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CONSOLATA HOSPITAL IKONDA 2017

The Consolata Hospital of Ikonda is a private, no-profit, catholic institution that belongs from its origin to Consolata Missionaries. Started in 1963, it was inaugurated by President of Tanzania Mwalimu Julius K. Nyerere on 7th October 1968. The mission of the Hospital is to provide general quality health care to the population of Tanzania and to promote access to health care for the needy with a special attention for children, women and people affected by chronic diseases.

Since 1997 it is registered with the Ministry of Health (reg.no.115002), The Hospital is recognised by NHIF (National Health Insurance Fund) and is member of CSSC (Christian Social Services Commission) and of ATE (Association of Tanzania Employers). In 2016, the hospital has received from Ministry of Health the upgrade from District level to Regional level. Today the hospital has a capacity of 359 beds and receives every day an average of 450-500 outpatients (including RCH and CTC), coming from different districts and regions Ikonda is located in the Southern Highlands of Tanzania, 2050m above sea level (9°22’10’’S, 34°14’22”E), in Njombe Region, in Makete District. The village has grown with the hospital and, especially in the last ten years, the increased number of people coming to hospital for treatment and work, has produced significant changes in its aspect and economy. It grew from a small village of farmers to an important centre for the all district with shops, one bank, many guesthouses and restaurants, daily buses and minibuses to Njombe, Makamabako, Iringa, Mbeya, and Tunduma. The Consolata Hospital stands in highlands, right hand side as one moves in Makete direction. It is accessible via compacted earth road of about 800 metres from village centre. Within an area of 30 acres of land it is “a village in the village” with various single storey buildings : the hospital building with administration block, outpatient department and

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various wards but also residential quarter for priests and employees, canteen/restaurant block, garage block, carpenter and stores for a total of 92 buildings.

OPD (Out Patient Department) consists in eight doctors’ offices, two First Aid, one dental units, one ENT clinic, one ophthalmic department, physiotherapy and gym, and one pharmacy. Other day-hospital clinics are RCH (Reproductive child health), TB clinic and CTC (HIV Clinic). Diagnostics include Laboratory Department, X-Ray Department, CT scan, Ultrasound, Endoscopy, ECG and Echo cardio. IPD (In Patient Department) consists of ten wards: Male Ward, Female Ward, Paediatric Ward, Maternity, Premature Unit, Annex/Isolation, Private Ward, Orthopaedic Ward, Surgical Male Ward, Surgical Female ward (inaugurated in August 2017) and Antenatal with 359 beds. Theatre consists in four Operating Rooms, two Sterilization Rooms, one POP Room and one Dressing Room. Four new theatres are under construction and will be ready in 2018. Pharmacy consists in three stores. Hospital water main is feed by four registered springs on the mountains around. A central wood heater provides hot water to all the hospital and the laundry. The hospital has its own implant for purifying black water.

Electricity is available 24/7. The Hospital has its own water power station. Four diesel power generators are used during the dry season when there is shortage of water. The hospital is connected also with Tanesco. Patient’s records and data are managed by a computerized system with access from administration offices, reception, pharmacy, OPD doctor offices, nurse station of every ward and theatres. A Vodacom tower built in the hospital compound is providing phone and high speed internet services (3G) to Ikonda hospital and village. The hospital has a small incinerator.

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Three oxygen generators provide medical oxygen feed to all the hospital wards. In the compound, there are also a garage, a workshop and a small carpentry for the needs of the hospital. A specialized workshop (Swissleg technology) produces artificial legs for amputated patients. A compound called “Kampini” gives accommodation to relatives who assist their patients admitted in the hospital. Because of increased number of patients and relatives, a new building has been built this year. There are now twelve big rooms, toilettes and showers and a large cooking area.

There are also two guesthouses of five and twenty rooms, one restaurant (another one will be opened in 2018) and some shops, all run by private people. This shopping centre has been opened in order to help people who are coming to the hospital to get food at very easy price. Inside hospital compound there is also a CRDB branch. The hospital has 85 single houses and 6 hostel for doctors, nurses and workers. Hospital chapel is under construction.

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PERSONNEL The hospital actually has 298 staff, of different categories:

To sustain the growing number of patients and activities, the hospital staff has been increasing every year and in the last 10 years has been doubled: from 157 of 2007 to 298 of 2017.

