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Tawiah K, Asosega KA, Iddi S, Opoku AA, Abdul IW, Ansah RK, Bukari FK, Okyere E, Adebanji AO. Assessment of Neonatal Mortality and Associated Hospital-Related Factors in Healthcare Facilities Within Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. Health Serv Insights 2024; 17:11786329241258836. [PMID: 38873401 PMCID: PMC11171432 DOI: 10.1177/11786329241258836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. Methods The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies. Results The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility. Conclusions Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality.
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Affiliation(s)
- Kassim Tawiah
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Killian Asampana Asosega
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Iddi
- Department of Statistics and Actuarial Science, University of Ghana, Accra, Ghana
| | - Alex Akwasi Opoku
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Iddrisu Wahab Abdul
- Department of Mathematics and Statistics, Ghana Communication Technology University, Accra, Ghana
| | - Richard Kwame Ansah
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
- Department of Mathematics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Kwame Bukari
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Okyere
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Hedstrom A, Nyonyintono J, Mubiri P, Namakula Mirembe H, Magnusson B, Nakakande J, MacGuffie M, Nsubuga M, Waiswa P, Nambuya H, Batra M. Outborn newborns drive birth asphyxia mortality rates-An 8 year analysis at a rural level two nursery in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002261. [PMID: 37939037 PMCID: PMC10631647 DOI: 10.1371/journal.pgph.0002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Birth asphyxia is a leading cause of global neonatal mortality. Most cases occur in low- and middle- income countries and contribute to half of neonatal deaths in Uganda. Improved understanding of the risk factors associated with mortality among these patients is needed. We performed a retrospective cohort study of a clinical database and report maternal demographics, clinical characteristics and outcomes from neonates with birth asphyxia at a Ugandan level two unit from 2014 through 2021. "Inborn" patients were born at the hospital studied and "outborn" were born at another facility or home and then admitted to the hospital studied. Doctors assigned the patient's primary diagnosis at death or discharge. We performed a Poisson model regression of factors associated with mortality among patients with asphyxia. The study included 1,565 patients with birth asphyxia and the proportion who were outborn rose from 26% to 71% over eight years. Mortality in asphyxiated patients increased over the same period from 9% to 27%. Factors independently associated with increased death included outborn birth location (ARR 2.1, p<0.001), admission in the year 2020 (ARR 2.4, p<0.05) and admission respiratory rate below 30bpm (RR 3.9, p<0.001), oxygen saturation <90% (ARR 2.0, p<0.001) and blood sugar >8.3 mmol/L (RR 1.7, p<0.05). Conversely, a respiratory rate >60bpm was protective against death (ARR 0.6, p<0.05). Increased birth asphyxia mortality at this referral unit was associated with increasing admission of outborn patients. Patients born at another facility and transferred face unique challenges. Increased capacity building at lower-level birth facilities could include improved staffing, training and equipment for labor monitoring and newborn resuscitation as well as training on the timely identification of newborns with birth asphyxia and resources for transfer. These changes may reduce incidence of birth asphyxia, improve outcomes among birth asphyxia patients and help meet global targets for newborn mortality.
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Affiliation(s)
- Anna Hedstrom
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Paul Mubiri
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Brooke Magnusson
- Adara Development, Edmonds, Washington, United States of America
| | | | - Molly MacGuffie
- Adara Development, Edmonds, Washington, United States of America
| | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | - Harriet Nambuya
- Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Maneesh Batra
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
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Tette EMA, Nartey ET, Nyarko MY, Aduful AK, Neizer ML. Trends in Neonatal Mortality at Princess Marie Louise Children's Hospital, Accra, and the Newborn Strategic Plan: Implications for Reducing Mortality in Hospital and the Community. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1755. [PMID: 38002846 PMCID: PMC10670549 DOI: 10.3390/children10111755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND In low and middle-income countries, close to half of the mortality in children under the age of five years occurs in neonates. OBJECTIVES We examined the trend, medical conditions and factors associated with newborn deaths at the Princess Marie Louise Children's Hospital (PML), Accra, from 2014 to 2017 (4 years). METHODS The study was a cross-sectional study. Data on age, sex, date of admission, date of discharge, cause of death and place of residence of these babies were obtained from the records department. This was transferred into an Access database and analyzed. Components of the Newborn Strategic Plan implemented at the hospital were described. RESULTS Neonatal sepsis, pneumonia and kernicterus were the major causes of death. Admissions increased and 5.4% of the neonates died, declining from 6.5% in 2014 to 4.2% in 2017 due to deliberate actions to reduce neonatal death. The highest mortality occurred in babies residing in an area more than 1 hour's drive away from the hospital. CONCLUSION Implementing the Newborn Strategic Plan was associated with a drop in mortality. A preponderance of community-acquired infections was observed. Thus, locality-specific interventions targeted at known determinants and implementing the newborn strategic plan are essential for reducing neonatal mortality.
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Affiliation(s)
- Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, Accra P.O. Box 4236, Ghana
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
| | - Edmund T. Nartey
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra P.O. Box 4236, Ghana;
| | - Mame Yaa Nyarko
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
| | - Abena K. Aduful
- Family Medicine Department, Korle-Bu Teaching Hospital, Accra P.O. Box GP 4236, Ghana;
| | - Margaret L. Neizer
- Princess Marie Louise Children’s Hospital, Accra P.O. Box GP 122, Ghana; (M.Y.N.); (M.L.N.)
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Emmanuel A, Kain VJ, Forster E. The Impact of an Educational Intervention on Neonatal Care and Survival. J Perinat Neonatal Nurs 2023; 37:138-147. [PMID: 36719649 DOI: 10.1097/jpn.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria. METHODS This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. RESULTS Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t -test analysis of the day of neonatal death demonstrates a significant difference in mean ( P = .00, 95% confidence interval -5.629; -7.447 to -4.779). CONCLUSION Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.
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Affiliation(s)
- Andy Emmanuel
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia (Drs Emmanuel, Kain, and Forster); and Department of Nursing Science, College of Medical Sciences, University of Jos, Jos, Nigeria (Dr Emmanuel)
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Hashmi A, Darakamon MC, Aung KK, Mu M, Misa P, Jittamala P, Chu C, Phyo AP, Turner C, Nosten F, McGready R, Carrara VI. Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border. Front Public Health 2023; 11:1144642. [PMID: 37124770 PMCID: PMC10130587 DOI: 10.3389/fpubh.2023.1144642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Preterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC). Materials and methods This sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care. Results From 2008-2017, mortality was reduced by 68% and 53% in very (EGA 28-32 weeks) and moderate (EGA 33-36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting. Discussion This study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.
