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Abel L, Perera SM, Yam D, Garbern S, Kennedy SB, Massaquoi M, Sahr F, Woldemichael D, Liu T, Levine AC, Aluisio AR. Association between oral antimalarial medication administration and mortality among patients with Ebola virus disease: a multisite cohort study. BMC Infect Dis 2022; 22:71. [PMID: 35057753 PMCID: PMC8772178 DOI: 10.1186/s12879-021-06811-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Empiric antimalarial treatment is a component of protocol-based management of Ebola virus disease (EVD), yet this approach has limited clinical evidence for patient-centered benefits. METHODS This retrospective cohort study evaluated the association between antimalarial treatment and mortality among patients with confirmed EVD. The data was collected from five International Medical Corps operated Ebola Treatment Units (ETUs) in Sierra Leone and Liberia from 2014 through 2015. The standardized protocol used for patient care included empiric oral treatment with combination artemether and lumefantrine, twice daily for three days; however, only a subset of patients received treatment due to resource variability. The outcome of interest was mortality, comparing patients treated with oral antimalarials within 48-h of admission to those not treated. Analysis was conducted with logistic regression to generate adjusted odds ratios (aORs). Multivariable analyses controlled for ETU country, malaria rapid diagnostic test result, age, EVD cycle threshold value, symptoms of bleeding, diarrhea, dysphagia and dyspnea, and additional standard clinical treatments. RESULTS Among the 424 cases analyzed, 376 (88.7%) received early oral antimalarials. Across all cases, mortality occurred in 57.5% (244). In comparing unadjusted mortality prevalence, early antimalarial treated cases yielded 55.1% mortality versus 77.1% mortality for those untreated (p = 0.005). Multivariable analysis demonstrated evidence of reduced aOR for mortality with early oral antimalarial treatment versus non-treatment (aOR = 0.34, 95% Confidence Interval: 0.12, 0.92, p = 0.039). CONCLUSION Early oral antimalarial treatment in an EVD outbreak was associated with reduced mortality. Further study is warranted to investigate this association between early oral antimalarial treatment and mortality in EVD patients.
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Affiliation(s)
- Logan Abel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Derrick Yam
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, Room 274, Providence, RI, 02903, USA
| | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Tao Liu
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, Room 274, Providence, RI, 02903, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, Room 274, Providence, RI, 02903, USA.
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Gainey M, Qu K, Garbern S, Barry M, Lee J, Nasrin S, Nelson E, Rosen R, Alam N, Schmid C, Levine A. 288 Assessing the Performance of Clinical Diagnostic Models for Dehydration among Patients With Cholera and Undernutrition in Bangladesh. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marqués CG, Moretti K, Amanullah S, Uwamahoro C, Ndebwanimana V, Garbern S, Naganathan S, Martin K, Niyomiza J, Gjesvik A, Nkeshimana M, Levine AC, Aluisio AR. Association between volume resuscitation & mortality among injured patients at a tertiary care hospital in Kigali, Rwanda. Afr J Emerg Med 2021; 11:152-157. [PMID: 33680737 PMCID: PMC7910191 DOI: 10.1016/j.afjem.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/23/2020] [Revised: 07/26/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Injuries cause significant morbidity and mortality in sub-Saharan African countries such as Rwanda. These burdens may be compounded by limited access to intravenous (IV) resuscitation fluids such as crystalloids and blood products. This study evaluates the association between emergency department (ED) intravenous volume resuscitation and mortality outcomes in adult trauma patients treated at the University Teaching Hospital-Kigali (UTH- K). METHODS Data were abstracted using a structured protocol for a random sample of ED patients treated during periods from 2012 to 2016. Patients under 15 years of age were excluded. Data collected included demographics, clinical aspects, types of IV fluid resuscitation provided and outcomes. The primary outcome was facility-based mortality. Descriptive statistics were used to explore characteristics of the population. Kampala Trauma Scores (KTS) were used to control for injury severity. Magnitudes of effects were quantified using multivariable regression models adjusted for gender, KTS, time period, clinical interventions, presence of head injury and transfer to a tertiary care centre to yield adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS From the random sample of 3609 cases, 991 trauma patients were analysed. The median age was 32 [IQR 26, 46] years and 74.3% were male. ED volume resuscitation was given to 50.1% of patients with 43.5% receiving crystalloid and 6.4% receiving crystalloid and packed red blood cell (PRBC) transfusions. The median KTS score was 13 [IQR 12, 13]. In multivariable regression, mortality likelihood was increased in those who received crystalloid (aOR = 4.31, 95%CI 1.24, 15.05, p = 0.022) and PRBC plus crystalloid (aOR = 9.97, 95%CI 2.15,46.17, p = 0.003) as compared to trauma patients not treated with IV resuscitation fluids. CONCLUSIONS Injured ED patients treated with volume resuscitation had higher mortality, which may be due to unmeasured confounding or therapies provided. Further studies on fluid resuscitation in trauma populations in resource-limited settings are needed.