2013 2014 2015 2016 2017

Physician 1 1 1 1 2

Surgeon 0 0 1 1 1

Medical Doctor 4 7 11 14 16

Assistant Medical Officer 7 6 5 5 6

Clinical Officer 7 8 6 4 5

Nurse 60 67 77 74 91

Medical attendant 36 36 41 41 39

Laboratory tech & assistant 8 11 13 13 14

X Ray technician 1 2 3 4 4

Pharmacy 7 8 8 8 8

Dental 2 1 1 2 2

Physiotherapy & orthopaedic tech 3 2 2 4 4

Administration Staff 13 16 15 19 20

Driver 5 5 5 5 5

Support Staff 72 75 69 73 79

On training 6 3

Total 225 245 258 274 298

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The opposite, the financial support from Central and Local Government has gone decreasing every year, as shown in the table below.

Despite all the surveys carried out by Government during this year didn’t discover any mistakes or irregularities in personnel documents and payments, the contribution received by government is inexorably decreasing year by year.

EMPLOYEES PAID BY 2015 2016 2017

Consolata Hospital Ikonda 200 220 241

Central Government 36 34 30

Makete District 18 16 14

Boresha Afya - - 7

Missionaries/Volunteers 4 4 6

TOTAL 258 274 298

The hospital is actually paying more than 80% of the staff. Salary levels are aligned with those of the Tanzanian Government. N.B. The 14 health workers sent by the District are considered as a kind of compensation for the different services that the hospital is providing to the population of the district

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During the year 2017, many specialized doctors came in our hospital from Europe. Registered at Medical Council of Tanganika, they worked in our hospital as volunteers. All of them are experienced specialized doctors with many years of practice in Europe and many missions abroad in their CV. We consider them as part of our hospital for the big efforts they have done by giving specialized services to the patients and training local young medical doctors.

Dr.Alessandro Calisti Paediatric surgeon

Dr.Alessandro Testa Surgeon

Dr.Andrea Favara Surgeon

Dr.Andrea Riela Anaesthetist

Dr.Anna Gerlach Radiologist

Dr.Bruno Monzio Compagnoni Surgeon

Dr.Federica Mazzoleni Urologist

Dr.Francesco Vasciaveo Orthopaedic Surgeon

Dr.Gaetano Povolo Cardiologist

Dr.Gian Maria Baldini Infectious diseases specialist

Dr.Gian Paolo Zara Surgeon

Dr.Gianfranco Francioni Surgeon

Dr.Giovanni Crestani Gynaecologist

Dr.Giovanni Scozzari Gynaecologist

Dr.Giuliano Novaretti Orthopaedic Surgeon

Dr.Giuseppe Tormen Anaesthetist

Dr.Maria Grazia Andriani Paediatric surgeon

Dr.Maria Teresa Zenorini Gynaecologist

Dr.Martina Fabian Radiologist

Dr.Maurizio Catalani ENT

Dr.Michele Savore Orthopaedic Surgeon

Dr.Otello Regeni Orthopaedic Surgeon

Dr.Patrizia Stasi Paediatrician

Dr.Riccardo Pellicci Surgeon

Dr.Riccardo Rota Graziosi Infectious diseases specialist

Dr.Roberto Plazzi Orthopaedic Surgeon

Dr.Roberto Tormen, Orthopaedic Surgeon

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Dr.Rolando Sancassani Orthopaedic Surgeon

Dr.Silvio Pasquato, Orthopaedic Surgeon

Dr.Simone Del Curto Anaesthetist

Dr.Stefano Nosengo ENT

Dr.Stefano Righini ENT

Dr.Wolters Bernhard Heinrich ENT

TRAINING AND CONTINUOUS EDUCATION

• During 2017 the Hospital supported three medical doctors who are attending specialization courses:

Specialization Number Year course University

ENT 1 2nd Bugando Catholic University

Urology 1 2nd Bugando Catholic University

Orthopaedic 1 1st Muhimbili University of Health

and Allied Sciences

• Even this year, the hospital sent three workers (one doctor and two nurses) for a stage of six weeks in theatre and ICU.at Ospedale degli Infermi, Rimini, Italy. We are thankful to Dr. Gianfranco Francioni and his staff for this great opportunity.

• Continuous education for doctors and nurses is carried on with meetings on different matters organized on weekly basis in the hospital.

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ACTIVITIES

SUMMARY OF THE MAIN HOSPITAL STATISTICS

Trends in the service output are shown in the table below.