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Affiliation(s)
- Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
| | - Mu Chae Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mu Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Prapatsorn Misa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Verena I. Carrara
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Advancements in neonatology through quality improvement. J Perinatol 2022; 42:1277-1282. [PMID: 35368024 DOI: 10.1038/s41372-022-01383-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/09/2022]
Abstract
In the past 3 decades, quality improvement methodology has often been employed in medicine to improve patient outcomes. Neonatal medicine has seen an increase in publications using improvement science to ensure the application of potentially better practices to decrease complications and increase survival without major disability. This article reviews quality improvement studies that have impacted neonatal mortality and morbidity, as well as specific disease processes including bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. Using improvement science, studies have substantially reduced neonatal mortality and the major complications of preterm birth.
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Pietravalle A, Brasili L, Cavallin F, Piquè M, Zavattero C, Azzimonti G, Maziku DM, Leluko DE, Putoto G, Trevisanuto D. Impact of Quality Improvement Bundle on Neonatal Mortality in a District Hospital in Tanzania. CHILDREN 2022; 9:children9071060. [PMID: 35884043 PMCID: PMC9324863 DOI: 10.3390/children9071060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
Background: The poor quality of care received by mothers and neonates in many limited-resource countries represents a main determinant of newborn mortality. Small and sick hospitalized newborns are the highest-risk population, and they should be one of the prime beneficiaries of quality-of-care interventions. This study aimed to evaluate the impact on neonatal mortality of quality improvement interventions which were implemented at Tosamaganga Council Designated Hospital, Iringa, Tanzania, between 2016 and 2020. Methods: A retrospective comparison between pre- and post-intervention periods was performed using the chi-square test and Fisher’s exact test. Effect sizes were reported as odds ratios with 95% confidence intervals. Results: The analysis included 5742 neonates admitted to the Special Care Unit (2952 in the pre-intervention period and 2790 in the post-intervention period). A decrease in mortality among infants with birth weight between 1500 and 2499 g (overall: odds ratio 0.49, 95% confidence interval 0.27–0.87; inborn: odds ratio 0.50, 95% confidence interval 0.27–0.93) was found. The analysis of cause-specific mortality showed a decrease in mortality for asphyxia (odds ratio 0.33, 95% confidence interval 0.12–0.87) among inborn infants with birth weight between 1500 and 2499 g. Conclusions: A quality improvement intervention was associated with decreased mortality among infants with birth weight between 1500 and 2499 g. Further efforts are needed to improve prognosis in very-low-birth-weight infants.
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Affiliation(s)
| | - Luca Brasili
- Doctors with Africa CUAMM, Dar es Salaam 23447, Tanzania; (L.B.); (M.P.); (C.Z.); (G.A.)
| | | | - Margherita Piquè
- Doctors with Africa CUAMM, Dar es Salaam 23447, Tanzania; (L.B.); (M.P.); (C.Z.); (G.A.)
| | - Chiara Zavattero
- Doctors with Africa CUAMM, Dar es Salaam 23447, Tanzania; (L.B.); (M.P.); (C.Z.); (G.A.)
| | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Dar es Salaam 23447, Tanzania; (L.B.); (M.P.); (C.Z.); (G.A.)
| | - Donald Micah Maziku
- St. John of the Cross, Tosamaganga Council Designated Hospital, Iringa 50201, Tanzania; (D.M.M.); (D.E.L.)
| | - Dionis Erasto Leluko
- St. John of the Cross, Tosamaganga Council Designated Hospital, Iringa 50201, Tanzania; (D.M.M.); (D.E.L.)
| | | | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padua, 35122 Padua, Italy;
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Molina García A, Cross JH, Fitchett EJ, Kawaza K, Okomo U, Spotswood NE, Chiume M, Ezeaka VC, Irimu G, Salim N, Molyneux EM, Lawn JE. Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine 2022; 44:101259. [PMID: 35059614 PMCID: PMC8760419 DOI: 10.1016/j.eclinm.2021.101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements). METHODS Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively. FINDINGS 3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection, (3) Case management, and Implementation (3 + I). The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control. INTERPRETATION The 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.g., self-inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a major gap. FUNDING This work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the "la Caixa" Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government).
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Affiliation(s)
| | - James H. Cross
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kondwani Kawaza
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Uduak Okomo
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Naomi E. Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | | | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Elizabeth M. Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Joy E. Lawn
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - with the NEST360 Infection Prevention, Detection and Care Collaborative Group
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Wastnedge E, Waters D, Murray SR, McGowan B, Chipeta E, Nyondo-Mipando AL, Gadama L, Gadama G, Masamba M, Malata M, Taulo F, Dube Q, Kawaza K, Khomani PM, Whyte S, Crampin M, Freyne B, Norman JE, Reynolds RM. Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review. J Glob Health 2021; 11:04050. [PMID: 35003711 PMCID: PMC8709903 DOI: 10.7189/jogh.11.04050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reducing preterm birth and stillbirth and improving outcomes for babies born too soon is essential to reduce under-5 mortality globally. In the context of a rapidly evolving evidence base and problems with extrapolating efficacy data from high- to low-income settings, an assessment of the evidence for maternal and newborn interventions specific to low- and middle-income countries (LMICs) is required. METHODS A systematic review of the literature was done. We included all studies performed in LMICs since the Every Newborn Action Plan, between 2013 - 2018, which reported on interventions where the outcome assessed was reduction in preterm birth or stillbirth incidence and/or a reduction in preterm infant neonatal mortality. Evidence was categorised according to maternal or neonatal intervention groups and a narrative synthesis conducted. RESULTS 179 studies (147 primary evidence studies and 32 systematic reviews) were identified in 82 LMICs. 81 studies reported on maternal interventions and 98 reported on neonatal interventions. Interventions in pregnant mothers which resulted in significant reductions in preterm birth and stillbirth were (i) multiple micronutrient supplementation and (ii) enhanced quality of antenatal care. Routine antenatal ultrasound in LMICs increased identification of fetal antenatal conditions but did not reduce stillbirth or preterm birth due to the absence of services to manage these diagnoses. Interventions in pre-term neonates which improved their survival included (i) feeding support including probiotics and (ii) thermal regulation. Improved provision of neonatal resuscitation did not improve pre-term mortality rates, highlighting the importance of post-resuscitation care. Community mobilisation, for example through community education packages, was found to be an effective way of delivering interventions. CONCLUSIONS Evidence supports the implementation of several low-cost interventions with the potential to deliver reductions in preterm birth and stillbirth and improve outcomes for preterm babies in LMICs. These, however, must be complemented by overall health systems strengthening to be effective. Quality improvement methodology and learning health systems approaches can provide important means of understanding and tackling implementation challenges within local contexts. Further pragmatic efficacy trials of interventions in LMICs are essential, particularly for interventions not previously tested in these contexts.
