Damico Health Outreach: 2023
2023 Report
In 2023, Damico Health furthered its mission of delivering high-quality, sustainable healthcare to underserved populations, building on the foundational work established between 2020 and 2022. Our ongoing commitment to preventative education, patient care, and women’s health services remained at the forefront of our efforts, as we expanded our reach and enhanced operational efficiency.
Outlined below are the broad categories of conditions and disease states encountered in our clinics this year. We discuss how these were addressed and provide insights into potential areas for future improvement.
Discussion on Conditions and Diseases
1. Malaria
Malaria, as stated by the Ministry of Health (MoH, 2023), remains the leading cause of death in Uganda. A comprehensive study conducted by the malaria consortium in 2022 prioritized addressing the underlying cause of the disease. All recorded cases were subjected to malaria rapid diagnostic tests, which confirmed the presence of the disease. Subsequently, the patients received prompt treatment in accordance with national guidelines.
What was observed
-Self-medication: There was a notable increase in self-medication practices for malaria, with individuals treating themselves without proper testing. The use of Coartem (artemether/lumefantrine) and paracetamol was commonly reported.
-Low utilization of treated mosquito nets: Despite living in areas prone to mosquito infestation, a small number of people reported sleeping under treated mosquito nets.
-Misperception of complicated malaria: Communities had a misperception regarding complicated malaria. There was a limited understanding of the signs and symptoms associated with severe malaria, and as a result, very few people sought healthcare for such cases.
What was done
-Provision of artemether/lumefantrine: Adequate doses of artemether/lumefantrine, the recommended medication for treating uncomplicated malaria, were provided to all confirmed cases of malaria.
-Contact and family screening: Screening contacts and family members of the positive cases, allowed the medical team to identify individuals at risk of malaria transmission within the same household or close proximity. This allowed for targeted interventions such as testing, treatment, and the provision of preventive measures like mosquito nets to those who were at increased risk due to their shared living environment.
-Families of all the confirmed malaria cases were provided with treated mosquito nets. However, due to limited availability, not all patients were able to receive nets.
2. Typhoid Fever
Typhoid or enteric fever was not commonly observed. The incidence of typhoid or enteric fever was relatively low compared to other diseases or conditions encountered in numerous communities.
What was observed
-The community of Bunakijja had fewer typhoid cases due to reliable and safe water supply, while Mpunge's compromised water supply increased the risk of infection. Terere's reliance on unsafe lake water and Ntanzi's access to clean piped tap water influenced their respective typhoid case numbers.
-Lack of awareness: A significant proportion of people in the communities were found to be unaware of the symptoms, transmission, and prevention of typhoid fever. This lack of knowledge hinders early detection, prevention efforts, and appropriate management of the disease.
-Proper waste disposal: A higher percentage of individuals reported having pit latrines, suggesting that proper waste disposal practices were being followed. Proper sanitation and waste management play a crucial role in preventing the contamination of water sources and reducing the spread of diseases like typhoid.
What was done
-Treatment of positive confirmed cases: All individuals who tested positive for typhoid were treated in accordance with the national guidelines. Ciprofloxacin, an antibiotic, was administered to the positive cases for appropriate management.
-Special care for pregnant women: Pregnant women who tested positive for typhoid received initial doses of intravenous ceftriaxone and amoxicillin, followed by continuation treatment as per medical protocols.
3. Respiratory Tract Infections
Respiratory tract infections were found to be the most common conditions encountered. The majority of cases presented as upper respiratory tract infections, characterized by symptoms such as cough, rhinitis, and the common cold. A smaller number of cases were identified as pneumonia, bronchiolitis, and bronchitis. It is important to note that no life-threatening conditions were reported among these cases.
Self-medication with botanical herbs was found to be prevalent in the community for managing respiratory tract infections. While the effectiveness of these herbal remedies varied, some cases showed positive outcomes. In addition to self-medication, patients were prescribed histamines, vitamins, and antibiotics to address their symptoms. Children, in particular, received syrups as part of their treatment.
4. Vaginitis
Vaginitis is a common condition that was observed and addressed continuously. The data collected provided insights into the prevalence and management of vaginitis in these communities. A significant number of cases of vaginitis were identified, with the highest numbers reported in Bunakijja, Mpunge, and Ntanzi.
Treatment options for vaginitis included a combination of antifungal and antibacterial medications. The specific medications prescribed varied based on the causative agent, such as Candida species or bacterial infections. Patients were provided with appropriate medications, including oral or topical antifungals or antibiotics, to address the underlying infection.
