CHAPTER 5 5.

1 HEALTH SERVICES OFFERED IN THE DISTRICT PRIMARY HEALTH CARE (PHC) ACTIVITIES AND SERVICES OFFERED BY THE HEALTH WORKERS AT THE DISTRICT LEVEL: The PHC activities and services offered by the health workers at the District level had 4 characteristics, i.e. they were; affordable, acceptable, and reliable and had full community participation. The PHC Services included; o Water and sanitation: Sanitation and Water Quality is a big challenge within Kisii municipal I participated in piped water mapping and its contaminants within Kisii municipal and Bacteriological water quality testing for household¶s workshop that was conducted by the UN habitat for 3 days at St Stephens Catholic hall in Kisii. 4 classification of water related diseases were discussed: 1. Water borne diseases: Diseases caused by ingestion of contaminated water by human or animal or urine containing bacteria or viruses. 2. Water washed diseases: Caused by poor personal hygiene as a result of poor access to water 3. Water based diseases: Diseases caused by parasites found in the intermediate organism leaving in water. 4. Water related diseases: Transmitted by insect¶s vectors which breed in water

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Whereby in Kisii Central District the following were found to be the most common diseases In terms of prevalence Malaria is the highest in prevalent then typhoid, dysentery, Amoeba, Tungiasis Water supply in Kisii Central District is divided in to two: 1. Piped water: Kegati water treatment plant that supplies The lager Kisii was visited where conventional ways were used to treat water, The following Chemicals were used in the following stages: Presumptive test- where Aluminum Sulphate is used to suspend dirt in water Confirmed test ±Where Chlorine is used to disinfect and leave residue for further decontamination. Completed test ± Where sodium carbonate is used to neutralize the water that has been treated by Aluminum sulphate. - treated water entering the distribution system -Untreated water entering the distribution. 2. Un piped water: any other water not entering the distribution system which some are protected some not is unprotected like: -Springs -Streams --Wells -Bore holes

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-Rivers -Rainwater. Possible sources of water contaminant in Kisii central District are: Industrial waste e.g. from slaughter houses, Chemicals from agricultural practices, Soil erosion, Poor disposal of waste, Poor storage or handling of domestic water, Run offs e.g. leachates from dump sites, Underground contamination. Existing sanitation facilities in KMC are not well planned hence the greatest water contaminants: Latrines, Dump sites, sewerage system, septic tanks and most of this existing sanitation were down streams hence contribute a lot in water contamination. o Waste management services: Kisi Central District has waste from the level five

hospitals and the Municipal waste. Medical waste: Classified in to three categories 1. Highly infectious put in a red polythene bag then collected every morning and taken for incineration. Infectious waste: put in a yellow polythene bag and collected every morning for incineration too. Non Infectious waste: Put in black polythene and taken to the hospital dump site. The main ways of managing hospital waste at Kisii level five hospitals are damp sites for non infectious waste, open drains for rain water disposal, pits e.g. placental pits, sewage drains for liquid infectious waste and safety boxes for syringes and vials, they are all kept in a strategic point for collection for disposal.

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Municipal waste: it has both solid and liquid wastes; municipal mainly uses sewerage system and septic tanks for liquid wastes and damp sites for solid wastes. o Immunization: This was also done in the Mother Child health clinic different vaccines were learnt, their doses; routes use to administer them and participated in administering them at Oresi health center, discussed KEPI diseases i.e. Poliomyelitis, Pertusis/whooping cough, Tetanus, hepatitis B, Heamophilus Influenza type B.For example we have the BCG vaccine for Tuberculosis given at birth or at first contact with the child dose is 0.05 cc under one year and 0.1cc above one year, route of administration is intradermal.There is also oral polio vaccine aganaist poliomyelitis2 drops given at birth, fast polio given after 6 weeks, second polio given at 10 weeks, and third polio given at 14 weeks. There is pentavalent vaccine given aganaist Diptheria,Pertusis/whooping cough,Tetanus,Hepatitis B,and hemophilus influenza type B this vaccine is given at 6 weeks in the thigh muscle the dose is 2.5cc.at 6 months or 9 months Vitamin A vaccine is given and at 9 months measles vaccine is administered intra muscle with a dose of 0.5cc in the right hand in some places like some parts of Rift valley yellow fever vaccine is administered so there is a total of 8 Kepi diseases but 9 with the inclusion of yellow fever.. o Learnt Cold chain process: Keeping vaccines safe from the manufacturer to the patient potent according to manufacturer¶s instructions. They arrive at the headquarters in Nairobi they are confirmed by the experts then transported to Regional stores example Kisumu for Nyanza province vaccines and they are transported by use of special vehicles purposely made for transporting vaccines this is done by Kenya Medical Supplies Agency(KEMSA) who also confirms their safety
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During transport and use health workers are required to record batch numbers of vaccines in the ledger book for control and references. Kisii district then to health centers. PHHC 420: PROFESSIONAL PRACTTICE PRESENTED BY: WANGECI FAITH KIRAGU ID: SWANKI0731 5 . Non ±K UNIVERSITY OF EASTERN AFRICA BARATON SCHOOL OF HEALTH SCIENCES DEPARTMENT OF BUBLIC HEALTH REPORT ON PROFFESSIONAL PRACTICE IN KAPTUMO DIVISION ASSIGNMENT DONE IN PARTIAL FULFILMENT OF THE COURSE.g.and potency at this level from the region level cool boxes and ice parks are used to transport them to District level e. At the facility level all vaccines must be kept at +2 and +8 degrees centigrade. dispensaries and to some Non Governmental Organizations offering the services.

