Prevalence and Classification of Misdiagnosis Among Hospitalised Patients in Five General Hospitals of Central Uganda

Katongole, Simon Peter; Akweongo, Patricia; Anguyo, Robert; Kasozi, Daniel Evans; Adomah-Afari, Augustine

doi:10.2147/ca.s370393

Cited by 6 publications

References 26 publications

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Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Katongole¹,

Akweongo

DDMO

et al. 2022

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Misdiagnosis of inpatients is a major public health issue whose scope and causes are unknown in Sub-Saharan African countries. The purpose of this cross-sectional study, which was conducted in five hospitals in central Uganda, was to identify the factors associated with inpatient misdiagnosis in general hospitals in Central Uganda. Records of 2,431 patients admitted between July 1st, 2019 and June 30th, 2020 were specifically reviewed to obtain data on variables thought to be associated with misdiagnosis. The admission diagnosis assigned at the emergency or outpatient department was compared to the discharge diagnosis assigned immediately after the patient’s admission, with any difference considered a misdiagnosis. The disease, patient, health system, and environmental factors associated with misdiagnosis were identified using multivariable logistic regression analysis.Misdiagnosis was found in the records of 223/2431 (9.2%) of the admitted patients. A patient admitted to Nakaseke hospital [aOR=1.95, 95% CI=1.17-3.25, p=0.01], being admitted at night [aOR=3, 95% CI=1.81-5.02, p0.01], male patient [aOR=1.89, 95% CI=1.35-2.64, p0.01], patient’s age groups 10-19 [AOR=2.3, 95% CI=2.3-9.25, p0.01]; 20-29 [AOR=8.15, 95% CI=4.18-15.89], p<0.01; 30-39; and 40-49;; AOR=8.12, 95% CI=3.99-16.54, p<0.01; AOR=7.88, 95% CI=3.71-16.73, p<0.01; and AOR=12.14, 95% CI=6.41-23.01, p<0.0]. Misdiagnosis was also associated with multimorbidity (aOR=4.71, 95% CI=1.91-11.65, p0.01) and patients treated for uncommon diseases (aOR=2.57, 95% CI=1.28-5.18, p0.01). Patients without underlying diseases [aOR=0.63; 95% CI=0.43-0.91, p=0.015] and those who were not referred [aOR=0.51; 95% CI=0.31-0.86, p=0] .011] were less likely to be related to misdiagnosis.To improve diagnostic accuracy, hospitals should reorganize patient admission processes, conducted targeted training, develop policy or guidelines targeting factors predisposing to misdiagnosis, and the adopt a diagnostic error prevention culture.

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Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Katongole¹,

Akweongo

DDMO

et al. 2022

Preprint

Self Cite

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Improving Clerkship to Enhance Patients’ Quality of care (ICEPACQ): a baseline study

Pangholi,

Kagoya,

Nsubuga

et al. 2024

BMC Health Serv Res

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Background Proper and complete clerkships for patients have long been shown to contribute to correct diagnosis and improved patient care. All sections for clerkship must be carefully and fully completed to guide the diagnosis and the plan of management; moreover, one section guides the next. Failure to perform a complete clerkship has been shown to lead to misdiagnosis due to its unpleasant outcomes, such as delayed recovery, prolonged inpatient stay, high cost of care and, at worst, death. Objective The objectives of the study were to determine the gap in clerkship, the impact of incomplete clerkship on the length of hospital stay, to explore the causes of the gap in clerkship of the patients and the strategies which can be used to improve clerkship of the patients admitted to, treated and discharged from the gynecological ward in Mbale RRH. Methodology This was a mixed methods study involving the collection of secondary data via the review of patients’ files and the collection of qualitative data via key informant interviews. The files of patients who were admitted from August 2022 to December 2022, treated and discharged were reviewed using a data extraction tool. The descriptive statistics of the data were analyzed using STATA version 15, while the qualitative data were analyzed via deductive thematic analysis using Atlas ti version 9. Results Data were collected from 612 patient files. For qualitative data, a total of 8 key informant interviews were conducted. Social history had the most participants with no information provided at all (83.5% not recorded), with biodata and vital sign examination (20% not recorded) having the least number. For the patients’ biodata, at least one parameter was recorded in all the patients, with the greatest gap noted in terms of recording the nearest health facility of the patient (91% not recorded). In the history, the greatest gap was noted in the history of current pregnancy (37.5% not provided at all); however, there was also a large gap in the past gynecological history (71% not recorded at all), past medical history (71% not recorded at all), past surgical history (73% not recorded at all) and family history (80% not recorded at all). The physical examination revealed the greatest gap in the abdominal examination (43%), with substantial gaps in the general examination (38.5% not recorded at all) and vaginal examination (40.5% not recorded at all), and the vital sign examination revealed the least gap. There was no patient who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The causes of the gap in clerkships were multifactorial and included those related to the hospital, those related to the health worker, those related to the health care system and those related to the patient. The strategies to improve the clerkship of patients also included measures taken by health care workers, measures taken by hospitals and measures taken by the government. Conclusion and recommendation There is a gap in the clerkships of patients at the gynecological ward that is recognized by the stakeholders at the ward, with some components of the clerkship being better recorded than others, and no patients who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The following is the recommended provision of clerkship tools, such as the standardized clerkship guide and equipment for patient examination, continuous education of health workers on clerkships and training them on how to use the available tools, the development of SOPs for patient clerkships, the promotion of clerkship culture and the supervision of health workers.

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Strengthening anthrax outbreak response and preparedness: simulation and stakeholder education in Namisindwa district, Uganda

Walekhwa,

Namakula,

Wafula

et al. 2024

BMC Vet Res

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Background Anthrax is a zoonotic disease caused by Bacillus anthrac is that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda. Methods We conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported. Results The overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects. Conclusion We found that the district’s preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the he...

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Prevalence and Classification of Misdiagnosis Among Hospitalised Patients in Five General Hospitals of Central Uganda

Cited by 6 publications

References 26 publications

Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Factors associated with misdiagnosis of hospitalised patients in general hospitals of Central Uganda

Improving Clerkship to Enhance Patients’ Quality of care (ICEPACQ): a baseline study

Strengthening anthrax outbreak response and preparedness: simulation and stakeholder education in Namisindwa district, Uganda

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