ANNUAL REPORT 2012
TABLE OF CONTENTS
FORE WORD...... 2 MISSION, VISION AND GOAL STATEMENTS ...... 3 AKNOWLEDGEMENT ...... 4 LIST OF ABREVIATIONS ...... 5 INTRODUCTION...... 7 COMMUNITY AND HEALTH STATUS ...... 9 TOP TEN DISEASES OPD 2011 .... Fout! Bladwijzer niet gedefinieerd.11 TOP TEN DISEASES AT IPD FOR 2012. Fout! Bladwijzer niet gedefinieerd.12 HEALTH POLICY & INFRASTRUCTURE...... 12 HOSPITAL MANAGEMENT...... 13 STAFF ESTABLISHMENT AS AT 31/12/2012...... 15 ARRIVALS AND DEPARTURES IN 2012 ...... 16 FINANCES ...... 17 OUT-PATIENT DEPARTMENT (OPD)...... 17 ADMITTED PATIENS IN DIFFERENT DEPARTMENTS FOR YEAR 2012...... 20 THEATRE DEPARTMENT...... 21 TUBERCULOSIS AND LEPROSY...... 26 DENTAL DEPARTMENT ...... 26 PHYSIOTHERAPY DEPARTMENT ...... 26 OPHTHALMOLOGY...... 27 MENTAL HEALTH...... 28 SUPPORTIVE AND DIAGNOSTIC SERVICES: ...... 29 PHARMACY...... 30 RADIOLOGY DEPARTMENT ...... 30 TECHNICAL DEPARTMENT ...... 31 ELECTRICITY AND WATER SUPPLY ...... 32 ADMINISTRATION...... 32 SOME IMPORTANT FIGURES SHOWING OVERALL SITUATION OF THE HOSPITAL ...... 33 IMPORTANT HOSPITAL INDICATORS FOR THE 2011...... 33 INPATIENTS DIAGNOSIS ...... 34 PRIMARY HEALTH CARE REPORT (PHC) ...... 43 PERFORMANCE DATA (STATIC AND MOBILE CLINIC) ...... 45 CARE AND TREATMENT CENTRE (CTC) ...... 47 MALARIA SITUATION: ...... 48 RUBYA SCHOOL OF NURSING AND MIDWIFERY ...... Fout! Bladwijzer niet gedefinieerd. THANKS GIVING ...... 54
1 FORE WORD
Rubya District Designated Hospital is running and managed by Bukoba Catholic Diocese. Its Vision, Mission and Goal reflect the core value of Bukoba Catholic Diocese.
Being a District Designated Hospital we get support from MOHSWF and we operate our Hospital by observing all Government policy.
This is 2012 annual report, under this report our progress for the entire year, our achievements, challenges and future plans will be reflected.
2 MISSION, VISION AND GOAL STATEMENTS FOR RUBYA DISTRICT DESIGNATED HOSPITAL
VISION: The vision of Rubya Hospital is to become the best health care provider in Muleba District.
MISSION: To provide comprehensive health care through curative and preventive services, with the help of Jesus Christ the Healer.
GOAL STATEMENT: To offer high quality health care to the beneficiaries/clients at affordable cost.
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AKNOWLEDGEMENT
We are very grateful to those who took part in preparation of this 2012 annual report.
To mention some, Hospital Management team, All Hospital in charges, MTUHA co- ordinator Mr Gideon Kinyina, Hospital Secretariat team, and Rubya School of Nursing, all deserve special thanks for their tireless effort in preparations of this report.
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LIST OF ABREVIATIONS
AMREF African Medical And research Foundation AIDS Acquired Immunodeficiency syndrome ARI Acute respiratory infections ACO Assistant Clinical officer AFB Acid Fast Baccila ANO Assistant Nursing officer ARV/ART Antiretrovirals/Antiretroviral terapy AMO Assistant Medical Officer ANC Antenatal Care BCG Bacilius Calmette Guerin BOG Board of Govervenance BTL Bilateral Tube ligation CPD Cephalopelvic proportion CCF Congestive cardiac failure CHF Community Health fund CBHC Community Based Health Care CEDHA Centre for Educational Development in Health Arusha CO Clinical Officer CTC Care and Treatment Centre DDH District Designated Hospital DMO District Medical Officer DPT Diphtheria Pertusis Tetanus DTLC Distric tuberculosis and leprosy coordinator EID Early Infant Diagnosis FSG Family support group HBC Home Based Care HIV Human Immune Defficiency Virus ITNs Impregnated Treated Nets ICAP International Care for Aids Programme ICU Intensive care unit IT Information Technology IPD In Patient Department KCMC Kilimanjaro Christian Medical Centre MO Medical Officer MPH Masters in Public Health MSD Medical Store Department MC Male circumcision MOHSWF Ministry Of Health and social warfare
5 NHIF National Health Insurance Fund OPD Out Patient Department OIs Opportunistic infections PHC Primary Health Care PCR Polymerise Cain reactions PMTCT Prevention Maternal to Child Transmission PE Peer Educator RC Roman Catholic RMO Regional Medical Officer RCH Reproductive and Child Health RNMTC Rubya Nursing Midwife Training Centre STD Sexual Transmitted Disease TB Tuberculosis TT Tetanus Toxoid UTI Urinary tract infections VHWs Village Health Workers VCT Voluntary Counselling and Testing VVF Vesco Vaginal Fistula VSO Voluntary Service Overseas WHO World Health Organization
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INTRODUCTION
HISTORICAL BACKGROUND
The beginning of Rubya Hospital was initiated by the Roman Catholic Missionaries from Germany in the years 1920 to 1930. From then they prepared Mr. Leo Rufulebe to take over the medical services which was enhanced by Father Otto Mors in the early 1940 -1950. The services were provided at a Modest Dispensary attached to the parish church.
Until 1956 Rubya Hospital when was opened by Franciscan Sisters of Breda from Netherlands, the hospital gradually developed from a small pre-existing dispensary with 20 maternity beds. Over the years the complex was expanded until it reached its present shape.
STATUS OF THE HOSPITAL
After signing the contract between the Government of Tanzania and Bukoba Catholic diocese authority, the hospital became the Designated District Hospital for Muleba district that was in 1977. Official bed capacity which was agreed in 1977 is 162; the government pays a major part of the running costs of the hospital. To date, the hospital has remained under the ownership of Bukoba Catholic Diocese. Since 1977 the government was covering all cost for treatment of patients thus patients were not paying anything for the services, but in February 1994 cost sharing was started as stipulated by the government. However, children under five years, pregnant mothers, poor old men above sixty years of age and those on ARV are treated free of charge. Since then, Rubya Hospital has a main building containing the theatre, an X-ray- room, CTC, mortuary, the pharmacy and administration offices. Besides there are six wards: male ward, female ward, children ward, maternity ward, and a nutrition unit. There is a separate outpatient department containing the laboratory and a separate unit for reproductive and child health.
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In 1963 Rubya Nurses Training Centre was opened. It provided a three-year course in general nursing and in 1970 a one-year course in midwifery was added. The certificate course ended in 2007.In the year 2004 upgrading diploma course in nursing was started, the first bunch graduated on August 2006. In the year 2008 we have opened an integrated nursing school, the overall intake of pre service and in service nurse students per year is 50 and 35 nurses respectively.
GEOGRAPHY AND POPULATION Muleba district is situated in Kagera Region in northwest Tanzania. Kagera Region is bordered by Uganda to the north, Rwanda and Burundi to the west and Lake Victoria to the east. The region is divided into 8 districts, Muleba being one of them.
Rubya is the Designated Hospital for Muleba district. Muleba District covers an area of approximately 2500 square kilometers with a total population of 386,320 inhabitants in 2002 census (457,600 projected populations for 2009). It has 5 main divisions Nshamba, Muleba, Kamachumu, Kimwani and Izigo. Nshamba division is a catchment area for Rubya hospital which is estimated to have approximately 1/3 of the district population. Besides Rubya Hospital there are two non-governmental (fee- paying) hospitals in Muleba District namely Ndolage Hospital in Kamachumu divisions, 25 kilometers from Rubya, and Kagondo Hospital in Izigo division, 45 kilometers from Rubya. Other health facilities in Muleba district includ 3 health centers: Kaigara Health centre in Muleba division, Kimeya health centre in Kimwani division and Kamachumu Health centre in Kamachumu division. Also there are a number of dispensaries run on governmental and private basis. In reality more people come to Rubya Hospital, probably the other two hospitals are more expensive comparatively; moreover its catchment area is highly populated. Most people by pass the peripheral dispensaries and health centers and come directly to Rubya hospital to receive health care without being referred. The cause of by passing is not yet known.
8 The climate of Muleba District is mild with 2 main rainy seasons, one from March to May and the other from September until December. The average rainfall varies between 800-1600mm per year. Soil erosion is due to woodcutting and overgrazing and is one of the serious problems in some areas.
Rubya lies in Nshamba division, on the west side of a high sandstone plateau on an altitude of 1500 meters above sea level overlooking the Ngono plains. The hospital is 85 kilometers from Bukoba town, which is the regional capital, and 20 kilometers from Muleba, where the district headquarters are located. Rubya hospital is 20 kilometers off the main road Bukoba-Biharamulo-Mwanza. Also there is good communication by public transport to and from Muleba, internet services to communicate within and outside the District through e-mail. Availability of reliable electricity had contributed much to the development. Despite the improvement of public transport, patients are coming on foot, bicycles and on home made stretchers due to geographical physical features.