To the course coordinator.COURSE COORDINATOR: Ms ASENATH NYANTIKA BARONGO OCTOBER . for taking her time to prepare us by giving us the right counsel on how to conduct ourselves and also visiting us during the period.DECEMBER Acknowledgement First and foremost I give thanks to my God for enabling me to successfully go through the professional practice at kaptumo division. madam Asenath. To all the PHOs who helped us attain our objective in addition to giving us an opportunity to take part in the different activities. To the entire faculty in the department for giving us the right knowledge in the different courses. To my colleagues for being so supportive and finally to my dear friend Brenda who accommodated me during the entire period. 6 .

Declaration I hereby truthfully declare that this report is my own work and it has not been presented by any other person. 7 . Student name: Wangeci Faith Kiragu Id: SWANKI0731 Sign:««««««««««« Instructors name: Ms Asenath Barongo Sign:««««««««..

List of abbreviations PH ± public health PHO ± public health office/public health officer DPHO ±district public health office/officer TB .tuberculosis VCT ±voluntary counseling test PMTCT ± preventive mother-to-child transmission HAART-highly active anti-retroviral therapy IRS.indoor residual spraying EPI ± extensive program of immunization MOH ±Ministry of health PPE ± Personal protective equipment KEMSA ±Kenya extended medical supplies association BMI ± Body mass index KSDH ±Kaptumo sub-division hospital 8 .

................................................................. 40 9 .................................................................................... 13 Organization of health services .................................................................... 26 Laboratory services ..................................................................................... 33 Filter clinic ........................................................................................... 16 Immunization services .............................................................................................................................................. 7 List of abbreviations ........................................................ 8 Chapter 1 ........................................................................ 22 Food quality ........................................................................ 33 Occupational health..................................................................................................................................................... 12 Chapter 2 ......................................... 12 Methodology..... 25 Maternal health services ............................................................................................................................................................ 13 Water and sanitation .......................................................................................................................................................................................................................... 6 Declaration ................. 10 Objectives ................................................................................................................................ 29 Pharmacy and treatment services......................................... 20 School health services ......................... 36 Chronic disease control .................... 38 Health education and promotion . 23 Meat Inspection .....................................................HACCP ± hazardous critical control point Contents Acknowledgement ................................................................................................................................................................................................................................................................................................................................................... 40 Building inspection ........................................................................................................................................................................................................................................................................................................................................................................................................................................... 15 Waste management ..................................................................................................................................................................... ....................................................................................................................................................................... 17 Nutritional services .......................................................................................................................................... 34 Communicable disease control ................................................................. 28 Clinical care services................. 10 Introduction .............

.. the division has one health center and three dispensaries........... Disease control and community strategy  Formation of community units  Mobilization for EPI  Defaulter tracing  Enhancing condom distribution 10 .....782 people projecting to 35...................... 42 Conclusion ............................ there are26 established primary schools and 5 secondary schools....... temperature range of 130c............... 41 Chapter 3 ...................................................... It comprises of 4.................... There are four locations...........B sites and 8 spray teams.4km2 with a population of approximately 26................. There are several types of public health activities... 14 sub locations and 82 villages/estates......a....... Looking at the level of education. 42 Chapter 1 Introduction Kaptumo division is an area of about 137.... The division has an altitude of about 1860m.................. Pit latrines  Auditing old latrines and pegging/sitting new ones  Health education on the importance of pit latrines 2................Record services .980 households with a projection of 5.................... and a rainfall of 2100mm average p...... Some of them include: 1..........000................. In addition there are also 7 established markets..............300c. In addition.....300 households.............................. Looking at the organization of health services.................................... they have 9 major M........

School sanitation  Inspection of schools per term  Formation of health clubs  Improvement of disaster preparedness  Improving student personal hygiene practices 7. Water quality control  Mobilization of community spring protection  Treatment of drinking water  Water sampling  Intersectoral collaboration 4. Revenue  Comprehensive inventory of businesses  Procure adequate official and legal forms and receipts 5. 3. Food quality control  Enhance routine inspection/sanitation  Medical examination of all food handlers 6. Good housing  Enhance approval of building plans  Building site inspection  Improving lighting and ventilations  Enhance routine inspection and education 11 . Enhanced surveillance and reporting  Internal residual spraying.