2013 2014 2015 2016 2017

Number of beds 310 322 322 322 359

Admissions 13,052 14,499 15,009 13,907 15,047

Major surgical operations 2,560 2,921 3,106 4,128 4,545

Minor surgical operations 907 1,602 2,085 2,371 2,474

Deliveries 1,646 1,697 1,756 1,622 1,605

OPD visits 59,369 74,228 83,063 85,607 98,754

HIV Clinic visits 22,141 21,155 21,459 23,632 23,148

RCH visits 15,498 14,832 23,215 18,474 17,220

Dental treatments 2,387 2,170 2,185 2,092 2,158

Laboratory examinations 117,951 143,212 195.059 221,609 242,481

X-RAY 11,348 14,862 19,268 19,137 18,704

Hospital deaths 626 595 619 641 559

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LABORATORY EXAMINATIONS AND BLOOD TRANSFUSION

Laboratory services are available every day from 8 a.m. to 8 p.m. and during the night in case of emergency. In the table below a resume of the activities performed in 2017.

Blood sugar RBS 14,515

Serum Creatinine 11,998

Serum Urea 9,898

Serum Cholesterol 6,409

Liver function test - ALT (GPT) 5,893

Serum Uric Acid 5,339

Liver function test - AST (GOT) 2,812

PSA (Prostatic specific Antigen) 1,047

Serum Bilirubin:Direct & Total 457

Thyroid function test -T4 406

Thyroid function test - T3 397

Thyroid function test - TSH 324

Serum Potassium 228

Serum Tryglicerides 64

Serum Total Protein 51

Full Blood Picture (FBP) 36,753

ESR (Erythrocyte Sedimentation Rate) 14,252

CD4 3,421

Hemoglobin (Hb) 2,106

Sickle cell test 146

Differential WBC (periferal smear) 99

Bleeding & Clotting time 70

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Urine analysis 10 parameters (UA) 19,435

Stool Analysis 14,325

Stool Occult Blood 5,773

Urine for Pregnancy Test (UPT) 849

Sputum x 3 569

Urine deposit 430

Sperm fluid 256

Malaria (B/S or MRDT) 9,093

HIV viral load 1,310

Culture & sensitivity/gram stain 628

MTB GeneXpert 235

CSF examination 48

Microfilaria (B/S) 15

Widal test (WT) 23,326

H.Pylory test 12,927

Syphilis test (VDRL/RPR) 10,178

HIV test 9,375

Rheumatoid factor (RF) 7,901

ASOT (Anti Streptolysin O Test) 7,337

Hepatitis B 903

Hepatitis C 883

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BLOOD TRANFUSION UNIT Despite the high request of blood, the experience of our laboratory staff and the high standard of laboratory equipment, we did not carry on any blood donation campaign in the schools of Njombe Region. Following the restriction of Government, we relied on Zonal BTS Mbeya but the blood provided was insufficient for the needs of the patients. Nevertheless, many people were ready to help their

sick relatives and to donate their blood directly in the hospital. The numbers are shown in the table below:

BLOOD UNITS RECEIVED FROM MBEYA 642

BLOOD UNITS DONATED BY RELATIVES 913

TOTAL BLOOD UNITS TRANSFUSED 1,555

RADIOLOGY DEPARTMENT

X Ray

X Ray Chest PA 7,832

X Ray Pelvis AP 1,472

X Ray Lumbar-sacral spine AP&L 1,118

X Ray Chest AP&L 971

X Ray Knee AP&L (left) 829

X Ray Knee AP&L (right) 812

X Ray Tibia/Fibula AP&L (right) 533

X Ray Ankle AP&L (left) 406

X Ray Ankle AP&L (right) 371

X Ray Femur AP&L (right) 359

X Ray Femur AP&L (left) 356

X Ray Lumbar spine AP&L 338

X Ray Tibia/Fibula AP&L (left) 295

X Ray Abdomen Supine/Erect 255

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X Ray Elbow AP&L (left) 218

X Ray Shoulder AP&L (right) 203

X Ray Skull AP&L 193

X Ray Thoracic Spine AP&L 193

X Ray Shoulder AP&L (left) 170

X Ray Ulna/Radius AP&L (right) 145

X Ray Wrist AP&L (left) 135

X Ray Elbow AP&L (right) 132

X Ray Foot AP&L (left) 115

X Ray Ulna/Radius AP&L (left) 115

X Ray Homeruns AP&L (left) 113

X Ray Homeruns AP&L (right) 113

X Ray Foot AP&L (right) 112

X Ray Cervical Spine AP&L 111

X Ray Hip AP&L (right) 109

X Ray Wrist AP&L (right) 94

X Ray Hip AP&L (left) 90

X Ray Hand AP&L (right) 62

X Ray Clavicle 57

X Ray Hand AP&L (left) 56

X Ray Foot O (left) 43

X Ray Calcaneus AP&L (left) 29

X Ray Foot O (right) 27

X Ray Calcaneus AP&L (right) 24

X Ray Skull O 22

X Ray Finger AP&L 20

X Ray Hip O (right) 18

X Ray Hip O (left) 16

X Ray Hand O (left) 12

X Ray Hand O (right) 10

TOTAL 18,704

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CT SCAN

CT Scan Head 757

CT Scan Abdomen 276

CT scan Spine 141

CT Scan Chest 62

CT Scan Bones 28

CT Scan Pelvic 16

CT Scan Neck 6

TOTAL 1,286

OTHER INVESTIGATIONS

Ultrasound pelvic (USS) 11,145

Electrocardiography (ECG) 9,674

Ultrasound abdomen (USS) 6,187

Gastroscopy 718

Ultrasound Doppler (USS) 315

Echocardiography 299

Hysterosalpingography 164

Urethrography (UTR) 110

Barium Swallow (BaS) 36

Cystoscopy 24

Barium Meal (BaM) 15

Cystourethroscopy 13

Pancolonoscopy 11

Barium Enema (BaE) 3

Note: The ultrasound done in Maternity ward are not counted in this statistic

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ADMISSIONS

Beds Admissions Days

Average length

Deaths Occupancy

Male General 42 2,079 17,223 8.3 119 114%

Female General 42 2,630 17,348 6.6 135 113%

Paediatric 33 1,784 12,070 6.8 67 100%

Annex/Isolation 36 1,859 12,884 6.9 110 98%

Surgical male 42 1,498 20,838 13.9 55 *

Surgical female 33

Orthopaedic 33 1,174 13,478 11.5 8 112%

Maternity/ Gynaecology

27 2,664 16,535 6.2 16 168%

Premature 12 72 892 12.4 12 20%

Private 14 309 2,974 9.6 37 58%

Antenatal 45 978 13,796 14.1 0 84%

TOTAL 359 15,047 128,038 8.5 559

Average length of stay per admission: Number of in patients days / Number of admissions

Bed occupancy rate: (Number of in patient days X100) / = (Number of beds x 365)

The number of in patient’s days is calculated as follows: every day, at midnight, the number of patients present in each ward is counted. When a patient is discharged and the same day another patient is admitted in the same bed, only one in patient day is counted.

Until July 2017 all surgical patients, men’s and women’s, were accommodated in one ward. In August 2017, a new ward with 33 beds was opened for women. The beds in surgical department are now 75, 42 for men and 33 for women.

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THEATRE

The hospital has four operation theatres: one for General Surgery, one for Maternity/Gynaecology, one for Orthopaedic Surgery and the forth one used on rotation by urologists, paediatric surgeons, ENT surgeons... Due to the increased number of patients, new theatres are under construction and will be ready in 2018. Planned surgery procedures are done from Monday to Friday but theatre is open 24/7 for emergencies

