHS Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and the site of pregnancy from any cause related to or aggravated by the pregnancy or its management.

Maternal deaths

2013

2014

Anaemia due to PPH

0

1

Haemorrage

1

0

Total

1

1

2013

2014

Maternal mortality rate

0.060%

0.059%

Perinatal mortality rate

1.5%

0.92%

Early neonatal mortality rate

1.1%

0.94%

Hospital maternal mortality rate: (Hospital maternal deaths x 100.000) / Total number of hospital deliveries Perinatal death: a death taking place in the period going from the 28th week of gestation and the first week after birth. Hospital perinatal mortality rate: (Hospital Stillbirth+deaths at 0-7 days after birth) x 1.000 / (Hospital Live birth + Stillbirths) Early neonatal death: a death taking place from within 28 days after birth. Hospital early neonatal mortality rate: (Hospital deaths within 28 days after birth x 1.000) / Hospital live births

Page 27

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

OUT PATIENT DEPARTMENT (OPD) The OPD is open every day from Monday to Sunday from 7.30a.m. to 8.00p.m. Pharmacy and laboratory services within OPD are available with the same timetable. The total OPD attendance has been increasing yearly in the time period shown below. People are coming also from far and not only from our catchments area. OPD Visits Trends

80,000 70,000 60,000 50,000 40,000 30,000 Visit Trend

2009

2010

2011

2012

2013

2014

37,878

41,771

46,249

51,699

59,369

74,258

NOTE: Persons attending RCH clinics or CTC are not included unless they are referred to the General O.P.D.

2013

2014

Total number of patients referred to the hospital from lower levels

56

97

Total number of patients referred from the hospital to higher levers

367

195

Total number of patients transfer to lower levels for TB treatment

127

174

Page 28

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

MONTHLY ATTENDANCE IN OPD

OPD ATTENDANCE 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000

ug us ep t te m be r O ct o N ber ov em b D ec er em be r S

A

Ju ly

Ju ne

pr il M ay

A

Ja nu a Fe ry br ua ry M ar ch

0

Page 29

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

TOP TEN: DISEASE/CONDITION (NEW CASES)

PHYSIOTHERAPY

Number of sessions

2012

2013

2014

3,294

2,971

3,039

DENTAL CARE Treatment

N. of Children (0-14 years)

N. of Adults (+15 year)

201

1,455

Fillings

6

163

Others

47

298

Total

254

1,916

Extractions

Page 30

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

EYE CLINIC Eye Clinic Statistics

2013

2014

adults

137

109

children

31

50

Allergic

178

287

Other

31

151

Cataract

96

180

Trauma

68

74

Corneal Ulcer

31

31

Retina / optic Nerve

23

27

Uveitis

14

18

Corneal Scar

27

17

Glaucoma

4

10

adults

15

10

children

0

0

655

964

Conjunctivitis Bacterial

Trachoma

TOTAL

Blind Patients 3/60 BE

2013

2014

Normal eyes

51

69

Retina/optic

2

15

Cataract

12

6

Corneal Scar

4

0

Corneal Ulcer

0

0

Other / Unknown

1

12

TOTAL

70

102

Page 31

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

Refractive Error

2013

2014

Presbyopia

68

104

Myopia

55

102

Aphasia

0

4

Other

16

154

ectropion

3

3

other

11

13

Lacrimal

2

3

Orbital

7

7

Strabismus / Ambilopia

3

0

Other diagnosis

33

32

TOTAL

198

422

Lids

MENTAL ILL Illness

New Cases

Re-Attendance

TOTAL

Schizophrenia

45

125

170

Epilepsy

49

106

155

Confusional state

44

33

77

Exogenic Depression

31

25

56

Hysteria

32

20

52

Organic psychosis

22

19

41

Anxiety Neuroses

23

10

33

Psychosomatic illness

13

10

23

Senile dementia

7

3

10

Hypomania

1

8

9

Mental retardation

6

3

9

Personality disorder

3

3

6

Endogenous Depression

2

2

4

Others

5

1

6

TOTAL

283

368

651

Page 32

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

TB CLINIC Patients who started treatment this year: DIAGNOSIS

5 years old

TOTAL

Pulmonary TB AFB Negative

4

175

179

Pulmonary TB AFB Positive

0

55

55

MILIARY

2

42

44

SPINE

1

29

30

GLANDULAR

1

18

19

Extra Pulmonary TB MENINGITIS

0

2

2

OTHERS

2

82

84

10

403

413

TOTAL

Results of treatment of AFB + patients detected last year Regimen

Cured (smearing positive)

Treatment completed (no smear res.)

Dead

Treatment Failed

Def.

Transferred

Total

Standard course

0

18

9

0

1

279

307

Short course

2

0

1

0

1

52

56

Re-treatment

1

0

0

0

0

1

2

TB/HIV COLLABORATIVE SERVICES 2014 TOTAL TB PATIENTS: 413

HIV NOT TESTED

HIV TESTED

HIV POSITIVE

HIV NEGATIVE

56

357

234

123

14%

87%

66%

34%

REFERRED TO CTC

NOT REF. TO CTC

UNDER ART

UNDER C.P.T.