 Participating in the carrying out inspections in the food premises. To describe the primary health care activities and services offered by the health workers at the community. 2. 3. To participate in the community health services offered by the public health officers and health center staff. tea factory and two different mala factories. Improve structural aspects Objectives 1. buildings under constructions and building maps before approval  Visiting the DPHO for a short briefing on the organization of health services. Methodology  Having discussions with the in charge of the different departments in the hospital. schools. 12 .  Participating in drafting of statutory notices and issuing medical examination certificates to food handlers. market.  Visiting factories for the purposes of learning more on occupational health. To describe the organization of health services from the ministry of health to the community level. slaughter slab.  Participating in health talks both in the hospital and schools.

Chapter 2 Organization of health services There are six levels of health services: National hospital Provincial hospital Sub-division/division hospital Health center Dispensaries Community level There are two ministries dealing with health issues: 13 .

1. Ministry of public health and sanitation MINISTRY OF HEALTH MINISTER FOR MEDICAL SERVICES MINISTER FOR PUBLIC HEALTH ASSISTANT MINISTER FOR PUBLIC HEALTH ASSISTANT MINISTER FOR PUBLIC HEALTH PERMANENT SECRETARY FOR PUBLIC HEALTH DIRECTOR OF MEDICAL SERVICES (DMS) PROVINCIAL DIRECTOR OF PUBLIC HEALTH (PDPH) PROVINCIAL MEDICAL OFFICER OF HEALTH (PMOH) PROVINCIAL HEALTH MANAGEMENT BOARD (PHMB) PROVINCIAL HEALTH MANAGEMENT TEAM (PHMT) PROVINCIAL HOSPITAL MANAGEMENT TEAM (P-HMT) SUB-DISTRICT HOSPITAL MANAGEMENT BOARD (SDHMB) chaired by the DISTRICT MEDICAL OFFICER OF HEALTH 14 DISTRICT HEALTH MANAGEMENT BOARD (DHMB) DISTRICT HEALTH MANAGEMENT TEAM (DHMT) DISTRICT HOSPITAL MANAGEMENT BOARD (DHMB) DISTRICT HOSPITAL MANAGEMENT TEAM (DHMT) . Ministry of medical services 2.

protected springs. while the hydram springs have been erected where the eyes are in the low lands and there is need to reach people in the high lands. The springs are of different kinds. Water and sanitation A big percentage of people at kaptumo get their water from the springs. gravity schemes and hydram springs. unprotected springs. eye from top to bottom. 15 . The public health departments have the responsibility of protecting the unprotected springs to ensure that people not only get water but safe water. Discussion The gravity schemes have been established in places with high gravity gradient i. it has been upgraded to level 4.Discussion Kaptumo sub division hospital was ideally supposed to be a at level 3 but due to the fact that it is the largest in the division and serves all the facilities near it. It has limited personnel and equipments e. A spring is a place where water appears from the ground.e.g surgery equipments. Challenge Being the central point of all other facilities in the division it requires more recourses of which it doesn¶t have.

Springs are protected to. Blue gum trees are discouraged since they take in more water. The hole should be trapezium shaped with the floor sloping towards the hole. increase spring water yield and reliability. the history of the spring. Waste management Disposal of human waste is very important and a crucial area to be attended to. Solid waste is disposed in compost pit and a soakage pit for the liquid waste that is later used as manure in the farms. protect the spring from pollution as well as water contamination during water drawing and facilitates improved access to the spring. there are two things that should be of concern. After the excavation of the eyes.For any spring to be protected. Kaptumo divisions being an area with no much water VIP latrines have the biggest coverage. an embankment wall is constructed and a collection point provided for. from the people around the spring. Discussion There is a certain criteria used in construction of VIP latrines to ensure that they serve the right purpose. Critique There being reasons as to why springs should be protected. It should have a floor space of 4´ by3´ with an allowance of 2-4´ outside. Trees are finally planted around to provide shade preventing it from drying out. and the positioning of the spring eyes. 16 . some people especially the children insert various objects in the collection pipe with an excuse of wanting to increase water pressure. The area is later surrounded by a fence to keep off humans and animals from the site in addition to protecting the spring from any pollution at the source.

providing ventilation etc. Immunization services Administration of vaccines is a major way of preventing diseases. it is administered appropriately e. polio vaccine. the latrine should be dark in the Inside. No ventilation is required. The door should open outwards so as to maintain the inner space and also it should have a 2´ space at the bottom and no space at the top. The vaccines should be kept at a given temperature to maintain their potency thus the cold chain regime/schedule should strictly be followed. DPT vaccine. holes being bigger than required. BCG vaccine. measles vaccine and yellow fever vaccine. with the fly trap present it helps control flies and thermal effect that ensures continuous suction of air. In case of any outbreak or introduction of a new vaccine. passage for fowl smell.The vent pipe should be placed outside and should be 4´ wide and 30m above the highest point of the roof. the people at kaptumo division end up constructing improper VIP latrines. some having their vent pipes outside. Critic Being in haste of providing the VIP latrines. It has several functions.g H1N1 vaccine. Children are given a maximum of five compulsory vaccines. Discussion 17 .

