Gardo General Hospital

Introduction. Despite the global decrease, the neonatal mortality rate has remained high in sub-Saharan Africa, including Somalia. There is a need to continually identify and localize the drivers of neonatal mortality to help policy interventions aimed at its reduction. This study estimated the prevalence of and factors associated with Neonatal Mortality among newborns attending Banadir Hospital 2023. Methods. A facility-based cross-sectional study was conducted among 1435 neonates admitted to the neonatal intensive care unit (NICU) of Banadir Hospital from January to December 2023, and data were extracted from the medical charts and through a structured questionnaire administered to the parents. Descriptive and logistic regression analyses were performed to identify the factors associated with neonatal mortality. Results. The median age of the neonates was 1 (IQR: 1-6) days, 59.4% (853/1435) were male, 54.5% (782/1435) were born at Banadir Hospital, 25.6% (95% CI: 23.5-28.0, 368/1435) newborns died before discharge. The median age of the mothers was 27 years (IQR: 23-30) years. The majority of the mothers 1127 (78.5%) were multiparous, 50.7% (728/1435) had no ANC follow-up, and 79.4% of the neonates stayed at the hospital <7 days. Mother’s education (aOR: 0.01; 95% CI: 0.01-0.05), parity (aOR: 9.7; 95%: 5.33-17.7), age of the baby (aOR: 0.23; 95% CI: 0.13-0.39), gestational age (aOR: 7.12; 95% CI: 2.61-19.33), history of chronic disease (aOR: 0.2; 95% CI: 0.06-0.41) and History of abortion (aOR: 0.2; 95% CI: 0.11-0.31) were significantly associated with neonatal mortality. Conclusion. The prevalence of neonatal mortality is high. Neonatal mortality was associated with mother’s education, parity, prematurity, history of abortion, history of chronic disease, and being less than 7 days of life. Improved maternal education, early management of preterm birth, and newborn illnesses should be priorities for reducing neonatal deaths.

Background Necrotizing fasciitis which is commonly known as “Flesh-Eating Disease” is an uncommon soft-tissue infection. It is characterized by widespread fascial necrosis with relative sparing of overlying skin and underlying muscle. Mostly it is associated with severe systemic toxicity and a fulminant course. It is usually rapidly fatal unless promptly recognized and aggressively treated with appropriate antimicrobials and surgical debridement at the earliest. Methods Our study was a prospective study conducted on 140 patients over a period of 2 years from June 2018 to June 2020 in a tertiary care hospital, GGH, Kadapa. All patients were selected randomly and evaluated by taking proper history, thorough clinical examination, routine laboratory investigations and histopathological examination of the debrided tissue and the outcomes were analysed to know the efficacy of LRINEC Scoring in diagonising necrotizing fasciitis. Results Most common age group was 41-50 years. Males were commonly affected, accounting to 74% i.e., 111 patients and the remaining 39 patients were females (39%). Fever, inflammation of the involved area were the most common presentations. Majority were diabetic and hypertensive accounting to 55.3% and 52.7% respectively. All patients presented with symptoms with swelling, redness, pain and induration. Eighty-one percent had elevated CRP. Total WBC count was raised in 78.7% of the cases. Fifty-six percent of the cases had haemoglobin less than 11g/dl. Hyponatremia was observed in 81.3% of the patients. Majority (52.7%) had normal sr. creatinine i.e., &lt; or =1.4. RBS was elevated in 54.7% of the cases. In our study 87.3% of the patients had a LRINEC score &gt;6. Histology was positive for necrotising fasciitis in 92% of the cases, among them majority had polymicrobial organisms on culture. Conclusion In patients with severe soft tissue infections, LRINEC scoring based on laboratory parameters is an easy and reliable diagnostic tool to diagnose Necrotizing fasciitis accurately.

There is insufficient trained personnel to do adequate individual therapy under medical guidance for several million partially handicapped individuals. If Government and private agencies assume that serious therapy is worth while, three suggestions are offered for improved utilization of the “unfit.” 1. Improved techniques for maintaining high morale which will strengthen ego organization and provide social support for both the sick and healthy. 2. Study more intensively the problems of thinking by “qualitative” techniques, notably in cases of cerebral injury, “post-operative cases” and “lobotomy.” The methodology developed in this field is valuable in the study of psychotics, neurotics, and psychopaths. 3. Industrial psychiatrists and engineers should cooperate in a program in which patients are trained to do jobs which are designed to match their capabilities. The present programs for rehabilitation seem inadequate in view of the great need to get some useful work out of the huge population with marginal ability. The lack of trained personnel to operate such programs is a serious drawback, but might be overcome. For the working conditions which surround the men assigned to the task of drawing the diagrams of the future, I can think of no better description than that given by Doctor Alan Gregg in the Terry Lectures, “The Furtherance of Medical Research” (11).