Epidemiologische und spezifische Merkmale einer HNO-Praxis in Nairobi

In einem Entwicklungsland wie Kenia steht Medizin vor besonderen Problemen und Herausforderungen. Die Patientenversorgung findet zunehmend in privaten medizinischen Gesundheitseinrichtungen statt. Basisdaten zur Patientenversorgung in privaten HNO-Praxen sind bisher kaum erhoben worden, wären aber f...

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Bibliographic Details
Main Author: Schwarz, Peggy-Beatrice
Contributors: Werner, J. (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2008
Online Access:PDF Full Text
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Table of Contents: Low income countries like Kenya face special problems and challenges in the health sector as part of medical issues as well as part of socioeconomic, cultural and political structures. Private medicine is increasingly involved in health care. The purpose of the study was to determine the epidemiology of ear, nose and throat diseases and to evaluate the diagnostic and therapeutic procedures at a private ENT practice in Nairobi in order to supply basic data useful for improving the health care. Data of 161 current patient files was collected at the ENT practice of Dr. Oburra during July until September 2001. Observations, interviews and questionaires were applied. 212 cases and 281 diagnoses were noted. The average age of the patients was 31 years, the ratio female:male was 1,12:1. Patients have had their disorders 18 weeks (median) until seeking the doctor. The distribution of diseases was in the field of nose/sinuses/face 37%, ear 29,9%, pharynx/mouth 22,1% and larynx/salivary glands/trachea/neck 12,5%. Most frequent diseases were common upper airway infections (23x), impacted cerumen (22x), tonsillitis (22x), allergic rhinosinusitis (17x), otitis media (12x), common mouth/throat infections (12x), otitis externa (10x), hearing impairment (10x) rhinitis hypertrophicans (9x), adenoids (9x) and dys-/odynophagie (9x). HIV associated diseases occured six times. 40 out of 212 cases were sent to other specialties or to the hospital for further diagnostical or surgical treatment, mostly adenotonsillectomy (14x), and tympanoplastic (7x). Each patient got on average 2,06 drugs. Medication orders (526) were mostly for chemotherapeuticals (169), then antihistamines (74), systemic steroids (69), topical steroids (50), analgetics (43), mucolytics (42) and bronchodilatators (39). There is need for education of patients about riscs of delayed treatment, about appropriate use of antibiotics, about allergies as well as risc factors for airway infections and hearing impairment. Investments in diagnostic equipment and improved time management at the practice are to be considered. Regarding the HIV epidemic it is advisable to promote more HIV-tests and carefully watch for oral lesions. Development work should concentrate on preventive measures, applied technology and education of staff and patients. The aim of a better health status of the population implies extensive measures of health development, poverty reduction and political stability.