Mpilo Central Hospital

Bulawayo, Zimbabwe

Mpilo Central Hospital

Bulawayo, Zimbabwe
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Ngwenya S.,Mpilo Central Hospital | Ngwenya S.,National University of Science and Technology
International Journal of Women's Health | Year: 2017

Background: Severe preeclampsia is a disorder of pregnancy characterized by high blood pressure and significant proteinuria after 20 weeks gestation. Severe preeclampsia and eclampsia have considerable adverse impacts on maternal, fetal, and neonatal health especially in low-resource countries. Hypertensive disorders of pregnancy are the third leading cause of maternal deaths in Sub-Saharan Africa. Significant avoidable maternal and neonatal morbidity and mortality may result. Objectives: This study aimed 1) to determine the incidence of severe preeclampsia/eclampsia in a low-resource setting; 2) to determine the maternal complications of severe preeclampsia/ eclampsia in a low-resource setting; 3) to determine the perinatal outcomes of severe preeclampsia/eclampsia in a low-resource setting. Methods: This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the birth registers in labor ward, intensive care unit, and neonatal intensive care unit of patients who had a diagnosis of severe preeclampsia or eclampsia for the period January 1, 2016, to December 31, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered. Results: There were 9,086 deliveries at the institution during the period January 1, 2016, to December 31, 2016. There were 121 cases of severe preeclampsia/eclampsia. The incidence of severe preeclampsia/eclampsia was 1.3% at Mpilo Central Hospital. The most common major complication was HELLP syndrome (9.1%). Maternal mortality was 1.7%. There were 127 babies born with six sets of twins, 49.6% of the babies were lost through stillbirths and early neonatal deaths. Conclusion: The incidence of severe preeclampsia/eclampsia at Mpilo Central Hospital was 1.3%. The most common maternal complication was hemolysis elevated liver enzymes low platelet syndrome. Maternal mortality was 1.7% due to acute renal failure. Nearly half (49.6%) of the babies born were lost to stillbirths and early neonatal deaths. © 2017 Ngwenya.

Ngwenya S.,Mpilo Central Hospital | Ngwenya S.,National University of Science and Technology
BMC Research Notes | Year: 2017

Background: Stillbirths are distressing to the parents and healthcare workers. Globally large numbers of babies are stillborn. A number of strategies have been implemented to try and reduce stillbirths worldwide. The objective of this study was to assess the impact of leadership and accountability changes on reducing full term intrapartum stillbirths. Methods: Leadership and accountability changes were implemented in January 2016. This retrospective cohort study was carried out to assess the impact of the changes on fresh full term intrapartum stillbirths covering the period 6 months prior to the implementation date and 12 months after the implementation date. The changes included leadership and accountability. Fresh full term stillbirths (>37 weeks gestation) occurring during the intrapartum stage of labour were analysed to see if there would be any reduction in numbers after the measures were put in place. Results: There was a reduction in the number of fresh full term intrapartum stillbirths after the introduction of the measures. There was a statistical difference before and after implementation of the changes, 50% vs 0%, P = 0.025. There was a reduction in the time it took to perform an emergency caesarean section from a mean of 30 to 15 min by the end of the study, a 50% reduction. Conclusions: Clear and consistent clinical leadership and accountability can help in the global attempts to reduce stillbirth figures. Simple measures can contribute to improving perinatal outcomes. © 2017 The Author(s).

Crofts J.,University of Bristol | Moyo J.,Mpilo Central Hospital | Ndebele W.,Mpilo Central Hospital | Mhlanga S.,Mpilo Central Hospital | And 2 more authors.
Bulletin of the World Health Organization | Year: 2014

Problem The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and "not timely enough for practical use by health planners and administrators". Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Approach Clinical "dashboards" based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility's clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. Local setting An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Relevant changes Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Lessons learnt Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.

Masukume G.,Mpilo Central Hospital | Zumla A.,University College London
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2012

Medicine is traditionally known as an 'art', and not an exact 'science'. Medical images of clinical signs and pathology were communicated through 'metaphors' in the 19th and early 20th centuries to make recognition easier in anticipation of the clinical counterpart when encountered in medical practice. They have served as teaching aids, enhancing memory retention for medical students, nurses and doctors and have withstood the test of time. Standard medical textbooks contain metaphors that have become entrenched in teaching, learning and examining in medical schools and hospitals worldwide. The continued use of metaphors has given rise to an ongoing debate, particularly in Africa, due to the usage of inappropriate or unfamiliar metaphors which are not locally or culturally relevant. Despite this, medical analogies will no doubt continue to be useful for medical education, clinical practice and 'aide memoirs' for examinations, and bring light humour, for a long time to come. © Royal College of Physicians, 2012. All rights reserved.

Masukume G.,Mpilo Central Hospital | Sengurayi E.,Mpilo Central Hospital | Muchara A.,Mpilo Central Hospital | Mucheni E.,Mpilo Central Hospital | And 2 more authors.
Journal of Medical Case Reports | Year: 2013

Introduction. Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation. We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion: Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn. © 2013 Masukume et al.; licensee BioMed Central Ltd.

