FIELD ATTACHMENT REPORT

BY

AYAN BASHIR ABDI : ADMISION NUMBER CHD-09-0527/2023

ATTACHMENT PERIOD THREE MONTHS (3MONTHS)

INSTITUTION OF ATTACHMENT: DADAAB SUB-COUNTY HOSPITAL

ATTACHMENT REPORT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR AWARD OF

CERTIFICATE IN COMMUNITY HEALTH AND DEVELOPMENT

EMAIL: [email protected]

STUDENT PHONE NUMBER:0743341728

i. ACKNOWLEDGEMENT

I would like to express my gratitude to Dadaab Hospital for providing me with the opportunity to
undertake my attachment as a community health.

Secondly I would like to thank the Almighty God for the care and mercies that he offered me all
through my attachment period. Special appreciation also

Goes to my family at large they have been supportive and thank them for dedicating their time to
making sure the attachment was a success. I would like to thank the Head of department at the
dispensary, for sharing their knowledge and supporting me.

ii. DEDICATION.

I dedicate this report to all the patients and the community members whose live intersected with
mine during my time at masalani hospital ,your resilience and strength in the face of health
challenges have inspired me and reinforced my commitment to improving community health
outcomes.
 iii. DECLARATION

I hereby declare that this report is a true reflection of my experience and observation during my
attachment at at Dadaab hospital .i affirm that information presented in this report is based on my
own efforts and that any external sources used have been properly cited.
iv. LIST OF ABBREVIATIONS

QA-Quality Assurance

FP-Family Planning

CHW- Community Health Worker

MCH- Mother Child Health

CHU – community Health Unit

CHEW – community health extension worker

CHIS- community Health information system

PMTCT – prevention of mother to child transmission

MUAC - Mid Upper Arm Circumference

BMI – Body Mass Index

RUTF- Ready to use therapeutic food

RUSF- Ready to use Supplemental food

CSB-combined soya blend

Table of Contents
Acknowledgment……………………………………………………………………………………..i

Declaration………………………………………………………………………………………………ii

Dedication……………………………………………………………………………………………….iii

1.0. CHAPTER ONE

1.1. Historical background ……………………………………………………………………………..…4

1.2 .Vision………………………………………………………………………………………………….………..5

1.3 .Mission............................................................................................................5

1.4. Motto…………………………………………………………………………………………………………..5

1.5. Core values…………………………………………………………………………………………….…..…6

1.6. Quality values……………………………………………………………………………………………….6

1.7. Core function……………………………………….……………………………………………………….6

1.8. Organizational structure……………………………….……………………………………………..7

1.9. Broad objectives……………………………………..……………………………………………………8

1.9.1. Specific objectives………………………………….…………………………………………………….

2.0. CHAPTER TWO……………………………………………….…………………………………………………9

2.1. Health facility experience……………………….……………………………………………………9

2.2. Comprehensive care clinic………………………..………………………………………………….9

2.3. Roles at the facilities………………………………..…………………………………………………..9

2.4. Nutrition department ………………………….……………………………………………………..10

2.5. Maternal and child health……………………………………………………………………….….11

2.6. Family planning………………………………………..……………………………………………….…12

2.7. Natural methods of family planning……………………….…………………………………..13

2.8. Artificial methods of family planning………………………………………………………....14

2.9. Laboratory and pharmacy ………………………………………………………………………….15

3.0. CHAPTER THREE………………………………………………………………………………………..15

3.1. Community experience ………………………………..……………………………………………15

3.2. Evaluation of community health programs ………………………….……………………16

3.3. Participation in health promotion activities……………………….……………………..16

3.4. Community diagnosis……………………………………………………………………………… 17

3.5. Home visits……………………………………………………………….……………………………….17

3.6. Community strategy………………………………………………………………………………....17

3.7. Community health reporting tools ………………………………………..………………….18

3.8. Community health field achievement………………………………..………………………18

CHAPTER FOUR.

