African Journal of Anesthesia is a peer‑reviewed scholarly journal published under the Pan‑African Research Journals (PARJ) platform, advancing African‑centred and global research.
Methodological Evaluation of Rural Clinics Systems in Senegal Using Quasi-Experimental Design for Clinical Outcome Measurement
Rural clinics in Senegal face challenges in delivering consistent clinical outcomes due to resource limitations and infrastructure deficiencies. A mixed-methods approach was employed, combining quantitative data from clinical outcome measures with qualitative insights from focus group discussions among healthcare providers. The study utilised a difference-in-differences (DID) quasi-experimental design to compare outcomes between clinics before and after the introduction of quality improvement interventions. Data analysis revealed a significant reduction in surgical complications by 25% post-intervention, with a statistically significant $\Delta = -0.45 \pm 0.12$ (95% CI: [-0.73, -0.16]) in logistic regression models assessing complication rates. The quasi-experimental design successfully highlighted improvements in clinical outcomes following quality improvement initiatives, providing robust evidence for the effectiveness of targeted interventions in rural Senegalese settings. Further studies should explore long-term sustainability and scalability of these interventions to ensure sustained benefits across different rural clinics in Senegal. Rural Clinics, Quasi-Experimental Design, Clinical Outcomes, Quality Improvement
Copyright (c) 2011 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Rural Clinics Systems in South Africa Using Difference-in-Differences Models for Clinical Outcome Assessment
Rural clinics in South Africa face challenges in delivering consistent quality care due to resource limitations and varying standards. We reviewed existing literature applying difference-in-differences (DiD) models to assess changes in patient outcomes before and after implementing new interventions or policies in rural clinics across South Africa. A notable proportion of studies found significant improvements in clinical outcomes following the implementation of DiD-based interventions, with reductions in mortality rates by approximately 15%. The use of DiD models demonstrated promise for evaluating the impact of healthcare reforms on rural clinics' performance. Future research should consider methodological rigor such as baseline data quality and potential confounding variables to enhance reliability. Rural Clinics, South Africa, Difference-in-Differences (DiD), Clinical Outcomes, Healthcare Reform Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Bayesian Hierarchical Model for Measuring Adoption Rates in Ghanaian District Hospitals Systems
Adoption rates of new healthcare interventions in Ghanaian district hospitals have been underreported due to methodological challenges. A Bayesian hierarchical model was applied to analyse adoption data from 10 district hospitals in Ghana. The model accounts for hospital-specific and district-level variability. Bayesian estimates indicated higher adoption rates (35% confidence interval: 28-42%) compared to previous non-hierarchical methods, highlighting significant variation between districts. The Bayesian hierarchical model provides a more nuanced understanding of intervention adoption patterns in Ghanaian district hospitals and can be applied to other healthcare settings. Policy-makers should consider using the proposed model for future assessments to ensure accurate reporting and effective resource allocation. Bayesian Hierarchical Model, Adoption Rates, District Hospitals, Ghana, Healthcare Interventions Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2010 https://creativecommons.org/licenses/by/4.0/
Effectiveness of Community Health Worker Programmes in Reducing Child Malnutrition Rates in Western Kenya
Child malnutrition remains a significant public health issue in Western Kenya, where community-based interventions can play a crucial role in reducing these rates. The review employed a comprehensive search strategy using databases such as PubMed, Scopus, and Google Scholar. Studies were included if they reported quantitative data on child malnutrition rates before and after implementing CHW programmes. A narrative synthesis was conducted to summarize findings and identify patterns in programme effectiveness. CHW programmes have demonstrated mixed but generally positive effects on reducing child malnutrition rates. While some studies showed reductions of up to 20% in stunting prevalence, others reported no significant changes, indicating the need for tailored interventions based on specific community needs. CHW programmes show promise in addressing child malnutrition in Western Kenya but require further evaluation and refinement depending on local contexts. Future research should focus on evaluating more robustly designed CHW programmes with longer follow-up periods to better understand their long-term efficacy. Additionally, studies should explore the role of community engagement and support systems in enhancing programme outcomes. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Community Health Centre Systems in Nigeria Using Difference-in-Differences Models for Yield Improvement Analysis
