Jinja Educational Trust
Healthcare Report to the Trustees September 2015
Background
During the last medical visit in February 2015 we started a monthly disease reporting
process via Nurse Rose for Sonrise Babies and Children that Dave has passed back for
collation and analysis. With six months of data now available we can examine the
true background of what is happening across Sonrise Babies and Children and we
also collected basic data on the aunties/adults associated with these facilities. The
idea was to benchmark the background incidence, develop some disease-based
protocols for the commonest illnesses to improve the level of health and to prioritise
support/supplies for future medical and general visits. These actions are all part of
the set-up activities described in the Health Care Plan 2014-2020, first presented at
the May 2014 Trustee meeting.
Data Collection Method: The basic data collection form used by Nurse Rose is shown
below:Fig1: Monthly Medical Activity Report Form
ACTIVITY REVIEW SONRISE BABIES AND CHILDREN
Month:
Year:
Total number
Babies
Children
New children this month
Babies
Children
Malaria tests this month
Vaccinations this month
Babies
Total
Pos
Children
Total
Pos
Babies
Children
Number of new diagnoses this month
Condition
RTI (cough/flu)
Malaria
Skin/fungal
Gastric
Diarrhoea
Other infection
Other skin (rash)
Eye
CNS (headache/fits
Babies
Children
Adults
The forms collected information for all common illnesses and, in addition the
number of tests/positive tests for malaria were recorded. The basic numerical data
Sonrise Babies, Sonrise Children and Adults linked to both units are shown in the
following tables:Table 1: Sonrise Babies: all reported diagnoses by month (Feb-Jul 2015)
HEALTH ACTIVITY REVIEW SONRISE BABIES 2015
Feb
Mar
April
May
June
July
Total babies
New babies
Nos malaria tests
Nos pos
23
4
1
1
25
2
4
4
25
0
4
4
25
0
3
3
25
0
2
2
25
0
5
5
New diagnoses:
RTI (cough)
Malaria
Skin/fungal
Gastric
Diarrhoea
Other infection
Other skin (rash)
Eye
CNS (Headache/fits)
Others (specify)*
Total treated (new+existing)
11
1
0
0
7
1
4
1
0
0
25
6
4
4
0
3
0
3
1
0
0
21
10
2
1
0
3
1
2
0
0
4
23
12
3
0
0
3
2
2
0
1
3
26
11
2
2
1
4
1
0
1
0
0
22
14
5
1
1
4
0
3
1
0
0
29
*boils
*boils
Table 2: Sonrise Children: all reported diagnoses by month (Feb-Jul 2015)
HEALTH ACTIVITY REVIEW SONRISE CHILDREN 2015
Feb
Mar
April
May
June
July
Total children
New children
Nos malaria tests
Nos pos
34
0
2
2
34
0
3
3
34
0
3
3
34
0
2
2
34
0
2
2
34
0
3
3
New diagnoses:
RTI (cough)
Malaria
Skin/fungal
Gastric
Diarrhoea
Other infection
Other skin (rash)
Eye
CNS (Headache/fits)
Others (specify)*
Total treated (new+existing)
17
2
3
1
0
1
0
1
1
0
26
10
3
2
0
0
0
2
0
1
0
18
13
1
4
0
0
1
0
0
0
2
21
16
2
2
0
0
1
0
0
0
1
22
20
2
4
1
0
0
3
0
0
0
30
22
3
2
3
1
0
0
0
0
0
31
*boils
*boils
Table 3: Sonrise Adults: all reported diagnoses by month (Feb-Jul 2015: Total sample
size not available)
HEALTH ACTIVITY REVIEW SONRISE ADULTS 2015
Feb
New diagnoses:
RTI (cough)
Malaria
Skin/fungal
Gastric
Diarrhoea
Other infection
Other skin (rash)
Eye
CNS (Headache/fits)
Others (specify)*
Total treated (new+existing)
Mar
7
4
0
6
0
0
0
0
3
0
20
April
15
7
0
3
0
0
0
0
5
0
30
May
7
4
1
4
0
0
0
0
0
0
16
June
July
14
0
0
3
0
0
0
0
0
0
17
9
5
0
5
0
0
0
0
2
0
21
17
8
0
5
0
0
0
0
0
0
30
Rather than just deal with the absolute number of diagnoses (which may be
somewhat distorted as a child may have had more than one treatment for the same
condition or more than one disease recorded during the month) it is perhaps better
to look at the incidence of disease expressed as a percentage of all treatment events
during each month. Table 4 and 5 show summarise the numerical data for the adults
and combined Babies and Children respectively to give an overall view.