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Affiliation(s)
- Catalina González Marqués
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
- Department of Epidemiology and Pediatrics Brown University School of Public Health, Providence, USA
| | - Katelyn Moretti
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
- Department of Epidemiology and Pediatrics Brown University School of Public Health, Providence, USA
| | - Siraj Amanullah
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
- Department of Epidemiology and Pediatrics Brown University School of Public Health, Providence, USA
| | - Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
| | - Sonya Naganathan
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
| | - Kyle Martin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
| | - Joseph Niyomiza
- Department of Anaesthesia, Emergency Medicine and Critical Care, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Annie Gjesvik
- Department of Epidemiology and Pediatrics Brown University School of Public Health, Providence, USA
| | - Menelas Nkeshimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Accident and Emergency, University Teaching Hospital of Kigali, Rwanda
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA
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Roupetz S, Garbern S, Michael S, Bergquist H, Glaesmer H, Bartels SA. Continuum of sexual and gender-based violence risks among Syrian refugee women and girls in Lebanon. BMC Womens Health 2020; 20:176. [PMID: 32795272 PMCID: PMC7427881 DOI: 10.1186/s12905-020-01009-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A myriad of factors including socio-economic hardships impact refugees, with females being additionally exposed to various forms of sexual and gender-based violence (SGBV). The aim of this qualitative analysis was to understand and to provide new insight into the experiences of SGBV among Syrian refugee women and girls in Lebanon. METHODS The data are gained from a larger mixed-methods study, investigating the experiences of Syrian refugee girls in Lebanon, using an iPad and the data collection tool, SenseMaker®. The SenseMaker survey intentionally did not ask direct questions about experiences of SGBV but instead enabled stories about SGBV to become apparent from a wide range of experiences in the daily lives of Syrian girls. For this analysis, all first-person stories by female respondents about experiences of SGBV were included in a thematic analysis as well as a random selection of male respondents who provided stories about the experiences of Syrian girls in Lebanon. RESULTS In total, 70 of the 327 first person stories from female respondents and 42 of the 159 stories shared by male respondents included dialogue on SGBV. While experiences of sexual harassment were mainly reported by women and girls, male respondents were much more likely to talk explicitly about sexual exploitation. Due to different forms of SGBV risks in public, unmarried girls were at high risk of child marriage, whereas married girls more often experienced some form of IPV and/or DV. In abusive relationships, some girls and women continued to face violence as they sought divorces and attempted to flee unhealthy situations. CONCLUSIONS This study contributes to existing literature by examining SGBV risks and experiences for refugees integrated into their host community, and also by incorporating the perceptions of men. Our findings shed light on the importance of recognizing the impact of SGBV on the family as a whole, in addition to each of the individual members and supports considering the cycle of SGBV not only across the woman's lifespan but also across generations. Gendered differences in how SGBV was discussed may have implications for the design of future research focused on SGBV.
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Affiliation(s)
- Sophie Roupetz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany
| | - Stephanie Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI 02912 USA
| | - Saja Michael
- ABAAD Resource Center for Gender Equality, Beirut, Lebanon
| | - Harveen Bergquist
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany
| | - Susan A. Bartels
- Department of Emergency Medicine, Queen’s University, 76 Stuart Street, Victory 3, Kingston, ON K7L 4V7 Canada
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
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Moretti K, Marqués CG, Garbern S, Mbanjumucyo G, Uwamahoro C, Beaudoin FL, Amanullah S, Gjelsvik A, Aluisio AR. Transfusion, mortality and hemoglobin level: Associations among emergency department patients in Kigali, Rwanda. Afr J Emerg Med 2020; 10:68-73. [PMID: 32612911 PMCID: PMC7320208 DOI: 10.1016/j.afjem.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/02/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. METHODS This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013-16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. RESULTS Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p = 0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51-3.21) as compared to those ≤5.0 mg/dL. CONCLUSIONS No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice.