Hospital drugs and other major requirements are bought from Medical Store Department (MSD) Mwanza around 400 kilometers by car and difficult to reach in the rainy seasons. However, availability of drugs at MSD is still a problem. Patients can be referred to Bukoba Regional Hospital, Bugando Medical Center in Mwanza , Kilimanjaro Christian Medical Centre (KCMC ) in Moshi and Muhimbili National Hospital in Dar es Salaam, this can be done by referring patients physically or by using telemedicine.
COMMUNITY AND HEALTH STATUS Muleba District is divided into 5 divisions with 31 wards (subdivisions). The majority of the people are Haya by tribe but there are also some immigrants from Rwanda and Burundi who live among citizens; however the District authority is making efforts to make sure that non-citizens are returned back to their homes. The language of daily life is Kihaya; Kiswahili the national language is mostly spoken in trading centers and towns but rarely used in villages. The main religions of the area are Christianity (predominantly Roman Catholic), Protestants and the Muslims.
9 AGRICULTURE Majority of people are peasants cultivating their own plots. Staple food consists of bananas that are available almost throughout the year. However, the banana trees are infested with weevils resulting in decreasing yields. Other products grown are maize, beans, groundnuts, cassava and sweet potatoes. Some have small vegetable gardens for home use. Few gardens produce enough vegetables to sell at the local markets. Coffee is the only cash crop grown. It is sold at co-operative unions and being processed in the coffee factory in Bukoba. Many families own either chickens, goats, cows or both.
HEALTH STATUS Vulnerable groups among the population include pregnant mothers, underfive children and orphans. The under five-mortality rate is fluctuating. The childbearing group suffers from conditions related to pregnancy and pregnancy outcome. For the year 2012, the hospital health status is shown below by a list of the top ten diseases for OPD as well IPD.
TOP TEN DISEASE AT OPD FOR 2012.
BELOW FIVE YEARS ABOVE FIVE YEARS SN DISEASE NO. DISEASE NO. CASES CASES 01 MALARIA 4,827 MALARIA 2,499 02 OTHER DIAGNOSIS 3,290 EYE INFECTIONS 1,923 03 ARI 1,945 INTESTINAL 1,592 WORMS 04 ILL DEFINED 1,700 OTHER 1,148 SYMPTOMS DIAGNOSIS 05 INTESTINAL WORMS 807 ARI 1010 06 PNEUMONIA 765 EMERGENCY 956 ORAL CARE 07 UTI 752 STI 894 08 DIARRHOEA 432 PID 632 09 EYE INFECTIONS 323 UTI 415 10 SKIN INFECTIONS 174 DIABETES 315 MELLITUS
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TOP TEN DISEASE AT OPD FOR 2011.
BELOW FIVE YEARS ABOVE FIVE YEARS SN DISEASE NO. DISEASE NO. CASES CASES 01 MALARIA 3,225 OTHER DIAGNOSIS 2648 02 DIARRHOEA 841 MALARIA 1,728 03 PNEUMONIA 603 FRACTURE/DISLOCATION 284 04 ANAEMIA 527 HYPERTENSION 268 05 ILL DEFINED CONDITION 388 HIV/AIDS 258 06 OTHER DIANOSIS 335 DIARRHOEA 244 07 UTI 303 UTI 135 08 INTESTINAL WORMS 301 ARI 218 09 ARI 292 PID 215 10 FRACTURE/DISLOCATION 120 1DC 211
NOTE: From the above tables, it shows that Malaria and STI were the problems for 2011 but we see a tremendous decrease of these conditions for the year 2012 the explanations for this could be; On going intervention of health education in the community especially on the utilization of bed nets. Early and effective treatment of STI infections.
TOP TEN DISEASE AT IPD FOR 2012.
BELOW FIVE YEARS ABOVE FIVE YEARS SN DISEASE NO.CASES DISEASE NO.CASES 01 Malaria 3,225 Other diagnosis 2,648 02 Diarrhea 841 Malaria 1,728 03 Pneumonia 603 Diarrhea 476 Diseases 04 Anaemia 527 Fractures/dislocat 284 ion
11 05 IDC 388 HIV/AIDS 258 06 Other diagnosis 335 Hypertension 268 07 UTI 303 Acute respiratory 218 Infection 08 Intestinal worms 301 PID 215 09 Acute respiratory 292 Peptic ulcer 150 Infection 10 Fractures/Dislocation 120 Diabetes mellitus. 135
TOP TEN DISEASE AT IPD FOR 2011.
BELOW FIVE YEARS ABOVE FIVE YEARS SN DISEASE NO.CASES DISEASE NO.CASES 01 Malaria 2298 Malaria 684 02 Diarrhea 1151 Other 570 diagnosis 03 Anemia 728 UTI 381 04 Pneumonia 571 Wounds 326 05 Other diagnosis 507 Pneumonia 183 06 UTI 350 Anemia 181 07 Acute respiratory 306 Diarrhea 167 Infection 08 Malnutrition. 146 Peptic ulcer 118 09 Intestinal worms 117 ARI 86 10 Wounds 60 Diabetes 70 mellitus.
NOTE:
Malaria and diarrhea of were major issues for year 2012 which also caused many deaths to community. For chronic illnesses like Clinical IDS, Hypertension and Diabetes mellitus and Malnutrition are still major problems.
HEALTH POLICY & INFRASTRUCTURE
Muleba District has 5 divisions and each division has at least one major health facility. There are 3 hospitals and 5 health centers. The 3 hospitals in the area (Kagondo, Ndolage, Rubya) act as referral centers for the dispensaries and health centers. For many unclear reasons patients bypass dispensaries and health centers without being referred. The health care delivery system in Muleba District focuses on
12 curative and preventive activities. Rubya hospital several programme are inco operated with our daily activities, these include:
a) Malaria control programme/Sentinile site b) School health programme, c) Expanded Programme of Immunization (EPI) d) Nutrition programme, e) National Tuberculosis and Leprosy control Programme (NTLP) f) National AIDS Control Programme (NACP) CTC VCT PMTCT PITC HBC EID PE M.C Primary Health Care activities done in Rubya Hospital are in accordance with the national policy. The government and development partners used to sufficiently fund these programs but recently not all programme are funded.
MAINTENANCE AFTER COMPLETION OF RENOVATION 2011 According to the undersigned note and part of an agreement made 04/12/2011 that Bukoba Catholic Diocese to fulfill the obligation to provide 15% of the cost of maintenance Rubya Hospital and Rubya School of Nursing . From our mutual understanding and joint promise to pay 15% of the maintenance, the work is now in good progress. The following activities have been done from local contribution on our part in 2012. i) Floor making with floor tiles lower and upper of the maternity ward ii) Renovation and replacement of sewerage system around the ward. iii) Replacement of new pipes into staff House Kanoni Street.
HOSPITAL MANAGEMENT
13 The main management boards of the Hospital are as follows:
BOARD OF GOVERNORS This is the supreme board of the hospital with 6 representative from the Diocese and 3 from the Government, 1 representative from the District council.
The board is responsible for policy making and approval of the annual budget and other major issues related to Hospital. It ensures smooth running of the hospital according to the guidelines laid down by the Ministry of Health and social welfare and the Diocese. The composition of Board members for the year 2012 included the following:
1. Rt.Rev. Bishop Nestory Timanywa Chairperson 2. Dr. Diocles L. Ngaiza Secretary 3. Rev. Fr. Peter Mutashobya (DHS) Member 4. DMO Member 5. Sr. Anchilla Musigula(H/Matron) Member 6. Mr. Nestor Rweyemamu(H/Admin.) Member 7. Sr. Nicolaus Nshekanabo (Tutor i/c) Member 8. RMO Member 9. MOH Representative Member 10. Representative from the Council Member 11. Sr Immaculate Katunzi Invitee
MANAGEMENT COMMITTEE This committee consists of 5 members of whom the Medical officer in charge is the chairperson. The management committee is responsible for the daily running of the hospital and usually meets monthly unless there is an urgent matter to be discussed.
Management committee members for 2012 included:
1. Dr. Diocles L. Ngaiza M.O I/c -Chairperson 2. Mr. Nestor Rweyemamu H/Adm - Secretary 3. Sr. Anchilla Musigula H/Matron - Member 4. Sr. Immaculate Katunzi H/Acct - Member 5. Sr. Nicolaus Nshekanabo Principle RNMTC - Member
DAILY BOARD This board manages the day – to day running of the hospital or urgent issues in case the management team cannot be called upon quickly. It’s composition include only 3 members such as, Medical officer in charge, Hospital Administrator and Hospital matron.