5. Skin Infections/Conditions
A significant number of patients presented with various skin infections/conditions. Fungal infections, including tinea capitis, corporis, pedis, versicolor, and ringworm, were the most commonly observed. Other infections included chickenpox, molluscum contagiosum, warts, burns, and boils.
The spread of these infections was found to be largely influenced by certain behaviors and practices within families. Sharing of beddings, clothing, and shaving materials among children was identified as a major contributing factor to the high numbers of fungal infections among children. Treatment for these skin conditions involved the prescription of antifungal, antiviral, and antibiotic medications, along with the use of topical antifungal and steroid creams to manage the symptoms.
6. HIV/AIDS
The HIV testing and counseling services provided an opportunity for individuals to know their HIV status and receive appropriate support and guidance. This initiative aimed to increase awareness, reduce stigma, and promote early detection and management of HIV infections. Individuals who tested positive, were linked to Kojja Health Center IV for further management and care. This step ensures that they receive appropriate medical attention, treatment, and ongoing support from specialized healthcare professionals.
7. Other Sexually Transmitted Infections
A number of patients presented with sexually transmitted infections (STIs) other than HIV/AIDS. The most common STI observed was syphilis, predominantly among female patients. Diagnosis of syphilis was confirmed through testing using the rapid RPR (Rapid Plasma Reagin) test for all patients who presented with symptoms. Other STIs diagnosed included genital herpes and gonorrhea.
Due to limited resources, management of these STIs involved the use of available oral medications. Viral infections, such as genital herpes, were treated with antiviral medication, specifically acyclovir tablets, which were the only available medication for viral infections. Education and counseling were provided to all patients, focusing on the prevention and spread of these STIs within the communities. Patients were reassured that these conditions are curable with appropriate treatment and were informed about preventive measures.
8. Urinary Tract Infections
Urinary tract infections (UTIs) were identified as the second most common conditions among the patients who presented to us. These UTIs varied from urethritis and cystitis too complicated pyelonephritis. Many patients were aware of these infections and their spread, but financial constraints or difficulties in accessing healthcare facilities prevented them from seeking medical care. Only a small number of patients reported having received treatment for UTIs at least once in their lives.
Treatment for uncomplicated UTI cases involved the use of oral antibiotics such as ciprofloxacin, metronidazole, doxycycline, erythromycin, cephalexin, among others. Complicated cases were managed with stat doses of intravenous ceftriaxone and stronger antibiotics like levofloxacin and clindamycin.
Patients were strongly urged to adhere to preventive measures for UTIs since many of them faced challenges in accessing medical treatment. Emphasis was placed on practices such as maintaining good personal hygiene, proper hydration, and emptying the bladder regularly to reduce the risk of UTIs.
9. Hypertension and Cardiovascular Disease
It was observed that a significant number of people were unaware of hypertension and other cardiovascular diseases. This lack of awareness was primarily due to the absence of screening and information about these conditions. Additionally, many elderly individuals faced difficulties in accessing healthcare facilities for routine check-ups due to limited mobility.
Among those who were aware of hypertension, several challenges were identified. Some individuals could not afford to purchase monthly or weekly antihypertensive drugs. There was a misconception that taking a course of antihypertensive medication would completely eliminate the problem. Newly diagnosed patients also exhibited resistance towards lifelong medication adherence.
Confirmed cases of hypertension were initiated on treatment using available medications such as nifedipine, captopril, furosemide, and atorvastatin. Approximately 70% of patients received monthly treatment. All patients were advised to establish a connection with the nearest health facilities for further management and routine check-ups.
10. Diabetes Mellitus
Type I and Type II diabetes were found to be relatively uncommon conditions . Most of these cases were already known, but the patients were non-adherent to medication, and many had at least one complication of diabetes, such as retinopathy, neuropathy, or periodontal disease. The low number of cases seemed to be attributed to certain lifestyle factors, including maintaining a proper weight through active work and a balanced diet.
For the newly confirmed cases, education was provided on managing the condition through diet and exercise. Some individuals were initiated on low-dose metformin, a commonly prescribed medication for Type II diabetes. Non-adherent patients were educated about the benefits of taking diabetic medications and were re-initiated on treatment.
11. Peptic Ulcer Disease
Peptic ulcer disease caused by H. pylori infection was commonly encountered. Patients who showed signs of peptic ulcer disease (PUD) but tested negative for Helicobacter pylori were treated for other gastrointestinal disorders.
