W. C. Wanjau1, N. R. Gitau4, J. K. Wanjeri3, A. L. Kushner1, S. M. Wren2 1Johns Hopkins University School Of Public Health,International Health,Baltimore, MARYLAND, USA 2Stanford University,Center For Innovation In Global Health,Palo Alto, CA, USA 3University Of Nairobi,Department Of Surgery,Nairobi, NAIROBI, Kenya 4Embu County Referral Hospital,Surgery,Embu, EMBU, Kenya
Introduction: Inadequate treatment of wounds leads to avoidable complications and extended healing time. First line management is most often provided by junior doctors in Kenya. We assessed baseline knowledge of standardized wound care practices and wounds to identify opportunities for improvement.
Methods:
A qualitative cross sectional study using a wound treatment questionnaire was administered by telephone to medical officers in 20 of 47 counties in Kenya between 11th and 25th August 2015. Medical Officers and Medical Officer interns working in outpatient and surgery departments in the different counties were randomly surveyed; total of 20 doctors; 1 per county. Verbal consent was obtained. Variables collected included wound cleaning solution used, availability of advanced dressings, use and duration of antibiotics, cosmetic consideration when managing wounds, knowledge on the existence of standardized guidelines, and the definition of a chronic wound.
Results: The treatment of wounds varied widely across all assessed variables. Povidine Iodine was used at 80% of facilities to clean wounds, saline in 43% of the facilities and peroxide in 9.5%. Only 45.5% of facilities had advanced wound care material apart from gauze. Advanced dressings used included: Impregnated gauze, vacuum dressing and antimicrobial laced dressing. A total of 65% of doctors gave antibiotics to treat wounds all of the time. Only 30% of doctors considered cosmetics all the time when managing wounds, with 60% some of the time, and 10% never considering it. Only 9.1% were aware of standardized international guidelines for wound care management. None were aware of standardized guidelines for treatment of wounds in their facility. Using a standard definition of 4 weeks to classify a chronic wound, 55% classified the chronic wounds correctly at 4 weeks , 30% at less than 4 weeks and 15 % after more than 4 weeks.
Conclusion: There is wide variability in wound care management and no standardized guidelines across Kenya. Wound management and patient care could be improved by adoption and dissemination of countrywide guidelines. Evidence based care for wound management is needed to avoid preventable morbidity and mortality.