14 STAFF ESTABLISHMENT AS AT 31/12/2012
S.No CADRE ESTABLISHMENT CURRENTREMARKS NO. 01 Medical Doctor 1 1 3 More needed 02 AMO (General) 5 1 Less 4 03 AMO (Radiology) 1 1 Ok 04 AMO ( Ophthalmology) 1 1 Ok 05 AMO (Psychiatric) 1 0 LESS 1 06 AMO (Anaesthesia) 1 0 LESS 1 07 Clinical Officers 13 5 Less 8 08 Nursing officer 1 Less 5 09 Assist.Nursing Officers 10+ 46 LESS 22 10 Public Health Nurse 5 1 Less 1 11 Nurse & Midwife 33+ 29 Ok 12 Pharmaceutical Tech 1 1 LESS 1 13 Pharmaceutical Ass 1 1 LESS 1 14 Lab. Technician 1 3 Ok 15 Ass. Lab Technician 2 4 Ok 16 Hospital Secretary 1 1 Less 1 17 Hospital Accountant 1 1 Ok 18 Ass.Hospital 1 1 Less 5 Accountant 19 Health Officer 1 1 Ok 20 Personal secretary 2 3 Ok 21 Nursing officer i/c 1 1 Ok 22 Office assistant 2 1 Less 1 23 Supplies Assistant 1 0 Less 1 24 Medical recorder 2 0 Less 2 25 General technician 1 1 Ok 26 Physiotherapist 1 1 Ok 27 Dobi 4 0 Less 2
15 28 Mortuary attendant 2 1 Less 1 29 Medical Attendant 25+ 163 Exceed 30 Radiographer 1 1 Ok 31 Dental Assistant 1 0 Less 1 32 Drivers 3 5 Ok 33 Watchmen 4 8 Ok 34 ACO 0 0 Ok 35 IT Technician 0 2 Need training 36 Biomedical Eng. Tech 1 0 Less1 37 Stores& supp Officers 0 2 Less 2 38 Ocup. Therapist 0 1 Less 1
ARRIVALS AND DEPARTURES IN 2012
ARRIVALS IN 2012
S/No. CADRE TOTAL NUMBER 01 ANO 4 02 Clinical officers 5 03 Lab. Technician 1 TOTAL 10
DEPARTURES IN 2012
S/No. CADRE TOTAL NUMBER 01 Medical attendants 2 02 Clinical Officers 5 03 Nurses 4 04 Technician 1 05 ANO 4 TOATAL 16
16 FINANCES
Our income and expenditure starts from January to December every year. Rubya Hospital being Designated District Hospital for Muleba it gets funds mainly from Ministry of Health and social warfare (MHSWF), this includes basket fund, salary grant, MSD funds and other charges, call allowances, others include cost sharing and NHIF for the running costs of the hospital.
Government grants are still based on a total of 162 bed capacity signed in 1977; actually since 2002 the bed occupancy rate has been above 100% posing a big challenge to the hospital in running the hospital costs.
OUT-PATIENT DEPARTMENT (OPD)
UTILIZATION
The total number of Outpatient attendances in 2012 including other special clinics is 53,045 Compared to 54,429 for 2011 cases. It shows that the number of OPD attendances is almost the same as we continue saving all clients from the entire district.
All normal cases are seen by clinical officers with exception of pregnant mothers and difficult cases which are seen by Doctors at OPD. The general outpatient department operates from 8 a.m to 7p.m seven days per week. Every week there are special clinics for Diabetes mellitus, Tuberculosis and leprosy, mental health, Dental clinic. VCT/CTC and Eye clinics and they operate as special clinics from Monday to Friday.
INPATIENT DEPARTMENT For the year 2012, total numbers of admissions were 13, 273 while for 2011 were 14, 509 This department involves all patients admitted in hospital; it includes Male ward, Female ward, Maternity ward, Children ward, Private ward and General ICU.
For the year 2012, the number of admission, discharges as well as deaths in the respective wards are narrated in the table below:-
Department Admissions Discharge Deaths Patient days
17 Children ward 1 4,647 4,468 162 17,978 Children ward 2 770 725 39 2,864 Male ward 1,685 1474 125 9,550 Female ward 1,925 1769 98 9,690 Maternity ward (Mother) 3,939 3889 5 12,064 Maternity (Baby) 111 94 11 423 Private ward 196 178 6 1,172 Total 13,273 12,620 446 53,741
MALE WARD STAFF ESTABLISHMENT.
For the year 2012 the numbers of staff in Male ward was, Nurse Midwifes 4, Trained Nurses 2 and medical attendants 10, plus one Doctor for the ward round daily. In general this department continued to be understaffed hence overload to available staff.
FEMALE WARD
For the year 2012 the numbers of staff in Female ward was, Registered nurse 3, Enrolled Nurses 3 Medical attendants 10 and Ward attendant 2 plus one Doctor for the ward round daily.
PAEDIATRICS WARD.
For the year 2012 the numbers of staff in Pediatric ward was, Registered nurse 6, Enrolled Nurses 4 , Ward attendants 7 and Nurse assistants 9 plus one Doctor for the ward round daily, This ward is responsible for admitting children under five years and above 5 year up to 13 years of age. It is among the busy ward contributed by Intravenous medications and special attention of those under fives getting blood transfusion.
MATERNITY AND DELIVERIES
Maternity ward mainly deals with both Obstetric cases as well as Gynecological cases, Sick babies who are below four weeks of age are also admitted in Maternity ward, premature babies as well. For year 2012 we had 13 Assistant nursing officers, 3 Nurse II, 9 Nurse Assistants, 5 Medical attendants and One Doctor of the ward.
18 Total deliveries 3,547 with an average of 296 deliveries per month, 10 deliveries per day. Caesarian sections were 447 most of them with an indication of Obstructed Labour secondary to CPD most of them where referred from our nearby Dispensaries and Health centers.
In 2012 we had 5 maternal deaths compared to 5 maternal deaths for 2011, the main reason being late referral from other health facilities.
The table below shows some important figures in Maternity ward for the year 2012 compared to the year 2011.
S/No. ITEM 2011 2012. 01 Total deliveries 3715 3547 02 Normal deliveries 2618 2448 03 Abnormal deliveries 475 544 04 Multiple gestation 86 76 05 Caesarean section 368 447 06 Breech 47 50 07 Vacuum extraction 30 39 08 Abortion 228 291 09 Ectopic Pregnancies 8 18
NOTE: Normal deliveries have increased because of an increased antenatal awareness as health education is conducted at our health facility but also during our outreach services, those from remote area are allowed to stay in maternity waiting home until they deliver.
PERINATAL DEATHS
In the year 2012 we had a total of 9 deaths compared with 11deaths for the year 2011.
Among the causes of these deaths, home delivaries is the most predisposing factor, effort on heath education through PHC, RCH and others are in progress so as to increase the number of Hospital deliveries, Maternity renovation was finished and handled over by now it is in use with good quality care of antenatal and post natal care, although there was same challenges thus lack of some moden equipment used to care premature babies as prematurity was found to another factor contributing to these deaths.
TABLE SHOWING ADMITTED PATIENS IN DIFFERENT DEPARTMENTS FOR YEAR 2012 COMPARED TO THE YEAR OF 2011
YEAR 2012
19 Department Admissions Deaths Percentage Children ward 1 4,647 162 3% Children ward 2 770 39 5% Male ward 1,685 125 7% Female ward 1,975 98 5% Maternity ward (Mother) 3,717 5 0.1% Maternity (Baby) 129 11 8% Private ward 330 6 2% Total 13,273 446 3%
YEAR 2011
Department Admissions Deaths Percentage Children ward 1 5821 180 3% Children ward 2 861 28 3.2% Male ward 1742 116 7% Female ward 1975 212 11% Maternity ward (Mother) 3717 5 0.1% Maternity (Baby) 129 22 17% Private ward 330 8 2.4% Total 14,509 571 4%
NOTE: Total percentage of death for the year 2012 were 3% while for 2011 was 4%, it shows from above that we have significantly reduced the number of deaths for this year.
20 Perinatal death is still high at our facility this could be attributed by home deliveries whereby babies come already infected. Currently our Maternity ward has no Incubator for premature babies, may be this could be another factor contributing to an increased rate of perinatal death.
THEATRE DEPARTMENT
Rubya Hospital has one major theatre with two operating table, and two rooms Minor procedures one being at OPD with one operating table each. For the year 2012 the total number of Major operations performed were 876 and minor procedures were 4,632 compared with 788 major operations and 3,798 minor procedures for the year 2011, Operations conducted were both emergency cases and elective.
Most of the operations done are obstetric cases followed by trauma associated with accident. At our hospital we have a programme one by frying doctor by AMREF and another is Ophthalmologist from Ndolage Hospital.
This way we get opportunity of getting specialist (VVF, Orthopedic, Obstetric and Gynaecologist, Paeditrcian e.t.c) to visit us regularly.
It shows from above that the number of operations for 2012 have increased significantly because; Increased Motor Traffic Accidents. Increased referral obstetric cases from our near facilities.
