1
|
Fernando M, Tillakaratne S, Gunetilleke B, Liyanage C, Appuhamy C, Weerasuriya A, Uragoda B, Welikala N, Ranaweera L, Ganewatte E, Dissanayake J, Mudalige A, Siriwardana R. Challenges faced in establishing a pediatric liver transplant program in a lower-middle-income country with free healthcare service. Pediatr Transplant 2024; 28:e14681. [PMID: 38317346 DOI: 10.1111/petr.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/06/2023] [Accepted: 12/08/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months-15 years) and 23.3 kg (6.4-49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.
Collapse
Affiliation(s)
- Meranthi Fernando
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Suchintha Tillakaratne
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Bhagya Gunetilleke
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Division of Anaesthesia, Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Chinthaka Appuhamy
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Aruna Weerasuriya
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Nadeeshya Welikala
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Division of Anaesthesia, Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | - Rohan Siriwardana
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| |
Collapse
|
2
|
Ahmed S, Pinnock H, Dowrick A, Steed L. Generational perspective on asthma self-management in the Bangladeshi and Pakistani community in the United Kingdom: A qualitative study. Health Expect 2022; 25:2534-2547. [PMID: 35999685 PMCID: PMC9615058 DOI: 10.1111/hex.13579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Self‐management strategies improve asthma outcomes, although interventions for South Asian populations have been less effective than in White populations. Both self‐management and culture are dynamic, and factors such as acculturation and generation have not always been adequately reflected in existing cultural interventions. We aimed to explore the perspectives of Bangladeshi and Pakistani people in the United Kingdom, across multiple generations (first, second and third/fourth), on how they self‐manage their asthma, with a view to suggesting recommendations for cultural interventions. Methods We purposively recruited Bangladeshi and Pakistani participants, with an active diagnosis of asthma from healthcare settings. Semi‐structured interviews in the participants' choice of language (English, Sylheti, Standard Bengali or Urdu) were conducted, and data were analysed thematically. Results Twenty‐seven participants (13 Bangladeshi and 14 Pakistani) were interviewed. There were generational differences in self‐management, influenced by complex cultural processes experienced by South Asians as part of being an ethnic minority group. Individuals from the first generation used self‐management strategies congruent to traditional beliefs such as ‘sweating’ and often chose to travel to South Asian countries. Generations born and raised in the United Kingdom learnt and experimented with self‐management based on their fused identities and modified their approach depending on whether they were in familial or peer settings. Acculturative stress, which was typically higher in first generations who had migration‐related stressors, influenced the priority given to asthma self‐management throughout generations. The amount and type of available asthma information as well as social discussions within the community and with healthcare professionals also shaped asthma self‐management. Conclusions Recognizing cultural diversity and its influence of asthma self‐management can help develop effective interventions tailored to the lives of South Asian people. Patient or Public Contribution Patient and Public Involvement colleagues were consulted throughout to ensure that the study and its materials were fit for purpose.
Collapse
Affiliation(s)
- Salina Ahmed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.,School of Health Sciences, University of Greenwich, London, UK
| | - Hilary Pinnock
- Usher Institute, College of Medicine and Veterinary Science, The University of Edinburgh, Edinburgh, UK
| | - Anna Dowrick
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.,Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Liz Steed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
3
|
Karim A, Jandu S, Sharif A. A survey of South Asian attitudes to organ donation in the United Kingdom. Clin Transplant 2013; 27:757-63. [DOI: 10.1111/ctr.12189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Asra Karim
- Department of Nephrology and Transplantation; Renal Institute of Birmingham; Queen Elizabeth Hospital; Birmingham; UK
| | - Surinder Jandu
- Department of Nephrology and Transplantation; Renal Institute of Birmingham; Queen Elizabeth Hospital; Birmingham; UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation; Renal Institute of Birmingham; Queen Elizabeth Hospital; Birmingham; UK
| |
Collapse
|