In the table below is listed the work done in 2017. MAJOR OPERATIONS: 4,545

OPERATIONS ON THE NERVOUS SYSTEM

Craniotomy 8

Carpal Tunnel syndrome (CTS) decompression 1

OPERATIONS ON THE ENDOCRINE SYSTEM

Complete thyroidectomy 127

Thyroglossal cyst removal 7

Other partial thyroidectomy 4

Monolateral Thyroidectomy (lobectomy) 1

OPERATIONS ON THE NOSE, MOUTH AND PHARYNX

Nasal polypectomy 33

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Tonsillectomy 26

Adenoidectomy 7

Parotidectomy 5

OPERATIONS ON THE RESPIRATORY SYSTEM

Tracheostomy 2

Excision of lesion/tissue of larynx 1

Thorax drainage (Underwater seal drainage) 1

OPERATIONS ON THE CARDIOVASCULAR SYSTEM

Varicectomy 5

OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEM

Splenectomy 21

Radical neck dissection 1

OPERATIONS ON THE DIGESTIVE SYSTEM

Laparotomy 348

Unilateral repair of inguinal hernia 198

Intraperitoneal Abscess Incision and Drainage 196

Repair of umbilical hernia 156

Haemorrhoidectomy 93

Anal fistulectomy/fistulotomy 77

Appendectomy simple 61

Cholecystectomy 48

Secondary suture (abdomen) 46

Anal fixure (Lord's procedure/internal sphincterotomy) 26

Incisional Hernia Repair 17

Rectum prolapse: abdominal rectopexy 15

Bilateral repair of inguinal hernia 12

Anal warts cauterization 8

Colostomy 7

Intraperitoneal Evacuation of hematoma 7

Tumor-wide excision (debulking) 7

Closure of stoma of large intestine 6

Rectum prolapse: perineal procedure 6

Re-opening recent laparotomy site 4

Abdominoperineal resection of the rectum (APR) 3

PSARP (anorectal plasty) 3

Gastric/duodenal ulcer excision and suture (perforation) 2

Right Hemicolectomy 2

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Total gastrectomy 2

Gastric resection 1

Gastrojejunostomy 1

OPERATIONS ON THE URINARY SYSTEM

Re-opening post prostatectomy 15

Urethroplasty (for urethral stricture) 14

Repair of hypospadias or epispadias 7

Nephrectomy 3

Urethral dilatation (Bourgenage) 2

Urethroplasty 2

OPERATIONS ON THE MALE GENITAL ORGANS

Prostatectomy 273

Orchiectomy 99

Hydrocele Repair 88

Orchiopexy 9

Penectomy total 7

OPERATIONS ON THE FEMALE GENITAL ORGANS

Total abdominal hysterectomy 268

Dilatation & curettage of uterus following delivery or abortion 186

Myomectomy 76

Subtotal abdominal hysterectomy 38

Hysterectomy 15

Marsupialization of Bartholin's gland (cyst) 9

Excision of ovarian cyst 5

Unilateral oophorectomy 5

Repair of rectovaginal fistula 1

OBSTETRICAL PROCEDURES

Caesarean Section 780

OPERATIONS ON THE MUSCULOSKELETAL SYSTEM

ORIF: unspecified site 479

Removal of implanted devices from bone: unspecified site 79

Total Hip replacement 60

Sequestrectomy: unspecified site 55

Hip spica cast 26

Below knee amputation 20

Above knee amputation 19

Wedge osteotomy: unspecified site 18

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Amputation through foot 15

Tendon Repair 14

Backslap 6

Acute Osteomyelitis Drainage 4

Maxillary sinus osteotomy 3

Open reduction of dislocation of hip 3

Amputation through hand 2

Ankle fusion 2

Arthrodesis of knee 2

Maxi facial multiple fractures reduction open 2

Amputation stump revision 1

Application of external fixator: tibia, fibula 1

Arthrodesis of hip 1

Arthrotomy for removal of hip prosthesis without replacement 1

Closed reduction of facial fracture: unspecified site 1

Toe amputation 1

Upper limb amputation 1

Zigoma fracture reduction 1

OPERATIONS ON THE INTEGUMENTARY SYSTEM

Skin grafting major 90

Excisional biopsy of Breast (lumpectomy) 48

Mastectomy 37

Post-burn contracture release 19

Keloid excision 18

Skin grafting medium 12

MINOR PROCEDURES: 2,474

OPERATIONS ON THE NOSE, MOUTH AND PHARYNX

Lingual frenotomy 4

OPERATIONS ON THE RESPIRATORY SYSTEM

Thoracentesis 10

OPERATIONS ON THE HEMIC AND LYMPHATIC SYSTEM

Biopsy of bone marrow 1

OPERATIONS ON THE DIGESTIVE SYSTEM

Abdominal Paracentesis 113

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Liver Abscess Incision & Drainage 1