18 .The immunization schedule for all children in Kenya and that followed at kaptumo division in all health facilities is as follows.

0. When the vaccines are being transported from one facility to another. 19 . 0.0.5mls: at 9 months Dose 0. They are also stored temporarily in the cold box before being administered.OPV3 Measles vaccine Subcutaneously right upper arm Yellow fever vaccine: 9 months Intra muscular left upper arm Dose.BCG VACCINES: at birth Intra-dermal left fore arm DPT + Hep B/Hi b Intra muscular outer thigh Dose. 2 drops orally Birth dose: birth/ within 2weeks OPV0 1st dose at 6 weeks OPV1 2nd dose at 10 weeks. they are carried using the ice box (have ice packs inside).5mls Vaccines in stock are maintained at a temperature of +20c to +80c either in a deep freezer or in a normal refrigerator.5mls 1st at 6 weeks 2nd at 10 weeks 3rd at 14 weeks Oral polio vaccine Dose.5mls for children below 1 year . OPV2 3rd dose at14 weeks.1mls for children above 1 year Dose. 0.

Red DPT +Hep B/ Hi b Orange Tetanus Yellow Green Blue BCG measles/ yellow fever polio Nutritional services The nutritional services offered at kaptumo sub-division hospital majorly favors the HIV/AIDS patients from every category. old and children. spring. The BMI of a HIV/AIDS patient guides the nutritionist on what kind of advice is to be given. also benefit by acquiring some knowledge from the PHOs on their mission to inspecting protected and unprotected springs on how they can use the runoff water for nutritional purposes such as irrigation or fishing in manmade fish ponds.In the deep freezer. mothers. some of them forget and come at a later date. Those living near sources of water. 20 . the vaccines are arranged in a specific format starting with the most sensitive on trays of different colors. pregnant mothers and that bed ridden. Despite the notification of the next day of return for their child¶s immunization to the parents. MUAC is also used for children. youths. Tray5 Tray 4 Tray 3 Tray 2 Tray 1 Critique The yellow fever vaccine is not administered at kaptumo sub-division hospital.

 F 75. given from day3 to day5. they are given the following supplements to use at home:  Fast food ± for children 21 . helps to catch up growth. These feeds are of different kinds. given from day one to day three.  F 100.5 need supplements and those above 24.  Pedisure .16ml per kg body weight  Day3«««. 22ml per kg body weight For adults. Those with a BMI of below 16 are considered to severely malnourished and should be admitted and given therapeutic feeds.Discussion Normal BMI ranges between 18.  70-80ml per kg body weight Note: for those admitted and they can not easily eat they are given.  F 75. its dense in calories and helps boost weight gain.9 need advices on how to watch their diet.9 and those below 18. On admission.  F75.  Day 1«««11ml per kg body weight  Day2«««.for children  En-sure ±for adults On discharge.5-24. For children.

50years  Advantage ± for pregnant and lactating mothers. Critique Nutritional services should not only be for those with HIV/AIDS but also for those without for healthy life is a right to every person. the target population. 22 . with an aim of bringing up healthy children. students are still willing to learn and have a greater capacity of changing unlike the grownups or old. School health services The PH departments at kaptumo division are required to offers the following health services to schools:  Deworming and dispensation of vitamin A tablets  Assist and encourage the formation of school health clubs and committees. Discussion School health is considered to be one of the best ways to help make a difference in the society.  Routine inspection of schools. The existence of health clubs or committees in a school greatly help both the students and stuff to make it a personal initiative to take care of their health and not wait to become sick and get treated.  Health talks on basic hygiene and other matters that may benefit the pupils in regard to their health. Deworming and administration of vitamin A drugs from in schools ensures that even those not readily accessible to these health services benefit. This is because. Foundation plus ± 11years.

e both external factors (size. Cap 254. The routine inspection are done to ensure that . Critique Deworming should be done after every three months which is not the case at kaptumo division. seizure of unfit foods supplied to hospitals or other institutions especially for tender cases and inspection of food eating premises and trade premises. staff and students. the sanitary facilities are adequate and well maintained.g. Food and Drug Act is the relevant tool used. the source of water is sufficient and safe for use etc. 23 . disposal of ceased food. There is also some reluctance in routine inspection of schools which has led to poor running of schools with evidence of unfit structures e. color) and internal factors (ingredients). existence of dilapidated toilets and classrooms Food quality It refers to the quality characteristics of food that is acceptable to consumers i.Health talks on hygiene and importance of hand washing was given much emphasis in schools in addition to providing hand washing tins with an objective to help reduce fecal-oral diseases. The PHOs at kaptumo are responsible of issuing medical examination certificates to food handlers. there are proper methods of both solid and liquid waste management.the buildings are safe to the occupants. shape.

