1
|
Gebremariyam ZT, Woldemariam ST, Beyene TD, Baharu LM. Reconstruction of massive chest wall defect after malignant chest wall mass excision in resource limited setting, a case report. Int J Surg Case Rep 2024; 117:109496. [PMID: 38503161 PMCID: PMC10963599 DOI: 10.1016/j.ijscr.2024.109496] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chest wall tumors, rare but impactful, constitute less than 2 % of the population and 5 % of thoracic neoplasms. Wide-margin resection is vital, often causing substantial defects necessitating reconstruction. However, in resource-limited settings like sub-Saharan Africa, access to reconstruction materials is limited. We present a successful case of managing a massive chest wall defect using flexible wire and polypropylene mesh in such a context. CASE PRESENTATION A 40-year-old male presented with a gradually enlarging anterolateral chest wall mass, diagnosed as low-grade synovial sarcoma. Imaging revealed involvement of the 6th to 11th ribs with compression of the diaphragm and liver. A multidisciplinary team planned wide-margin excision, chest wall reconstruction, and adjuvant chemoradiation. Using a sternal wire bridge and polypropylene mesh, the 25 cm by 15 cm defect was reconstructed, covered with a latissimus dorsi flap. The patient recovered well postoperatively, highlighting the feasibility of innovative approaches in resource-limited settings. CLINICAL DISCUSSION Defects larger than 5 cm or involving over 4 ribs require reconstruction to prevent lung herniation and respiratory issues, especially for anteriorolateral defects. Our case featured a 25 by 15 cm anteriorolateral chest wall defect, necessitating rigid reconstruction. Due to resource constraints, we utilized flexible wires and polypropylene mesh, offering a cost-effective solution for managing massive chest wall defects. CONCLUSION This case underscores the challenges faced in managing chest wall tumors in resource-constrained regions and emphasizes the importance of innovative solutions for achieving successful outcomes in chest wall reconstruction.
Collapse
|
2
|
Atwine O, Mucunguzi D, Ebine J, Ainomugisha R, Muhumuza J, Mwesigwa MM. Retrocaval ureter in a child presenting at a regional referral hospital in South-Western Uganda: A case report. Int J Surg Case Rep 2023; 111:108899. [PMID: 37797526 PMCID: PMC10558303 DOI: 10.1016/j.ijscr.2023.108899] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/30/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Retrocaval ureter is a rare developmental abnormality of the inferior vane cava. Commonly presents in the 3rd and 4th decades of life hence a rare presentation in the pediatric population. This condition presents a surgical challenge both in terms of diagnosis and management due to costly investigations and few urology specialists in resource limited settings. We present a case of retrocaval ureter surgically managed in a resource limited setting with excellent outcome. CASE PRESENTATION A 13-year-old female presented with 3 months history of progressive right sided abdominal pain and history of treatment for recurrent lower urinary tract infections. Intravenous pyelogram showed a ureter with a fish hook shape. At laparotomy, the ureter was identified, divided, relocated and ureteroureterostomy done anterior to the inferior vena cava. The patient recovered with no complications. DISCUSSION AND CONCLUSION To the best of our knowledge, this is the first reported case of retrocaval ureter in a child surgically managed in Africa. It's a congenital anomaly of the inferior vena cava not ureter hence a misnomer. Amidst of being in a less resourced setting, an intravenous pyelogram may be all that is required to make a diagnosis.
Collapse
Affiliation(s)
- Oscar Atwine
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Denis Mucunguzi
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Johnson Ebine
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Racheal Ainomugisha
- Department of Radiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western campus, Ishaka, Bushenyi, Uganda; Department of Surgery, Mubende Regional Referral Hospital, Mubende, Uganda.