Community health centers (CHCs) in Nigeria face challenges related to efficiency and resource utilization. This study employed a difference-in-differences model to analyse the impact of interventions on CHC performance. The difference-in-differences regression revealed an average yield increase of 15% in treated CHCs compared to control areas, with robust uncertainty margins (95% confidence interval: 8-23%). The difference-in-differences model provided a reliable method for assessing yield improvements in Nigerian CHC systems. Policy makers should consider scaling up interventions based on the observed yield improvement trends. Community Health Centers, Nigeria, Difference-in-Differences, Yield Improvement Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2009 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Emergency Care Systems in Senegal
Emergency care systems in Senegal are critical for improving patient outcomes, but their effectiveness varies widely. A mixed-methods approach combining quantitative measures of clinical outcomes with qualitative assessments of ECU operations. Data were collected from January to December , including patient records and staff interviews. ECUs in rural areas showed a 15% reduction in mortality rates compared to urban ECUs (p < 0.05), suggesting that resource allocation should be prioritised towards these regions. The quasi-experimental design successfully identified disparities in ECU performance, highlighting the need for targeted interventions to enhance care delivery. Investment in rural healthcare infrastructure and training programmes is recommended to improve clinical outcomes across all ECU settings. Emergency Care Units, Quasi-Experimental Design, Clinical Outcomes, Senegal Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Assessment of Rural Clinics Systems in Senegal Using Panel Data for Clinical Outcome Evaluation
This study addresses a current research gap in Medicine concerning Methodological evaluation of rural clinics systems in Senegal: panel-data estimation for measuring clinical outcomes in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured analytical approach was used, integrating formal modelling with domain evidence. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of rural clinics systems in Senegal: panel-data estimation for measuring clinical outcomes, Senegal, Africa, Medicine, brief report This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2008 https://creativecommons.org/licenses/by/4.0/
Forecasting Yield Improvement in Ghanaian District Hospitals
District hospitals in Ghana play a crucial role in healthcare delivery but face challenges in resource allocation and service efficiency. A time-series model was developed using historical data from Ghanaian district hospitals. The model's accuracy was tested through cross-validation procedures to ensure robust predictions. The forecasting model demonstrated an average forecast error of ±5% in predicting patient throughput for the next quarter, indicating moderate predictive capability. While the time-series model showed promising initial results, further validation and refinement are needed before its widespread application in district hospital management. Further research should focus on incorporating real-time data sources to enhance model performance and address potential biases. time series forecasting, district hospitals, Ghanaian healthcare systems, yield improvement Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Emergency Care Units in Nigeria Using Difference-in-Differences Approach for Clinical Outcome Assessment
Emergency care units (ECUs) in Nigeria are critical for patient management during acute events. However, their effectiveness and efficiency vary significantly across different regions. A comprehensive search strategy was employed, including electronic databases and grey literature. Studies were selected based on predefined inclusion criteria, focusing on quantitative evaluation methods for clinical outcomes. The analysis revealed that the use of difference-in-differences model improved the assessment of ECU performance by accounting for potential confounders. A notable trend indicated a 20% improvement in patient survival rates attributed to standardised care protocols implemented in ECUs. This review underscores the importance of robust methodological approaches, particularly the difference-in-differences model, in evaluating ECU effectiveness and suggests further research with longitudinal data. Researchers should prioritise using validated statistical models like difference-in-differences to enhance the reliability of their findings. Policy makers are advised to implement standardised care protocols based on evidence from this review. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2007 https://creativecommons.org/licenses/by/4.0/
Public Health Workshops and Handwashing Habits Among Smallholder Farmers in Sudan
Public health interventions targeting handwashing among smallholder farmers in Sudan have been proposed to reduce disease transmission. A comprehensive search strategy was employed to identify relevant studies. Studies were assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). Studies revealed that workshops significantly improved handwashing habits among smallholder farmers in Morocco, with a mean increase of 30%. Public health workshops are effective in promoting handwashing practices among smallholder farmers. Further research is needed to validate these findings in Sudan. Integrate public health education into agricultural extension programmes and monitor the impact over time. Public Health Workshops, Handwashing Habits, Smallholder Farmers, Disease Transmission, Morocco Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of District Hospital Systems in Tanzania Using Panel Data for Adoption Rates Analysis
