Global Health Presentation - Dominican Republic

7/27/2019 Global Health Presentation - Dominican Republic

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UTMB Global Health

Do

Dominican Republic


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p

UTMB Global Health

University of Texas Medical Branch at Galveston


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UTMB Global Health in the DR

6 weeks in the Dominican Republic

3 main goals:

The Prevalence and Effects of Depression and Anxiety

in Patients Receiving Maintenance Care in the DialysisUnit of Buen Samaritano Hospital

Prevalence of water borne illnesses with respect toinstallation of water filters

Field epidemiology course at El Universidad Centraldel Este

Rotation at Hospital El Buen Samaritano


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The Prevalence and Effects of

Depression and Anxiety in Patients

Receiving Maintenance Care in the

Dialysis Unit of Buen Samaritano

Hospital


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Study/ Objective

For the last 6 weeks we have been conductinga study on the prevalence of depression andanxiety in the dialysis patients at Buen

Samaritano Hospital. Objective: Investigate the levels of depression

and anxiety in 11 patients between the agesof 27 and 77 with chronic renal insufficiencyundergoing hemodialysis at Buen SamaritanoHospital.


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Inclusion Criteria

Subjects were all adults.

Subjects must have the physical and mental

capacity to respond to the questions given in

the study.

Patients must have been in dialysis for at least

6 months to be considered for the study.


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Materials

Hospital, ansiedad y depresin (HAD) questionnaire

Eadg56: escala de ansiedad y depresin de Goldberg(Versin adaptada al castellano por A. Lobo ycolaboradores.)

Both of these questionnaires have been translated intoSpanish and the Goldberg has been shortened.

The revised version has been peer reviewed andapproved as an effective tool in the diagnosis ofdepression and anxiety in Spanish speakingpopulations.


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Methods HAD

Patients were asked 14 questions from the HAD. Fouranswer choices were provided for each question andlabeled 0-3 based on their likelihood of representing asymptom of anxiety or depression.

To ensure no bias in the study due to a patientsinability to read the questions a researcher dictated thequestions to them and recorded their answers.

After the patient had answered all of the questions

their total score was calculated and used to determineif the patient was a high risk for anxiety or depression.


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Methods HAD

Scores of 7 or below were considered low risk

for depression and anxiety.

Scores ranging from 8-10 are considered

possible risks for depression and anxiety

Scores of 11 or high are considered a very

likely indicator of depression and anxiety.


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Methods-Goldberg


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En la Unidad de Dilisis del Hospital General El Buen Samaritano, el Departamento

de Investigacin Medica de la mano con la Universidad de Texas desarrollo un

proyecto de investigacin para determinar los niveles de ansiedad y depresin en

los pacientes de dicha unidad, con la finalidad de ejecutar un programa que

mejore su calidad de vida y por ende reduzca la morbilidad en dichos pacientes.

La muestra estuvo integrada por un total de 11 pacientes para un 100%.

En cuanto al sexo que mayor proporcin se present en la unidad fue el femenino

con 6 mujeres para un 54% y el masculino 5 pacientes para un 44%.

Con respecto a la edad de los pacientes, lo dividimos en 3 grupos. En el primer

grupo de 25-40 aos tuvimos 2 pacientes para un 17%; en el segundo grupo de 41-

55 aos tuvimos 5 pacientes para un 44%; en el tercer grupo tuvimos 2 pacientespara un 17%.

En cuanto al estado civil de los pacientes, 5 estn casados para un 44%, 3 solteros

para un 26% y 3 viudos para un 26%.


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Con respecto al nivel educativo, 5 de los pacientes tienen un nivel educativo bsico

para un 44%; en el nivel medio hay 5 pacientes para un 44% y 1 paciente

profesional para un 12%.

En cuanto a la situacin laboral 2 de los pacientes en estudio estn activos para un

17% y el resto (9 pacientes) se encuentran inactivos para un 83%.