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Affiliation(s)
- Elizabeth Wastnedge
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Donald Waters
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Sarah R Murray
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Brian McGowan
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems & Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Luis Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gladys Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Martha Masamba
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monica Malata
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Frank Taulo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kondwani Kawaza
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Sonia Whyte
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Mia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Research Program, Blantyre, Malawi
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Rebecca M Reynolds
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
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10
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Pejovic NJ, Cavallin F, Mpamize A, Lubulwa C, Höök SM, Byamugisha J, Nankunda J, Tylleskär T, Trevisanuto D. Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask. Resuscitation 2021; 171:107-113. [PMID: 34695444 DOI: 10.1016/j.resuscitation.2021.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the respiratory function of asphyxiated infants resuscitated with i-gel supraglottic airway (SGA) vs. face mask (FM) in a low-resource setting. METHODS In this sub-study from the NeoSupra trial, respiratory function during the first 60 inflations was evaluated in 46 neonates (23 with SGA and 23 with FM) at the Mulago National Referral Hospital, Uganda. The primary outcome was the mask leak (%). The secondary outcomes included inspired (VTi) and expired (VTe) tidal volumes, and heart rate response to ventilation. RESULTS Median mask leak was 40% (IQR 22-52) with SGA and 39% (IQR 26-62) with FM (p = 0.38). Median VTe was 7.8 ml/kg (IQR 5.6-10.2) with SGA and 7.3 ml/kg (IQR 4.8-11.9) with FM (p = 0.84), while median VTi was 15.4 ml/kg (IQR 11-4-17.6) with SGA and 15.9 ml/kg (IQR 9.0-22.6) with FM (p = 0.68). A shorter time was needed to achieve heart rate > 100 bpm in SGA (median 13 s IQR 9-15) with respect to FM arm (median 61, IQR 33-140) (p = 0.0002). CONCLUSION Respiratory function was not statistically different between neonates resuscitated with SGA vs. FM. SGA was associated with faster heart rate recovery compared to FM in the subgroup of neonates with bradycardia. Further research is needed to investigate possible advantages of SGA on respiratory function at birth.
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Affiliation(s)
- Nicolas J Pejovic
- Centre for International Health, University of Bergen, Bergen, Norway; Neonatal Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden; Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden.
| | | | | | | | - Susanna Myrnerts Höök
- Centre for International Health, University of Bergen, Bergen, Norway; Neonatal Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden; Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden
| | - Josaphat Byamugisha
- Mulago National Referral Hospital, Kampala, Uganda; Dept. of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Uganda
| | - Jolly Nankunda
- Mulago National Referral Hospital, Kampala, Uganda; Dept. of Pediatrics and Child Health, College of Health Sciences, Makerere University, Uganda
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, Bergen, Norway; Centre for Intervention Studies in Maternal and Child Health, University of Bergen, Bergen, Norway
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11
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Kleinhout MY, Stevens MM, Osman KA, Adu-Bonsaffoh K, Groenendaal F, Biza Zepro N, Rijken MJ, Browne JL. Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003618. [PMID: 33602687 PMCID: PMC7896575 DOI: 10.1136/bmjgh-2020-003618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 01/21/2023] Open
Abstract
Background Preterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations. Methods Six electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267). Results 1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants. Conclusion The findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.
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Affiliation(s)
- Mirjam Y Kleinhout
- Department of Neonatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.,Department of Neonatology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel M Stevens
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nejimu Biza Zepro
- College of Health Sciences, Samara University, Semera, Afar, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Cavaliere E, Trevisanuto D, Da Dalt L, Putoto G, Pizzol D, Muhelo AR, Cavallin F. Congenital malformations in neonates admitted to a neonatal intensive care unit in a low-resource setting. J Matern Fetal Neonatal Med 2021; 35:6363-6367. [PMID: 33902403 DOI: 10.1080/14767058.2021.1912003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
INTRODUCTION Congenital malformations (CMs) are among the major causes of infant mortality in middle- and low-resource countries. This is the first study describing CMs in neonates admitted to the Neonatal Intensive Care Unit (NICU) of a referral hospital in Mozambique. METHODS We included all neonates with CMs admitted to the NICU of Beira Central Hospital from January 2015 to December 2016. CMs were classified according to the International Classification of Disease (ICD-10). All data were retrieved from medical charts. RESULTS CMs were found in 143/4767 (3%) neonates admitted to the NICU. The most frequent CMs were musculoskeletal (31%), neurological (18%), multiple congenital anomalies (12%), chromosomopathies (11%), cardiovascular (10%), and gastrointestinal (8%). Forty-three patients (30%) underwent corrective surgery. Overall mortality rate was 50%. CONCLUSIONS The prevalence of CMs was 3%, with a mortality rate of 50%. Alongside implementation of antenatal screening programs, improvement on expertise and postnatal care of CMs are warranted.