OPERATIONS ON THE URINARY SYSTEM

Suprapubic Cystotomy (SPC) 8

OPERATIONS ON THE MALE GENITAL ORGANS

Circumcision (adult) 22

Circumcision (child) 16

OBSTETRICAL PROCEDURES

Perineal tear repair 3

OPERATIONS ON THE MUSCULOSKELETAL SYSTEM

Biopsy of bone: unspecified site 1

Closed reduction of dislocation: unspecified site 139

Closed reduction of fracture & POP 178

Closed reduction of mandibular fracture 3

Club foot: percutaneous tenotomy 9

Disarticulation of ankle 4

Excision of bone for graft: unspecified site 1

Finger amputation 27

Finger fracture: epiblock treatment 1

Fracture reduction/POP: large 338

Fracture reduction/POP: medium 237

Fracture reduction/POP: small 116

Removal of k-wire 17

Closed reduction of temporomandibular dislocation (TMJ) 3

Talipes (Club foot): corrective POP 15

OPERATIONS ON THE INTEGUMENTARY SYSTEM

Debridement of wound/infection/burn 132

Escharotomy 1

Excision of cyst (skin and subcutaneous tissue) 268

Excision of skin warts 1

Foreign body removal without incision, not otherwise specified 6

Genital Cauterization Warts 32

Lipoma Excision 50

Skin grafting minor 8

Wound suture (deep/big) 22

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Wound suture small 76

OTHER PROCEDURES

EAR wax removal 78

Foreign body removal ear 4

Foreign body removal eye 2

Foreign body removal nose 58

Removal of external fixators 49

Removal of intrauterine contraceptive device (IUD) 4

Removal of POP 194

Skeletal traction application 144

Skin traction 78

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MATERNITY SERVICES

2016 2017

Total number of deliveries 1,622 1,605

Normal deliveries 904 825

Caesarean sections 718 780

Multiple deliveries 30 20

Total number of new-born 1,660 1,675

Total number of live births 1,645 1,660

Fresh stillbirths 4 5

Macerated stillbirths 10 9

Born before arrival 16 12

Premature 54 50

New-born with body weight < 2,500 g 183 162

Early neonatal deaths 16 14

Referral from lower level 16 30

Delivery: The process leading to the expulsion of the products of conception with a gestational age of 28 weeks or more. A multiple delivery should be recorded as one delivery. Due to multiple pregnancies, the total number of children born is usually bigger than the total number of deliveries.

Abnormal delivery: A delivery that, to take place, had to be assisted “actively“with an outside intervention like pharmacological induction, vacuum extraction, symphisiotomy, forceps extraction, caesarean section. A delivery where just an episiotomy has been done has to be considered a normal delivery.

Stillbirth: Any child delivered after the 28 week of pregnancy that does not afterwards breathe or show any sign of life. If the heart is beating after delivery, although there is no sign of respiration, the death should not be recorded as a stillbirth but as a neonatal death. A child born dead before 28 weeks gestation should not be recorded as a stillbirth.

ASSISTED DELIVERIES

2016 2017

Caesarean sections 718 770

Breech delivery 6 14

Induction 8 4

Vacuum extractions 1 4

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CAESAREAN SECTIONS Caesarean sections are many because many mothers with previous caesarean sections or other problems are coming to our hospital even from other districts.

Previous caesarean sections 355

Prolonged Labour 17

Foetal Distress 121

Cephalic-pelvic disproportion 3

Mal position

Breech 10

POPP 11

Transverse 9

Face 1

Arm 0

Obstructed Labour 33

Gestosis PIH 20

Bad Obstetrical History (BOH) 5

Failure induction 8

Big Baby 4

Premature rupture membrane 1

Placenta previa 0

Twin 6

Antepartum haemorrhage (APH) 8

Oligohydramnios 8

Abruption placenta 2

Compound presentation 0

Cervical dystocia 2

Cephalic pelvic disproportion 1

Imminent rupture 0

Oblique lie 0

Congenital malformation 0

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MATERNAL DEATHS Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and the site of pregnancy from any cause related to or

aggravated by the pregnancy or its management.

Maternal deaths 2016 2017

Cardiogenic shock due to PPH and DIC 1 1

Probable cardiogenic shock 2 malaria in pregnant 1 1

Pulmonary embolism 1 1

Acute respiratory distress 1 1

Total 4 4

Maternity care is the first target of the hospital since its foundation in 1963. The hospital carries on this project providing all the maternity services at a very low price, starting from free accommodation in Nuru house, free check up and ultrasound, and very low charge for delivery and caesarean section. This is for all the mothers with a special attention to the ones coming from our catchment area.

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OUT PATIENT DEPARTMENT (OPD)

The total OPD attendance has been increasing yearly. People are coming also from far and not only from our catchments area.

NOTE: Persons attending RCH clinics or CTC are not included unless they are referred to the General O.P.D.