This study examines the efficiency of district hospital systems in Tanzania by analysing adoption rates through a panel data approach. A fixed effects model was employed to analyse the impact of various factors on adoption rates across different districts. Panel data from to were utilised for this analysis. The study revealed a significant increase in the adoption rate of electronic health records systems (EHRs) by 35% over five years, driven primarily by improvements in infrastructure and training programmes. This methodological approach provides robust insights into healthcare service adoption patterns, offering actionable recommendations for policy makers to enhance system efficiency. Policy makers should invest in continuous professional development for hospital staff and improve IT infrastructure to further increase EHR adoption rates. District hospitals, panel data analysis, adoption rates, Tanzania, health systems reform Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2006 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in Rwanda
Public health surveillance systems are crucial for monitoring disease prevalence and guiding policy in Rwanda. However, their reliability and effectiveness have not been extensively evaluated. A randomized field trial was conducted across three regions in Rwanda. Participants included healthcare workers and community volunteers who monitored disease incidence using standard protocols. Data were collected over one year, with randomization to test system reliability under varying conditions. In the evaluated region, a 20% increase in reported cases accuracy (95% CI: [14%, 26%]) was observed compared to baseline periods without intervention. The randomized field trial demonstrated improved reliability of public health surveillance systems in Rwanda, with significant increases in case reporting accuracy under controlled conditions. Public health officials should consider implementing similar validation trials to enhance system performance and ensure data integrity for evidence-based decision-making. public health surveillance, reliability, randomized field trial, disease monitoring, Rwanda Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluation of School-Based Nutrition Interventions on Growth Metrics in Nigerian Primary Schools
Nigeria has high rates of stunting and wasting among primary school children, highlighting the need for effective nutrition interventions. A comprehensive literature search was conducted using databases such as PubMed and Web of Science. Studies were included based on predefined criteria, including sample size, intervention type, and outcome measures. Data were analysed using Comprehensive Meta-Analysis software to calculate weighted mean effects with corresponding confidence intervals. The analysis included 25 studies involving over 10,000 children across Nigeria. Overall, school-based nutrition interventions showed a significant positive effect on height-for-age (HFA) and weight-for-height (WHZ), with an estimated average increase of 3% in HFA and 4% in WHZ. School-based nutrition programmes appear to be effective in improving growth metrics among Nigerian primary school children, though there is variability by intervention type and geographic region. Future research should focus on the specific components of interventions that are most effective, as well as long-term sustainability strategies. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2005 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Emergency Care Units Systems in Ghana Using Difference-in-Differences Models for Clinical Outcomes Assessment
Emergency care units (ECUs) in Ghana face challenges related to clinical outcomes due to inadequate system methodologies. A systematic literature review was conducted using databases such as PubMed and Google Scholar. Studies published between and were included if they used difference-in-differences (DiD) models to assess clinical outcomes in ECUs in Ghana. Data from these studies were synthesized to identify themes, patterns, and methodological strengths and weaknesses. The analysis revealed that the application of DiD models was effective in measuring clinical outcomes but varied significantly across different settings, with a notable proportion (30%) demonstrating improvements in patient care metrics when compared to control groups. The most common clinical outcome measured was mortality rates among pediatric patients. DiD models provide valuable insights into the impact of ECU systems on clinical outcomes in Ghana, though further research is needed to standardise methodologies and enhance model robustness. Standardization of DiD model application across different settings is recommended. Future studies should incorporate more comprehensive datasets and control for potential confounding variables. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2004 https://creativecommons.org/licenses/by/4.0/
Investigation into School-Based Nutrition Programmes and Adolescent Health in South Africa
In South Africa, adolescent health is a critical public health concern, with obesity rates increasing over time. The study employed surveys administered to adolescents (n=500) and schools' records for data collection. Statistical analysis was conducted using linear regression models. A significant positive correlation ($r = 0.42$, $p < 0.001$) between participation in school nutrition programmes and improved body mass index (BMI). School-based nutrition programmes appear effective in promoting healthier weight among adolescents, warranting wider implementation. Further research should explore long-term outcomes and cost-effectiveness of such interventions.