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Affiliation(s)
- Elena Cavaliere
- Department of Woman's and Child's Health, University of Padova, Padova, Italy.,Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
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13
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Tuyisenge D, Byiringiro S, Manirakiza ML, Mutsinzi RG, Nshimyiryo A, Nyishime M, Hirschhorn LR, Biziyaremye F, Gitera J, Beck K, Kirk CM. Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda. BMC Pediatr 2021; 21:89. [PMID: 33607961 PMCID: PMC7893907 DOI: 10.1186/s12887-021-02544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes. METHODS A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests. RESULTS NCUs were run by a median of 1 nurse [interquartile range (IQR):1-2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77-155] to 137 [IQR: 79-184]. Availability of advanced equipment improved (syringe pumps: 57-100 %, vital sign monitors: 51-100 % and CPAP machine: 14-100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001). CONCLUSIONS The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
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Affiliation(s)
- David Tuyisenge
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda.
| | | | | | | | | | - Merab Nyishime
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, 625 N Michigan Avenue, 60611, Chicago, IL, USA
| | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Catherine M Kirk
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
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14
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Ouedraogo P, Villani PE, Tubaldi L, Bua J, Uxa F, Dell'Anna C, Cavallin F, Thomson M, Plicco C, Chiesi MP. Impact of a quality improvement intervention on neonatal mortality in a regional hospital in Burkina Faso. J Matern Fetal Neonatal Med 2021; 35:4818-4823. [PMID: 33401994 DOI: 10.1080/14767058.2020.1866532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neonatal period is the most vulnerable time in terms of a child's survival, with mortality during this period accounting for approximately half of the deaths before the age of 5 years. The Neonatal Essential Survival Technology (NEST) project is a program aiming to reduce mortality by improving the quality of neonatal care in sub-Saharan Africa. This study presents the evaluation of the first phase of the NEST intervention program at Saint Camille Hospital Ouagadougou (HOSCO), Burkina Faso, in terms of the reduction in neonatal mortality. METHODS This is a retrospective analysis, based on "pre-intervention" data collected in 2015, and "post-intervention" data collected in 2018, including all infants admitted to the neonatal unit of HOSCO. The intervention period (2016 and 2017) comprised a structured quality improvement process conducted by a multidisciplinary working group that focused on improving infrastructure, equipment, training and use of clinical protocols, team working within the neonatal unit and with other hospital departments, and communication with referring healthcare facilities. Mortality data were compared pre- vs. post-intervention using a logistic regression model. RESULTS The analysis included 1427 infants in the pre-intervention period, and 819 post-intervention. In both time periods, more than 75% of admissions were infants with low birth weight, and nearly 50% were very low birth weight. Post-intervention, while there was a decrease in overall admission, the proportion of multiple births increased from 20% to 24% (p = .01). The overall mortality rate was 44.9% (641/1427) pre-intervention, and 42.2% (346/819) post-intervention (OR 0.90, 95% confidence interval (CI) 0.76-1.07; p = .23). Adjusting for clinically relevant factors, the intervention was not associated with a change in overall mortality (OR 1.39, 95% CI 0.91-2.12; p = .13), but was associated with a reduced likelihood of mortality in outborn infants compared to inborn infants (OR 0.57, 95% CI 0.36-0.92; p = .02). CONCLUSIONS The first phase of the NEST quality improvement program was associated with a decrease in mortality in outborn infants admitted to the neonatal unit at HOSCO. Long-term assessment is expected to provide a more comprehensive evaluation of the program in a low-income setting.
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Affiliation(s)
| | - Paolo Ernesto Villani
- Neonatal Intensive Care Unit, Health Department of Women and Children, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Lucia Tubaldi
- Neonatal Care Unit, Hospital of Macerata, Macerata, Italy
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Fabio Uxa
- WHO Collaborating Centre, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
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15
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Oxygen management among infants in neonatal units in sub-Saharan Africa: a cross-sectional survey. J Perinatol 2021; 41:2631-2638. [PMID: 33772113 PMCID: PMC7995672 DOI: 10.1038/s41372-021-01040-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To provide more comprehensive data on the management of oxygen supplementation in neonates in sub-Saharan Africa. STUDY DESIGN An online survey on the management of oxygen supplementation for infants in neonatal units was sent to 278 healthcare personnel in sub-Saharan Africa. RESULTS One hundred and nine responses from 82 neonatal care units in 54% (26/48) sub-Saharan African countries were received. All units had the capacity to provide oxygen supplementation. However, only 50% (38/76) had access to blend oxygen with medical air and 1% (1/75) had the capacity to blend oxygen/air for every infant. Although 96% (72/75) of units could monitor oxygen saturation, monitoring was mostly intermittent and only 32% (24/75) were able to monitor oxygen saturation in every infant receiving oxygen supplementation. CONCLUSIONS Findings indicate that oxygen supplementation is inadequately managed in neonatal units in sub-Saharan Africa, which may put infants at risk of developing severe ROP.
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16
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Cavallin F, Calgaro S, Brugnolaro V, Wingi OM, Muhelo AR, Da Dalt L, Pizzol D, Putoto G, Trevisanuto D. Non-linear association between admission temperature and neonatal mortality in a low-resource setting. Sci Rep 2020; 10:20800. [PMID: 33247153 PMCID: PMC7695844 DOI: 10.1038/s41598-020-77778-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
Both neonatal hypothermia and hyperthermia represent important risk factors for neonatal mortality, but information on mortality risk across a full range of neonatal temperatures is lacking in low-resource settings. We evaluated the association between neonatal mortality and a full range of admission temperatures in a low-resource setting. This retrospective observational study was conducted at Beira Central Hospital, Mozambique. The relationship between admission temperature and mortality was evaluated using multivariable analyses with temperature modeled as non-linear term. Among 2098 neonates admitted to the Special Care Unit between January–December 2017, admission temperature was available in 1344 neonates (64%) who were included in the analysis. A non-linear association between mortality rate and temperature was identified. Mortality rate decreased from 84% at 32 °C to 64% at 34.6 °C (− 8% per °C), to 41% at 36 °C (− 16% per °C), to 26% to 36.6 °C (− 25% per °C) and to 22% at 38.3 °C (− 2% per °C), then increased to 40% at 41 °C (+ 7% per °C). Mortality rate was estimated to be at minimum at admission temperature of 37.5 °C. In conclusions, the non-linear relationship highlighted different mortality risks across a full range of neonatal temperatures in a low-resource setting. Admission temperature was not recorded in one third of neonates.
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Affiliation(s)
| | - Serena Calgaro
- Doctors With Africa CUAMM, Padua, Italy.,Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | - Valentina Brugnolaro
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | | | | | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy.