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Affiliation(s)
- Katelyn Moretti
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
- Brown University School of Public Health, Providence, USA
| | | | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
| | - Gabin Mbanjumucyo
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Service d'Aide Médicale Urgente, Kigali, Rwanda
| | - Chantal Uwamahoro
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Service d'Aide Médicale Urgente, Kigali, Rwanda
| | - Francesca L Beaudoin
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
| | - Siraj Amanullah
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
| | - Annie Gjelsvik
- Brown University School of Public Health, Providence, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
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Aluisio AR, Perera SM, Yam D, Garbern S, Peters JL, Abel L, Cho DK, Woldemichael D, Kennedy SB, Massaquoi M, Sahr F, Liu T, Levine AC. Association between treatment with oral third-generation cephalosporin antibiotics and mortality outcomes in Ebola virus disease: a multinational retrospective cohort study. Trop Med Int Health 2020; 25:433-441. [PMID: 31912627 DOI: 10.1111/tmi.13369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). METHODS This retrospective cohort studied EVD-infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). RESULTS Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%) vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32-0.71; P = 0.01). In the bootstrap analysis, a non-significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64-1.16, P = 0.11). CONCLUSION Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Derrick Yam
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jillian L Peters
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Logan Abel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel K Cho
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Tao Liu
- Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Aluisio AR, Perera SM, Yam D, Garbern S, Peters JL, Abel L, Cho DK, Kennedy SB, Massaquoi M, Sahr F, Brinkmann S, Locks L, Liu T, Levine AC. Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak. J Nutr 2019; 149:1757-1765. [PMID: 31268140 PMCID: PMC6768816 DOI: 10.1093/jn/nxz142] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. OBJECTIVE To evaluate the association between vitamin A supplementation and mortality in EVD. METHODS This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014-2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. RESULTS There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. CONCLUSION Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | | | - Derrick Yam
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Jillian L Peters
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Logan Abel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Lindsey Locks
- Department of Health Sciences, Boston University: Sargent College, Boston, MA, USA
| | - Tao Liu
- Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, RI, USA
| | - Adam C Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
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Aluisio A, Yam D, Peters J, Cho D, Perera S, Kennedy S, Massaquoi M, Sahr F, Garbern S, Liu T, Levine A. 314 Treatment With Intravenous Fluid Therapy Was Not Associated With Improved Survival Among Patients With Ebola Virus Disease: An International Multisite Cohort Study. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bakhache N, Michael S, Roupetz S, Garbern S, Bergquist H, Davison C, Bartels S. Implementation of a SenseMaker® research project among Syrian refugees in Lebanon. Glob Health Action 2018; 10:1362792. [PMID: 28857014 PMCID: PMC5645689 DOI: 10.1080/16549716.2017.1362792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 11/19/2022] Open
Abstract
The Syrian conflict has displaced over 1.2 million Syrians into Lebanon. As a result of displacement, some Syrian families are turning to child marriage as a coping mechanism. The prevalence of early marriage has reportedly increased and the average age of marriage decreased during the crisis. The aim of the project was to understand the underlying factors contributing to child marriage among Syrian refugees in Lebanon using Cognitive Edge’s SenseMaker®. This manuscript explores the process of implementing this novel research tool in a humanitarian setting. Twelve interviewers conducted SenseMaker® interviews with married and unmarried Syrian girls, Syrian parents, as well as married and unmarried men. Participants were asked to share a story about the lives of Syrian girls in Lebanon and to self-interpret the narratives by answering follow-up questions in relation to the story provided. Data collection occurred across three locations: Beirut, Beqaa, and Tripoli. In total 1422 narratives from 1346 unique participants were collected over 7 weeks. Data collection using SenseMaker® was efficient, capable of electronically capturing a large volume of quantitative and qualitative data. SenseMaker® limitations from a research perspective include lack of skip logic and inability to adjust font size on the iOS app. SenseMaker® was an efficient mixed methods data collection tool that was well received by participants in a refugee setting in Lebanon. The utility of SenseMaker® for research could be improved by adding skip logic and by being able to adjust font size on the iOS app.