Excess alcohol consumption and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) during self-medication were identified as the major risk factors among most of the patients. Many patients reported self-medicating with omeprazole, which provided temporary relief but led to symptom recurrence upon completion of the capsules. This was because they were not receiving the triple therapy regimen necessary for complete eradication of the bacteria causing the condition.
All patients were educated on dietary and lifestyle changes that can aid in the eradication of H. pylori infection. They were prescribed a triple therapy regimen consisting of omeprazole, amoxicillin, and metronidazole for a duration of 14 to 28 days, depending on the severity of symptoms.
12. Other Gastrointestinal Conditions
In the rural setting, a wide range of gastrointestinal (GIT) complications were observed, varying from mild to extreme cases, particularly among children. The most common conditions identified included gastritis, gastroesophageal reflux disease (GERD), gastroenteritis, worm infestation, constipation, and diarrhea. Additionally, there was one case of gallstones from Terere and one case of hiatal hernia, which were referred for further management and booked for hernia repair.
Treatment approaches for these different gastrointestinal conditions involved the use of known medications such as metronidazole, omeprazole, loperamide, bisacodyl, and vitamin supplements. Patients who met the criteria for deworming received albendazole for deworming purposes. In addition to medication, patients were advised on proper hygiene practices in their environments, food handling, and waste disposal. Emphasizing these practices was considered crucial for preventing the occurrence of most of these gastrointestinal infections.
13. Psychiatric Disorders
The diagnosis of psychiatric disorders was rare in the communities, with only three cases identified. In Bunakijja, two cases were reported, one of epilepsy and another of bipolar disorder. Additionally, there was one case of delirium in an elderly patient who had previously been hospitalized for five weeks due to COVID-19 in 2021.
The absence of antipsychotic and anticonvulsant medications made it challenging to manage these mental health conditions effectively. As a result, all three cases were promptly referred to the nearest health facilities for further assessment and appropriate treatment.
14. Musculoskeletal Conditions
Musculoskeletal conditions were relatively common, particularly among elderly women who engaged in fieldwork and domestic chores. A significant percentage of patients aged 60 and above reported symptoms such as back pain, numbness, limb immobility, and bone cracking. Commonly diagnosed conditions included osteoarthritis, tendinitis, and sciatica. Some of these conditions were diagnosed through on-site ultrasound scans, while others were clinically diagnosed based on symptoms and medical history.
Treatment for these musculoskeletal conditions focused on pain relief, mineral supplementation, and nerve pain management. Medications such as naproxen, ibuprofen, calcium lactate, and vitamin B complex were commonly prescribed. Additionally, patients were advised to reduce their workload, especially those involved in heavy manual labor for extended hours, as well as elderly individuals with comorbidities.
15. Other Medical Conditions
In addition to the commonly observed conditions, there were several rare and unclassified medical conditions identified. These included post-menopausal syndrome, parkinsonism, fibroadenoma, epistaxis (nosebleeds), ascites of unknown cause, suspected cancers, leg ulcers, cataracts, cleft lip, nasal polyps, suspected cases of Mycobacterium tuberculosis, schistosomiasis, and Down syndrome.
For these less common conditions, the primary approach was to provide health education and referrals to specialized centers or healthcare providers for further assessments. This ensured that patients received the necessary attention and appropriate care specific to their condition.
Community Education on Chronic and Acute Diseases
The education programs conducted played a vital role in fulfilling our mission of providing comprehensive healthcare to the communities. These programs served as a crucial platform for raising awareness, disseminating valuable information, and empowering individuals to make informed decisions about their health. By addressing specific diseases and conditions through targeted seminars, we were able to equip community members with the knowledge and tools necessary to prevent illnesses, recognize symptoms, seek appropriate treatment, and make positive lifestyle choices. These education programs were an integral part of our mission to promote community well-being and ensure sustainable healthcare practices. The following topics were discussed separately or together based on the needs and scheduling on the clinic day:
1. Malaria and Typhoid: This seminar focused on emphasizing the importance of differentiating between the two and being aware of the potential complications of malaria. Participants were educated about the transmission, symptoms, and preventive measures for each disease. Special emphasis was given to the recognition of complicated malaria cases that require additional treatment beyond Coartem (artemether/lumefantrine). By providing comprehensive information on these two prevalent diseases, the seminar aimed to empower individuals to take appropriate preventive measures and seek timely medical care for accurate diagnosis and effective treatment.
2. Gastrointestinal Infection Prevention: This seminar aimed to educate the community about preventing gastrointestinal infections, such as gastroenteritis and peptic ulcer disease. Topics covered included proper handwashing techniques, safe water usage, and hygienic food preparation and storage practices.