stool. urine. drainage system. presence of dustbins or improvised containers and sitting/ design of the compost pit. roofing ± paint.Discussion Medical examination certificates are only issued to those food handlers who have been examined. laboratory tests ± BS WIDAL. This practice helps greatly in the control of communicable diseases especially the fecal oral infections. this include the general environment. floor ± easy to clean with no potholes. The unfit foods are seized and a seizure form issued to the supplier. Liquid waste management. The ceased foods from the trading premises are disposed specifically by the PHOs themselves or persons strictly appointed by the officers by incineration or burial to ensure no villagers or person get access to the foods that could actually cause harm to them.e walls ± presence of cracks. 24 . All foods supplied by tender contracts to be inspected to prevent mass supply of unfit food to a larger group of people that might cause harm. from source of waste to the end point (soakage pit) Solid waste management. Routine inspection of both food and trade premises are done using a certain criteria and below is a step ± to ± step guidance on how to do it: Surrounding. paint. waste around the premises. to be fit to handle food. condition of iron sheets. both externally and internally i. window openings ± for ventilation and lighting. fencing etc Structural aspects.

To test if a latrine is full one should through a stone inside and listen to the variation of sound. clean and well maintained latrines should be present. The carriage containers should also be inspected 25 . first. there is verbal warning. If spring. Excreta disposal. then a written warning and failure to comply. Meat Inspection It includes both ante mortem and postmortem. overcrowding should also be discouraged. This is as a result of limited staff in the PHO department. Irrespective of the animal being inspected.e clean overalls/aprons . hot/cold water supply for washing utensils and a hot water supply with provision of a detergent for hand washing outside or inside the eating premises. There should be storage tank(s). Facilities/Equipment for Food Preparation. Personnel. They should posses a medical examination certificate to certify ones physical health. the source of water used should be safe. Critique Follow-ups are not done effectively as stipulated in the statutory notices issued. Water supply. Plastic equipment is not easy to wash and they retain oil. footwear and headscarf. especially in kitchen. NOTE: The inspections are done in stages. they should not be plastic but galvanized.Ventilation and lighting. i. preferable a protected spring. the premise is closed. the slaughter slab/ slaughter house should also be inspected to ensure it is well cleaned and maintained. they should have adequate and appropriate PPE.

The personnel should be well protected with adequate and appropriate PPEs.before putting in any meat. antenatal care. flaring. evisceration. The animal is also given time to relax to prevent hyperglycemia which affect the quality of meat. Inspection should ideally be done at every stage to ensure no contamination at the critical points. Despite having the provision of separate drainage. Discussion Every slaughter slab or house should have a holding area where ante mortem is carried out. At the end of the inspection the carcass that has been passed should be stamped before dispatching it. The animal is carefully examined by the vetenary doctor and treated when necessary before slaughter. This stages include. and splitting. the animals are slaughtered as they come thus being exposed to risks of getting hyperglycemia which leads to rigomotis of the meat. bleeding. stunning ± a humane way should be used. They use the crude method of stunning the animals that recurrently leads to hemorrhages of the carcass. Maternal health services Under the maternal health services at kaptumo sub-division hospital the following services are offered to the mothers. Critique The kaptumo slaughter slab has no holding area. there is sometimes mixture of blood and liquid waste which is later released to the farms as manure. delivery care and postnatal care 26 . the PHOs have failed in carrying out routine inspection of the slaughter slab. The vetenary department having taken up the responsibility of meat inspection.

They are then left to make a decision of which method they would prefer to use. During this period the mother makes regular visits to the hospital for checkup purposes to ensure that the development of both the baby and the mother is fine. After the onset of labor pains. Minimal or no advice is given to mothers on the expected postnatal outcomes. The mother should be well cleaned and given the baby for breastfeeding within the first 30minutes ± 1hour after birth. weighing. Discussion Antenatal care is given to pregnant mothers from time of conception. She then leaves the hospital after 10 ± 12 hours of close observation by the nurses. administration of TT vaccine. Critique There are cases of dropout of mothers from attending the regular visits during antenatal care. KDSH has a delivery room. supplements of FeSo4. some mothers end up giving birth at home instead of doing it in hospital. folic acid and provision of LLITN under the PH department. malaria prophylaxis (IPT). In addition. the mother reports to the hospital for close monitoring and vaginal examination after every four hours until birth. measuring BP. 27 . For delivery services.and family planning inclusive. In addition there is also distribution of nets during antenatal and postnatal care. It involves. Family planning is also a service given to the mothers after proper counseling for every beginner. Postnatal care begins immediately after birth. palpation of the mother to determine the stage of the baby in development.