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Affiliation(s)
- Nour Bakhache
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Saja Michael
- b Sexualities and Sexual and Reproductive Health and Rights , ABAAD Resource Center for Gender Equality , Beirut , Lebanon
| | - Sophie Roupetz
- c University of Leipzig , Department of Psychology , Leipzig , Germany
| | - Stephanie Garbern
- d Department of Emergency Medicine , Beth Israel Deaconess Milton , Milton , MA , USA
| | - Harveen Bergquist
- e Brigham and Women's Hospital , Department of Emergency Medicine , Boston , MA , USA.,f Department of Emergency Medicine , Harvard Medical School , Boston , MA , USA
| | - Colleen Davison
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.,g Department of Emergency Medicine , Queen's University , Kingston , ON , Canada.,h Kingston General Hospital Research Institute , Kingston , ON , Canada
| | - Susan Bartels
- a Department of Public Health Sciences , Queen's University , Kingston , ON , Canada.,g Department of Emergency Medicine , Queen's University , Kingston , ON , Canada.,h Kingston General Hospital Research Institute , Kingston , ON , Canada
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Aluisio AR, Garbern S, Wiskel T, Mutabazi ZA, Umuhire O, Ch'ng CC, Rudd KE, D'Arc Nyinawankusi J, Byiringiro JC, Levine AC. Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country. Am J Emerg Med 2018; 36:2010-2019. [PMID: 29576257 DOI: 10.1016/j.ajem.2018.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/27/2018] [Accepted: 03/07/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting. METHODS This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA=0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status. RESULTS Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9-12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1-19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6-4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4-6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified. CONCLUSION The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA.
| | - Stephanie Garbern
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
| | - Tess Wiskel
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
| | - Zeta A Mutabazi
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Olivier Umuhire
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | | | - Kristina E Rudd
- Department of Medicine, University of Washington, Seattle, USA
| | | | | | - Adam C Levine
- Department of Emergency Medicine, Brown University Alpert Medical School, Providence, USA
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Bartels SA, Michael S, Roupetz S, Garbern S, Kilzar L, Bergquist H, Bakhache N, Davison C, Bunting A. Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon. BMJ Glob Health 2018. [PMID: 29515914 PMCID: PMC5838398 DOI: 10.1136/bmjgh-2017-000509] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Indexed: 12/01/2022] Open
Abstract
Introduction The Syrian conflict has resulted in over 2.3 million child refugees in the Middle East and the prevalence of early marriage has reportedly increased among displaced Syrian families. This study explores the underlying factors contributing to child marriage among Syrian refugees in Lebanon with the goal of informing community-based strategies to address the issue. Methods In July–August 2016, trained interviewers collected self-interpreted stories in Lebanon using Cognitive Edge’s SenseMaker, a mixed-method data collection tool. Participants included married and unmarried Syrian girls, Syrian parents as well as married and unmarried men. Each participant shared a story about the experiences of Syrian girls and then interpreted the story by plotting their perspectives on a variety of questions. Patterns in the responses were analysed in SPSS and the accompanying qualitative narratives were reviewed to facilitate interpretation of the quantitative results. Results 1422 self-interpreted stories from 1346 unique participants were collected with 40% of shared stories focused on (n=332) or mentioning (n=245) child marriage. Quantitative data summarised the different perspectives of female and male participants. Syrian girls and mothers were more likely to share stories about protection/security and/or education and were more likely to report that girls were overprotected. Male participants were more likely to share stories about financial security as well as sexual exploitation of girls and more often reported that girls were not protected enough. Despite these gendered perspectives, many of the shared narratives highlighted similar themes of financial hardship, lack of educational opportunities and safety concerns around sexual and gender-based violence (SGBV). Conclusions A complex myriad of factors contribute to early marriage including poverty, lack of educational opportunities and concerns about SGBV. Sexual exploitation under the guise of marriage is a reality for some Syrian girls. Gender-specific strategies to address child marriage might be more effective in reducing this harmful practice.
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Affiliation(s)
| | - Saja Michael
- ABAAD Resource Center for Gender Equality, Beirut, Lebanon
| | - Sophie Roupetz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Stephanie Garbern
- Department of Emergency Medicine, Beth Israel Deaconess Milton, Milton, Massachusetts, USA
| | - Lama Kilzar
- ABAAD Resource Center for Gender Equality, Beirut, Lebanon
| | - Harveen Bergquist
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nour Bakhache
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Colleen Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Annie Bunting
- Department of Social Science, York University, Toronto, Ontario, Canada
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