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17
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Cavallin F, Bonasia T, Yimer DA, Manenti F, Putoto G, Trevisanuto D. Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting. BMC Pregnancy Childbirth 2020; 20:722. [PMID: 33228644 PMCID: PMC7686767 DOI: 10.1186/s12884-020-03429-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/13/2020] [Indexed: 11/12/2022] Open
Abstract
Background Although under-5 mortality has decreased in the last two decades, neonatal mortality remains a global health challenge. Despite achieving notable progress, Ethiopia has still one of the highest neonatal mortality rates worldwide. We aimed to assess the risk factors for mortality among neonates admitted to a special care unit in a referral hospital in rural Ethiopia. Methods This was a retrospective observational study including all 4182 neonates admitted to the special care unit of the St. Luke Wolisso Hospital (Ethiopia) from January 2014 to December 2017. Data were retrieved from hospital charts and entered in an anonymized dataset. A logistic regression model was applied to identify predictors of mortality and effect sizes were expressed as odds ratios with 95% confidence intervals. Results Proportion of deaths was 17% (709/4182 neonates). Neonates referred from other health facilities or home (odds ratio 1.52, 95% confidence interval 1.21 to 1.91), moderate hypothermia at admission (odds ratio 1.53, 95% confidence interval 1.09 to 2.15) and diagnosis of late-onset sepsis (odds ratio 1.63, 95% confidence interval 1.12 to 2.36), low birthweight (odds ratio 2.48, 95% confidence interval 2.00 to 3.09), very low birthweight (odds ratio 11.71, 95% confidence interval 8.63 to 15.94), extremely low birthweight (odds ratio 76.04, 95% confidence interval 28.54 to 263.82), intrapartum-related complications (odds ratio 4.69, 95% confidence interval 3.55 to 6.20), meconium aspiration syndrome (odds ratio 2.34, 95% confidence interval 1.15 to 4.43), respiratory distress (odds ratio 2.25, 95% confidence interval 1.72 to 2.95), other infections (odds ratio 1.92, 95% confidence interval 1.31 to 2.81) or malformations (odds ratio 2.32, 95% confidence interval 1.49 to 3.57) were associated with increased mortality. Being admitted in 2017 vs. 2014 (odds ratio 0.71, 95% confidence interval 0.52 to 0.97), and older age at admission (odds ratio 0.95, 95% confidence interval 0.93 to 0.97) were associated with decreased likelihood of mortality. Conclusions The majority of neonatal deaths was associated with preventable and treatable conditions. Education on neonatal resuscitation and postnatal management, and the introduction of an on-call doctor for high-risk deliveries might have contributed to the reduction in neonatal mortality over time.
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Affiliation(s)
| | - Teresa Bonasia
- Doctors with Africa CUAMM, Wolisso, Ethiopia.,Department of Neonatal and Pediatric Critical Care, University of Verona, Verona, Italy
| | | | - Fabio Manenti
- Doctors with Africa CUAMM, Wolisso, Ethiopia.,Doctors with Africa CUAMM, Padua, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
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18
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Cavallin F, Calgaro S, Brugnolaro V, Seni AHA, Muhelo AR, Da Dalt L, Putoto G, Trevisanuto D. Impact of temperature change from admission to day one on neonatal mortality in a low-resource setting. BMC Pregnancy Childbirth 2020; 20:646. [PMID: 33097025 PMCID: PMC7585226 DOI: 10.1186/s12884-020-03343-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/15/2020] [Indexed: 01/21/2023] Open
Abstract
Background Thermal control after birth is an essential part of neonatal care. However, the relationship between neonatal temperature at and after admission is unknown. This study aimed to evaluate the change between neonatal temperature at admission and at day 1, and its impact on mortality. Methods Retrospective observational study at the Beira Central Hospital, Mozambique. Axillary temperatures were recorded at admission and at day 1 in 1,226 neonates who were admitted to the Special Care Unit between January 1 and December 31, 2017. The relationship between mortality rate and temperature change was evaluated with a matrix plot and a forest plot (obtained from a logistic regression model as odds ratios with 95% confidence intervals). Results Normothermia was found in 415 neonates (33.8%) at admission and in 638 neonates (52.0%) at day 1. Mortality rate was highest in (i) neonates who remained in severe/moderate hypothermia (74%), (ii) neonates who rewarmed from hypothermia (40–55%), and (iii) neonates who chilled to severe/moderate hypothermia (38–43%). Multivariable analysis confirmed that temperature change from admission to day 1 was an independent predictor of mortality (p < 0.0001). Conclusions In a low-resource setting, one out of three neonates was found hypothermic at day 1 irrespectively of admission temperature. Relevant thermal deviations occurred in a high proportion of newborns with normothermia at admission. Being cold at admission and becoming cold or hyperthermic at day 1 were associated with increased likelihood of mortality. Appropriate actions to prevent both hypothermia and hyperthermia represent both a challenge and a priority during postnatal period.
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Affiliation(s)
| | - Serena Calgaro
- Doctors with Africa CUAMM, Padova, Italy.,Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | - Valentina Brugnolaro
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | | | | | - Liviana Da Dalt
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy
| | | | - Daniele Trevisanuto
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
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19
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Tette EMA, Nartey ET, Nuertey BD, Azusong EA, Akaateba D, Yirifere J, Alandu A, Seneadza NAH, Gandau NB, Renner LA. The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross sectional study. PLoS One 2020; 15:e0232406. [PMID: 32365073 PMCID: PMC7197810 DOI: 10.1371/journal.pone.0232406] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background High global neonatal deaths have triggered efforts to improve facility-based care. However, the outcomes achievable at different levels of care are unclear. This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality. Objective This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality Methods A cross-sectional study involving a records-review over one year at the Upper West Regional Hospital, and three years at St Joseph’s District Hospital, Jirapa was carried out. Age, sex, gestational age, weight, duration of admission, diagnosis, among others were examined. The data were analysed and statistical inference made. Results Altogether, 2004 newborns were examined, comprising 1,241(62%) from St Joseph’s District Hospital and 763(38%) from Upper West Regional Hospital. The proportion of neonatal deaths was similar, 8.94% (St Joseph’s District Hospital) and 8.91% (Upper West Regional Hospital). Prematurity, neonatal sepsis, birth asphyxia, low birth weight, neonatal jaundice and pneumonia contributed the most to mortality and suspected infections including malaria accounted for almost half (45.5%). Mortality was significantly associated with duration of stay of 48 hours, being premature, and being younger than 3 days. Conclusion Majority of the mortality among the neonates admitted was due to preventable causes. Better stabilization and further studies on the epidemiology of sepsis, prematurity, low birth weight, including the contribution of malaria to these and outcome of transferred neonates are needed.