3. Chronic Disease Management: This seminar focused on chronic conditions like hypertension and diabetes, this seminar provided information on lifestyle modifications, including healthy eating habits, regular exercise, and medication adherence. It aimed to empower individuals to manage their conditions effectively and reduce the risk of complications.
4. Mental Health Awareness Seminar: This seminar addressed the stigma surrounding mental health and provided information on common mental illnesses, their symptoms, and available support resources. The goal was to promote understanding, encourage early detection, and emphasize the importance of seeking help for mental health concerns.
Prenatal Care and Ultrasound
Our clinic encountered numerous women who had not received adequate prenatal care. To address this, we utilized our portable ultrasound machine to estimate gestational age and performed various tests available, including HIV, syphilis, and hepatitis B screenings. Additionally, women who presented with suspected pregnancy based on their last menstrual period or requested testing and were confirmed as pregnant were provided with comprehensive care. Our team made concerted efforts to connect these pregnant patients with local healthcare resources for ongoing support and follow-up. Furthermore, all pregnant patients received a comprehensive written report encompassing all the information gathered during their visit, ensuring a thorough and well-documented record of their prenatal care.
The presence of a portable ultrasound machine proved to be invaluable in our work, particularly in certain cases and for prenatal screening. We were able to perform ultrasound scans to monitor fetal growth, identify any potential abnormalities or complications, and ensure the well-being of expectant mothers and their unborn babies. Early detection of conditions such as fetal anomalies, placental issues, or multiple pregnancies enabled us to provide appropriate guidance, counseling, and referrals to ensure the best possible outcomes for both mother and child.
The ultrasound machine proved highly beneficial beyond prenatal care, enabling us to diagnose and assess a wide range of conditions. Furthermore, the portable nature of the machine allowed us to bring diagnostic capabilities directly to the communities, facilitating real-time decision-making and immediate interventions. Its versatility greatly enhanced our ability to provide comprehensive care and timely interventions for various medical conditions.
Family Planning
The family planning services offered included the provision of implants, combined oral contraceptives, and injectables. In addition to the provision of various family planning methods, free condoms were also distributed as part of the family planning initiative.
Recommendations
1. Strengthen community education and awareness programs to increase knowledge about various diseases, their causes, prevention methods, and the importance of seeking timely medical care. For example, educating the community about the symptoms and prevention of malaria can help individuals recognize the signs early on and seek appropriate treatment, reducing the risk of complications.
2. Improve access to healthcare services in the community, including diagnostics and medications, to reduce fatalities and improve outcomes for conditions such as malaria and typhoid. By establishing regular healthcare services in the community, individuals can receive timely diagnosis and treatment for these diseases, preventing the progression of illness and reducing the burden on healthcare facilities.
3. Organize regular and frequent medical camps in the remote communities to track disease trends, treatment responses, and prognosis, enabling timely interventions and follow-ups. These camps can serve as platforms for comprehensive healthcare delivery, ensuring that individuals receive ongoing care, monitoring, and necessary interventions for conditions like diabetes or hypertension.
4. Distribute mosquito nets to all community members in the community to prevent malaria and reduce its transmission. Distributing mosquito nets is a cost-effective preventive measure against mosquito-borne diseases.
5. Promote proper hygiene practices, such as handwashing, safe water usage, and waste disposal, to prevent the spread of gastrointestinal infections and other communicable diseases.
6. Advocate for the expansion of family planning services, including access to contraceptives and education on family planning methods, to empower individuals and promote reproductive health. Ensuring access to family planning services can help individuals make informed choices about their reproductive health, reducing the risk of unintended pregnancies and promoting overall well-being.
7. Strengthen collaboration between healthcare organizations, NGOs, and government agencies to ensure comprehensive and coordinated efforts in addressing healthcare needs in the communities. By fostering partnerships and collaboration, resources can be pooled, expertise can be shared, and services can be delivered more efficiently, maximizing the impact on community health.
Surgeries
Numerous individuals with minor to moderate surgical conditions were identified and scheduled for surgeries. Priority was given to those who had comorbidities, and they were contacted via phone and provided with appointments at KOJJA Health Center IV in Ntanzi, where the surgeries would take place.
A special acknowledgment was given to the management and staff of KOJJA Health Center IV for their support in providing full access to their operating theater for this initiative. Additionally, the theater staff joined the team in this endeavor, dedicating their time and expertise to make the surgeries possible.