Table 4: Sonrise Adults: disease incidence expressed as a percentage of all treatment
events Feb-Jul 2015
HEALTH ACTIVITY SONRISE ADULTS expressed as a percentage of all treatment events
RTI (cough)
35
50
44
82.4
42.8
Malaria
20
23
25
0
23.9
Skin/fungal
30
0
6
0
0
Gastric
0
10
25
17.6
23.8
Diarrhoea
0
0
0
0
0
Other infection
0
0
0
0
0
Other skin (rash)
0
0
0
0
0
Eye
15
0
0
0
0
CNS (Headache/fits)
0
17
0
0
9.5
Others (specify)*
0
0
0
0
0
56.7
26.7
0
16.6
0
0
0
0
0
0
Table 5: Sonrise babies and children: disease incidence expressed as a percentage of
all treatment events Feb-Jul 2015
HEALTH ACTIVITY REVIEW SONRISE BABIES + CHILDREN 2015 expressed as a percentage of all treatment events
RTI (cough)
Malaria
Skin/fungal
Gastric
Diarrhoea
Other infection
Other skin (rash)
Eye
CNS (Headache/fits)
Others (specify)*
Feb
54.9
5.8
5.8
1.9
13.7
3.9
7.8
3.9
1.9
0
Mar
41
17.9
15.4
0
7.6
0
12.8
2.5
2.5
0
April
52.2
6.8
11.4
0
6.8
4.5
4.5
0
0
13.6
May
58.3
10.4
4.2
0
6.2
6.2
4.2
0
2.1
8.3
June
59.6
7.6
11.5
3.8
7.7
1.9
5.8
1.9
0
0
July
60
13.3
5
6.6
8.3
0
5
1.6
0
0
The data are also presented below in graphical form for better analysis of trends,
first for the adults and second for the combined Sonrise Babies and Children;Fig 2: Adults (Aunties) at Sonrise – disease incidence expressed as a % of all
treatment events
85
80
75
70
65
60
RTI (cough)
55
Malaria
Skin/fungal
50
Gastric
45
Diarrhoea
Other infec on
40
Other skin (rash)
35
Eye
CNS (Headache/fits)
30
Others (specify)*
25
20
15
10
5
0
Feb
Mar
April
July
June
May
Fig 3: Sonrise Babies and Children – disease incidence expressed as a % of all
treatment events
65
60
55
50
45
RTI (cough)
Malaria
40
Skin/fungal
Gastric
35
Diarrhoea
Other infec on
30
Other skin (rash)
Eye
25
CNS (Headache/fits)
Others (specify)*
20
15
10
5
0
Feb
Mar
April
May
June
July
Discussion
Nurse Rose is to be congratulated for the thorough and consistent way in which she
has recorded the data. The dataset was complete and there is no indication it has
suffered from any lack of detail. There may be an issue with the number of malaria
tests undertaken vs number of positive tests as they always matched – either she is a
brilliant diagnostician (quite possible!) and gets it right every time or negative tests
have not been fully recorded – however, given the numbers involved it is not a
critical observation. I am still not certain if all the reported events represent new
diagnoses (the category on the form) or whether some illnesses have been carried
over from month to month. It is quite possible that a given child/adult may have
been treated more than once for the same condition in any given month – hence the
presentation of the data as a percentage of all treatment events.
The additional reports about individual children (e.g. state of nutrition or general
wellbeing) were collected as free text on the form and some children probably do
need a more formal assessment linked to an improved dietary plan to encourage
proper growth and development.
So, what can we conclude from these data? (while recognising the relatively small
sample size):1. The pattern of illness is pretty stable over time across adults and children
2. It is not just the children who report sickness - adults have a significant rate
of illness although the pattern is somewhat different
3. Upper respiratory symptoms (cough, colds, runny nose) are by far the
commonest ailment in both groups and these symptoms seems to be
negatively correlated in some way with malaria diagnoses – higher malaria
rates were associated with fewer respiratory cases suggesting respiratory
symptoms may be a more common feature of malaria presentation.
4. The percentage incidence of malaria events is higher in adults than in
children
5. There will be a lower number of adults in the sample but they consistently
report respiratory and gastric symptoms alongside the continuous
background incidence of malaria.
6. In the children dermatological conditions, including fungal infection, were
present throughout, but in April and May there was an outbreak of
cutaneous boils (probably a bacterial or viral infection) which then settled in
June.
7. It is interesting to speculate to what extent having a nurse on site helps
reduce the incidence of disease and/or helps children and adults to get
treatment and recover more quickly. Some of her written comments suggest
Nurse Rose would like more help with the management of infection and
dermatological conditions and advice on diet to improve general wellbeing.
Conclusions and actions
The general health and wellbeing of the children and adults in JET facilities continues
to be of a good standard. This survey indicates that we should pay attention to the
adults probably just as much as the children and that the primary support areas
should focus on malaria prevention and symptomatic treatment of respiratory
conditions including, where appropriate, more targeted antibiotic treatment to clear
chest or sinus infections.
I shall prepare a protocol for the systematic management of respiratory disease and
we can then align this with supplies taken out during any trip to Jinja.
For malaria we need to have a campaign of education about the disease and its
prevention, a full check on the integrity of window mesh covers and malaria nets at
each facility (Mama Jane’s could usefully be included) and then follow through to
make sure they are used. As the mosquito usually bites during the night we can also
consider use of insect sprays before bedtime to reduce the mosquito count but that
has to be balanced against the risk of chemical exposure or triggering lung reactions
in children. However, given that repeated attacks of malaria (the common pattern in
young children) can affect growth and development and probably reduces the child’s
ability to learn while challenging their immune system it would be worthwhile raising
this to the status of a special campaign across JET facilities and then monitor the
impact through the monthly reporting mechanism.
For this we can draw on the work already done by the London School of Hygiene and
similar agencies. They will have some suitable training materials that we could use
for such a campaign.
Finally I have been impressed how use of healthcare data is used on the Soft Power
Health website as a way of communicating their work objectives and the positive
impact of donations which are linked to specific projects, staff or equipment. This is
something we could usefully consider for fundraising purposes. Check out their 2nd
Quarter 2015 update report
http://softpowerhealth.org/pdf/SPH2ndQuarter2015Report%28FINAL%29-2.pdf
and their 4th quarter 2015 newsletter which, at the end, itemises, the individual costs
of items supported by donations
http://softpowerhealth.org/pdf/SPHNewsletter-Dec2014.pdf
The other event I should report since the last meeting was contact with CIPLA
(http://www.cipla.com/), an Indian generics pharmaceutical company with an office
in London which apparently has strong links with Africa and an interest in possibly
supplying products to charities and providing philanthropic support. I have a
meeting planned with the Deputy Chairman (Kamil Hamied) in London and will see if
this might be of any help.
I look forward to discussing these possible ideas with the Trustees at our next
Meeting.
Hamish Cameron
September 22nd 2015