4.0. Discussion………………………………………………………..…………………………………………18

4.1. Compliment…………………………………………………………………………………………………19

4.2. Recommendations…………………………………………….………………………………………..20

: 1.0.CHAPTER ONE

1.1. Historical Background

Dadaab Hospital was started, many years back it has been a cornerstone of healthcare provision in the
region.it was established with the aim of providing quality care to the communities around and those
outside the region, the facility is headed by a nursing officer whose work is to coordinate all the
activities taking place in the facility it has several departments including

 Mother and child health

 Pediatrics ward
 Medical ward and female ward
 Pharmacy
 Kitchen
 Nutrition department
 Comprehensive care clinic

1.2: Vision
 Is to become a leading center of excellence in healthcare delivery.

1.3: Mission

 Is to provide accessible
 affordable,
 Quality healthcare services to the community.

1.4: The motto,

"Health for All," reflects its commitment to universal healthcare.

1.5: Core values include

i. Compassion
ii. professionalism
iii. integrity,
iv. Teamwork.

1.6: The hospital's quality policy

Emphasizes continuous improvement and patient satisfaction.

1.7: Core functions

 include primary healthcare,

 specialized medical services,
 emergency care,
 community outreach programs

1.8: Overall Objective

Broad objectives;

To exercise the knowledge gained in class into practical’s and to gain more experience from the
community as they learn from me.

Specific Objectives
1. To offer quality health care services to all the patients.
 2. To advance and protect the public image of the hospital at all times.
3. To uphold teamwork at all times.
4. To uphold integrity accountability and transparency in our dealings.

1.9: The organizational structure

- Comprises various departments, each contributing to the hospital's overall objectives.

The hospital typically follows the hierarchical organizational structure common in the health care
settings

The administrators Chief executive Medical directors

officers

Mch- department Ccc-department Nutr-department

Pharmacy
laboratory Store/kitchen

The board of directors –this oversees the hospital operations, set policies and ensures legal and
financial compliances

The chief executive officers - this gives the overall management and gives the strategic
directions.
The administrator - responsible for the management of the hospital, they oversees medical staff,
ensures quality patient care, and implements medical policies and procedure

The medical director –they oversees the medical staff and ensure work is done perfectly.

The departmental heads- each department such as pediatric has a head who manages daily
operation.
 2.0: CHAPTER TWO:

2.1: Health Facility Experience.

My specific roles at the hospital ware:

 Patient Advocacy: Social workers advocate for patients' rights and ensure they receive
appropriate care and support.
 Psychosocial Assessment: They conduct assessments to understand patients' social,
emotional, and psychological needs, helping to develop tailored care plans.
 Crisis Intervention: Social workers provide support during times of crisis, such as sudden
illness or trauma, offering counseling and connecting patients with resources.
 Care Coordination: They collaborate with medical teams, families, and external agencies to
coordinate services and ensure continuity of care for patients.
 Discharge Planning: Social workers assist in planning for patients' safe discharge from the
hospital, including arranging follow-up care and support services.

During my attachment, I had the opportunity to work in various departments, including:

2.2: Nutrition Department:

Providing nutritional counseling and support to patients. This is a department within the hospital
that deal with nutritional care and management of patients with different malnutrition, medical
and surgical conditions. The department currently contains a nutritionists headed by (H.O.D)
who is qualified to carry out nutritional activities within and outside the hospital. The units
covered by nutrition department in the hospital include the following:

 Hospital wards.
 Nutrition clinic
 C.C.C.
 TB clinic.
 Hospital kitchen.

The roles of the department include:

1. Involved in assessment of the patient nutritional status, which is mainly achieved through
collection of information/data and intervention. The patients are identified through observation
of physical signs suggestive of malnutrition or through diagnosis.

Examples of data collected include;

-Anthropometric measurement of weight, height and BMI.

-Nutritional/Dietary history.

-Biochemical data e.g., electrolytes, stool and hemoglobin.

-Growth monitoring.