Masukume G.,Mpilo Central Hospital | Chibwowa S.,Mpilo Central Hospital | Ndlovu M.,Mpilo Central Hospital
Journal of Medical Case Reports | Year: 2011

Introduction. Reports on children with Ramsay Hunt syndrome are limited in the literature, resulting in uncertainty regarding the clinical manifestations and outcome of this syndrome. Treatment for Ramsay Hunt syndrome is usually with antivirals, although there is no evidence for beneficial effect on the outcome of Ramsay Hunt syndrome in adults (insufficient data on children exists). Here, we report a case of Ramsay Hunt syndrome occurring in a child who inadvertently received a lower dose of aciclovir and steroid administered for shorter than is usual. Our patient made a full recovery. Case presentation. A 13-year-old African boy presented to our out-patients department with an inability to move the right side of his face for one week. He had previously been seen by the doctor on call, who prescribed aciclovir 200 mg three times per day and prednisone 20 mg once daily, both orally for five days, with a working diagnosis of Bell's palsy. After commencement of aciclovir-prednisone, while at home, our patient had headache, malaise, altered taste, vomiting after feeds, a ringing sound in his right ear as well as earache and ear itchiness. Additionally, he developed numerous fluid-filled pimples on his right ear. On presentation, a physical examination revealed a right-sided lower motor neuron facial nerve palsy and a healing rash on the right pinna. On direct questioning, our patient admitted having had chicken pox about three months previously. Based on the history and physical examination, Ramsay Hunt syndrome was diagnosed. Our patient was lost to follow-up until 11 months after the onset of illness; at this time, his facial nerve function was normal. Conclusions: This case report documents the clinical manifestations and outcome of pediatric Ramsay Hunt syndrome; a condition with few case reports in the literature. In addition, our patient made a full recovery despite inadvertently receiving a lower dose of aciclovir and steroid administered for shorter than is usual. © 2011 Masukume et al; licensee BioMed Central Ltd.

Ngwenya S.,Mpilo Central Hospital
International Medical Case Reports Journal | Year: 2016

Introduction: The complications of HIV/AIDS can produce grossly abnormal pathology. In low-resourced settings, women can present late with huge lesions. Massive vulval pathology copresenting in pregnancy produces difficulties in managing the patients and may lead to poor maternal or fetal outcomes. Case report: A 27-year-old P1 G2 (second pregnancy one live birth) patient presented at 30 weeks gestation with a massive vulval lesion. She was HIV seropositive and taking antiretroviral therapy. She was anemic with a hemoglobin level of 5.9 and was transfused 4.0 of packed cells. She underwent examination under anesthesia and vulval biopsy. She went into preterm labor and was delivered by cesarean section. Unfortunately, the baby had died while receiving corticosteroid therapy. The histopathological report confirmed a Kaposi’s sarcoma, and she was referred to oncologists for chemotherapy. Conclusion: Kaposi’s sarcoma can occur in pregnancy in both seropositive and seronegative patients. Kaposi’s sarcoma causes significant fetal and maternal health complications. © 2016 Ngwenya.

Masukume G.,Mpilo Central Hospital
Malawi Medical Journal | Year: 2012

PubMed and Google Scholar were searched to obtain articles originating from Mpilo Central Hospital, Bulawayo, Zimbabwe - 1958 to August 2011 (54 years). 168 articles cited 999 times were retrieved giving about 6 citations per article. Analysis of publication trends over time as well as publication avenues is made. The full research dataset for this study is shared. This study adds to the body of knowledge on teaching hospital research performance assessment particularly in low-income settings, a topic with few studies. Africa needs data on research.

Ashmawy H.,Mpilo Central Hospital
UroToday International Journal | Year: 2011

INTRODUCTION: The erect penis is very vulnerable to blunt trauma, which is mostly sustained during sexual intercourse or through vigorous manipulations during masturbation or other violent sexual activities. These actions may lead to a fracture of the penis. The purpose of this retrospective study is to review the effect of early surgical exploration and repair of penile fractures and to report the overall healing of these injuries and the patient's ability to regain erectile function. METHODS: A total of 20 patients presented with a fractured penis between October 1999 and November 2009. Their mean age was 27 years (range, 16-48 years). All were managed with surgical repair within 24 hours of the injury by the same surgeon (HA). Postoperative follow-up occurred monthly up to 6 months. The outcome measures were: (1) patient satisfaction with the cosmetic results, and (2) patient satisfaction with erectile function, as determined by the International Index of Erectile Function (IIEF). Complications during the follow-up period were summarized. RESULTS: All 20 patients had successful wound healing, although 4 patients who were HIV-positive developed superficial wound infections that were treated by antibiotics. All patients reported normal psychogenic response, nocturnal erection, and full sexual activity at 3 months after surgery. The mean IIEF score was 23.5 out of a total 25 points (range, 22-25). CONCLUSION: A fractured penis is a urological emergency that is best treated with immediate surgical exploration and repair of the tunica albuginea and any associated injuries. Surgical repair minimizes the incidence of erectile dysfunction. © 2011 UroToday International Journal/Vol 4/Iss 1/February.

PubMed | Morriston Hospital, Mpilo Central Hospital, University of Bristol, Foundation Medicine and 2 more.
Type: Journal Article | Journal: Bulletin of the World Health Organization | Year: 2015

In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital.Maternal mortality in Zimbabwe has increased from 555 to 960 per 100,000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.

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