pregnancy test. Despite its importance. Discussion It involves collection of specimens that are then examined: Blood sugar test. most mothers lack support from their husbands concerning FP issues. malaria test and TB test. 28 . Laboratory services The lab services are quite important since they confirm clinical diagnosis of patients with an aim of ensuring appropriate management of the patients is administered.Children do not get the BCG immunization at birth since it always take place on Friday during immunization hours. hymolysis. Urinalysis. The test is for typhoid. urinalysis. an electronic centrifuge is used to separate blood and serum. urine is the specimen. Urinalysis reagent strip is used to check the normality or abnormality of urine content in relation of the body composition of sugars. Uncooperative mothers during delivery which is as a result of labor pains leading to hostility of nurses as they struggle to perform their duty. blood is used as the specimen. the specimen use is blood and it is measured using an instrument called on-call plus measuring in Mmol/Lit. Three reactions can be done using different reagents. Normal blood sugar is below 10Mmol/Lit. agglutination and neutralization. Since serum is used in the test. HB test WIDAL test. WIDAL test. blood sugar test. Some of the tests doe at the KSDH include.

satili haemometer.Pregnancy test. Clinical care services This refers to the services the patients receive in the ward from the nursing staff and clinical doctors as done in KSDH. breakfast. every patient is required to buy an impatient book for proper record keeping on his/her progress. 6:00am-6:45am ± feeding. Discussion On admission. There is also failure in the use of PPEs irrespective of the risks of being infected in the process of handling the specimens. 6:45am ±7:30am ± cleaning of wards. Malaria test. urine is the specimen used and the pregnancy strip is the instrument used. blood is the specimen. 7:30am ± 8:00am ± ward round. Critique Despite the high reliability and validity given to results from the laboratory. Blood smear is prepared and plasmodium parasite observed under a microscope. there was improper labeling specimen resulting to wrong results for different patients¶ thus wrong management. reviewing of patients. sputum is the specimen. TB test. 29 . The following activities take place from morning to evening. HB test. blood is the specimen using the and instrument called.

handing over to day staff. temperature. pulse. They all have separate departments that care for the clients different needs. HIV/AIDS services The HIV/AIDS services offered at KSDH include. BP.8:00am ±9:00am . Note: observation and treatment takes place continuously. respiration etc. -Bed making and changing of soiled beddings. Discussion 30 . VCT services. There is also no impatient registry at the ward reception area of which it is a very important data collection tool. 12noon.12:30 ± lunch break 1:00pm ± 2:00pm ± visiting hours 3pm and 3am ± are times for observation of vital signs. Critique There are no restrictions on visiting hours thus leading to overcrowding of the wards at every given time. PMTCT services and HAART services.

mothers are educated on ways of preventing transmission to their infants during pregnancy. PMTCT services are offered at the MCH department. clients voluntary visit to either get information on HIV/AIDS. Below is a dosing guide for Antiretroviral Drugs in PMTCT. delivery and breastfeeding by use of ARVs and use of safer infant feeding practices. where women living with HIV/AIDS are provided with appropriate counseling and support to enable them make informed decisions about their reproductive lives. program for 4 months: Confirmed HIV infection in a pregnant woman during ANC Determine. Un-gold acts as a tie breaker after using the two first kits and they happen to give different results. y y WHO clinical stage CD4 count WHO clinical stage 3 or 4 WHO clinical stage 1 or 2 31 . labor. Bioline and Uni-gold. to know their status or both.At the VCT. There are three kind of test that are available. as at KSDH. Determine. In addition.

or CD4 count ” 350 Start on ARV therapy(ART) prophylaxis (if 38 weeks or less) after) Start 1st line ART regime pregnancy y AZT 300mg twice daily labor y y 3TC 150mg twice daily NVP 200mg twice daily or CD4 count > 350 start on ARV (at 28 weeks or anytime start: AZT 300mg twice daily for the during dispense: single dose NVP 200mg at the onset of dispense: ARV prophylaxis. 32 . to infants after birth labor and delivery give preferred ARV prophylaxi after delivery of new Labor and delivery Continue ART regime born Give ARV prophylaxis as soon as possible.

they are given referrals to higher levels of health services. 33 . This comprehensive care helps greatly in minimizing the incidence rate of opportunistic infections.. those clients having a CD4 counts of below 350 is started on ARVs and are given comprehensive care in terms of counseling and nutritional supplements.Under the HAART department. Critique There are many defaulters and follow ups is not easy due to constrains such as harsh climatic conditions. Filter clinic This office is also called clerking office. administration of injection and dressing of wounds. Pharmacy and treatment services. Discussion Drugs after supply by KEMSA and are arranged in the provided shelves in a systematic order ready to be dispensed. Here the patient¶s history taken and the patient managed respectively. lack of transport means and finances. There is also an area designed for injection and dressing of minor wounds. injects and at the same time dresses wounds. This department deals with dispensation of drugs. In case the patient¶s problem is far much complicated. It is also from this office that patients are referred to the laboratory if any tests are to be taken. Critique Every pharmacy should have a pharmacist but KSDH pharmacy lacks one thus the nurse in charge dispenses drugs.