| | - Marvin Mutakooha Mwesigwa
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
3
|
Mohamed MA, Abraha D, Olasinde AA, Kiswezi A, Molen SF, Muhumuza J, Lule H. Testicular salvageability and its predictors among patients with testicular torsion in a resource limited setting: a multicentre longitudinal study. BMC Surg 2023; 23:248. [PMID: 37605257 PMCID: PMC10441739 DOI: 10.1186/s12893-023-02118-z] [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] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/22/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Testicular torsion refers to ischemia of the testicle due to twisting or rotation of the vessels supplying the testes. It is a urologic emergency requiring a high index of clinical suspicion and prompt surgical intervention with management aimed at avoiding testicular loss and resulting infertility. This paper gives an update on the current situation regarding this topic in low-income settings. The aim of this study was to determine testicular salvageability and its predictors amongst patients with testicular torsion at two tertiary African hospitals. METHODS This was a hospital-based multicentre longitudinal study at two tertiary hospitals in western Uganda. Patients with acute scrotum were enrolled and evaluated for testicular torsion. Those with confirmed testicular torsion underwent surgery and salvageability was reported as the primary outcome. Predictors for testicular salvageability were determined using backward binary logistic regression in SPSS version 22. RESULTS During the study period, 232 patients with acute scrotum were enrolled. The mean age was 35.3 (SD = 20.4) years. Forty-one (17.7%) patients had testicular torsion. Only 16 (39.0%) of patients with torsion had viable testes that were salvageable. Orchiectomy was performed on 25 patients (61.0%). At multivariate analysis, a patient who presented after 48 h from the onset of symptoms was 34.833 times more likely to have orchiectomy compared to one who presented within 12 h [AOR = 34.833, (95% CI = 5.020-60.711), P < 0.001]. CONCLUSION In this study, the testicular salvage rate was low. The only predictor of salvageability was the time from the onset of symptoms to presentation. All males should be sensitized about the clinical features of testicular torsion to ensure early presentation to increase salvage rates.
Collapse
Affiliation(s)
- Mohamed Abdullahi Mohamed
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Demoz Abraha
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Anthoney Ayotunde Olasinde
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Ahmed Kiswezi
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Herman Lule
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neurosciences, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Atwine O, Odongo CN, Ainomugisha R, Tayebwa E, Muhumuza J, Dreque CC. A giant choledochal cyst in a 17 year old female managed in a resource limited setting: A case report. Int J Surg Case Rep 2023; 106:108284. [PMID: 37148731 DOI: 10.1016/j.ijscr.2023.108284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Choledochal cysts are rare congenital bile duct anomalies that lead to cystic dilatations of the biliary tree. This condition is very rare in Africa. When these cysts exceed 10 cm in diameter, they are referred to as giant choledochal cysts, which are much rarer. Giant choledochal cysts present both a diagnostic and surgical challenge. We present a case of a giant Choledochal cyst surgically managed in a resource limited setting with excellent outcome. CASE PRESENTATION A 17-year-old female presented with 4 months history of progressive abdominal distension associated with abdominal pain, yellow discoloration of eyes, and occasional constipation. Abdominal CT-scan revealed a huge cystic mass in the right upper quadrant extending inferiorly to the right lumbar region. Complete excision of a type IA choledochal cyst was done plus cholecystectomy in addition to bilioenteric reconstruction. The patient recovered uneventfully. DISCUSSION AND CONCLUSION To the best of our knowledge, this is the largest giant Choledochal cyst reported in literature. Even in a resource limited settings, sonography and a CT scan may be all that is required to make a diagnosis. During surgical excision, the surgeon should take extra caution to carefully dissect the adhesions off the giant cyst for a successful complete excision.
Collapse
Affiliation(s)
- Oscar Atwine
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Charles Newton Odongo
- Department of Anatomy, Faculty of Medicine, Soroti University, Soroti, Uganda; Department of Surgery (Division of Pediatric Surgery), Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Racheal Ainomugisha
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edson Tayebwa
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala international University Western campus, Ishaka-Bushenyi, Uganda; Department of Surgery, Mubende Regional Referral Hospital, Mubende, Uganda.
