Pain Management and Factors Associated with Its Severity among Post Surgical Patients Admitted in the Intensive Care Unit at Muhimbili National Hospital, Tanzania

Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.

Understanding Laboratory Methods and Their Impact on Antimicrobial Resistance Surveillance, at Muhimbili National Hospital, Dar es Salaam, Tanzania

The study sought to describe laboratory methods and blood culture procedures and their impact on antimicrobial resistance surveillance among nosocomial bacteria. We conducted a systematic audit of blood culture procedures and practices in the Department of Microbiology, Central Pathology Laboratory at Muhimbili National Hospital, between 19th and 23rd March 2012. A total of 25 -30 blood culture specimens were received each day as an indication of low volumes of blood culturing at this site. More blood culture requests came from the neonatal unit of the hospital, and were performed manually with high culture negative specimens. The laboratory performed antibiotic susceptibility testing as per the CLSI guidelines. No vancomycin resistance was ever reported at this site. All blood culture results were entered into the JEEVA laboratory information system, where results could be accessed by clinicians in the wards and data could be retrieved to assess patterns of antimicrobial resistance. Blood culture data entry system lacked quality control checks hence numerous errors and missing data were observed. Our results support the relevance of having improved laboratory procedures and good quality blood culture since surveillance of antimicrobial resistance primarily depends on good laboratory procedures, good quality and reliable blood culture data. This would essentially minimise imprecise estimates of rates of antimicrobial resistance at this hospital.