2. Nutrition education and counseling which are done in wards and nutrition outpatient clinic.

3. Therapeutic nutrition involves implementation of nutrition care process through.

-Educating the patient on their prescribed diet.

-Ordering meals by filling of diet requisition sheet.

-Evaluation of nutritional care i.e., monitoring food and fluid intake

4. Training.

Teaching and assessment of nutrition students attached from various institutions.

MOTHER AND CHILD HEALTH

In this section mother and child clinic, various activities cater to the health and well-being of both
mothers and their children. These may include

 Prenatal check-ups for expecting mothers,

 Vaccinations for infants and young children,
 Developmental assessments,
 breastfeeding support and guidance
 , nutritional counseling
 parenting classes,
 postnatal care for mothers,
 monitoring growth and development milestones,
  and addressing any health concerns or questions that mothers or caregivers may have about
their children
 Additionally, some clinics may offer support groups or counseling services for mothers dealing
with postpartum depression or other emotional challenges.

Prenatal Check-ups: Providing comprehensive healthcare to expecting mothers, including monitoring

fetal development, addressing any health concerns, and offering prenatal education and counseling.

Postnatal Care: Ensuring the well-being of both mother and child after childbirth, including postpartum
check-ups, guidance on breastfeeding, and assistance with any postnatal issues.

Vaccinations: Administering immunizations to infants and young children according to recommended

schedules to protect against various diseases.

Developmental Assessments: Monitoring the growth and development milestones of children to ensure
they are progressing healthily.

Breastfeeding Support and Guidance: Offering education, counseling, and assistance to mothers on the
importance of breastfeeding, proper breastfeeding techniques, and overcoming common breastfeeding
challenges.

Nutritional Counseling: Providing guidance on proper nutrition for both mothers and children, including
prenatal nutrition, breastfeeding nutrition, and introducing solid foods during complementary feeding.

Parenting Classes: Offering classes or workshops to educate parents on topics such as infant care, child
nutrition, child safety, and parenting skills.

Health Education: Providing information on various health topics relevant to mothers and children, such
as hygiene practices, disease prevention, and family planning.
Procedure for Taking Weight and Height of a Child:

Weighing: The child is placed on a calibrated scale while wearing minimal clothing. The weight is
recorded accurately.

Height Measurement: The child is positioned barefoot against a stadiometer or wall-mounted measuring
tape. Their height is measured from the top of their head to the bottom of their feet.

Importance of Breastfeeding:

Breastfeeding provides numerous benefits for both the mother and the child. It offers optimal nutrition
for infants, promotes bonding between mother and child, boosts the child's immune system, reduces
the risk of infections and chronic diseases, aids in healthy growth and development, and provides long-
term health benefits for both mother and child.

How to Breastfeed a Child:

Positioning: Hold the baby close, supporting their head and neck. Ensure the baby's mouth is level with
the nipple.

Latch: Encourage the baby to open their mouth wide and latch onto the breast, ensuring they take in a
good amount of the areola along with the nipple.

Feeding: Allow the baby to nurse at their own pace, switching sides as needed. Ensure proper
positioning and latch throughout the feeding session.

Mothers counseled on breast conditions Examples of Breast Conditions:

Engorgement: Occurs when the breasts become overfilled with milk, causing swelling and discomfort.
Mastitis: Inflammation of the breast tissue, often accompanied by pain, redness, and swelling, usually
caused by a bacterial infection.

Blocked Ducts: Occurs when milk ducts become blocked, causing localized pain and swelling in the
breast.

Complementary Feeding:

Mothers were educated on complementary feeding at six months of their child.

Complementary feeding refers to the introduction of solid foods alongside breastfeeding or formula
feeding. It typically begins around six months of age and involves gradually introducing a variety of
nutritious foods to complement the child's breast milk or formula intake, helping to meet their
increasing nutritional needs as they grow. It's important to introduce foods one at a time and monitor
for any signs of allergies or adverse reactions.