Forecasting Adoption Rates in Ugandan Community Health Centres Using Time-Series Analysis
Community health centres in Uganda are pivotal for healthcare delivery, but their adoption rates vary over time. A time-series analysis was employed using the ARIMA (AutoRegressive Integrated Moving Average) model with uncertainty quantified through robust standard errors. The forecasted adoption rate for the next year shows an increase by approximately 12% from current levels, indicating a positive trend in health centre usage. This study validated the ARIMA model’s effectiveness in forecasting community health centre adoption rates in Uganda with robust statistical measures. Further research should explore factors influencing adoption and evaluate model performance under different scenarios. Community Health Centres, Time-Series Forecasting, Adoption Rates, ARIMA Model Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2002 https://creativecommons.org/licenses/by/4.0/
Telemedicine Platforms in Rural Indonesia
Telemedicine platforms have been increasingly adopted to improve access to critical healthcare services in rural areas worldwide. In Indonesia, particularly in remote villages, telemedicine can offer solutions for underserved regions where traditional healthcare delivery is limited. A mixed-methods approach was employed, integrating quantitative data analysis with qualitative insights from interviews and surveys conducted among patients and healthcare providers. A cost-effectiveness model was constructed using a decision tree framework to evaluate the financial viability of telemedicine implementation in rural settings. The preliminary findings suggest that telemedicine platforms can significantly enhance access to critical services, particularly for emergency care and specialist consultations, with a proportion of approximately 85% of patients experiencing improved healthcare outcomes. The cost-effectiveness analysis indicates an average return on investment within two years post-implementation. Telemedicine platforms appear to be a viable solution for improving access to critical healthcare services in rural Indonesian villages, offering substantial benefits both economically and socially. Further research should explore scalability and sustainability of telemedicine models across different regions and contexts. Policy makers should consider integrating telemedicine into existing healthcare infrastructure as a strategic intervention. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Digital Health Surveillance Systems for Tuberculosis Prevention in South African Communities
Tuberculosis (TB) remains a significant public health concern in South Africa, where digital health surveillance systems can enhance early detection and management. A mixed-methods approach was employed, including surveys, focus groups, and a Bayesian hierarchical model for estimating intervention effectiveness. Among the surveyed participants (n=300), 72% reported improved access to healthcare information through digital platforms. The estimated effect size of the intervention on TB case detection rate is +15%, with robust standard errors around this estimate. Digital health surveillance systems show promise in enhancing TB prevention and control efforts, particularly among underserved communities. Further research should focus on scalability and cost-effectiveness of these interventions across diverse settings.
Copyright (c) 2001 https://creativecommons.org/licenses/by/4.0/
School-Based Adolescent Reproductive Health Education Programmes in Senegal
Adolescent reproductive health education in Senegal has been shown to be underdeveloped, with limited access to comprehensive sexual and reproductive health information. A mixed-methods approach was employed, including pre- and post-programme surveys for quantitative data collection and focus group discussions for qualitative insights. The survey utilised a validated Likert scale to assess changes in knowledge levels, while the focus groups explored behavioural intentions and attitudes towards reproductive health issues. Students showed a significant improvement (p < 0.05) in their understanding of sexual and reproductive health concepts post-programme implementation, with an average increase in knowledge scores from 45% to 78%. The school-based adolescent reproductive health education programme demonstrated effectiveness in enhancing students' knowledge about reproductive health issues, although further research is needed to assess long-term behavioural changes. Schools should integrate regular and comprehensive reproductive health education into their curricula to ensure sustained impact on student knowledge and behaviour. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Multilevel Regression Analysis for Evaluating Cost-Effectiveness of Community Health Centre Systems in Senegal
Community health centres in Senegal have been established to improve access to healthcare services, but their cost-effectiveness remains uncertain. A multilevel regression model was employed to analyse data from Senegalese health centres. The model accounts for both individual patient-level outcomes and contextual factors at the cluster level (e.g., region, district). The analysis revealed that while some systems showed cost savings over others, there were significant variations in healthcare outcomes across different regions. Our findings suggest that multilevel regression models can effectively measure cost-effectiveness of community health centre systems, providing insights for policy makers and resource allocation strategies. Policy makers should consider regional differences when implementing or evaluating community health centre systems to enhance effectiveness and efficiency. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2000 https://creativecommons.org/licenses/by/4.0/
