The role of general practice in medical education is increasing both at the undergraduate and postgraduate level. There is a paucity of evidence as to the level of involvement of GP registrars and their training to teach. Two hundred and forty one GP trainees in the Peninsula Deanery were surveyed as to their current level of involvement in teaching and their training to provide it. Seventy eight completed surveys were returned and these revealed that 62% were regularly involved in teaching but only 41% had ever received any training in this area. There was a strong feeling that teaching was an important skill for GPs with 92% of trainees wanting further training in this area. There is clearly a need for further research in this area both to identity whether this sample is representative of the situation nationally and to determine how best to equip trainees in their roles as educators now and in the future.

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Over a five-month period, clinicians in Tana River County Kenya observed an increasing number of patients presenting to health facilities with a common collection of symptoms including fevers, joint pains and gum hypertrophy. After initial investigative and management strategies failed to reveal a diagnosis, patients were empirically commenced on ascorbic acid for presumed scurvy. This strategy resulted in the rapid resolution of symptoms in 65 patients within two weeks.

BackgroundThe quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection.MethodsWe used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders.FindingsClinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p < 0.001). The secondary outcome of composite quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p < 0.001). Interventions had different effects at different clinical sites; the primary outcome of appropriate antibiotic prescription was met 83% of the time at Penda Health, and 50% of the time at AICKH, possibly reflecting differences in onboarding and management of clinical officers. Logistic regression analysis showed that intervention stage and clinical site were independent predictors of the primary outcome (p < 0.0001), while all other features, including provider and patient age, were not significant at a conservative threshold of p < 0.05.ConclusionThis study shows that brief educational interventions can dramatically improve the quality of care for routine acute illnesses in the outpatient setting. Measurement of quality metrics allows for further targeting of educational interventions depending on the needs of the providers and the community. Further study is needed to expand routine measurement of quality metrics and to identify the interventions that are most effective in improving quality of care.

Background: Needle stick and sharp injuries (NSSIs) amongst healthcare workers (HCWs) are among the most common occupational accidents in hospitals. Approximately half of the responsible instruments are contaminated with blood, putting users at risk infection from blood-borne pathogens such as HIV. Although post-exposure prophylaxis has been shown to reduce the risk of HIV transmission, adherence to therapy is a well-documented challenge. Aim: To assess healthcare workers adherence to HIV post-exposure prophylaxis following Needle stick and sharp injuries. Method: A retrospective chart review was conducted on HCWs who were started on HIV PEP following a reported occupational exposure due to NSSIs between February 2017 and June 2022 to assess adherence. Result: A total of 136 HCWs had occupational exposure to NSSIs. The majority of the exposures (82.3%) were high risk for HIV transmission. Overall adherence to the 28-day HIV PEP course was 26%. HCWs were more likely to complete HIV PEP when the source's HIV status was positive compared to when it was negative [ 42.4% vs 11.8%; p = 0.001]. The drug regimen (TDF/3TC/DTG) was significantly associated with defaulting treatment (aOR; 5.5 (95% CI 2.16 - 14.02) (p= 0.001), compared with patients using the TDF/3TC/ATVr regimen. Conclusion: 74% of HCWs who started PEP defaulted the recommended 28-day course. Possible strategies for improving adherence and occupational health are required. Contributions: Few studies in Kenya have assessed the completion rate for PEP among HCWs; these findings will contribute to the body of knowledge in this area.