Pakistan: Nowshera Health Centre

Q1/2015 Nowshera Morbidity and Progress Report

June 03, 2015

Dr. Rubina Mumtaz

Morbidity Report from 1st January to 31st March 2015
 
In the first quarter of 2015, a total of 3,078 women, men and children frequented our MCH center during OPD hours. The percentage distribution between women (65.7%) and children (33.3%) has remained somewhat the same as in the previous years. The local goodwill has been established this to be a total of 2,807 (90.4%) were women, 14 (0.5%) men and 362 (9.1%) were children of which gender distribution was somewhat equal. Although this is primarily a women’s clinic, we do not turn away any male patient should they present at the premises with an emergency medical problem of primary health level which is usually an accident (both road traffic and non-RTA).
 
MCH Statistics: In these past three-month reporting period, antenatal services were sought by 607 women while 93 came for postnatal checkups. Family planning services were provided to 32 women while only 11 women sought advice and guidance for both primary and secondary infertility issues.

Distribution of Types of MCH Services Provided

The surprising aspect of this quarter was the sharp increase in antenatal and postnatal care sought in our MCH center and the concurrent decrease in the demand for family planning services. The OB/Gyn category covered the following pathologies which were provided to 665 women. They include:
 

Gynecological Pathologies Presentation  
Amenorrhea 23
Dysmenorrhea 89
Leukorrhea 245
P/V Discharge 43
P/V Bleeding 13
Ovarian Cyst 14
Irregular Period 113
Polymenorrhoe 33
PID (Pelvic Inflammatory Disease) 76
Fibroid 5
Total 665
 

Primary Health Statistics: The number of primary health cases presented at the center totaled to 1,645 women and children. In this quarter over the winter season, the most common complaints were respiratory tract infections (23.4%) followed by diarrhea (15.3%). Anemia (13.5%) came as the third most frequent complaint congruent with the poor diet of these IDPs. Other ailments presented were:
 

Primary Health Presentation  
Anemia 228
Abdominal Pain 67
Respiratory Tract Infections 385
Enteric Fever (Typhoid) 34
Dyspepsia 125
Vomiting 67
Scabies 99
Food Poisoning 8
Urinary Tract Infections 125
Hypertension 108
Suspected Meningitis 3
Burns 7
Acute Appendicitis 0
Jaundice 13
General body aches and weakness 122
Diarrhea 252
Total 1,645
Non-RTA related injuries were presented by 9 patients. Our location on the main road means that we are often presented with road traffic accidents and in this 3-month period a total of 17 cases were provided with immediate emergency care, all men.  The total number of referrals made to the MCH were10 patients.
 
Pathology Lab Statistics: The pathology lab conducted a total of 491 routine investigative tests in this three-month period.  The table below shows the breakdown.
 

Lab Tests Performed from 1st January to March 31st  2015  
Pregnancy Urine Test 113
Urine Routine Examination 66
Blood Grouping 46
Blood Hb 116
Blood Glucose 35
Vidal Test 29
Blood Malarial Parasite (MP) 26
RA Factor 8
Toxoplasma 7
SGPT 0
Total Tests 491
 

Ultrasound Investigations: This is our second quarter to offer ultrasound services to our patients and the statistics show a tremendous leap from the last quarter (which actually constituted of two months as the ultrasound machine came into operation in November 2014). The word of ultrasound services, the first of its kind at a not-for-profit health facility, spread in the community like wildfire with many women referred to us by other NGO clinical setups and government based hospitals. These women came to us seeking an ultrasound only but then also chose to have a check-up. A total of 590 women utilized the ultrasound services and the investigations conducted were as follows:
 

Ultrasound investigations 1st January to March 31st 2015  
Ultrasound for antenatal check-up 399
Ultrasound abdomen only 28
Ultrasound pelvis only 96
Ultrasound abdomen and pelvis 67
Ultrasound for fatty liver 0
Total 590
Third Party Evaluation:  The trend of disease presentation in this quarter is markedly different and this difference became apparent from as early as the first month of the quarter (January). Although the average numbers of patients being reported were the same, surprise M&E visits by the head office on different days revealed that the number of patients observed were fewer than the official records.  However, use of drug supply and hence its monthly demand was unchanged. We had had a change in staff where we had hired a new LHV in replacement of the previous one who had to resign for personal reasons. However, in our opinion at the head office, keeping the administrative M&E reports aside, the degree of change in disease presentation was very important as it was too marked to be a simple attribution to the change of personnel since diagnosis of case presentation follows medical and technical guidelines other than personal opinions. It needed to be investigated.
 
