Battered lives…Domestic violence sends many to hospital, study says

-more studies needed to determine ‘true extent’

The study, which was conducted by several doctors from Vanderbilt University in conjunction with head of the A&E at the GPHC, Dr Navindranauth Rambarran, said that the frequency of IPV in the study population suggests that identification and intervention programmes as well as resident and staff education about IPV should be a  high priority for the staff at the hospital’s emergency unit. It has also been suggested that a more detailed study be done to ascertain the true extent of the problem.

The findings of the IPV study was one of many presented at the second annual Guyana Medical Scientific Conference 2010 which was held under the theme ‘Bringing Research to the Bedside through Evidence- Based Practice.’  The conference, which was held at the Princess Hotel, was organised by the Institute of Health Sciences Education and the GPHC.

Presenter of the findings of the study, Dr Shannon Langston, said that the objective was to look at the prevalence rate of IPV and it was conducted over a two-week period last July. The patients were specifically asked if the injury had been inflicted by a domestic partner and it was those 18 years or older who presented a traumatic condition, who were included in the data analysis.
Dr Langston said that 475 patients met the inclusion criteria and overall, 38 or 8% of that number stated that their injury was inflicted by a domestic partner. Most of the 38 -31 to be exact-patients were female with a rate of IPV among injured females being 16.0% compared to a 2.5% in males. The mean age was 34 years and most of the assaults-73.4%-occurred at the home of the victims. The majority of injuries were soft tissue injuries and lacerations to the face, head or extremities with one patient being admitted to the hospital. All the patients came from Region Four except for one who came from Region 10.

The doctor said that IPV occurs globally and affects all societies but is considered to be a preventable problem. She added that about one in six women presented to the GPHC with an injury admits to IPV as a cause but as with other studies, it is likely a significant underestimate of the true prevalence. While IPV among men is low, it is not insignificant.

Another important finding presented at the conference was that the HIV prevalence among children in orphanages is higher than the national figure. This is according to a study of 579 children from 23 orphanages countrywide. The study was conducted by the National AIDS Programme Secretariat (NAPS) in collaboration with Child Protection Agency of the Ministry of Human Services & Social Security.

According to Nafeeza Ally, who presented the findings, of the 579 children tested, 4.3 percent-25- were found to be positive. The children tested were between the ages of one to twenty with the mean age being 10 years. Children less than 15 years accounted for 89.6% of those tested and females accounted for 56% of this group. 3.4% of the females tested in that group were positive and 5.4% of the males were positive. The HIV-positive children were followed up by social workers from the human services ministry to ensure that they were enrolled in the HIV care and treatment programme.

Ally indicated that it is important for the early diagnoses of paediatric HIV infection with early management resulting in important outcomes such as the reduction of morbidity and mortality and improvement in the quality of life.  It was recommended that HIV testing be integrated into the medical assessment prior to admission and caregivers should be trained to care for HIV-positive children. Ally said that obtaining approval to conduct the study was challenging but in the end, a high acceptance rate was obtained.

Paediatric cancers
Meanwhile, a study on the prevalence of paediatric cancers and tumours at the GPHC has found that there is a problem with paediatric cancers and tumours in Guyana and the need of more detailed studies has highlighted the risk factors and natural history of some cancers, especially ones affecting the hematopoietic system.

The study, done by Dr Chaitra Singh, an intern at GPHC, and Dr Clive Bowman – the head of the GPHC paediatrics department, was conducted to determine the prevalence of paediatric cancers and tumours at the GPHC between January 2005 and May 2010.

According to Dr Singh, during the study period, 73 patients were diagnosed with some form of cancer or tumour in the paediatric department and some 24 difference types of cancers and tumours were found, of which acute lymphoblastic leukemia and hemangioma were the most common. In addition, there was a 31% prevalence of all hematopoietic cancers; a 21% of CNS tumours; 9.5% of bone tumours; and a sparse occurrence of rare tumours such as ovarian and yolk sac tumours.

She said that the patients diagnosed with hematopoietic cancers were mostly males, East Indians who lived in Region Six and were diagnosed in 2008. They were diagnosed mainly by use of biopsy in addition to imaging and history and physical examination. Further, treatment was principally with chemotherapy, steroid therapy and supportive treatment. The maximal survival time was years and the minimum was three days.

And a study done on the epidemiological profile of glaucoma at GPHC found that glaucoma is the second leading diagnosis at the hospital’s eye clinic representing 9% of new cases.

According to Dr Ilona Perreira-an intern at GPHC who conducted the study along with head of the GPHC’s ophthalmology department, Dr George Norton-a person with glaucoma at the hospital may be either male or female between the ages of 44 and 76 and is of Afro-Guyanese descent and residing in Region Four.

Dr Perreira, who won the Deen Sharma Award for the best research presentation, said that it is not likely that the individual has a known family history of glaucoma but the patient is likely to have cataract as a co-existing eye condition. Timolol was part of the treatment regimen in most patients-73%- and surgery is rarely used-0.015%.

The doctor said that epidemiological data in the national population was mostly anecdotal and she suggested that glaucoma is a very common cause of blindness. She suggested that improving epidemiological data is the first step in developing strategies for diagnosis and treatment.

A sample size of 600 patients was used which represented all patients who were presented to the eye clinic between January 2007 and December 2009 who were newly diagnosed with glaucoma. Of the population studied, 51.5% were female and 48.5% were male, approximately 71.03% of the patients were between the ages of 44 and 76. Afro-Guyanese represented 58% of the patients followed by Indo-Guyanese, 32% then mixed race, 7.5%. Amerindians represented 1.5% and Portuguese 0.33%. Sixty-nine percent of the patients came from Region Four, 15.5% from Region Three and 6.6% from Region Ten.

A third of the patients had at least one other eye condition, 73% of those is cataract; pterygium was next with 8% and trauma 7%. Dr Perreira said 349 of the patients had no history of co-existing general medical condition while hypertension and DM accounted for 38.2%. One hundred of the patients had hypertension alone, 50 had diabetes alone while 78 persons had both. Fifty-three persons had a history of glaucoma; in 32 or 5.4% of patients it was a first degree relative and in 21 or 3.5% of patients it was a second degree relative.

The doctor recommended that a glaucoma clinic be established and that there should be more screening of patients coupled with an increased awareness campaign about the disease. Most the glaucoma diagnosed during that period were in the chronic stage.

Director of Medical Services at GPHC, Dr Madan Rambarran said the hospital is working to establish an electronic library where the findings of the studies done over the years by doctors, can be accessed.

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