2.3: Infant nutrition and child nutrition

Nutritional requirements for healthy newborns vary widely according to birth weight, gestational
age, rate of growth and environmental factors. They have higher protein, energy as well as
minerals requirements than older children due to their rapid growth.

Exclusive breastfeeding is recommended for all infants 0 to 6 months of age. Breast milk alone is
sufficient for al nutrient requirements at this age. Complementary feeding is initiated from 6
months onwards.

Complementary feeding is giving other foods in addition to breast milk. It is important to

introduce one food at a time, beginning with pureed vegetables, fruits, or rice etc. Offer small
amount of food at first. Naturally sweet fruits (such as bananas) should be used to sweeten foods
rather than adding sugar.

2.4: Antenatal section

At this section I did relevant anthropometric measurements which aided my nutrition counseling.
I first had to identify prenatal mothers in need of nutrition intervention. I then prioritize them to
enable me give time to those who needed it more since the patients were too many to effectively
handle each one. Where possible I conducted group counseling. From that I gave appointments
to those visiting antenatal care for the first time and those with complications for follow up.

2.5: Vaccination and immunization room

Vaccination involves administering a vaccine, which contains weakened or inactive parts of a pathogen
or its toxins. This stimulates the immune system to produce antibodies , providing immunity against
future infections. Immunization is the process of becoming immune to a disease through vaccination or
exposure to the disease itself. It's a crucial tool in public health for preventing the spread of infectious
diseases.

The schedule followed to do immunization included

Vaccine Age Route

BCG At birth Intra-dermal left for arm

Oral polio vaccine OPV Birth dose at birth 2 drops orally

1st dose at 6 weeks

2nd dose at 10 weeks

3rd dose at 14 weeks

DPT ( Diphtheria, pertussis, 1st dose at 6 weeks Intramuscular left outer thigh
tetanus, hepatitis B, homophiles
2nd dose at 10 weeks
influenza type b
3rd dose at 14 weeks

Pneumococcal vaccine 1st dose at 6 weeks Intramuscular right thigh

2nd dose at 10 weeks

3rd dose at 14 weeks

Rota virus vaccine 1st dose 6 weeks 1.5ml orally

 2nd dose at 10 weeks

Measles vaccine 6 months Subcutaneously right upper

arm
9 m0nths

18 months

Yellow fever vaccine 9 months Intra muscular left upper

deltoid

2.6: COMPREHENSIVE CARE CLINIC

I was involved in So many activities like .counseling the affected patients, taking anthropometric

measurements daily and supplementation.

Doing anthropometric assessment that is weight

Anthropometric Measurements: These are crucial for assessing an individual's nutritional status and
overall health. To take these measurements accurately, one typically follows standardized procedures.
For example:

Height: Use a audiometer like , ensuring the person stands straight with heels together and head
aligned in the Frankfort plane.

Weight: Utilize a calibrated scale, having the person remove shoes and heavy clothing for accuracy.

Body Mass Index (BMI): Calculate using the formula weight (kg) / height (m^2).

Waist Circumference: Measure at the midpoint between the lower margin of the last palpable rib and
the top of the iliac crest.

Body Fat Percentage: Can be estimated using skinfold calipers or bioelectrical impedance analysis.
Nutrition Counseling: This involves providing personalized guidance on dietary habits and lifestyle
choices to promote optimal health. The process typically includes:

1. Assessment: Gathering information about the individual's dietary intake, lifestyle habits, medical
history, and goals.
2. Goal Setting: Collaboratively establishing realistic and achievable nutrition goals tailored to the
individual's needs and preferences.
3. Education: Providing evidence-based information on topics such as portion control, food groups,
nutrient balance, meal planning, and reading food labels.
4. Behavior Change: Assisting individuals in adopting healthier eating patterns by addressing
barriers, implementing strategies, and fostering motivation.
5. Follow-Up: Monitoring progress, adjusting goals as needed, and offering ongoing support and
encouragement to promote sustainable lifestyle changes.