We hired a consultant as a third party evaluation party for a period of 10 working days. We had to limit our selection to a female consultant in keeping with the women-only arena of our MCH Center. Also female patients would not object to a woman taking photographs. An observership-participation methodology was the approach adopted for the evaluation process and was based on electronic monitoring and evaluation to give a continuous ‘real time’ report of every hour of every working day during this consultancy.
Requirements for this e-M&E was a smart phone with a 3G connection and every patient receiving treatment was photographed and sent by the WhatsApp application to the head office in real time. This was followed by the end-of-the-day of both the patient record and the Pharmacy record registers. The Pathology lab and Ultrasound register records for each day were also submitted simultaneously. 
 
Results and Conclusion: The number of women and children frequenting our MCH Centre were consistent with the average number reported in the morbidity reports and hence the drug stocks statistics exhibited congruency along the same lines. The numbers of tests performed in the pathology lab were similar to the previous quarter but there was a tremendous increase in the ultrasounds being conducted. Here it became interesting in that the number of women seeking ultrasound were significantly higher. The word has spread in the community, including in the other health care facilities, private, government as well as not-for-profit in the district and pregnant women were being referred to us for ultrasounds. Naturally every woman needed to have an antenatal consultation as well and hence the explanation for the sudden increase in antenatal and postnatal visits.
 

RMF Health Centre Nowshera from 1st January to March 31st 2015
  Month Jan-15 Feb-15 Mar-15 Total
  Total Patients for the month 1023 1086 969 3078
1 Female 714 761 548 2023
  Male 10 11 6 27
  Total Adults       2050
2 Children (Male) 123 185 213 521
  Children (Female) 176 129 202 507
  Total children 299 314 415 1028
  MCH Details        
1 Antenatal Care 201 178 228 607
2 Postnatal Care 23 50 20 93
3 Family Planning 12 15 5 32
4 Infertility 1 7 3 11
5 Amenorrhea 3 15 5 23
6 Dysmenorrhea 44 30 15 89
7 Leukorrhea 75 80 90 245
8 P/V Discharge 13 20 10 43
9 P/V Bleeding 6 5 2 13
10 Ovarian Cyst 2 7 5 14
11 Irregular Period 53 30 30 113
12 Polymenorrhoe 12 16 5 33
13 PID Pelvic Inflammatory Disease 31 25 20 76
14 Fibroid 0 3 2 5
  Total MCH 476 481 440 1397
  Primary Health Details        
15 Anemia 65 84 79 228
16 Abdominal Pain 33 15 19 67
17 Respiratory Tract Infections 123 112 150 385
18 Enteric Fever (Typhoid) 4 20 10 34
19 Dyspepsia 45 50 30 125
20 Vomiting 22 25 20 67
21 Scabies 29 40 30 99
22 Food Poisoning 1 5 2 8
23 Urinary Tract Infections 45 50 30 125
24 Hypertension 23 50 35 108
25 Suspected Meningitis 0 2 1 3
26 Burns 0 5 2 7
27 Acute Appendicitis 0 1 1 0
28 Jaundice 6 5 2 13
29 General body aches & weakness 67 30 25 122
30 Diarrhea 67 100 85 252
  Total Primary Health 530 594 521 1645
31 Non-RTA Injuries 6 2 1 9
32 RTA (Road Traffic Accident) 4 8 5 17
33 Referral 7 1 2 10
    17 11 8 36
Lab Tests and Ultrasounds Performed from 1st January to 31st March 2015
  Lab Test and Ultrasound Jan-15 Feb-15 Mar-15 Total
  Pregnancy Urine Test 45 38 30 113
  Urine Routine Examination 36 20 10 66
  Blood Grouping 15 14 17 46
  Blood Hb 61 53 47 161
  Blood Glucose 11 15 9 35
  Vidal Test 5 13 11 29
  Blood Malarial Parasite (MP) 6 10 10 26
  RA Factor 3 4 1 8
  Toxoplasma 1 2 4 7
  SGPT 0 0 0 0
  Total Lab Test 183 169 139 491
  Ultrasound for antenatal check-up 115 149 135 399
  Ultrasound abdomen 8 15 5 28
  Ultrasound pelvis 24 61 11 96
  Ultrasound abdomen & pelvis 32 25 10 67
  Fatty lever 0 0 0 0
  Total Ultrasounds 179 250 161 590