216

18

152

136

92%

8%

70%

63%

Page 33

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

HIV CLINIC Ikonda Hospital has a busy CTC clinic, open from Monday to Friday from 8.00 a.m. to 3 p.m. and on Saturday from 8.00 to 1.00 p.m. Started in 2004, it is one of the CTCs in Makete District with Makete, Bulongwa, Matamba, Lupila, Mang’oto and Lupalilo. It has 5,158 registered patients and 3,088 treated with ARVS. It follows the national guidelines of NACP. HIV test kits and ARVs are provided from government on quarterly base. Ikonda CTC also provides free clinical and laboratory follow up for the registered patients.

SUMMARY OF CTC ACTIVITIES QUARTER I

QUARTER II

QUARTER III

QUARTER IV

No. New patients

62

85

37

64

No consultations

5,433

5,240

5,400

5,082

Recorded patients

4,990

5,069

5,102

5,158

Male

1,771

1,798

1,811

1,840

Female

2,742

2,789

2,806

2,827

Children

477

482

486

491

N.B. The number of recorded patients is a cumulative number

PATIENTS TREATED WITH ARVs IN IKONDA CTC QUARTER I

QUARTER II

QUARTER III

QUARTER IV

57

69

60

67

Patients on ARVs

2,894

2,963

3,021

3,088

Male

1,046

1,066

1,084

1,111

Female

1,592

1,637

1,672

1,707

Children

256

260

265

270

Transferred

20

28

45

12

Dead

8

20

11

11

New patients

Page 34

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

VOLUNTARY COUNSELLING AND TESTING (VCT) CLIENT COUNSELLED

Tested HIV +

Tested HIV -

Age

M

F

M

F

M

F

1.5 - 14

172

178

27

26

145

152

15 – 24

267

333

39

52

228

281

25 – 49

1,289

1,460

308

270

981

1,190

50+

445

490

57

66

388

424

2,173

2,461

431

414

1,742

2,047

TOTAL

Note: In September 2014 VCT was not done because of shortage of HIV tests in the country.

Tested Clients per Age Band (Year 2014) 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 0

1.5 -14

15 - 24

25 - 49

50+

HIV +

53

91

578

123

HIV -

297

509

2,171

812

PITC results are not included in these data.

Page 35

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

MOTHER AND CHILD HEALTH (RCH) CLINIC There is an RCH clinic in the hospital that serves Ikonda and Tandala people and a mobile RCH that serve the people of Ihela, Usagatikwa, Masisiwe and Ibaga. Hospital RCH

Outreach RCH

Total

ANTENATAL (first visits)

127

41

168

CHILD CARE (first visits)

115

49

164

First visits is the number of new registrations during the year

IMMUNIZATION

BCG

DPT 3

OPV 3

MEASLES

Hospital RCH

1034

168

168

239

Outreach RCH

0

49

49

0

FOLLOW UP OF CHILDREN UNDER FIVE YEARS 2014 Villages

Follow-Up

Leave

Died

Cont. Follow-Up

IHELA

731

9

1

721

MASISIWE

604

5

1

598

TANDALA

2,492

23

2

2,467

IKONDA

2,460

16

0

2,444

USAGATIKWA

1,072

15

0

1,057

TOTAL

7,359

68

4

7,287

Page 36

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

P.M.T.C.T. (PREVENTION OF MOTHER TO CHILD TRANSMISSION) Ikonda Hospital runs P.M.T.C.T. program according to national guidelines, both inside the hospital, in maternity ward and in RCH, and in5 villages: Tandala, Ihela, Usagatikwa, Masisiwe and Ibaga and Ikonda and surroundings.

2012

2013

2014

Total clients counseled

255

256

273

Total clients tested

255

256

273

22 233 0 22 22

31 225 0 31 31

21 252 0 0 40

22

33

39

86 9 77

112 8 104

142 5 137

0

2

9

0 0

0 2

0 9

31

30

40

1 30

0 30

0

Positive Negative Clients not tested Clients given drugs (NVP) Children given milk (exposed baby) Total partners tested

Adults Children

Positive Negative Total children tested at 18 months Positive Negative Total children tested by PCR Positive Negative

Note: Most of these children were born before PMTCT program has been started.

FOOD PROGRAM ASSISTANCE In 2014 the Hospital has continued a food program assistance to prevent and cure malnutrition. This program involves 5 villages visited every month by the mobile clinic but also children admitted in paediatric ward and other patients in bad conditions admitted in the hospital.

Page 37

CONSOLATA HOSPITAL IKONDA

Annual Report 2014

PHARMACY Drug list includes 350 items for gastro-intestinal system, cardiovascular system, respiratory system, central nervous system, infections, endocrine system, obstetrics, gynaecology and urinary-tract disorders, nutrition and blood, musculoskeletal and joint deseases, eye, ear, nose, skin problems, immunological products, vaccines and anaesthesia. The expenditure for drugs in 2014 was 805,691,889 tsh. Government supplied free ARVs, drugs for TB, Coartem for malaria and drugs for STI (2,957,050 tsh).

INFUSION UNIT Infusion unit started in 2000, is still producing fluids. Dextrose 5% in small volumes for children is produced in the hospital because still not available in the local market. Normal saline produced in our unit is used for irrigation and dressing . In the table below the quantities produced in 2014 I.V.Fluids

Produced in Ikonda

Dextrose 5% 100ml

1,223

Dextrose 5% 150ml

448

Dextrose 5% 250ml

316

Sodium Chloride 500ml

3,319

Water for inj 100ml

327

Page 38