| | - Carlos Cabrera Dreque
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
5
|
Bhardwaj A, Srivastava MP, Wilson PV, Mehndiratta A, Vishnu VY, Garg R. Machine learning based reanalysis of clinical scores for distinguishing between ischemic and hemorrhagic stroke in low resource setting. J Stroke Cerebrovasc Dis 2022; 31:106638. [PMID: 35926404 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106638] [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] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying ischemic or hemorrhagic strokes clinically may help in situations where neuroimaging is unavailable to provide primary-care prior to referring to stroke-ready facility. Stroke classification-based solely on clinical scores faces two unresolved issues. One pertains to overestimation of score performance, while other is biased performance due to class-imbalance inherent in stroke datasets. After correcting the issues using Machine Learning theory, we quantitatively compared existing scores to study the capabilities of clinical attributes for stroke classification. METHODS We systematically searched PubMed, ERIC, ScienceDirect, and IEEE-Xplore from 2001 to 2021 for studies that validated the Siriraj, Guys Hospital/Allen, Greek, and Besson scores for stroke classification. From included studies we extracted the reported cross-tabulation to identify and correct the above listed issues for an accurate comparative analysis of the performance of clinical scores. RESULTS A total of 21 studies were included. Comparative analysis demonstrates Siriraj Score outperforms others. For Siriraj Score the reported sensitivity range (Ischemic Stroke-diagnosis) 43-97% (Median = 78% [IQR 65-88%]) is significantly higher than our calculated range 40-90% (Median = 70% [IQR 57-73%]), also the reported sensitivity range (Hemorrhagic Stroke-diagnosis) 50-95% (Median = 71% [IQR 64-82%]) is higher than our calculated range 34-86% (Median = 59% [IQR 50-79%]) which indicates overestimation of performance by the included studies. Guys Hospital/Allen and Greek Scores show similar trends. Recommended weighted-accuracy metric provides better estimate of the performance. CONCLUSION We demonstrate that clinical attributes have a potential for stroke classification, however the performance of all scores varies across demographics, indicating the need to fine-tune scores for different demographics. To improve this variability, we suggest creating global data pool with statistically significant attributes. Machine Learning classifiers trained over such dataset may perform better and generalise at scale.
Collapse
Affiliation(s)
- Aman Bhardwaj
- School of Information Technology, Indian Institute of Technology Delhi, Room 409, SIT Building, IIT Delhi main road, Delhi 110016, India.
| | - Mv Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences New Delhi, 7th Floor, CNC Building, Delhi 110029, India
| | - Pulikottil Vinny Wilson
- Department of Internal Medicine, Armed Forces Medical College Pune, Pune, Maharashtra 411040, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Block III, Room No: 298, IIT Delhi main road, Delhi 110016, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences New Delhi, 7th Floor, CNC Building, Delhi 110029, India
| | - Rahul Garg
- Computer Science and Engineering, Indian Institute of Technology Delhi, Room 104, SIT Building, IIT Delhi main road, Delhi 110016, India
| |
Collapse
|
6
|
Bista S, Rajbhandari S, Karki S, Pokharel S, Karki S. Knowledge of point-of-care ultrasound and management of deep vein thrombosis patient in resource limited setup: A case report. Ann Med Surg (Lond) 2022; 77:103702. [PMID: 35638037 PMCID: PMC9142702 DOI: 10.1016/j.amsu.2022.103702] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance: Deep vein thrombosis (DVT), frequently encountered in an emergency setting, if not identified and managed early, leads to pulmonary embolism that may be life threatening to the patient. The use of point-of-care ultrasound (POCUS) can be used as an effective and time saving tool for diagnosis of such life threatening conditions. Case presentation We present a case of a 53 years old male who presented to the emergency department (ED) with complaints of swelling and pain in the left lower limb for one week and redness of overlying skin for the same duration. Following a point-of-care ultrasound scan, a diagnosis of DVT was made. The condition was quickly identified and promptly treated preventing possible complications. Discussion Use of point-of-care ultrasound to diagnose DVT has been shown to decrease the need for comprehensive scans, decrease time to diagnosis and length of stay at the emergency department. To improve medical care by increasing early detection, lowering costs, and improving overall patient care, more training of emergency physicians in ultrasound technique and standardized use of ultrasound to screen for DVT in the ED is required. Conclusion This case report highlights how, despite the unavailability of sophisticated diagnostic procedures, a skill of using POCUS can prove to be lifesaving in a resource-limited setting. Deep vein thrombosis is a life-threatening condition requiring prompt diagnosis and treatment. DVT, if not managed timely can lead to complications like pulmonary embolism. Point-of-care ultrasound (POCUS) can help detect DVT timely. Use of POCUS can prove valuable in resource limited setting where sophisticated tools to diagnose conditions such as DVT are unavailable.