MAJOR PROCEDURE DONE IN 2012
PROCEDURE NO. OF OPERATIONS 2011 2012 Herniotomy inguinal hernias 78 97 Umbilical hernias 16 23 Para umblical 6 0 Eigastric Hernia 0 8 Appendicectomy 3 5 Femoral hernia 1 0 Excision 11 11 TOTAL 116 144
OTHER OPERATIONS
21 NO. OF OPERATIONS PROCEDURE 2011 2012 Laporatomy/Bowel obstruction 43 38 Other emergency 48 19 Splenectomy 6 3 Burst abdomen 20 suture 1 0 Stab wounds Laporatomy 2 6 Re- Laporatomy 0 7 Peritonitis 16 34 TOTAL 116 107
GENITAL URINARY SYSTEM
NO. OF PROCUDURES PROCEDURE 2011 2012
Hydrocoelectomy 912 Orchidectomy 6 11 Orchidopexy 3 1 Prostatectomy 3 5 Urethrotomy 1 0 Urethral dilatation 2 4 Bladder rupture repair 1 0 TOTAL 25 33
GYNAECOLOGY
NO. OF OPERATIONS PROCEDURE 2011 2012 Sub and Total hysterectomy 13 14 Ovarian mass 4 18 Salpingectomy (ruptured 19 19 ectopic pregnancy) Tubal sugery 6 0
22 Adnexectomy 0 0 VVF repair 11 9 Colporaphy 1 0 TOTAL 70 60
OBSTETRIC
PROCEDURE NO. OF OPERATIONS 2011 2012 Caesarean section & BTL 392 73 Caesarean section 317 360 Without BTL BTL alone 75 27 Uterus rupture 7 9 Craniotomy 4 3 TOTAL 478 472
OPHTHAMOLOGY
PROCEDURE NO. OF OPERATIONS 2011 2012 Cataract surgery 18 32 Evisceration 5 0 Enucleation 3 0 Corneal repair 0 0 Foreign body removal 1 6 Others 0 5 TOTAL 27 43
ORTHOPAEDIC
23 PROCEDURE NO. OF OPERATIONS 2011 2012
Amputation limb 3 1 Tendon release 1 5 Club foot repair 0 0 Hare lip repair 0 1 Tendon repair 0 0 Cleft plate repair 0 1 Squestrectomy 0 5 Others 0 4 TOTAL 4 17
MINOR PROCEDURES
Some few cases of minor procedures done in 2012 were as follow:
PROCEDURE NO. OF OPERATION
2011 2012 Evacuation 228 196 Incision and drainage 189 159 FB removal (ear 2 nose) 41 52 Dressing 215 288 Stitching 270 307 Circumcision 2430 3,189 Ear syringing 7 24 Excision 19 6 Catheter change 186 115 Others 153 191 P.O.P Applications 12 24 Catheterizations 15 26 EUA 0 3 Suture removal 23 40 Social toilet 7 12 Total 3,798 4,632.
CIRCUMCISION
On September 2010 we started implementing a programme of Male Circumcision against HIV prevention as it was recommended by WHO that Male circumcision reduces the Rate of HIV transmissions for a bout 60%.
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Our main target group is those above 10 years who are sexually active. From January to December 2012 we had a total of 3,132 circumcised compared with 2,426 clients circumcised for the year 2011. M.C clinic operate two times a week with an average of 40 to 60 clients per day. This programme is supported by ICAP in collaboration with MOHSW.
MALE CIRCUMCISION REPORT 2012 COMPARED WITH 2011 SEE BELOW:-
JANUARY- DECEMBER 2012
Tot. No circumcised Month No.Reg tested Pos age group 26 No. adverse Tot. 1-14 years 15-25 yrs y+ events MC. Moderate Severe Jan 247 249 0 126 118 1 0 0 245 Feb 402 132 0 156 119 3 0 0 278 Mac 189 0 0 182 126 3 2 0 311 Apr 228 220 0 255 55 1 0 0 311 May 311 324 0 256 55 4 2 0 315 Jun 209 232 0 158 64 5 0 0 227 July 237 246 0 191 49 4 0 0 244 Aug 352 325 0 200 112 3 0 0 315 SEPT 300 307 2 221 63 4 0 0 288 Oct 292 293 1 210 69 5 0 0 284 Nov 109 109 0 57 45 3 0 0 105 Dec 220 219 0 119 85 5 0 0 209 Total 3096 2656 3 2131 960 41 4 0 3132
ANAESTHESIA IN MINOR THETRE.
Total numbers of anesthesia given in 2012 were 1,703 compared with 1,624 for the year 2011 this included general anesthesia, Spinal anaesthesia and local anesthesia. Types of anesthesia given see the table below:
PROCEDURE MAJOR MINOR 2011 2012 2011 2012
EMO(ETHER) 210 45 0 0 Halothane with 02 75 209 0 0 Spinal 393 553 7 5
25 Ketamine only 16 374 433 27 Thiopentone 78 148 78 0 Diazepam/Pethidine 0 0 1 0 Local lignocaine 42 42 291 301 Total 814 1370 810 333
From the above table, it shows that most of our Major operations are done by using spinal anaesthesia preferrably by using Macaine or 7.5% Lignocaine, unfortunately is drugs is not available at MSD also in Private pharmacies that creating big wories in running the theatre.
TUBERCULOSIS AND LEPROSY
The hospital policy for treatment and registration of tuberculosis and leprosy patients is in accordance with the National Tuberculosis and Leprosy Programme (NTLP). The DTLC visits and supervise our unit monthly. In the year 2012 we had 937 TB suspect and TB positive were 193, In the year 2011 we had 899 T.B suspect compared and positive were 143.We had no leprosy patients in 2011 as well as in the year of 2012.
HIV infections have been associated with T.B for about 60%, that is a patient with T.b infections will also test positive for HIV infection and vise versa is true. For the year 2012, among 937 tested for TB, 567 (61%) clients were also HIV positive, compare to the year of 2011, among 159 tested T.B positive 132 (83%) were also HIV positive.
DENTAL DEPARTMENT
The dental department is still not yet functioning well and this is due to lack of trained staff. We have one dental room lacking some equipment and staff, one staff running the unit just got on job training. The unit operates from Monday to Friday for decayed tooth extraction only. For the year 2012 we had 1,065 cases attended compare with 1,136 for the year 2011, most of these cases are for dental extraction.
Good lack we have only one Assistant Dental officer completed his training in 2012 working in this department together with one medical attendant although still there is a challenge to our facility as we still have no dental modern room and some equipments there still lacking, sometimes we are forced to refer these patients to other facilities.
Together with DMO’s office, we have now secured some equipment by using Buskek fund 2012/2013, we hope together with other efforts done by our partners including friends of Rubya, this department will be in good shape in the near future.
PHYSIOTHERAPY DEPARTMENT
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For the year 2012, one physiotherapist and one assistant who got on job training continued to runs this department having a main challenge of lacking some important equipment for physiotherapy.
The numbers of patients attended in the year 2012 were had 1,938 compared with 2,439 in the year 2011 this is because some of the equipment which were working in the past year are now not functioning any more.
Chronic illnesses like mental disorders especially in children and stroke associated with HIV/AIDS and Hypertension are the most leading cause for these patients to undergo physiotherapy. Burns as well as accidents leading to contracture are other contributing disorders.
OPHTHALMOLOGY Optic unit is now 7 year of age, Eye services are offered daily, Ophthalmic Nurse who is trained in preventive eye care runs this clinic. Assistant Medical Officer attends the special cases at any time. The eye specialist from Ndolage hospital visits our Hospital for cataract extractions and management of other difficult cases.
We also received eye specialist from CCBRT on April 2012, they attended 240 clients and operated 20 patients with different conditions including cataract extraction.
The ophthalmic services are integrated in the primary health care activities especially in respect to preventive eye care. The unit has got also a room now with limited equipment for refractive error correction, this is done by ophthalmic nurse and experienced Medical attendant, so glasses are provided.
Types of diseases attended excluding eye surgery for the year 2012 are shown below:
NO. OF CASE CONDITIONS 2011 2012 Refractive error 175 176 Conjunctivitis 190 194 Cataract 96 159 Allergic conjunctivitis 208 283 Trauma 44 38 Uveitis 9 15 Glaucoma 22 0 Normal Eyes 42 36 Aphakia 22 0 Ptergium 18 21 Trachoma inflammation 0 1 Foregn body 14 25
27 NPL Blind eyes 9 29 Optic Neuritis 17 39 Xelopthalmia 1 7 Cornea scar 15 10 Stye 5 11 Chalazion 12 13 Orbital cellulites 4 8 Trachoma follicles 0 1 Trachoma Trichiasis 0 2 Herpes zoster 2 1 Pinguelum 1 3 Orbit tumour 1 2 Penetrating injury 4 1 Proptosis 0 0 Ptosis 0 1 Corneal oedema 0 0 New growth lower lid 1 0 Tarsal paralysis 0 0 Burkits lymphoma 0 0 Keratitis 2 0 Dacrocystitis 4 7 Others 32 25 TOTAL 950 1,092
NOTE: From the above table, the optic conditions have increased for about 13% for the year 2012 compared with the year 2011. This could be explained by Current situation of chronic illnesses like HIV/AIDS, Cancers, Diabetes and Hypertension. Exposure to unfriendly environmental hazards.
MENTAL HEALTH
Two psychiatric Nurses run the mental unit both at clinic as well in patients. At clinic this service is conducted every Wednesday static and Friday mobile clinic.