Para validar que el paciente padece de insuficiencia renal crnica decidimos

utilizar como parmetro los niveles de urea y creatinina. De los pacientes enestudio, 10 presentaron niveles elevados de urea para un 90%, siendo el valor

mnimo en este grupo 35.0mg/dl y el mximo 145.6mg/dl. En cuanto a los niveles

de creatinina 10 de los pacientes en estudio presentaron niveles elevados para un

90%, siendo el valor mnimo 4.3mg/dl y el mximo 14.6mg/dl. Fue de inters para

esta investigacin tomar en cuenta el hematocrito de estos pacientes para validar

la presencia de anemia en los mismos, 3 de estos pacientes presentaron unhematocrito


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Con respecto al HAD, dentro del grupo de 0-7 (no indica caso) tuvimos 4 pacientes

para un 35%, en el grupo de 8-10 (caso dudoso) tuvimos 3 pacientes para un 26%,

dentro del grupo de >11 (paciente en una de las sub-escalas de Goldberg) tuvimos

4 pacientes para 36%.

En cuanto al Goldberg de los 4 pacientes que entraron este grupo, todospresentaron ansiedad para un 36% y 3 presentaron depresin para un 26% de la

poblacin en estudio.


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Results


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Results

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Depression andAnxiety

Depression Only

Anxiety only

Neither Depression or Anxiety

Percent Prevalence of Depression and Anxiety in Dialysis Patients at Buen Samaritano Hospitall

Depression andAnxiety

Depression Only

Anxiety only

Neither Depression or Anxiety


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Conclusion

With over half of the patients in dialysis possiblysuffering from depression, anxiety, or both it is highlyprobable that developing a program of treatment forthese conditions would improve the health of thepatients undergoing chronic dialysis.

A possible bias of the study is its extremely smallsample size. Collaboration with other hospitals anddoing similar studies in other dialysis wards couldprovide a large sample population and further validatethe results of this study.

Further research would greatly benefit ourunderstanding of the effects of depression and anxietyin patients in a dialysis setting in the DominicanRepublic and allow for the creation of treatment plansfor these conditions.


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Water Filtration Study: Background

According to the World Health Organization(WHO) 1.8 million people die every year fromdiarrheal diseases (including cholera) 90% are children under 5, mostly in developing

countries 88% of diarrheal disease are attributed to unsafe

water supply and inadequate sanitation


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Water Filtration Study: Background

Improved water supply reduces diarrhea

morbidity by 21%. Improved sanitation

reduces diarrhea morbidity by 37.5%

Additional improvement of drinking-waterquality, such as point of use disinfection,

would lead to a reduction of diarrhea

episodes of 45%. UTMB/ Hospital El Buen Samaritano study of

the prevalence of water borne disease before

and after date of installation


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Water Filtration Study: Methods

Interviewed 2 communities, BateyEl 80 and Batey Juaquincito

Administered questionnaire toeach household (44) that held a

water filter Questionnaire consisted of:

Personal and filter identifyinginformation

Questions regarding the usage ofwater filter

Prevalence of water bornediseases in relation to the waterfilter installation date