MONTHLY ATTENDANCE IN OPD

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2016 2017

Total number of patients referred to the hospital from lower levels 60 88

Total number of patients referred from the hospital to higher levers 195 236

Total number of patients transfer to lower levels for TB treatment 278 318

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EYE CLINIC

Eye Clinic Statistics 2016 2017

Conjunctivitis Bacterial

adults 153 199

children 77 52

Allergic 280 411

Other 138 52

Cataract 70 278

Trauma 48 98

Corneal Ulcer 40 41

Retina / optic Nerve 26 53

Uveitis 24 26

Corneal Scar 20 55

Glaucoma 17 15

Trachoma

adults

children

15

6

0 5

TOTAL 908 1,291

Blind Patients 3/60 BE 2016 2017

Normal eyes 107 163

Retina/optic 21 55

Cataract 111 251

Corneal Scar 12 37

Corneal Ulcer 0 22

Other / Unknown 74 208

TOTAL 325 736

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Refractive Error 2016 2017

Presbiopia 175 185

Miopia 138 153

Aphasia / Pseudophakia 0 20

Other 137 145

Lids

ectropion 3 1

other 30 33

Lacrimal 6 13

Orbital 0 17

Strabismus / Amblyopia 0 4

Other diagnosis 87 25

TOTAL 576 596

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DENTAL CARE

Forceps extraction permanent tooth 1,563

Forceps extraction of deciduous tooth (child) 313

Restoration of tooth by filling 167

Dental scaling and polishing 66

Impacted tooth extraction 14

Root canal treatment (endodontic) Premolar 7

Root canal treatment (endodontic) Molar 6

Flap Excision (Dental) 5

Removal of dental wiring 5

Root canal treatment .(endodontic) Anterior tooth 4

Dental abscess Incision & drainage 3

Tooth Extraction complex 3

Dental tumor excision 2

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ARTIFICIAL LEGS WORKSHOP AND PHYSIOTHERAPY

Started in 2016, the workshop produces artificial legs for amputated patients but also orthosis and splints for adult and children. This is the work done in 2017:

Orthosis Ankle Foot (AFO) Child 48

Prothesis Below knee 33

Orthosis Ankle Foot (AFO) Adult 22

Prothesis Above knee 13

Orthosis Arch support Child 8

Orthosis Arch support Adult 6

Orthosis Supramaleolar (SMO) Child 6

Orthosis Wrist (Cock-up splint) Adult 4

SACH foot replacement Adult 3

Stump Socks 30cm 3

Thomas splint without joint Child 3

Orthosis Wrist (Cock-up splint) Child 2

Prothesis Below knee Child 2

Prothesis Above knee Child 1

SEWHO (Shoulder Elbow Wrist Hand Orthosis)Child 1

Socket for Above knee Adult 1

Stump Socks 50cm 1

Thomas splint without joint Adult 1

The technicians work together with physiotherapy department in order to follow the patient’s rehabilitation. Hospital gym is open every day for inpatients and outpatients. In 2017 584 patients attended physiotherapy department.

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FREE TREATMENT FOR CHILDREN Since 2006, the hospital is providing free treatment to all the children under 10 coming from Makete District both outpatients and inpatients. During 2017 the children assisted free of charge were 5,590: they received 540 surgical operations, 2,370 laboratory tests, 324 radiology services, 4,436 bed/days, 110 dental treatments and medicines for a total cost for the hospital of tsh 82,924,705

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HIV CLINIC

Ikonda Hospital has a busy CTC clinic, open from Monday to Friday from 8.00 a.m. to 3 p.m. and on Saturday from 8.00 to 1.00 p.m. Started in 2004, it is one of the CTCs in Makete District with Makete, Bulongwa, Matamba, Lupila, Mang’oto and Lupalilo. It has 5,329 registered patients and 3,321 treated with ARVS. It follows the national guidelines of NACP. HIV test kits and ARVs are provided from government on quarterly base. Ikonda CTC also provides free clinical and laboratory follow up for the registered patients.

SUMMARY OF CTC ACTIVITIES

QUARTER I QUARTER II QUARTER III QUARTER IV

New patients 38 38 35 24

No consultations 5,457 5,114 5,380 5,076

Recorded patients 5,585 5,623 5,658 5,682

Male 2,285 2,305 2,317 2,325

Female 3,300 3,318 3,341 3,357

Children 508 511 512 513

N.B. The number of recorded patients is a cumulative number

PATIENTS TREATED WITH ARVs IN IKONDA CTC

QUARTER I QUARTER II QUARTER III QUARTER IV

New patients 64 44 32 35

Patients on ARVs 2,209 2,244 2,263 2,280

Male 840 864 870 870

Female 1,369 1,380 1,393 1,441

Children 135 136 124 115

Transferred IN 9 8 15 9

Transferred OUT 13 13 7 10

Dead 5 8 5 7

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VOLUNTARY COUNSELLING AND TESTING (VCT)

COUNSELLED Tested HIV + Tested HIV -

Age M F M F M F

1.5 - 14 187 123 14 11 173 112

15 – 24 164 290 12 37 152 253

25 – 49 883 886 194 190 688 796

50+ 284 255 42 36 242 760

TOTAL 1,518 1,554 262 274 1,255 1,921

Patients registered in our CTC clinic received ARVs but also prophylaxis with Co-trimoxazole for a total cost for the hospital of TSH 16,883,675.

They were also tested for CD4, full blood picture, renal function tests and liver function tests twice in a year with a total cost for the hospital of TSH 63,729,000.