For the year 2012, a total of 1,971 patients were attended at clinic and 105 Patients were attended in the wards compared with 1,810 patients attended at clinic and 66 patients in the wards for the year 2011. Their diagnoses are as written in the table below:
CLINIC IN PATIENTS
DIAGNOSIS 2011 2012 2011 2012
28 Epilepsy 1334 1412 20 12
Schizophrenia paranoid 339 245 23 33
Anxiety 5 45 2 4
Alcoholism 7 56 17 28
Un Exp.somatic 21 34 0 3
Depression 86 78 4 15
Bipolar 12 67 0 1
Drug misuse 6 34 0 9
TOTAL 1810 1971 66 105
It shows from above that, Epilepsy is still a leading cause of mental disorder; community awareness on the prevention of drug abuse could be a necessary step.
SUPPORTIVE AND DIAGNOSTIC SERVICES:
LABORATORY AND BLOOD BANK
Laboratory staff included 3 technologists, 2 Assistant Laboratory technologists and 3 Lab Medical Attendants. Annual laboratory investigation for the year 2012 was 61,586 compare with 52,985 for the year 2011.
Total Blood slides for Malaria parasite examined in 2012 were 8,254 while in 2011 were 8,910. Malaria positive cases were 2,075 (25%) compare with 2, 19 2 (28%) positive cases for the year 2011. MRDT done for the year 2012 were 7,340 against 4,480 MRTD done for the year 2011. RDT positive for the year 2012 were 2,490 (34%).
Malaria is still a problem to our community; more effort is still needed so as to reduce its morbidity and mortality rate; however its morbidity and mortality are not serious as it was in past days.
BLOOD BANK.
Due to high malaria prevalence for the year 2012 this also there were an increase in the number of patients who were transfused with Blood, blood transfusion were 1,359.
29 Through out the year we did not have any stock out of blood in our blood bank and no any blood transfusion reaction was noted.
PHARMACY
Pharmacy staff in the year 2012 remained the same that is consisted of two pharmaceutical Assistants and 5 pharmacy attendants who got experiences from on Job training. The pharmacy staffs are responsible for drug supply to the wards, OPD and RCH Clinic.
The Pharmacy in charge together with members of therapeutic committee are responsible for ordering, receiving and issuing drugs to their respective units.
Requisitions are prepared whenever the drugs are nearly stocking out, the amount of drugs to be ordered depend on the availability of fund at the zonal medical store in Mwanza, For the year 2012 major supply of our drugs was from MSD , some items which we missed from MSD were collected from other private pharmacies.
For the year 2012, we did not experience any stock outs for all necessary drugs and supplies in our Hospital pharmacy.
RADIOLOGY DEPARTMENT
For the year 2012, this department had only one qualified personnel. A Total of 496 were done compared with 485 x-rays for the year 2011.
Number and types of x-ray taken for the year 2012 Vs 2011 were as follows:
TYPE OF X- RAY FIRM TOTAL NUMBER 2011 2012 Chest 204 215 Lumber spine 16 31 Femur 19 24 Skull 8 7 Fore arm 8 14 Shoulder 101 28 Humerus 7 11 Cervical spine 0 2 Pelvis 22 36 HSG 0 7 Elbow joint 17 13 Knee joint 13 20 Leg 31 36 Foot 5 7
30 Hand 0 5 Ankle joint 8 6 Barium meal 0 0 Barium swallow 0 0 Abdominal 2 3 Hip joint 0 2 L.Sacral 1 2 Thoracolumber 7 3 Wrist 13 9 Mandible/ skull 0 12 Finger 3 3 TOTAL 485 496
NOTE: Most of the X – ray taken where Chest X rays as most of our clients suffers from respiratory tract infections and heart problems. Patient attending CTC also suffer from T.B and PJP as the manifestations of lowered immunity, Chest x ray is also indicated to these clients so as to rule out these Opportunistic infections.
ULTRA – SOUND
Ultrasound examination is mainly done by a trained doctor, who is an AMO radiologist however other doctors perform Ultra sound examination especially Obstetric and Gynecological cases. A total of 78 USS examinations were done against 205 USS examinations for the year 2011.
This significant decrease of the patients examined by USS is due to the ultra sound machine break down as up to now we are still in crises.
LAUNDRY
Patients’ linens are washed in the hospital laundry by boiling, rinsed and squeezed by the machine. We use firewood to boil the water and linens are air-dried. Despite the crude method used linens are cleaned to the maximum satisfaction. The main challenge facing this department is that its building as well as the machine is too old.
TECHNICAL DEPARTMENT
A mechanical engineer who is also experienced in electrical engineering heads the technical department. This department comprises of drivers, plumbers, mechanics, electricians, carpenters and masonry, Up to December 2012, we had 5 Vehicles, 4 Motorcycles, 2 Water Pump machines and 2 Generators (One standby and another portable) for the year 2012 this Department did not experience much difficulties.
31 ELECTRICITY AND WATER SUPPLY
The main supply of Electricity to our Hospital continued to be supplied by TANESCO.We have a small Generator (Honda), which is used for emergency operations and standby big generator for sterilization in case TANESCO power has cut off, these standby generator was donated by Friends of Rubya .Total Hospital bill for Electricity and Water for 2012 was about 24 millions with of an average of 2 millions per month.
Water supply is constant due to the availability of reliable electricity. Electrical meters are installed in the staff houses therefore each staff has to pay his/her bill depending on the use.
ADMINISTRATION.
Hospital Secretary heads this department. It deals with matters concerning staff particulars, accounts, statistics, finances and communications. There is one accountant, one account assistant, one cashier, two office secretaries and two computer trained personals that are both helping each other in communication.
There are separate offices for MO in charge, Hospital Matron and Administrator. Administrator, Matron and Doctor in charge normally meet every day to discuss several matters pertaining the Hospital.
MEDICAL RECORDS.
This unit is part of the Outpatient Department. The nurse in charge of the department supervises it in collaboration with Doctor in charge. This department deals with registration of patients, file keeping and identification of patient file in case of re attendance. Most of staff working at this department are medical attendants; our feature plan is to train two Medical recorders so as to make this department more effective and efficient.
HUMAN DEVELOPMENT
For year 2012, our staff continued to be supported in their studies, some completed their course others are still continuing with their studies;
The tables below summarize human development at Rubya DDH for the year 2012.
THOSE WHO GRADUATED IN 2012 S/No. CADRE TOTAL NUMBER 01 Dental Assistant 1 02 AMO 1 TOTAL 2
32
THOSE STILL IN STUDIES S/No. CADRE TOTAL NUMBER 01 Assistant Nursing officer (ANO) 3 02 Medical Doctor 4 03 Nurse I 1 04 Occupational Physiotherapist 1 05 Assistant Lab. Technologist 1 TOTAL 10
SOME IMPORTANT FIGURES SHOWING OVERALL SITUATION OF THE HOSPITAL.
TABLE SHOWING CAPACITY AND UTILIZATION FOR 2012.
WARD NO.BEDS NO.ADMSION NURSING DAILY BED (ACTUAL) DAYS OCCUP. RATE Male 36 1,685 9,550 73% Female 35 1,925 9,690 76% Children 1&2 92 5,417 20,842 62%
Mat & Babies 58 4,045 12,487 59% Private ward 06 196 1,772 81% TOTAL 227 13,268 54,341 65.5%
NOTE:FOMULAR: OCUPANCY RATE = PATIENTS DAYS X100 NO.OF BEDS X DAYS PER YEAR
IMPORTANT HOSPITAL INDICATORS FOR THE 2012
YEAR INDICATORS 2011 2012 Granted beds 162 162 Patients admitted 14,575 13,268 Total deaths 571 446 Total discharge 14,013 12,620 Average length of stay 4 4 Bed occupancy rate 97 91 Average daily admission 40 36
33 Deliveries 3,087 3,547 Major operation 788 876 Minor operations 1350 1,454 General attendances OPD 54,429 53,045
INPATIENTS DIAGNOSIS
GROUP 1 – INFECTIOUS AND PARASITIC DISEASES YEAR
2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 001 Cholera 1 0 0 0 002 Para(Typhoid fever) 287 7 193 5 004 Shigellosis 93 0 72 0 006 Ameobiasis 133 0 142 0 007 Other protozoa intestinal inf. 60 2 54 1 009 Ill defined int. infestation 1330 16 1432 18 011 Tuberculosis 50 5 62 7 030 Leprosy 0 0 0 0 036 Meningococcal 40 0 32 9 037 Adult Tetanus 2 1 0 0 040 Other Bacterial D’ses 2 0 3 1 045 Acute poliomyelitis 0 0 0 0 053 Herpes Zoster 12 0 13 0 053 Measles 0 0 0 0 071 Viral Hepatitis 0 0 0 0 078 Rabies 1 1 0 0 078 CLINICAL AIDS 340 76 345 78 084 Other Viral/Chlamydia 20 0 0 diseases 084 Malaria/uncomplicated 8270 1,406 0 malaria 086 Cerebral/complicated 2,982 107 3,547 99 malaria 087 Trypanasomiasis 0 0 0 0 091 Relapsing fever 0 0 0 0 098 Syphillis 5 0 7 0 099 Gonococcal infections 7 0 13 0 120 Other veneral diseases 4 0 18 0 125 Schistomiasis Manson 1 0 0 0 128 Filarial infection 0 0 0 0 Other and 203 0 214 0
34 unsp.Helminthiasis 139 All other diagnosis group 1 12 0 17 0 Late effects of infections 30 0 27 0 and parasitic diseases
SUBTOTAL GROUP 1 5565 210 7601 201
% OF TOTAL DIAGNOSIS 37.4% 56% 40% 44%
GROUP 2 – NEOPLASMS
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATH PATIENTS PATIENTS S 199 Malignant neoplasms 355 303 (unspecified) 208 Leukemia (unspecified) 1 0 0 0 229 Benign neoplasms 24 0 28 0 239 All other diagnosis 8 0 4 0 Subtotal group 2 68 5 62 3 % of total diagnosis 0.4% 1.3% 3% 0.6%
GROUP 3 – ENDOCRINE, NITRITIONAL, METABOLIC DISEASE AND IMMUNITY DISORDERS.