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ID Name Age Sex# of

Filter Batey

Levelof

Education

Employme

nt Q1 Q2 Q3 Q4 Q5 Q6a Q6b Q6c Q6d Q6e Q6f Q7

WRK01 MV 22 2 46919 El 80 1 2 11 1 1 4 4 4 4 4 4 4 1

WRK02 RM 46 1 99999 El 80 1 2 1 11 1 4 4 4 4 4 4 4 4 1

WRK03 MO 42 1 99999 El 80 1 1 1 1 1 3 4 4 4 4 4 4 4 1

WRK04 YR 28 1 99999 El 80 1 2 1 1 1 1 4 4 4 4 1 4 4 1

WRK0

5 AC 46 1 99999 El 80 1 1 1 1 1 1 4 4 4 4 3 4 4 1



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WRK24 MB 22 1 41395

Juaquincito 1 1 1 9999 1 2 4 2 4 4 2 4 4 1

WRK25 YF 19 1 99999

Juaquincito 1 2 1 11 2 5 4 4 4 1 4 1 4 1

WRK26 LC 24 1 99999

Juaquincito 1 2 1 11 1 2 10 4 4 4 1 4 4 1

WRK27 RM 28 2 41415

Juaquincito 1 2 1 11 2 3 4 4 4 1 1 1 4 1

WRK

28 MG 80 1 41412

Juaqu

incito 1 1 1 11 2 1 10 1 4 4 4 4 4 1



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Before

Installation

% Before

Installation

Diminished,

but still

present

after

Installation

%

Diminished,

but still

present

after

installation

After

Installation

% After

Installation Never Present

% Never

Present

Salmonalla Typhi 3

13.0434782

6 0 0 0 0 20 86.95652174

Salmonella

sp/Shigella 1

4.34782608

7 0 0 0 0 22 95.65217391

Colera 4

17.3913043

5 0 0 0 0 19 82.60869565

Entamoeba

histolytica 4

17.3913043

5 1 4.347826087 0 0 18 78.26086957

Contact

Dermatits 2

8.69565217

4 0 0 0 0 21 91.30434783

Urinary Infection 1

4.34782608

7 0 0 0 0 22 95.65217391

Water Filtration Study: El 80 Results


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Water Filtration Study: El 80 Results

0

10

20

30

40

50

60

70

80

90

100

Salmonalla TyphiSalmonella sp/ShigellaColeraEntamoeba histolyticaContact DermatitsUrinary Infection

13.04

4.35

17.39 17.39

8.7

4.35

0 0 0

4.35

0 00 0 0 0 0 0

86.96

9.65

82.61

78.26

91.3

95.65

El 80 Prevalence of Disease (%)

% Before Installation

% Diminished, but still

present after installation

% After Installation

% Never Present


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Before

Instillation %

Diminished,

but still

present

after

instillation %

After

Instillation % Never Present

% Never

Present

Salmonalla Typhi 3

14.2857142

9 1 4.761904762 1

4.76190476

2 16 76.19047619

Salmonella

sp/Shigella 0 0 0 0 0 0 21 100

Colera 1

4.76190476

2 0 0 0 0 20 95.23809524

Entamoeba

histolytica 2

9.52380952

4 0 0 3

14.2857142

9 16 76.19047619

Contact

Dermatits 1

4.76190476

2 0 0 3

14.2857142

9 17 80.95238095

Urinary Infection 0 0 0 0 2

9.52380952

4 19 90.47619048

Water Filtration Study: Juaquincito Results


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Water Filtration Study: Juaquincito Results

0

10

20

30

40

50

60

70

80

90

100

Salmonalla

Typhi

Salmonella

sp/Shigella

Colera Entamoeba

histolytica

Contact

Dermatits

Urinary

Infection

14.29

0

4.76

9.52

4.76

0

4.76

0 0 0 0 0

4.76

0 0

14.29 14.29

9.52

76.19

100

95.24

76.19

80.95

90.476

Juaquincito Prevalence of Disease (%)

% Before Installation

% Diminished, but still

present after installation

% After Installation

% Never Present


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Due to the low number of individuals used inthe study, compounded with recall bias ofindividuals interviewed, the results did notmatch our original hypothesis

However, set up a continuation of the studywith a greater amount ofcommunities/households for a greateramount of time

Demonstrates the importance of datacollection before the installation of waterfilters

Water Filtration Study: Conclusion


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Field Epidemiology


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Field Epidemiology Course

Field Epidemiology course given by Dr. Goldy

Mills at El Universidad Central del Este (UCE)


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Field Epidemiology Course at UCE

Experience, first hand, life in the bateyes and

barrios of the Dominican Republic

Visited 5 bateyes and barrios

Toured the local cemetery

Met with disabled children attending school

for the deaf and mute

Identified health risk factors associated with

living in these communities


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Water Contamination


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Unsanitary Waste Removal


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Impure Drinking Water


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Inadequate Living Conditions


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Cemetery


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School for the Deaf and Mute


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Hospital Rotations


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Hospital Rotations

2-3 days/ week worked in El Buen Samaritano

Met with patients, gained clinical experience


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Surgery


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Surgery


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Special Thanks:

Lic. Moises Sifren

Dr. Liddy Kiaty, MD

Dr. Franklin Bido

Dr. Goldny Mills

Daniel Barett and Filter Group


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Global Health Presentation - Dominican Republic

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