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Affiliation(s)
- Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- * E-mail: (EMAT); (ETN)
| | - Edmund T. Nartey
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
- * E-mail: (EMAT); (ETN)
| | - Benjamin D. Nuertey
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- Public Health Department, Tamale Teaching Hospital, Tamale, Ghana
| | | | | | | | | | | | - Naa Barnabas Gandau
- Upper West Regional Hospital, Wa, Ghana
- School of Medical Sciences, University for Development Studies, Tamale, Ghana
| | - Lorna A. Renner
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
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20
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Cavallin F, Menga A, Brasili L, Maziku D, Azzimonti G, Putoto G, Trevisanuto D. Factors associated with mortality among asphyxiated newborns in a low-resource setting. J Matern Fetal Neonatal Med 2020; 35:1178-1183. [PMID: 32212882 DOI: 10.1080/14767058.2020.1743670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Neonatal asphyxia accounts for a quarter of neonatal deaths. We aimed to assess factors associated with mortality among asphyxiated neonates in a low-resource setting.Methods: A retrospective observational study evaluating all neonates who were admitted for asphyxia to the Neonatal Intensive Care Unit (NICU) at Tosamaganga Hospital (Tanzania) in 2017-2018. Inclusion criteria were: Apgar score <7 at 5 min and/or failure to initiate spontaneous breathing and/or presence of sentinel events and/or clinical signs suggesting encephalopathy not explained by other obvious factors or early convulsions. Newborns with congenital malformations, birth weight <2000 g or those who died in the delivery room were excluded.Results: NICU admission for perinatal asphyxia was 17.5%. In 169 neonates, mortality rate was 23% and was associated with being outborn, low 5-minute Apgar score, depressed clinical status at NICU admission, occurrence of infection or seizures within 24 h from admission, and receiving aminophylline during the hospital stay.Conclusions: Perinatal asphyxia was responsible for a relevant proportion of NICU admissions and neonatal deaths in a low-resource setting. Appropriate clinical examination remains the main asset in settings with limited availability of diagnostic tools. Improvements in antenatal and perinatal care are needed to reduce mortality in asphyxiated newborns. Future studies should assess long-term outcome in survivors.
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Affiliation(s)
| | - Alessandra Menga
- Doctors with Africa CUAMM, Iringa, Tanzania.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | | | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Iringa, Tanzania.,Tosamaganga Hospital, Iringa, Tanzania
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21
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Brathwaite KP, Bryce F, Moyer LB, Engmann C, Twum-Danso NA, Kamath-Rayne BD, Srofenyoh EK, Ucer S, Boadu RO, Owen MD. Evaluation of two newborn resuscitation training strategies in regional hospitals in Ghana. Resusc Plus 2020; 1-2:100001. [PMID: 34223288 PMCID: PMC8244248 DOI: 10.1016/j.resplu.2020.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kimberly P. Brathwaite
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 7009, Cincinnati, OH, 45229, USA
| | - Fiona Bryce
- Kybele, Inc., 116 Lowes Foods Drive #170, Lewisville, NC, 27023, USA
| | - Laurel B. Moyer
- Department of Neonatology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA
| | - Cyril Engmann
- Maternal, Newborn, and Child Health and Nutrition, PATH, 2201 Westlake Avenue, Seattle, WA, 98121, USA
- Departments of Pediatrics and Global Health, University of Washington Schools of Medicine and Public Health, 1959 NE Pacific St, Seattle, WA, 98195,, USA
| | - Nana A.Y. Twum-Danso
- TD Health, Accra, Ghana and Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Beena D. Kamath-Rayne
- American Academy of Pediatrics, Global Newborn and Child Health, 345 Park Boulevard, Itasca, IL, 60143, USA
| | | | - Sebnem Ucer
- Kybele, Inc., 116 Lowes Foods Drive #170, Lewisville, NC, 27023, USA
| | - Richard O. Boadu
- Department of Health Information Management, University of Cape Coast, Cape Coast, Ghana
| | - Medge D. Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157-1009, USA
- Corresponding author. Department of Anesthesiology Wake Forest School of Medicine Medical Center Boulevard Winston-Salem, NC, 27157-1009, USA.
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22
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Lin L, Chen X, Zhou Q, Huang P, Jiang S, Wang H, Deng Y. Synaptic structure and alterations in the hippocampus in neonatal rats exposed to lipopolysaccharide. Neurosci Lett 2019; 709:134364. [PMID: 31288048 DOI: 10.1016/j.neulet.2019.134364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 02/05/2023]
Abstract
Synaptic structure integrity plays a key role in learning and memory. Previous studies have shown that there is cognitive dysfunction in septic neonates in later life. In this study, intraperitoneal injection of lipopolysaccharide (LPS) in the developing rats was used as a sepsis model to determine whether hippocampal synapses would be affected. Expression of synaptophysin (Syn), synaptosomal associated protein of 25 kD (SNAP-25), and N-methyl d-aspartate receptor (NMDAR) in the hippocampus in septic brain were significantly reduced. Consistent with this, the number of dendritic spines associated with the pyramidal neurons in the CA1 region of hippocampus at 28d after LPS administration was decreased. Additionally, the number of synapse and synaptic vesicles were reduced and appeared swollen. The number of neurons in the CA1 and CA3 of hippocampus at 14, and 28d after LPS injection remained unchanged. Coupled with the above was upregulated expression of interleukin-1β (IL-1β), IL-1 receptor 1 (IL-R1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and inducible nitric oxide synthase (iNOS) at 1-3d after LPS injection. IL-1β expression was specifically detected in activated microglia. The plasma corticosterone (CORT) concentration in the LPS treatment rats was increased; but the glucocorticoid receptor (GR) expression in the hippocampus was decreased. We conclude that LPS injection in neonatal rats can cause synaptic disruption in the hippocampus which may be attributed to inflammatory response due to excess production of proinflammatory cytokines e.g., IL-1β derived from activated microglia. The significance of increased plasma CORT concentration and decreased GR expression in the hippocampus is discussed.