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATH PATIENTS PATIENTS S 240 Simple and non-tox- 20 0 0 goitre 250 Diabetes mellitus 87 4 98 3 260 Kwashiokor 77 13 89 18 261 Nutritional marasmus 55 0 63 0 263 Other and 21 4 2 unsp.protein-calorie malnutrition 269 Other nutrition 00 0 0 deficiencies 277 Other metabolic 50 0 0 disorders 279 Other Immune 71 8 1 disorders Subtotal group 3 228 17 262 24 % of total diagnosis 1.5% 4.5% 1.3% 5%
35
GROUP 4 DISEASES OF BLOOD – FORMING ORGANS.
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 285 Anaemia 907 46 879 62 (unspecified) 289 All other diagnosis 12 0 13 0 group 4 Subtotal group 4 919 46 892 62 % of total 6.1% 12.2% 4.6% 13% diagnosis
GROUP 5-MENTAL DISORDERS.
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 307 Psychosis 48 0 53 0 308 Acute reaction to 40 7 0 stress 309 Adjustment 00 0 0 reaction 300 Depression 0 0 13 0 311 Other neurotic 50 10 0 personality and non-psychotic disorders 318 Mental 10 2 0 retardation Subtotal group 62 0 85 0 5 % of total 0.4% 0 0.4% 0 diagnosis
GROUP 6 DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS.
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS N0.OF DEATHS PATIENTS PATIENTS
36 320 Meningitis(Non 45 20 48 13 meningococcal 345 Epilepsy 20 0 23 0 349 Other 120 24 0 unsp.disorders of nervous system. 372 20 13 0 Inflamatory d’se of Eyes 365 Glaucoma 1 0 0 0 379 Other disorder of 30 4 0 eyes 366 Cataract 43 0 159 0 381 Otitis media 7 0 24 0 383 Mastoditis 7 0 13 0 388 Other disorders of 00 0 0 Ears Sub total group 6 100 20 308 0 0.6% 4% 1.6% 2.8% % of total diagnosis
GROUP 7 – DISEASES OF CIRCULATORY SYSTEM. YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATH NO.OF DEATHS PATIENTS S PATIENTS 390 Acute Rheumatic fever 0 0 0 0 393 Chronic Rheumatic 00 0 0 Heart Disease 401 Hypertension 160 7 183 5 425 Cardiomyopathy 0 0 2 0 428 Heart Failure 150 16 171 13 437 Cerebral Vascular 252 33 4 diseases 459 All other diagnosis 10 0 23 2 group 7 Sub total group 7 345 15 412 24 % of total diagnosis 2.3% 4% 2.1% 5.2%
37
GROUP 8 – DISEASES OF THE RESPIRATORY SYSTEM. YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS
465 Acute Upper 6120 721 0 Resp.Infections 463 Acute tonsillitis 10 0 27 0 478 Other diseases of 70 18 0 upper resp.infections 482 Pneumonia 746 25 833 27 490 Bronchitis 15 2 21 3 493 Bronchial Asthma 78 0 66 0 519 All other diagnosis 10 0 14 0 group 8 Sub Total group 8 1478 25 1691 30 % of total diagnosis 10% 7% 10% 6.6%
GROUP 9 DISEASES OF THE DIGESTIVE SYSTEM.
YEAR 2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 528 Diseases of the Oral 91 0 153 0 cavity 533 Peptic ulcers 124 1 98 2 540 Appendicitis 6 0 13 0 550 Hernia all types 133 0 144 0 570 Acute liver diseases 4 0 3 0 571 Chronic Liver diseases 12 3 8 2 All other diagnosis 109 0 98 4 group 9 Sub total group 9 479 4 373 8 % of total diagnosis 3.2% 1.0% 2% 2%
GROUP 10- DISEASES OF THE GENITAL URINARY TRACT
YEAR 2011 2012
38 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 586 Nephritis,N.Syndrome 18 0 23 0 595 Renal Failure(Unspecified) 3 1 8 4 599 Urinary Tract Infection 687 1 1210 0 603 Other disorders of urethra 27 1 21 1 and U.tract 608 Hydrocele 8 0 15 0 614 All other diagnosis of male 41 0 53 0 Genital tract 629 Imflamatory diseases of 109 0 300 0 female genital organs(PID) Other disorders of Female 86 0 76 0 Genital organs All other diagnosed group 40 7 0 10 Sub total group 10 979 2 1713 5 % of total diagnosis 6.5% 0.5% 9% 1%
GROUP 11-DISEASES OF PREGNANCY AND PUEPERIUM.
YEAR
2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 630- Pregnancy with 1860 312 0 639 Abotive outcome 646 Pregnancy releted 3250 614 0 conditions 648 Incidental conditions 00 0 0 in pregnancy 650 Normal deliveries 2587 0 2448 0 652 Malpresentations 117 0 213 0 662 Prolonged labour 45 0 64 0 669 Other complications 20 18 0 of labour and delivery 666 H’ge and other 500 69 0 complications of 3rd stage 674 Complications of 2460 182 0 Pueperium Sub total group 11 3558 0 3920 0 5 of total diagnosis 24% 0 21% 0%
GROUP 12- DISEASES OF THE SKIN AND SUBCUTANEUS TISSUES
39
YEAR
CODE DIAGNOSIS 2011 2012 NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS
682 Infection of the skin 23 0 52 0 and subc. Tissue All other diagnosis 12 0 18 0 group 12 Sub total group 12 35 0 70 0 % of total diagnosis 0.2% 0 0.3% 0%
GROUP 13 - DISEASES OF THE MASCULOSKELETAL SYSTEM AND CONNECTIVE TISSUES
YEAR
2011 2012 CODE DIAGNOSIS NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 710 Pyomyositis 18 0 27 0 730- All other 570 41 739 diagnosis group 13 Subtotal 75 0 68 0 % of total 0.5%0 0.3% 0% diagnosis
GROUP 14-CONGENITAL ANOMALIES
YEAR
40 2011 2012 NO.OF DEATHS NO.OF DEATHS PATIENTS PATIENTS 746 Congenital Heart 10 2 0 anomalies 756 Other Congenital 60 4 0 Animalies Subtotal group 14 7 0 6 0 % of total 0.04%0 0.03% 0% diagnosis
GROUP 15-CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD.
YEAR
CODE 2011 2012
DIAGNOSIS NO.OF NO.OF PATIENTS DEATHS PATIENTS DEATHS 763 Fetus affected by 60 13 0 comp.of labour&delivery 764 Birth trauma 7 0 18 0 779 All other diagnosis group 83 14 4 15 Subtotal group 15 21 3 45 4 % of total diagnosis 0.1% 0.7% 0.2% 0.8%
GROUP 16 - SYMPTOMS, SIGNS AND III DEFINED CONDITIONS
YEAR 2011 2012
CODE DIAGNOSIS NO.OF NO.OF PATIENTS DEATHS PATIENTS DEATHS 799 All Diagnoses 400 19 371 23
41 group 16 Subtotal group 16 400 19 371 23 % of total 2.6% 5.0% 2% 5.0% diagnosis
GROUP 17-INJURIES AND POISONING
YEAR
CODE DIAGNOSIS 2011 2012
NO.OF NO.OF PATIENTS DEATHS PATIENTS DEATHS 800- Fracture and 550 392 19 839 dislocation 977- Open 4067 678 14 989 wounds,burns FB,Bites,Beaten cases Poisoning and 460 59 03 toxic effects All other diagnosed 28 4 43 5 group 17 Subtotal group 17 535 11 1172 41 % of total 3.6% 3% 6.1% 9% diagnosis
GRAND TOTAL DIAGNOSIS.
YEAR
CODE DIAGNOSIS 2011 2012
NO.OF NO.OF PATIENTS DEATHS PATIENTS DEATHS Group 1-17 14,854 377 18,979 454.
From the above tables the following were observed;
42 Chronic illness like Hypertension, HIV/AIDs, Neoplasms and Heart failure are still major problem in our community as most of deaths are associated with these conditions.
Malaria in general as well as meningitis are also still major issue to be adressed. Efforts to eradicate these conditions by all stake holders are needed. Health education will be the most prefered initiative.
Malnutrition( Kwarshiokor) contributed for 18 deaths for 2012 compared with 13 deaths for 2011, it is a disease of poverty and lack of education. Though our PHC for the year 2011 we continued providing health education to our community members.