Collapse
Affiliation(s)
| | | | - Saurab Karki
- Military Hospital Itahari, Itahari, Sunsari, Nepal
- Corresponding author. Military Hospital, Itahari, Sunsari, Nepal.
| | | | | |
Collapse
|
7
|
Kunda-Ng'andu EM, Simuyandi M, Kapulu M, Chirwa-Chobe M, Mwanyungwi-Chinganya H, Mwale S, Chilengi R, Sharma A. Engagement of ethics and regulatory authorities on human infection studies: Proceedings of an engagement workshop in Zambia. Wellcome Open Res 2021; 6:31. [PMID: 33824912 PMCID: PMC7993625 DOI: 10.12688/wellcomeopenres.16432.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Human infection studies (HIS) have generally been used as a tool in the pathway for vaccine development in high income settings. Over the last decade, this model has been implemented in LMICs with the aim of accelerating development of next generation vaccines that would perform better in these settings. However, in most LMICs, the ethics and regulatory framework for the conduct of these studies are not in place. In Zambia, these studies are yet to be conducted and thus we conducted a stakeholder engagement workshop in October 2019. We engaged with bioethicists, regulatory authority officials, and scientists from within Zambia and other African countries to anticipate and address foreseeable ethical and regulatory issues when conducting HIS in Zambia for the first time. The workshop largely focused on sensitizing the stakeholders on the benefits of these studies with the following main points for consideration on the implementation of these studies in Zambia: need for in-country legal framework and guidelines; need for adequate informed consent based on comprehensive understanding of the concept of HIS and study requirements; and requirements for heightened vigilance to assure participant safety including good ethical and clinical practice with regulatory, ethical, data safety, and community oversight. Additionally, the workshop emphasized the need for rigorous health screening prior to enrolment; suitable infrastructure for containment; and personnel to provide appropriate treatment including emergency resuscitation and evacuation if indicated. Specific recommendations included compensation for burden of participation; access to care and provision for study related injury (e.g. no-fault insurance); and withdrawal and exit procedures to preserve individual and community safety. Finally, the meeting concluded that researchers should actively engage key gate keepers including civic leaders such as parliamentarians, universities, researchers, potential participants and laypersons to avoid circulation of misinformation.
Collapse
Affiliation(s)
| | - Michelo Simuyandi
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Melissa Kapulu
- Biosciences, KEMRI-Wellcome trust research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Masuzyo Chirwa-Chobe
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Hope Mwanyungwi-Chinganya
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Stanley Mwale
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Roma Chilengi
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Anjali Sharma
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| |
Collapse
|
8
|
Bagasha P, Namukwaya E, Leng M, Kalyesubula R, Mutebi E, Naitala R, Katabira E, Petrova M. Comparison of the health-related quality of life of end stage kidney disease patients on hemodialysis and non-hemodialysis management in Uganda. BMC Palliat Care 2021; 20:52. [PMID: 33794849 PMCID: PMC8017791 DOI: 10.1186/s12904-021-00743-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background Health-related quality of life is recognized as a key outcome in chronic disease management, including kidney disease. With no national healthcare coverage for hemodialysis, Ugandan patients struggle to pay for their care, driving families and communities into poverty. Studies in developed countries show that patients on hemodialysis may prioritize quality of life over survival time, but there is a dearth of information on this in developing countries. We therefore measured the quality of life (QOL) and associated factors in end stage renal disease (ESRD) patients in a major tertiary care hospital in Uganda. Methods Baseline QOL measurement in a longitudinal cohort study was undertaken using the Kidney Disease Quality of Life Short Form Ver 1.3. Patients were recruited from the adult nephrology unit if aged > 18 years with an estimated glomerular filtration rate ≤ 15mls/min/1,73m2. Clinical, demographic and micro-financial information was collected to determine factors associated with QOL scores. Results Three hundred sixty-four patients (364) were recruited, of whom 124 were on hemodialysis (HD) and 240 on non-hemodialysis (non-HD) management. Overall, 94.3% of participants scored