In addition to these core activities, comprehensive care clinics may offer additional services such as

1. medical examinations,
2. laboratory testing,
3. exercise prescription,
4. mental health counseling,
5. Referrals to specialists as needed, aiming to address the diverse health needs of their patients
comprehensively.

. The aim of this is to ensure that the client has optimal body weight depending on their

anthropometric measurements.

For underweight and SAM patients they are educated and counseled on importance of achieving

and maintaining normal nutritional status. Patients are also encouraged to consume food from all

the 8 groups. Supplementation was done to SAM patients where by adults were given 2 bags and

children 1 bag of Fortified Blended Flour (FBF).

2.7: Tuberculosis
TB is a common and, in many cases, fatal infectious disease that is caused by various strains of
mycobacteria usually mycobacterium tuberculosis.

It usually attacks the lungs but can also affect other parts of the body, it is spread through the air
when people who have an active TB infection cough, sneeze or otherwise transmit respiratory
fluids through the air.

TB can be Latent i.e.; it does not have symptoms and can spread or progress to active
tuberculosis if left untreated.

3.10.2.1 Symptoms of TB
Tuberculosis (TB)
Tuberculosis (TB) is caused by bacteria known as Mycobacterium typhi. TB can affect several
body parts including lungs, spine, and bones among others. Nutrition is a principal determinant
of morbidity and mortality from tuberculosis. TB increases as one passes from well-to-do to poor
populations. There is good epidemiological and clinical evidence that malnutrition contributes up
to 60% of both the incidence and severity of tuberculosis. Together with poverty, overcrowding
and HIV, poor nutrition has contributed to a global problem of TB “TRIPPLE TROUBLE”, i.e.,
Malnutrition, TB and HIV.

Symptoms associated with TB

 Cough lasting 2 weeks or more
 Fever/night sweat-which increase calorie requirement (10% extra calorie per every 1°c rise in
body temperature
 Loss of appetite-compromises nutrient intake leading to poor nutritional status
 Weight loss-compromise health and nutritional status predisposing the clients to frequent,
prolonged and severe infections due to impaired immunity
 Blood in the sputum-increase energy demand and loss of blood/iron predisposing the clients
to anaemia and other infections
 Oozing matted lymph nodes or enlarged lymph nodes-increase protein/micronutrients
requirement for tissue repair
 Breathlessness and fatigue – pulmonary effusion, pericarditis-increases energy need
Nutrition implications of TB
 Reduced protein synthesis and metabolism
 Nutrient deficiency
 Reduced immunity
 Reduced food and nutrient intake
 Increased nutrient requirements

2.8: Deworming

They are given once every six months to all children one year and above. Mebendazole at 500mg
or Albendazole 200mg for 1-2 years and 400mg for children 2 years and above

2.9: Prevention of mother to child transmission

To prevent transmission of mother-infant who are sero reactive, mother’s om ARV prophylaxis
is given AZT as from 14 weeks or there after then followed by AZT+3TC+NVP in labor and
during delivery then AZT+3TC for 7 days after delivery. The baby is put on NVP syrup
prophylaxis until a week after breastfeeding.

2.9.1 Family planning:

The hospital runs a comprehensive family planning program aimed at empowering women and couples
to make informed choices about their reproductive health.

.The family planning programs helps the people achieve the following.

 The number of children they desire

 Reduce the number of unwanted pregnancies
 Reduce the risk of sexually transmitted infections
 To improve the health of the children and the women.

At Dadaab hospital I got the opportunity to understand all the family planning methods both the natural
and the artificial ones
The natural methods of family planning included the following.
 Breastfeeding
 Abstinence
 Withdrawal methods
 Calendar methods
 Cervical mucus (billings methods)
 Sympathothermal

The Artificial methods included

 Barrier methods this is by use of condoms
 Intra-uterine device (IUD)
 Hormonal methods.
-pills
-implants
-injectable
 Surgical methods(permanent)
-tubal ligation

-vasectomy

 Emergency contraceptive.
 --IUD
 -hormonal control
3.0. CHAPTER THREE: COMMUNITY EXPERIENCE

My roles at the community ware.