PRIMARY HEALTH CARE REPORT (PHC)
This unit deals Mostly with preventive services as well as data collections, analysis and compilation. The catchment’s area for Primary Health Care (PHC) and Community Based Health Care (CBHC) services is Nshamba Division, with the estimate population of 153, 896 (2009) people leaving in 45 villages, in 9 wards
The responsibility of PHC and CBHC activities in Nshamba division include Rubya PHC centre which has 12 villages in 3 wards of Kashasha, Ijumbi and Ikondos. The PHC staff includes, One Nursing Officer- PHC Co-ordinator, One Senior Nursing officer, One Senior Medical attendant-supervising the locally made nutritious flower.
Under PHC programme, the following activities/ programme are being implemented; these include.
Malaria control program School Health Program Health Management Information System (HMIS) Health Education Reproductive and Child Health (RCH) HIV/AIDS and STDs control programme Home based care. Natural Family Planning Physiotherapy Eye, Dental and Mental Health Nutritional Promotion and Food Security Environmental Sanitation. Simple researches.
OVERVIEW OF THE IMPLEMENTED ACTIVITIES
43
PHC activities continued to be supported by the DMO’s office through the Basket fund program, hospital management and some student doctors who supported us by buying purchasing the nutritional ingredients for Malnourished children as well as those living with HIV/AIDS.
RCH AND FP (REPRODUCTIVE CHILD HEALTH AND FAMILY PLANNING)
Reproductive and child health services are provided to 3 wards of Ijumbi, Kashasha and Ikondo with 12 villages. The services are provided into two ways, static and mobile clinics. On Tuesdays and Thursdays are mobile clinics which are conducted at to six mobile sites, but few staff remain at Rubya RCH for providing RCH services through out the week and the rest of the days RCH services are provided at our health facility (static clinic).
The following are being done at the RCH clinics: ♦ Under five growth monitoring ♦ Under five nutritional assessment ♦ Pre and Postnatal care ♦ Health Education in different Health issues ♦ Vaccination ♦ General counseling ♦ Family Planning ♦ Ant natal care ♦ PMTCT – PITC/ General counseling ♦ Family Support Group (FSG)
VACCINATION
Vaccination coverage for the year 2012 was as follow, DTP- HB, 85% in average, OPV 87%, BCG 158% and T.T was around 60% in average. There were no any reported adverse events reported following immunization.
MOBILE CLINIC.
♦ Under RCH services, mobile outreach continued in 6 sites namely Ikondo, Kamishango, Ihangiro, Rihija, Buyaga and Buhangaza. The main activities conducted during the mobile clinics are under five growth monitoring, under five nutritional assessment, pre and postnatal care, health Education in different Health issues, general counseling, family Planning and ant natal care.
For the year 2012, the services offered were as follows compared with 2011.
MOBILE CLINIC DATA FOR 2012 COMPARED WITH 2011.
ACTIVITY DONE 2011 2012
44 Total number of children attended 15,983 17,393 New attendance 7,621 2452 Re – attendance 8,362 14,941 Total mothers attended 4,177 3,975 New attendants 1,143 1,100 Re- attendance 3,034 2,875 Pregnant mothers attended with minor illness 689 211 Above five pregnant 396 287
PERFORMANCE DATA (STATIC AND MOBILE CLINIC)
2011 2012 Total number of mothers who attended ANC 4177 3,975 New cases 1143 1100 Re- attendance 3034 2875 Pregnant mothers who attended with minor illness 289 211 Pregnant mothers above five pregnancies 444 287 Pregnant mothers above 35 years 196 137 Pregnant mothers below 16 years 137 147
PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT)
This programme is integrated into RCH activities were by all pregnant mothers coming for RCH services including Labour and deliveries get an opportunity to be counseled and tested for HIV. For those found to be HIV positive, initiatives for linking them to CTC are done also these mothers are given ART “ Efficacy regimen” as the a prophylaxis at the gestation age of 28 weeks till deliveries, this way their babies are borne free from HIV infections.
For those babies borne by HIV positive mothers are given Cotri moxazole as a prophylaxis for respiratory infection but also they get opportunity of checking if they are infected by taking DBS for PCR.
DATA BASE OF PMTCT JAN-DECEMBER 2012
1. ANTENATAL CLINIC (ANC)
PERIOD 2011 2012 Total clients tested 1143 1009 New clients tested 457 757 Tested negative 1213 993 Tested positive 29 16 B) Male partner tested 114 252
45 Male partner tested positive 4 4
2. PMTCT CARE (PREGNANT MOTHERS WITH HIV)
PERIOD 2011 2012 Registered 39 29 Total enrolled in CTC 20 13 Given AZT +NVP at ANC 12 20 On ART 3 9
3. PMTC MARTERNATY (LABOUR AND DELIVERY)
PERIOD 2011 2012 Total Deliveries 3715 3547 Total tested at labour and delivery 676 606 Positive HIV 90 96
4. MOTHER CHILD FOLLOW UP (HEI)
PERIOD 2011 2012 Total HEI Registered 58 50 Total HEI Tested 58 50 HEI Positive by PCR 5 8 HEI Positive by Antibody test 4 17 Died 2 0
4. PMTCT PSYCHOSOCIAL SUPPORT GROUP (PSG)
PERIOD 2011 2012 Rubya static: ANC 537 Postnatal 96 6 Partners 28 3 Graduated 69 23
MUBUNDA OUTRICH ANC 20 0 Post-Natal 15 0 Partner 13 0 Graduated 23 0
46 FAMILY PLANNING
Rubya Hospital being one of the Mission Hospital, it follows all Roman Catholic core values, this implies that, only natural family planning is practiced at our hospital. Women in reproductive age sometimes with their husbands are given health education on natural family planning.
For the year 2012,312 clients were given this service compared to 322 for the year 2011. The main challenge about this service is lack of education to our clients also women are still not yet empowered hence no decision making. The following villages have been given health education on family planning. Rubya, Rubaho, Ijumbi, Buhangaza,Kamishango, Rwagati and Nshambya.
CARE AND TREATMENT CENTRE (CTC)
This department deals this clients infected with HIV/AIDS. It was initiated at our Hospital since 2004. Up to December 2012 we had 3,356 clients in clinic, 1,218 Males and 1,911 Female, Children were 219 out of these, 1983 clients are on ART while 1373 not yet on ART. Clients are referred from VCT, PITC, T.B/STI clinic, PITC (OPD & IPD) and M.C clinic. This clinic provides services every day with exception of Wednesday were health providers go to distant areas for mobile clinics. Four sites are sited during outreach services namely Mubunda, Kishuro, Rwantege, and Kabare. Most of CTC activities are being supported by ICAP in collaboration with MOHSWF.
The table below shows summaries of the overall number of total tested, their results as well as those on ART and those not on ART.
ITEM 2011 2012 01 Total counseled and tested 3,223 2,905 02 Total Negative 2,679 2,408 03 Total Positive 540 497 04 Total on ART 1828 1,983 05 Total not on ART 1430 1,373
47
OVERALL HIV RAPID DIAGNOSTIC TEST.
Departments involved in HIV testing are, P.M.T.C.T, VCT, P.I.T.C, Early Infant diagnosis, Male circumcision and blood donors. Total number of clients tested for HIV were 8,033 where by 7,466 turned to be negative while 567 (7%) were positive for HIV.
It shows that AIDS is still a major problem requiring many innervations by all stake holders. Other explanation for the above findings could be increased awareness about HIV/AIDS to our community as many people come for testing but also change of human behavior, failure to disclose to their partners as well as stigma about HIV/AIDS is still big challenge to the community.
MALARIA CONTROL PROGRAMME IN NSHAMBA DIVISION
MALARIA SITUATION:
For the year 2012, the malaria trend showed a significant decrease at the beginning but late 2012, the Malaria trend picked up and this was associated with high Morbidity and Mortality. Monthly Malaria data collection is no longer sponsored by our MOHSW through Busket fund for the year 2012. For year 2012 malaria prevention in in Nshamba Division based on community sensitization through health education. The malaria data collected from the all-10 Health Facilities of Nshamba division in 2012 is as follows:
OPD IPD DEATHS Total DX Malaria Total DX Malaria Total Malaria Death <5 >5 <5 >5 <5 >5 <5 >5 <5 >5 <5 >5 23167 36542 3016 2137 6275 5631 893 942 89 97 9 10
The malaria data collected from the all-10 Health Facilities of Nshamba division in 2011 is as follows:
OPD IPD DEATHS Total DX Malaria Total DX Malaria Total Malaria Death <5 >5 <5 >5 <5 >5 <5 >5 <5 >5 <5 >5 22116 34522 2016 1127 5275 6231 703 282 111 118 24 1
From the above table the general observation is that, the incidence of Malaria has decrease significantly for the year 2012.
48 PERFORMANCE DATA ABOUT MALARIA
2011 2012 ACTIVITIES Total active VHWs 78 78 Meetings at village 139 145 level with VHWs Meeting at WDC 36 28 Meetings at 14 12 Division level. Health education 245 253 sessions Distribution of Bed 8600 nets
SCHOOL HEALTH PROGRAMME.
School health program is one of the PHC elements working on routine bases that are monitoring and supervision on school health activities. The service is given in three wards that is Kashasha ,Ijumbi and Ikondo ward. There are a total number of 18 primary schools and 5 secondary schools existing at the ward level with a total of 13,290 students and pupils. Interventions done were health education on prevention of HIV/AIDS and other prevention on effects of early marriage to school students.