less than 50 (maximum 100). Mean QOL scores were low across all three principal domains: physical health (HD: 33.14, non-HD: 34.23), mental health (HD: 38.01, non-HD: 38.02), and kidney disease (HD: 35.16, non-HD: 34.00). No statistically significant difference was found between the overall quality of life scores of the two management groups. Breadwinner status (p < 0.001), source of income (p0.026) and hemodialysis management type (p0.032) were the only factors significantly associated with QOL scores, and this was observed in the physical health and kidney disease principal domains only. No factors were significantly associated with scores for the mental health principal domain and/or overall QOL score. Conclusion The quality of life of Ugandan patients with ESRD has been found to be lower across all three domains of the Kidney Disease Quality of Life Short Form than reported anywhere in the world, with no difference observed between the non-HD and HD management groups. Interventions targeting all domains of QOL are needed among patients with ESRD in Uganda and, potentially, in other resource limited settings.
Collapse
Affiliation(s)
- Peace Bagasha
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. .,Makerere-Mulago Palliative Care Unit, Clinical Research Building, Mulago hospital site, P.O. Box 7072, Kampala, Uganda.
| | - Elizabeth Namukwaya
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Makerere-Mulago Palliative Care Unit, Clinical Research Building, Mulago hospital site, P.O. Box 7072, Kampala, Uganda
| | - Mhoira Leng
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Makerere-Mulago Palliative Care Unit, Clinical Research Building, Mulago hospital site, P.O. Box 7072, Kampala, Uganda
| | - Robert Kalyesubula
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Edrisa Mutebi
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ronald Naitala
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Baylor College of Medicine Children's Foundation Uganda, P. O Box 72052, New Mulago Road, Kampala, Uganda
| | - Elly Katabira
- School of Medicine, Department of Internal medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Mila Petrova
- Cambridge Palliative and End of Life Care Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Cambridge Institute of Public Health, Forvie Site, Cambridge, CB2 0SR, UK
| |
Collapse
|
9
|
Kunda-Ng'andu EM, Simuyandi M, Kapulu M, Chirwa-Chobe M, Mwanyungwi-Chinganya H, Mwale S, Chilengi R, Sharma A. Engagement of ethics and regulatory authorities on human infection studies: Proceedings of an engagement workshop in Zambia. Wellcome Open Res 2021; 6:31. [PMID: 33824912 DOI: 10.12688/wellcomeopenres.16432.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/20/2022] Open
Abstract
Human infection studies (HIS) have generally been used as a tool in the pathway for vaccine development in high income settings. Over the last decade, this model has been implemented in LMICs with the aim of accelerating development of next generation vaccines that would perform better in these settings. However, in most LMICs, the ethics and regulatory framework for the conduct of these studies are not in place. In Zambia, these studies are yet to be conducted and thus we conducted a stakeholder engagement workshop in October 2019. We engaged with bioethicists, regulatory authority, and scientists from within Zambia and other African countries to anticipate and address foreseeable ethical and regulatory issues when conducting HIS in Zambia for the first time. The workshop largely focused on sensitizing the stakeholders on the benefits of these studies with the following main points for consideration on the implementation of these studies in Zambia: need for in-country legal framework and guidelines; need for adequate informed consent based on comprehensive understanding of the concept of HIS and study requirements; and requirements for heightened vigilance to assure participant safety including good ethical and clinical practice with regulatory, ethical, data safety, and community oversight. Additionally, the workshop emphasized the need for rigorous health screening prior to enrolment; suitable infrastructure for containment; and personnel to provide appropriate treatment including emergency resuscitation and evacuation if indicated. Specific recommendations included compensation for burden of participation; access to care and provision for study related injury (e.g. no-fault insurance); and withdrawal and exit procedures to preserve individual and community safety. Finally, the meeting concluded that researchers should actively engage key gate keepers including civic leaders such as parliamentarians, universities, researchers, potential participants and laypersons to avoid circulation of misinformation.