 Community Development: engage in community-building activities, such as organizing
support groups, workshops, and advocacy campaigns to address social issues.
 Resource Navigation: They help individuals and families access community resources,
such as housing assistance, food banks, healthcare services, and educational programs.
 Counseling and Support: provide counseling and emotional support to community
members facing various challenges, including poverty, mental health issues, substance
abuse, and domestic violence.
 Advocacy: They advocate for social justice and work to address systemic issues that
impact marginalized communities, such as discrimination, inequality, and lack of access
to services.
 Prevention and Education: develop and implement prevention programs and
educational initiatives to promote health, well-being, and social inclusion within the
community.
 In both settings, I used to serve as integral members of interdisciplinary teams,
working collaboratively to address the holistic needs of individuals and communities

Evaluation of community health programs involved assessing the effectiveness of initiatives such

 immunization drives
 Health education campaigns.

Participating in health promotion activities included conducting workshops on:

 Hygiene,
 Sanitation,
 Disease prevention

. Community diagnosis entailed identifying health challenges and needs through

 Survey
 assessments
 Home visits allowed for personalized care
 Support to vulnerable individuals and families.

Community strategies

o focused on empowering local health volunteers

o and promoting community ownership of healthcare initiatives

Community health reporting tools

 facilitated data collection

  Monitoring of health indicators.

Community Field Achievement during Attachment

During my attachment, significant achievements in the community included

 increased immunization coverage,

 improved maternal and child health outcomes
 Enhanced awareness of family planning methods.

4.0. CHAPTER FOUR: DISCUSSION, RECCOMENDATION AND CONCLUSION.

during my period of attachment I was happy to meet experienced and talented health professionals
who helped me with one goal

Also I was given enough time to interact with the members of the hospital to ensure full achievement
of my dreams ,through them I learned to be responsible and ready to work and serve my community
with determination. The staffs were really committed and performed their duties diligently. This
enabled patients to get quality health care support leading to quick recovery and continued
health.The experience at Dadaab Hospital provided valuable insights into healthcare delivery and
community engagement.

: Challenges

 Language barrier since some could only communicate in vernacular making

communication difficult
 Insufficient supplements made prescription hard to follow
 Non-cooperating patients. Some were rude and others were not willing to give
information and adhere to diets recommended
 Stress. Some were on stress due to sickness and hence unable to provide adequate
information or even listen to counseling done
 Limited resources
 Cultural barriers were addressed through innovative approaches and collaboration with
community stakeholders.
Conclusion

Overall, the attachment at masalani Hospital was a rewarding experience that enhanced my skills as a
community health worker and deepened my understanding of community health.

4.2.1. Recommendations for the hospital

 Therapeutic foods and supplements stock should be ordered in time to prevent shortages
 Clinical rotations should be given more time since it is essential in providing skills learnt
theoretically to students
 The institution should arrange for seminars to provide interaction between students and
nutritionists and hence gaining of skill

 The public health department should organise more CME programmes to other medical
practitioners especially the nurses so as to ensure they have some public health
knowledge
 The public health department should organise more for community outreach programmes
in its environs. This will ensure health education is offered to the communities in helping
them to lead healthy lifestyles hence reducing mortality rates.
 The health facility should consider employing more community health staff so as to
reduce workload to the few who are there.
 Modern nutrition equipment’s like weighing scales and height boards should be provided
to at least each ward to ensure effective and quality anthropometric for both patients.
 Strengthen collaboration between the hospital and community organizations for sustainable
health interventions.
 Invest in capacity building for community health workers to enhance their effectiveness.
 Advocate for increased funding and resources to support healthcare initiatives in the region.

4.2.2. Recommendations for the institution health Department

 The department should create students awareness by visiting the hospital facilities while
on session.
 The department should focus more on competency based rather than theory in class.
 The department should ensure supervision of students is done twice at the start of the
attachment and when finalizing the attachment this is to ensure proper tracing of the
attaches’.