RUBYA SCHOOL OF NURSING AND MIDWIFERY - 2012
INTRODUCTION.
The training Centre started in 1963, seven years after the opening of Rubya hospital, by the Breda based charitable congregation of the Franciscan Sisters of the Netherlands; with the main aim of training nurses who could provide health care to the patients attending Rubya hospital. With the increase of nursing care providers demand the graduates are providing Health care to all Health care facilities in Tanzania and outside Tanzania. Up to date the training centre has trained 1639 graduates.
Rubya school of Nursing operates under the guidelines and directives as stated in the curriculum set up by the Ministry of Health and social welfare of Tanzania. Also adhere to the Medical ethical morals as stated by the Tanzania Episcopal conference. Adhering to the main aim of the founder; Rubya school of Nursing and Midwifery is a part and parcel of Rubya Hospital. It prepares the professional Nurses and Midwives who provide health care in preventive, curative and rehabilitative.
Throughout the training, the students are equipped with sufficient knowledge, skills and right attitudes.
49 In the clinical practices in Rubya Hospital the students proved remarkable bedside nursing care; also collaborate with the Primary Health Care (PHC) Department, VCT, CTC, RCH in Provision of Preventive health care in the communities. Since Rubya hospital is on and off overcrowded with patients, the training centre input (students) is one of major enabling factor for the smooth running of the nursing care services.
THE NURSING SCHOOL INFRASTRUCTURE
The school has 5 classrooms, library, Skill laboratory, Recreation and dinning hall, kitchen and hostels. The above infrastructures are in good physical state, which promote conducive learning to students but need regular repair and maintenance.
TEACHING STAFF
The nursing school is currently staffed by: 12 Nurse Tutors including the Principal 6 Part-time teachers from the hospital other hired from other Hospitals in the Region. Also has 15 supportive staff.
ENROLLMENT.
The academic year starts September and ends August each year. During the academic year 2012-2013 pre – service 60 students were admitted making total enrollment of 155 students Nurses and Midwives.
The number of students is as follows by December 2012
CLASS MALE FEMALE TOTAL In – service 1st Nil 8 8 year Pre – service 16 24 40 3rd year Pre-service 2nd 24 23 47 year Pre – service 1st 39 21 60 year Total 79 76 155
50 SCHOOL FEES ANNUALLY
Students in DIPLOMA course each pays T.shs. 1,300,000/=
ACADEMIC
- Adhering to fulfill the academic programmes according to the prescribed curriculum academic staff are Working very hard
IMPROVING SELF-RELIANCE ACTIVITIES PRODUCTION.
With the aim of increasing production, to contribute on the reduction of the high demand, as a result of day to day raising costs of the essential items.
ACHIEVEMENTS OF THE NURSING SCHOOL 2012
1. The school has recruited 1,639 graduates since it has started 2. Enrolled of 68 students 1st year October 2012. 3. All academic Programs were fulfilled accordingly 4. All students attempted final Examination passed at 100% 5. The Board meeting conducted per schedule 6. Students government is alive 7. Spiritual services; students attended 3days retreat 8. The 7th Batch of 25 students in the Diploma course graduated in August 2012 9. Training two staff in advanced computer course in Moshi
10. Final evaluation of the strategic plan was done
PROBLEMS ENCOUNTERED
ACADEMIC - The curriculum was too tight - Few candidates admitted in the Diploma course due to lack of science subjects
TRANSPORTATION - Students lacking transport for community field
FUTURE PLANS
1. Maintain high level of academic performance by:
51 - Increasing number of Trained Nurse Tutor, clinical Instructors and preceptors. 2. Increase the number of enrollment in the Diploma course 3. Maintaining the Learning and Resource centre buildings and environment at a good standard 4. Improve students’ skills – by increasing the number of Trained Preceptors in the clinical areas and supervisions. Improve on utilization of the skill laboratory 5. Maintaining the school building and the environment at a good standard 6. Soliciting funders for students transport in the community field. 7.
THANKS GIVING AND CONCLUSION
May our expressed sincere gratitude to the almighty God for the endurance of our nursing school till the present through those who have assisted us in one-way or another. May the Lord bless them all - The Bukoba Catholic Diocesan Authority for the invaluable help we receive from them materially, moral and spiritual support. - The Leadership of Saint Theresa Sisters Congregation for providing personnel running the training.
The Franciscan Sisters Congregation of Breda, the Netherlands for the heartfelt concerned on the well-being of the training Centre, moral and Financial Support.
- For their hard work to support the Nursing school development - Support the education for Nurse – tutors - Friends of Rubya for their support in the Construction of the Learning and Resource centre Training staff in advanced computer course and computer maintenance Dr. Woe Gianotten and Erno Gianotten Mr. Jacques G. Helsbergen to support the Learning and Resource centre Building. Dr. Fons Mathot the Chairmain of the Friends of Rubya for the effort to support the Nursing training centre. - The Rubya Hospital Management Team who take pains and trouble to support the Training Centre by providing the staff housing and staff for training as Nurse – tutor. It is the backbone of the nursing training centre. We are grateful to Sr. Annuciata Nelen`s family, and Sr. Mediatrix Koendraad’s family, Sr. Theodozia Visser the former principal for their invaluable support. DMO office Muleba to support skill laboratory activities by providing delivery tray The staff of Rubya Hospital by assisting the students in the clinical learning areas. The neighboring communities for their physical, material and spiritual care.
Last but not least may I extend my personal heartfelt gratitude to the staff of Rubya School of Nursing for the co-operation and tireless efforts, which has enabled the Training Centre to present as it is to date. To forget the students is a crime as their presence is what makes the school to exist. May the Lord bless all.
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INFRASTRACTURE: RENOVATION AND CONSTRACTION FOR 2012
Most of our Hospital buildings were renovated/ constructed during the Phase II renovation phase by Friends of Rubya which ended on 16 th December 2011, For the year 2012, few things were done by using the Hospital Income generating activities such as;
RENOVATION
Maternity tiles Shelves in Pharmacy sub store
NEW CONSTRACTION
Relative waiting area Three in one “Viosiki” Fencing of the staff recreation area.
HOSPITAL ACHIEVEMENTS FOR 2012
Patient care continued well in all departments despite of many challenges facing our Hospital. Interaction with our partners such as Government, American people through ICAP Tanzania, Friends of Rubya from Netherland and other local partners was good throughout the year Human development was done through conducting on job training, supporting staff in studies and through attending different seminars and workshops; this was done throughout the year. Most of the costs for running the Hospital were paid in time without much delay. Hospital meetings including BOG meeting were conducted as they were scheduled. Renovations, construction and maintenance of Hospital buildings were implemented to some extent. The Hospital SACCOS continued to run smoothly were by the hospital staff have opportunities to take soft loans hence soften their life.
HOSPITAL CHALLENGES FOR 2012
Shortage of staff in all cadres leading to compromising the patient care, was the first and most burning challenge faced our Hospital for 2012 Delays in including our newly employed staff to the Payroll done by MOHSWF brought about financial constraints as we had to solicit funds from other sources for paying their salaries.
53 Delays in arrears for Hospital staff Hospital income is declining as now we have significant numbers of exceptions. Some of our hospital progromme were not met including Human development because of shortage of funds. Unequal terminal benefits (NSSF) compared with those purely working in Government health facilities was the main reason for staff “Brain drain” to Government facilities creating a very critical shortage of staff.
HOSPITAL FUTURE PLANS
These are according to our Hospital five years strategic plan 2011 to 2015.
THANKS GIVING
On behalf of the hospital Management, I would like to express our sincere gratitude to the almighty God for the endurance of our Rubya Hospiatal till the present through those who have assisted us in one-way or another. May the Lord bless them. We would like to thank all hospital staffs for their efforts in trying to let the services pertaining our clients are moving on smoothly.
To mention some, our sincere gratitude should go to: ♦ The Ministry of Health and social warfare. ♦ Diocesan Health Office ♦ ICAP/Columbia university ♦ Our donors from Netherlands namely: - Friends of Rubya - Franciscan sisters of Breda - CORD AID - Lions Club Beilen - Rotary club - NCDO-Netherlands Center for Durable Development.
Our sincere thanks should also be extended to the following Organizations/ team/ Boards for their tireless efforts in co ordinating with us for improving our services. ♦ We are grateful for the good cooperation between the Board of Governors and the Hospital managers in planning, advising and solving problems pertaining our Hospital. ♦ District Commissioner, RMO’s office, DMO’s Office are highly appreciated for their co-orperation with us. ♦ AMREF team for outreach services. ♦ Advisory board for their constructive advices to us on different issues related to our services in our community. ♦ Secondary schools and other school institute in our catchments and outside our catchments area for donating blood voluntarily.
54 ♦ Rubya School of nursing for their close co operation with the Hospital, above all for the assistance of student nurses in caring patients during their rotation in the wards.
Lastly, we highly extend our gratitude to our Almighty God for rewarding and blessing us good health and the talent for saving the community. We hope these blessing to continue so that we also keep on offering these services to all members of the community. Prepared by:
……………………………………… Dr. DIOCLES L. NGAIZA Medical Officer in Charge. On behalf of the Hospital Managers
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