A short presentation describing the mobile clinics held in Kitale, Kenya, Aug 2012 - focussing mainly on clinical data and implications.

1. Mobile Clinics in Kitale district,
Kenya – July-Aug 2011
Key lessons from collection
of clinical data
Myer Glickman MFPH FHRIM FBMIS
Head of Life Events Modernisation, UK Office for National Statistics
Director & Consultant Statistician, Development & Health Informatics Ltd
Secretary of the Board of Trustees, UK-Africa Health Partnership - AEMRN(UK)

2. Data collection
• One clinic (out of three) in Kitale district
• Clinical records were kept by hand on A5 plain
paper
• Key data items were abstracted manually on site
for later analysis:
– sex, age, place of residence, weight, blood pressure,
symptoms and diagnoses, medications prescribed,
referral to hospital
• Data were collected for 307 patients out of an
estimated 504 (61%)
• Catchment population mainly local area but not
clearly defined

3. Clinic attendance by age and sex
40
35
30
25
Number
20
15
10
5
0
<1 1-04 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 +
Male Female

4. Key points on demographics
Statistics
• 65% of patients were female
• 53% were children <15 years
• 20% were aged 1-4 years
• 78% of patients (estimated) came in a family group
Lessons
• Paediatric expertise especially valuable
• Ensure sufficient supplies of common paediatric
formulations, tonics and wormers
• Opportunity for health promotion to women but not men
• Alternatives needed to approach men’s health issues?

5. Most common medical conditions
Number
0 5 10 15 20 25 30 35 40
Upper respiratory infection, m isc. sym ptom s
Dermatitis, m isc. skin problem s of body
Chest pain, palpitations
Eye and vision problem s
Non-specific headaches, dizziness
Diarrhoea, m isc. gastrointestinal sym ptom s
Dermatitis, m isc. skin problem s, head or face
Abdom inal pain, distension, ascites
Back pain, neck pain
Ear problem s, deafness
Malaria
Asthm a, bronchitis, m isc. respiratory problem s
Fever, unspecified
Other m usculoskeletal

6. Key points on medical conditions
Statistics
• 13% of all conditions diagnosed were upper respiratory tract
infections
• 12% were dermatitis of trunk or limbs, allergic or other
• 18% of patients had a potentially serious or life-threatening
condition
• At least 4% of patients were referred to hospital
Lessons
• The clinics provide mainly primary care for common diseases,
especially of childhood
• Most patients do not have regular access to healthcare and
conditions are often multiple and chronic
• Conditions seen may suggest health promotion opportunities
• A significant minority need potentially life-saving treatment

7. Most common medications
Percent
0 2 4 6 8 10 12 14
ASAQ
Amoxicillin
Paracetamol
Ibuprofen
Albendazole
Multivitamin
Ampicillin
Cetirizine
Metronidazole (Flagyl)
Iron, Folic acid

8. Key points on medications
Statistics
• An estimated 1,120 courses of medicine were prescribed
altogether
• Artesunate/amodiaquine was 13% of all prescriptions
• Amoxicillin was 11%, paracetamol 11% and ibuprofen 8%
• 36% of patients received a broad spectrum antibiotic
• 28% were prescribed ASAQ
Lessons
• Use of broad spectrum antibiotics may be excessive: on-site
testing and written prescribing guidelines might help
• On-site testing might also reduce use of antimalarials
• Prescribing practice was inconsistent: written guidelines
might improve practice
• Triage could possibly reduce burden on doctors e.g.
multivitamins/wormers could be given without prescription

9. Clinic utilisation study
• Reason for attending clinic
• How heard of clinic
• Means of travel to clinic
• Time taken to travel
• Cost of travel
• Family group composition
• Could be linked to medical record

10. Needs assessment study
• Household membership
• Educational level
• Type of accommodation
• Source of water, toilet facilities
• Recent illness in family
• Contact with healthcare services
• Subjective view on health impacts,
priorities

11. Final points
• Thanks to local colleagues who helped with translation and
data collection
• Valuable clinical and social information, supporting evidence-
based practice, can be derived from very basic record-
keeping
• Quality of record-keeping could be improved by structured
forms (since designed) or even electronic records
• Potential for integrating studies into clinic process e.g. needs
assessment, health knowledge
• Full report is available at
http://www.ukahp.org/resources/Kipsongo%20clinic%202011
%20report.pdf
• Email me on myer.glickman@yahoo.co.uk