These services were majorly offered to those in industries and factories and incase of any hazardous exposure. mitigation measures are recommended. y Treatment and the return date Critique Not all clinical officers follow the above procedures in clerking of patients. y y y y y y y y Taking of demographic data Chief complains Duration of the chief complains History of the present illness Past medical history Family medical history ± for women. after the necessary questions based on the chief complains seek more on. development of the child.Discussion When clerking a patient. immunization history and nutritional history. There is also a lot of misdiagnosis mainly due to overworking of the staff. chemical and other workplace hazards in order to establish and maintain a safety and healthy working environment. Occupational health It refers to the identification and control of the risk arising from physical. take gynecological history Making an impression Management of the patient Note: for children. the following procedures are followed by the clinical officer . Discussion 34 .

those handling chemicals should be well protected with the appropriate PPEs from head to foot wear. cooling area. Critique Despite the management of various industries and factories having provided the right PPEs. due to lack of enough personnel. those producing a lot of noise. In addition there was a visit to a lala cottage industry which dealt with milk. a sensitive product. there was much to learn on occupational health. At the lala cottage industry. Note: for those working in noisy or vibrating environment. ear muffs. Personnel handling automated machines should be well trained. It was installed with all kinds of machinery. In general. the lala industry.g. shifts could be a good remedy since it reduces on the time of exposure of risk. culturing area and packaging area. The moving machines such as conveyers should be guarded o help minimize on accidents. takes long to be repaired hence resulting to inefficiency and contamination of the products. the concept of HACCP should be put to practice. the following precautions should be taken: Any personnel working with noisy machines should be provided with protective gears for the ears. moving machines and also automated ones. all the factories with such kind of machines. At the tea factory. with reference to the kaptumo tea factory.g worn out floors. especially those dealing with foods. the receiving area. some of the staff have a negative attitude and end up not wearing them. With respect to any other sensitive product producing industry. the staff present end up being overloaded and thus the risk of multiple exposure. pasteurization area. E. repairs of damages e. 35 .On a visit to kaptumo tea factory.

IRS is the application of long-acting insecticides on the walls and internal surfaces in order to kill the adult vector mosquitoes that land and rest on those surfaces. handling dog bites and snake bite cases. sufficient baseline information should be gathered to facilitate appropriate planning and implementation. All these activities need proper coordination to ensure smooth running of events. The primary effects of IRS towards cartailing malaria transmission are: reduce the life span of vector mosquitoes. Discussion Malaria control program It involves a collection of intervention measures: distribution of nets to pregnant mothers and children under 1 year. district level and community levels. IRS intervention involves a great deal of involvement and planning: 1.no longer transmit of malaria parasite. Pre and post IRS surveys Being an expensive operation. reduce the density of the vector mosquitoes. The PH department at kaptumo is greatly involved in the control of malaria.Communicable disease control A communicable disease is one due to a specific agent or its product which arises through the transmission of the agent or its product from a reservoir to a susceptible host. and IRS using icon and fendona chemicals. Commodities and other consumables need to be procured in advance. 2. Planning for IRS operations The operation involves people at national level. The surveys include among others: 36 .

it also provides indicators for identifying areas that need spraying at a particular time. population figure from the target areas are used. This information gives an estimate of the total sprayable surface area for a target area. In establishing the number of structures for spraying. and demographic surveys. The surveys above are of importance to delineate low and high risk areas for prioritization. particularly rains. Timing and cycles of spraying Malaria transmission is greatly influenced by climate and environmental factors. IRS supplies estimate. Mapping and targeting IRS It helps identify areas for spraying it gives a basis upon which coverage is monitored and evaluated. It entails identification of vector breeding sites. supervisors and the spraying duration. number of spray operators. Estimation of IRS requirements Several factors are considered when establishing the quantities of required resources: required information to calculate sprayable surface areas by district. The spray cycles depends on the transmission pattern and insecticides¶ protective duration. The number of house units per household is determined using population and housing census. 5. geo-referenced maps need to be developed to guide the process of accessing targeted spraying structures. transport needs. Therefore the operation will be time d to take effect just before a rainy season begins. 37 . 4. For efficiency. This guides calculation of amount of insecticide required. location and type of house structures to target. In addition. IRS accessories estimation. entomological. sprayers protective clothing.epidemiological. 3.

Most of the patients who visit KSDH present with cases of pulmonary problems as a result of the cold climatic conditions of the area. even after mobilization. Discussion 38 . Chronicity is usually applied to a condition that lasts more than three months. there is inadequate supply of anti. For dog bites. During a visit at kipletito primary school a referral was recommended to a suspected case of osteoporosis. Before starting the operation at the grassroots. DVBD AND DEH. the patients are given anti-rabies vaccine and those with snake bites. Irrespective of the life threatening situation the dog bite and snake bite patients are in. anti-venom vaccine which is administered intravenously after admission under strict supervision due to its intense side effects. Chronic disease control A chronic disease is one that is long-lasting or recurrent. TB which can sometimes be classified as a chronic disease is a priority at the KSDH and comprehensive care is given to the infected patients.rabies and anti-venom vaccine and can only be bought in the private sectors at a high price. there is mobilization. Critique During the IRS operations. some people are uncooperative and thus this houses end up not being sprayed.Note: national supervision is coordinated from DOMC.