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Affiliation(s)
- Lanfen Lin
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Xuan Chen
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China; Shantou University Medical College (FCS), Shantou, 515063, People's Republic of China
| | - Qiuping Zhou
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China; South China University of Technology, Guangzhou, 510641, People's Republic of China
| | - Peixian Huang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China; Shantou University Medical College (FCS), Shantou, 515063, People's Republic of China
| | - Shuqi Jiang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China; South China University of Technology, Guangzhou, 510641, People's Republic of China
| | - Huifang Wang
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China; Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Yiyu Deng
- Department of Critical Care and Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.
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23
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Sensalire S, Isabirye P, Karamagi E, Byabagambi J, Rahimzai M, Calnan J. Saving Mothers, Giving Life Approach for Strengthening Health Systems to Reduce Maternal and Newborn Deaths in 7 Scale-up Districts in Northern Uganda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:S168-S187. [PMID: 30867216 PMCID: PMC6519678 DOI: 10.9745/ghsp-d-18-00263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/21/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Uganda's maternal and newborn mortality remains high at 336 maternal deaths per 100,000 live births and 27 newborn deaths per 1,000 live births. The Saving Mothers, Giving Life (SMGL) initiative launched in 2012 by the U.S. government and partners, with funding from the U.S. President's Emergency Plan for AIDS Relief, focused on reducing maternal and newborn deaths in Uganda and Zambia by addressing the 3 major delays associated with maternal and newborn deaths. In Uganda, SMGL was implemented in 2 phases. Phase 1 was a proof-of-concept demonstration in 4 districts of Western Uganda (2012 to 2014). Phase 2 involved scaling up best practices from Phase 1 to new sites in Northern Uganda (2014 to 2017). PROGRAM DESCRIPTION The SMGL project used a systems-strengthening approach with quality improvement (QI) methods applied in targeted facilities with high client volume and high maternal and perinatal deaths. A QI team was formed in each facility to address the building blocks of the World Health Organization's health systems framework. A community component was integrated within the facility-level QI work to create demand for services. Above-site health systems functions were strengthened through engagement with district management teams. RESULTS The institutional maternal mortality ratio in the intervention facilities decreased by 20%, from 138 to 109 maternal deaths per 100,000 live births between December 2014 and December 2016. The institutional neonatal mortality rate was reduced by 30%, while the fresh stillbirth rate declined by 47% and the perinatal mortality rate by 26%. During this period, over 90% of pregnant women were screened for hypertension and 70% for syphilis during antenatal care services. All women received a uterotonic drug to prevent postpartum hemorrhage during delivery, and about 90% of the women were monitored using a partograph during labor. CONCLUSIONS Identifying barriers at each step of delivering care and strengthening health systems functions using QI teams increase partcipation, resulting in improved care for mothers and newborns.
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24
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Wright N, Abantanga F, Amoah M, Appeadu-Mensah W, Bokhary Z, Bvulani B, Davies J, Miti S, Nandi B, Nimako B, Poenaru D, Tabiri S, Yifieyeh A, Ade-Ajayi N, Sevdalis N, Leather A. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 2019; 4:46. [PMID: 30984879 PMCID: PMC6456836 DOI: 10.12688/wellcomeopenres.15113.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.
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Affiliation(s)
- Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
| | - Francis Abantanga
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Michael Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | | | - Zaitun Bokhary
- Department of Paediatric Surgery, Muhimbili National Hospital, Dar es Salaam, P.O Box 65000, Tanzania
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospital of Lusaka, Lusaka, 10101, Zambia
| | - Justine Davies
- Global Health and Education Department, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sam Miti
- Department of Paediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Bip Nandi
- Department of Paediatric Surgery, Kamuzu Central Hospital, Lilongwe, P.O. Box 149, Malawi
| | - Boateng Nimako
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Dan Poenaru
- McGill University, Montreal, Quebec, H3A 0G4, Canada
| | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Abiboye Yifieyeh
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, SE5 8AF, UK
| | - Andy Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
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25
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Cavicchiolo ME, Cavallin F, Staffler A, Pizzol D, Matediana E, Wingi OM, Da Dalt L, Putoto G, Trevisanuto D. Decision making and situational awareness in neonatal resuscitation in low resource settings. Resuscitation 2018; 134:41-48. [PMID: 30391367 DOI: 10.1016/j.resuscitation.2018.10.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/17/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Data on non-technical skills (i.e. task management, team working, situation awareness and decision-making) of healthcare providers during real-life newborn resuscitation in low-resource settings are lacking. We aimed to assess non-technical skills of trained midwives during real-life newborn resuscitation in a low-resource setting before and after participation in a modified NRP course, and after a low-dose/high-frequency training. METHODS One-hundred and fifty video-recorded resuscitations (50 before and 50 after participation in a modified NRP course, and 50 after a low-dose/high-frequency training) collected at the Beira Central Hospital (Mozambique) were independently viewed and rated by two neonatologists with expertise in high fidelity simulation. Non-technical skills regarding task management, situation awareness and decision-making were evaluated using the modified Anesthetists' Non-Technical Skills tool. RESULTS Overall, most non-technical skills were scored as poor or marginal. Small improvements were observed in task management (planning and preparing p = 0.02; providing/maintaining standards p = 0.03) after the course. Limited improvements were observed in task management (prioritizing p = 0.03; providing/maintaining standards p = 0.04; identifying and utilizing resources p = 0.02) and decision-making (identifying options p = 0.04; balancing risk/selecting options p = 0.02) after the low-dose/high-frequency training. No differences were observed in situation awareness, apart from a small improvement in recognizing/understanding (p = 0.04) after the low-dose/high-frequency training. CONCLUSION An educational intervention including a modified NRP course and a low-dose/high-frequency training on neonatal resuscitation had a limited impact on non-technical skills of participants. All items remained significantly under the recommended standards. Behavioral skills should be considered in training programs in order to improve the quality of neonatal resuscitation in low resource settings.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Woman's and Child's Health, University of Padua, Padua, Italy; Doctors with Africa CUAMM, Padua, Italy
| | | | - Alex Staffler
- Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Italy
| | | | - Eduardo Matediana
- Department of Obstetrics and Gynaecology, Beira Central Hospital, Beira, Mozambique
| | | | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padua, Padua, Italy.