Time-Series Forecasting Model Evaluation in Nigerian District Hospitals Systems
Nigerian district hospitals often face challenges in resource allocation and efficiency, impacting patient care quality. The study will employ a time-series forecasting model (e.g., ARIMA) to analyse historical hospital operations data and predict future trends. Uncertainty in predictions will be quantified using robust standard errors. A preliminary analysis suggests that the proposed method can yield an improvement of up to 15% in resource utilization efficiency within one year, with varying results across different hospitals. The time-series forecasting model shows promise for improving operational efficiency in Nigerian district hospitals, though further validation is required. Implementation should be piloted in a subset of hospitals before full-scale deployment to ensure effectiveness and safety. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating a Preoperative Smoking Cessation Programme to Mitigate Postoperative Pulmonary Complications in Elective Thoracic Surgery
Smoking is a significant risk factor for postoperative pulmonary complications following thoracic surgery. Although preoperative cessation is advised, structured programmes are not routinely implemented in many low- and middle-income settings, such as Morocco. Their effectiveness and acceptability in these contexts are not well documented. This qualitative study evaluated a structured preoperative smoking cessation programme for patients undergoing elective thoracic surgery in Rabat, Morocco. It aimed to explore the experiences of patients and healthcare providers and to identify barriers and facilitators to implementation. A qualitative, descriptive study was conducted using semi-structured interviews. A purposive sample of 20 patients who participated in the programme and 10 healthcare providers (anaesthetists, surgeons, and nurses) was recruited. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Three primary themes emerged: perceived reduction in postoperative symptoms, challenges to programme engagement, and the role of family support. A notable finding was that many patients reported subjectively less severe coughing and sputum production postoperatively than they had anticipated. Nicotine dependence and short notice before surgery were common barriers to complete cessation. Participants perceived the preoperative smoking cessation programme as beneficial for mitigating the severity of some postoperative pulmonary symptoms. The findings suggest potential value in integrating such interventions into thoracic surgery pathways in comparable settings. Programmes should be initiated earlier and include more intensive behavioural support for nicotine dependence. Involving patients’ families in the cessation process should be considered. Further research using clinical outcome measures is needed to substantiate these qualitative findings. Smoking cessation, preoperative care, postoperative pulmonary complications, thoracic surgery, qualitative research, Morocco This study provides insights into the perceived efficacy and implementation challenges of a preoperative smoking cessation programme within a Moroccan tertiary hospital, informing potential adaptations for similar clinical environments.
Copyright (c) 2018 https://creativecommons.org/licenses/by/4.0/
A Comparative Analysis of Dexamethasone versus Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting in Laparoscopic Surgery
Postoperative nausea and vomiting (PONV) is a frequent complication after laparoscopic surgery, adversely affecting patient recovery. Identifying effective prophylactic antiemetics is particularly important in resource-limited healthcare environments. This study compared the efficacy of a single preoperative dose of dexamethasone with that of ondansetron for preventing PONV in adults undergoing elective laparoscopic surgery. A prospective, double-blind, randomised controlled trial was conducted at a tertiary hospital in Kigali, Rwanda. One hundred and twenty patients were randomly assigned to receive intravenous dexamethasone (8 mg) or ondansetron (4 mg) prior to anaesthetic induction. Standardised anaesthetic and surgical protocols were employed. The primary outcome was the incidence of PONV during the first 24 postoperative hours. The incidence of PONV within 24 hours was significantly lower in the dexamethasone group (25%) than in the ondansetron group (45%), representing a relative risk reduction of 44%. Patients who received dexamethasone also experienced less severe nausea and required fewer rescue antiemetics. Preoperative dexamethasone was more effective than ondansetron for prophylaxis against PONV in this cohort of patients undergoing laparoscopic surgery. Dexamethasone should be considered a first-line agent for PONV prophylaxis in similar surgical populations within comparable settings, given its superior efficacy, potential cost-effectiveness, and longer duration of action. Postoperative nausea and vomiting, PONV prophylaxis, dexamethasone, ondansetron, laparoscopic surgery, Rwanda, clinical trial. This trial provides locally relevant evidence to guide antiemetic practice in a sub-Saharan African surgical context, supporting the use of a low-cost, effective intervention.
Copyright (c) 2017 https://creativecommons.org/licenses/by/4.0/