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TB CLINIC

Patients who started treatment this year:

DIAGNOSIS CHILDREN ADULT TOTAL

Pulmonary TB AFB Negative 21 84 105

Pulmonary TB AFB Positive 0 112 112

Miliary 0 22 22

Spine 2 31 33

Glandular 3 23 26

Extra Pulmonary TB Meningitis 1 3 4

Others 7 48 55

TOTAL 34 323 357

Since January 2017, a GeneXpert machine has been installed in the hospital, donated by Italian Episcopal Conference.

Results of treatment of AFB + patients detected last year

Regimen Cured (smearing

positive)

Treatment completed (no smear

res.)

Dead Treatment Failed

Defaulters Transferred Total

Standard course

0 28 3 3 3 156 187

Short course 6 0 0 4 0 101 111

Re-treatment 0 2 0 0 0 19 21

MTB-MDR 1 0 0 0 0 3 4

TB/HIV COLLABORATIVE SERVICES 2017

TOTAL TB PATIENTS: 357

HIV NOT TESTED: 9 HIV TESTED: 348

HIV POSITIVE: 172 HIV NEGATIVE: 176

REFERRED TO CTC:169 NOT REF TO CTC: 3 (died)

UNDER ART: 142 UNDER C.P.T.:84

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MOTHER AND CHILD HEALTH (RCH) CLINIC

Clinic in the hospital that serves Ikonda and Tandala people and a mobile RCH that serve an RCH the people of Ihela, Usagatikwa, Masisiwe and Ibaga.

Hospital

RCH Outreach

RCH Total

ANTENATAL (first visits) 159 40 199

CHILD CARE (first visits) 116 53 169

First visits is the number of new registrations during the year

IMMUNIZATION BCG DPT 3 OPV 3 MEASLES

Hospital RCH 1,081 131 131 352

Outreach RCH 0 44 44 0

FOLLOW UP OF CHILDREN UNDER FIVE YEARS 2016

Villages Follow-Up Leave Died Cont. Follow-Up

IHELA 644 12 1 631

MASISIWE 567 4 0 563

TANDALA 3,260 23 0 3,237

IKONDA 3,893 37 2 3,854

USAGATIKWA 945 12 2 931

TOTAL 9,309 88 5 9,216

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P.M.T.C.T. (PREVENTION OF MOTHER TO CHILD TRANSMISSION)

Ikonda Hospital runs P.M.T.C.T. program according to national guidelines, both inside the hospital, in maternity ward and in RCH, and in five villages: Tandala, Ihela, Usagatikwa, Masisiwe and Ibaga and Ikonda and surroundings.

2013 2014 2015 2016 2017

Total clients counselled

256 273 247 149 169

Total clients tested

256

273

247

149

169

Positive 31 21 38 4 4

Negative 225 252 209 145 165

Clients not tested 0 0 0 0 0

Clients given drugs (NVP)

Adults Children

31 31

0 40

0 38

0 4

0 31

Children given milk (exposed baby)

33 39 53 56

639

Total partners tested

112 142 174 96 112

Positive 8 5 15 9 8

Negative 104 137 159 87 104

Total children tested

at 18 months

2 9 10 26

22

Positive 0 0 0 0 0

Negative 2 9 10 26 22

Total children tested by PCR

30 40 39 28

36

Positive 0 0 0 0 0

Negative 30 40 39 28 36

Note: Most of these children were born before PMTCT program has been started.

FOOD PROGRAM ASSISTANCE

In 2017, the Hospital has continued a food program assistance to prevent and treat malnutrition. This program involves five villages visited every month by the mobile clinic but also children admitted in paediatric ward and other patients in bad conditions admitted in the hospital.

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PHARMACY

Pharmacy Department provides pharmaceutical care services to both inpatients and outpatients attending the hospital. It is organized into three operational units: Main pharmacy, Outpatient pharmacy and CTC Pharmacy.

Main Pharmacy ensures that all essential medicines are available in the hospital through proper procurement, inventory, storage, and distribution with assistance of a computerized network system.

Hospital drug list includes around 400 items for gastro-intestinal system, cardiovascular system, respiratory system, central nervous system, infections, endocrine system, obstetrics, gynaecology and urinary-tract disorders, nutrition and blood, musculoskeletal and joint diseases, eye, ear, nose, skin problems, immunological products, vaccines and anaesthesia. Local factories like Aspen Shelys, Prince Pharmaceuticals and Mansoor Daya Chemicals are among our suppliers with a percentage of 11.4% of the total. ARVs, TB drugs and vaccines only are supplied free of charge by Government through MSD.

Documents

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