All the TB patients require adherence conseling on how to take the drugs. TB drug regime Initial phase Children Adults 2SRHZ 2SRHZE Continuation phase 4RH 4RH Note: for retreatment incase one is a defaulter.4tablets per day. to render the patient rapidly non-infectious and to prevent the emergence of drug resistance. 39-54kgs3 tablets per day. If the test result is positive. <30-39kgs. On report of a patient presenting with signs and symptoms of TB. Critique 39 . >54kgs. 2SRHZE/ RHZE/ 5RHE TB drugs are given on the basis of ones weight i. Every patient with TB is entitled to free drug supply from whichever facility one visits only if already enrolled into the program. defaulter tracing is done with an aim of reducing the mortality rate as a resulting to TB cases.A special department has been set up so as to well manage the TB patients. the patient is sent to the laboratory for a sputum test for confirmation. the regime is different.e.2 tablets per day. For defaulters. The treatment of TB serves three main purposes: to cure the individual patient. treatment is started immediately.

inspection of buildings under construction and inspection of existing building with an aim of ensuring the safety of the occupants. This is because majority of those suffering are faced with the challenge of limited funds to visit the hospital thus end up staying at home with their problem. prevention of fecal-oral transmitted infections. harsh climatic conditions and impassable roads are a barrier to the defaulter tracers. It was well done through health talks in the hospital premises and during school health program. In addition a health talk on the importance and effective hand washing was given in different schools with a goal of reducing on the incidence of communicable diseases. Health education and promotion This refers to the creation of awareness to the members of the community on health related issues with an aim of preventing diseases.Despite the urgency of defaulter tracing. Critque The health talks are not regular and no evaluation is done after the talks therefore little or no behavior change in correspondence to the information given. Building inspection It involves approval of building plans. treatment of water and proper use of mosquito nets was given on different days respectively. Discussion 40 . Control of chronic diseases at kaptumo is not well covered. Discussion In collaboration with the nursing department the PH department gathered all outpatients near the clerking office and a health talk on basic sanitation.

g. exit doors in case of emergencies etc. They include: MOH 504. Discussion. adequate ventilation. proper drainage system. Record services Each department at KSDH has data collecting tools that are all assembled at the District health records and information office located in the hospital. On inspection of buildings under construction. signs of dampness in a building. poor lighting. Records from any health service starting from level 3 include both inpatients and out patient records. appropriate judgment is made concerning the condition of the building under inspection e. a statutory notice should be issued and follow-ups done respectively.recommend installation of translucent iron sheets. For any kind of improvement to be done by the owner. On the inspection of already existing buildings. Critique Not all buildings under construction are inspected. repairs on cracked floors or those with potholes should be done to prevent breeding of fleas.it should be demolished. the PHO is required that the plan includes a provision for sanitary facilities. This is aimed at preventing collapse of houses and settlements of buildings.monthly surveillance report form. used by the PHO to monitor diseases on the ground. Follow ups of statutory notices issued is not well done as a result of limited staff. This has greatly led to the existence of dilapidated structures which can not be repaired but stand to be demolished.On approval of building plans. the inspection of proper foundation depending on the drainage of the site is very important. MOH 704-child health nutrition information 41 . adequate water supply.

HIV/AIDS.immunization summary sheet. first time seen during neonatal and maintenance of patient to the date of delivery.used for comparison for under 5 and below 5 males and females respectively.they are used for general conditions of patients i. reproductive health records. it requires one to have an understanding of what it is.maternity services.system. HIV/AIDS reports.after a three month interval etc. used to monitor the growth of a child. MOH 710. AL reports. MOH 705A. weekly malaria reports. there is poor recording done by the personnel in charge of recording. MOH 240laboratory register. Chapter 3 Conclusion The professional practice at KSDH displayed three important things.national intergraded form for reproductive health. MOH 702-immunization and vitamin A tally sheet. Critique Despite the clear display of particulars in the different record books. Despite health being a right to every human being. 42 . MOH 717-work load.for under 5 and above 5respectively.postnatal register.health facility inventory for equipments in the hospital. MOH 204A and 204B-outpatient register for under 5 and over 5 respectively. MOH 715. cold chain recording.e disease diagnosis at the hospital. TB. PMTCT services and treated nets distribution. MOH 406. Some people expose themselves to various hazards only because they are not aware it is a hazard.and child nutrition.on TB cases and defaulter tracing. MOH 105service delivery. done by every worker and shows the number of people received in every department. TB reports. MOH 511-child welfare clinic. quarterly reports. MOH 711A.

43 .Having being empowered to enforce law concerning health on people. some improvisations and modification have to be done i. the ideal is not always the real. a PHO should be humane with an aim of helping and not frustrating.e. For theoretical knowledge to be applied practically.