Browsing by Author "Mlawanda, Ganizani"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    An analysis of blood pressure measurement in a primary care hospital in Swaziland
    (AOSIS Publishing, 2014-12) Mlawanda, Ganizani; Pather, Michael; Govender, Srini
    Background: Measurement of blood pressure (BP) is done poorly because of both human and machine errors. Aim: To assess the difference between BP recorded in a pragmatic way and that recorded using standard guidelines; to assess differences between wrist- and mercury sphygmomanometerbased readings; and to assess the impact on clinical decision-making. Setting: Royal Swaziland Sugar Corporation Mhlume hospital, Swaziland. Method: After obtaining consent, BP was measured in a pragmatic way by a nurse practitioner who made treatment decisions. Thereafter, patients had their BP re-assessed using standard guidelines by mercury (gold standard) and wrist sphygmomanometer. Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg (pragmatic) and 133 mmHg (standard) using a mercury sphygmomanometer; and 140 mmHg for standard BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg for pragmatic, standard mercury and wrist, respectively. Bland Altman analyses showed that pragmatic and standard BP measurements were different and could not be interchanged clinically. Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of cases, whilst 16.7% of participants had their treatment outcomes misclassified. A total of 19.5% of patients were started erroneously on anti-hypertensive therapy based on pragmatic BP. Conclusion: Clinicians need to revert to basic good clinical practice and measure BP more accurately in order to avoid unnecessary additional costs and morbidity associated with incorrect treatment resulting from disease misclassification. Contrary to existing research, wrist devices need to be used with caution.
  • Thumbnail Image
    Item
    Pragmatic versus standardised BP measurement : an analysis of BP measurement in a primary care hospital in Swaziland
    (Stellenbosch : Stellenbosch University, 2013-03) Mlawanda, Ganizani; Pather, Michael; Govender, Srini; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Background: Measurement of blood pressure (BP) is done poorly due to both human and instrument errors. The standard protocol for measurement is often not followed by healthcare workers. Objectives: There were three main objectives: firstly to assess the difference between BP recorded in a pragmatic way and that recorded using standard BP measurement guidelines; secondly to assess difference between BP measurements done by wrist sphygmomanometer compared to mercury sphygmomanometer; and finally to assess if the differences affect decision to start or adjust hypertension treatment. Setting: RSSC Mhlume hospital, Swaziland Study design: cross sectional study Study Method: Following consent, BP was assessed in a pragmatic way by nurse practitioner who made treatment decisions. Thereafter, patients had BP re-assessed using standard BP protocol by mercury (gold standard) and wrist sphygmomanometer. In addition demographic and clinical data was collected. Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg for pragmatic BP, 133 mmHg for standard BP using mercury sphygmomanometer and 140 mmHg for standard BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg for pragmatic, standard mercury and wrist respectively. Pearson and intra-class correlation coefficients were similar for both systolic and diastolic BP and for all BP measurement pairs which were being compared. Bland Altman analyses showed that pragmatic and standard BP measurement were different and could not be used interchangeably. Standard mercury and wrist based methods were not clinically interchangeable. Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of cases; 16.7% of participants had their treatment outcomes misclassified. Twenty-five percent of patients were erroneously started on anti-hypertensive therapy based on pragmatic BP. Conclusion: There is a difference between pragmatic and standard BP measurements which affect decisions not to start treatment and decision to start treatment but not treatment alteration decision for those already on treatment. There are also marked differences between wrist and standard mercury based BP devices. Clinicians need to revert to basic good practice and measure BP more accurately to avoid unnecessary additional costs and morbidity associated with incorrect treatment due to disease misclassification. Contrary to existing research, wrist devices need to be used with caution.
  • Thumbnail Image
    Item
    Suspected dog bite associated HIV horizontal transmission in Swaziland
    (AOSIS Publishing, 2013-08) Mlawanda, Ganizani
    Background: Dog bites may lead to transmission of bacteria and viruses over and above tetanus and rabies. Theoretically human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C may be transmitted after dog bites where transfer of blood from one victim to another occur in clinical practice HIV, Hepatitis B and Hepatitis C are not considered when making treatment decisions, nor adequate patient history taken to consider all potential risks after dog bites in succession. Objective: To present case of suspected HIV transmission after dog bites in close succession involving two HIV sero-discordant victims. Management and outcome: HIV rapid test and/or HIV Ribonucleic acid (RNA) polymerase chain reaction (PCR) results for the victim(s) at presentation and a month later. Results: Two night patrol guards presented to casualty after dog bites in close succession by the same dog. They were managed according to the dog bite protocol. Thinking out of the box, the first victim was found to be HIV positive by rapid test whilst the second victim was negative based on both HIV rapid test and HIV RNA PCR. One month after the dog bites, a case of HIV sero-conversion was confirmed in the second victim despite post-exposure prophylaxis (PEP). Discussion: Although an isolated case, shouldn’t clinicians re-think the significance of HIV transmission after animal bites where there is repeated blood exposure in several people in succession? Conclusion: Clinicians should be aware of the potential of HIV, Hepatitis B and C transmission, when faced with dog bites in succession.