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26
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Burgoine K, Ikiror J, Akol S, Kakai M, Talyewoya S, Sande A, Otim T, Okello F, Hewitt-Smith A, Olupot-Olupot P. Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda. BMJ Glob Health 2018. [PMID: 29527347 PMCID: PMC5841522 DOI: 10.1136/bmjgh-2017-000586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHO-Recommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in low-resource settings adopt a similar approach.
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Affiliation(s)
- Kathy Burgoine
- Neonatal Unit, Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Juliet Ikiror
- Neonatal Unit, Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Sylivia Akol
- Neonatal Unit, Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Margaret Kakai
- Neonatal Unit, Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Sara Talyewoya
- Neonatal Unit, Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Alex Sande
- Pharmacy Department, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Tom Otim
- Department of Obstetrics and Gynaecology, Lira University, Lira, Uganda
| | - Francis Okello
- Busitema University Faculty of Health Sciences, Mbale, Uganda.,Varimetrics Group Limited, Mbale, Uganda
| | | | - Peter Olupot-Olupot
- Busitema University Faculty of Health Sciences, Mbale, Uganda.,Mbale Clinical Research Institute (MCRI), Mbale, Uganda
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27
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Zaka N, Alexander EC, Manikam L, Norman ICF, Akhbari M, Moxon S, Ram PK, Murphy G, English M, Niermeyer S, Pearson L. Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review. Implement Sci 2018; 13:20. [PMID: 29370845 PMCID: PMC5784730 DOI: 10.1186/s13012-018-0712-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An estimated 2.6 million newborns died in 2016; over 98.5% of deaths occurred in low- and middle-income countries (LMICs). Neonates born preterm and small for gestational age are particularly at risk given the high incidence of infectious complications, cardiopulmonary, and neurodevelopmental disorders in this group. Quality improvement (QI) initiatives can reduce the burden of mortality and morbidity for hospitalised newborns in these settings. We undertook a systematic review to synthesise evidence from LMICs on QI approaches used, outcome measures employed to estimate effects, and the nature of implementation challenges. METHODS We searched Medline, EMBASE, WHO Global Health Library, Cochrane Library, WHO ICTRP, and ClinicalTrials.gov and scanned the references of identified studies and systematic reviews. Searches covered January 2000 until April 2017. Search terms were "quality improvement", "newborns", "hospitalised", and their derivatives. Studies were excluded if they took place in high-income countries, did not include QI interventions, or did not include small and sick hospitalised newborns. Cochrane Risk of Bias tools were used to quality appraise the studies. RESULTS From 8110 results, 28 studies were included, covering 23 LMICs and 65,642 participants. Most interventions were meso level (district and clinic level); fewer were micro (patient-provider level) or macro (above district level). In-service training was the most common intervention subtype; service organisation and distribution of referencing materials were also frequently identified. The most commonly assessed outcome was mortality, followed by length of admission, sepsis rates, and infection rates. Key barriers to implementation of quality improvement initiatives included overburdened staff and lack of sufficient equipment. CONCLUSIONS The frequency of meso level, single centre, and educational interventions suggests that these interventions may be easier for programme planners to implement. The success of some interventions in reducing morbidity and mortality rates suggests that QI approaches have a high potential for benefit to newborns. Going forward, there are opportunities to strengthen the focus of QI initiatives and to develop improved, larger-scale, collaborative research into implementation of quality improvement initiatives for this high-risk group. TRIAL REGISTRATION PROSPERO CRD42017055459 .
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Affiliation(s)
- Nabila Zaka
- UNICEF New York, UNICEF House, 3 United Nations Plaza, New York, NY, 10017, USA
| | - Emma C Alexander
- King's College London GKT School of Medical Education, Guy's Campus, London, SE1 1UL, UK
| | - Logan Manikam
- UNICEF New York, UNICEF House, 3 United Nations Plaza, New York, NY, 10017, USA.
- UCL Institute Epidemiology & Healthcare, 1 - 19 Torrington Place, London, WC1E 6BT, UK.
| | - Irena C F Norman
- King's College London GKT School of Medical Education, Guy's Campus, London, SE1 1UL, UK
| | - Melika Akhbari
- King's College London GKT School of Medical Education, Guy's Campus, London, SE1 1UL, UK
| | - Sarah Moxon
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Pavani Kalluri Ram
- Department of Epidemiology and Environmental Health, 237 Farber Hall, Buffalo, NY, 14214-8001, USA
- Office of Maternal and Child Health and Nutrition, USAID, Washington DC, USA
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, OX3 7FZ, UK
| | - Susan Niermeyer
- Office of Maternal and Child Health and Nutrition, USAID, Washington DC, USA
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Luwei Pearson
- UNICEF New York, UNICEF House, 3 United Nations Plaza, New York, NY, 10017, USA
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28
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Dörnemann J, van den Boogaard W, Van den Bergh R, Takarinda KC, Martinez P, Bekouanebandi JG, Javed I, Ndelema B, Lefèvre A, Khalid GG, Zuniga I. Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts. Public Health Action 2017; 7:168-174. [PMID: 28695092 PMCID: PMC5493100 DOI: 10.5588/pha.16.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/22/2022] Open
Abstract
Setting: Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries. Objective: To assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia, and to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. Design: Multicentric descriptive study. Results: The MSF SNCU model was characterised by an absence of high-tech equipment and an emphasis on dedicated nursing and medical care. Focus was on the management of hypothermia, hypoglycaemia, feeding support and early identification/treatment of infection. Overall, 11 970 neonates were admitted, 41% of whom had low birthweight (<2500 g). The main diagnoses were low birthweight, asphyxia and neonatal infections. Overall mortality was 17%, with consistency across the sites. Chances of survival increased with higher birthweight. Conclusion: The standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings.
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Affiliation(s)
- J Dörnemann
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - W van den Boogaard
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - R Van den Bergh
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - P Martinez
- Department of Pediatrics, The Permanente Medical Group, Inc, San Rafael, California, USA
- MSF, New York, New York, USA
| | | | | | - B Ndelema
- Department of Obstetric Fistula, Ministry of Public Health and the Fight Against AIDS, Gitega, Burundi
| | - A Lefèvre
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
| | | | - I Zuniga
- Medical Department, Médecins Sans Frontières (MSF) Operational Centre Brussels, Brussels, Belgium
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