Collapse
Affiliation(s)
| | - Michelo Simuyandi
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Melissa Kapulu
- Biosciences, KEMRI-Wellcome trust research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Masuzyo Chirwa-Chobe
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Hope Mwanyungwi-Chinganya
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Stanley Mwale
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Roma Chilengi
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| | - Anjali Sharma
- Research Department, The centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 10101, Zambia
| |
Collapse
|
10
|
Nakubulwa F, Lusobya RC, Batte A, Ssuna B, Nakanjako D, Nakiyingi L, Nalukenge C, Sebabi FO, Mulinde B, Otiti-Sengeri J. Prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment in a resource-limited setting. BMC Ophthalmol 2021; 21:55. [PMID: 33482766 DOI: 10.1186/s12886-021-01817-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nephrotic syndrome is the most common glomerulopathy among children aged 2–18 years and high dose corticosteroids are the backbone of its management. Potentially blinding ocular complications often result from nephrotic syndrome and/or its treatment. We conducted a study to determine the prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment at Mulago National Referral Hospital. Methods This was a cross-sectional study conducted for three [3] months at the pediatric renal unit of Mulago National Referral Hospital (MNRH). Data from a consecutive sample of 100 children was collected using a semi-structured questionnaire, entered into Epi-data 4.4.2 and exported to STATA 14 for analysis at univariate, bivariate and multivariate levels. A robust Poisson regression model was used to identify predictors of ocular complications. Results Out of 100 patients examined, 80(80%) had ocular complications. The median age was 10 (IQR: 7–12) and 52 (52%) were girls. The most frequent complications were hypertrichosis and refractive errors in 71% (95%CI 61.1–79.6) and 56% (95%CI 45.7–65.9) of the patients respectively. Age above 10 years was the predictor for ocular complications with a RR = 1.37 (95%CI:1.14–1.64) p = 0.001. Conclusions We found a high prevalence of ocular complications among children with nephrotic syndrome in this tertiary hospital. The predictor of ocular complications was age greater than 10 years. We recommend that all children with nephrotic syndrome undergo a baseline ocular examination prior to commencement of treatment and be reviewed periodically by an ophthalmologist. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01817-6.
Collapse
|
11
|
Bagasha P, Leng M, Katabira E, Petrova M. Health-related quality of life, palliative care needs and 12-month survival among patients with end stage renal disease in Uganda: protocol for a mixed methods longitudinal study. BMC Nephrol 2020; 21:531. [PMID: 33287725 PMCID: PMC7720495 DOI: 10.1186/s12882-020-02197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/10/2020] [Accepted: 11/29/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease is on the rise globally and in sub-Saharan Africa. Due to its "silent" nature, many patients often present with advanced disease. At this point options for care are often limited to renal replacement therapies such as hemodialysis and kidney transplantation. In resource limited settings, these options are associated with catastrophic expenditures and increased household poverty levels. Early palliative care interventions, if shown to ensure comparable quality of life (QoL), can significantly mitigate this by focusing care on comfort, symptom control and QoL rather than primarily on prolonging survival. METHODS A mixed methods longitudinal study, recruiting patients with End Stage Renal Disease (ESRD) on hemodialysis or conservative management and following them up over 12 months. The study aims are to: 1) measure and compare the health-related quality of life (HRQoL) scores of patients with ESRD receiving hemodialysis with those receiving conservative management, 2) measure and compare the palliative care needs and outcomes of patients in the two groups, 3) explore the impact of treatment modality and demographic, socio-economic and financial factors on QoL and palliative care needs and outcomes, 4) review patient survival over 12 months and 5) explore the patients' lived experiences. The Kidney Disease Quality Of Life Short Form version 1.3 (KDQOL-SF) will be used to measure HRQoL; the African Palliative Care Association Palliative care Outcome Score (APCA POS) and the Palliative care Outcome Score for renal symptoms (POS-S Renal) will be used to assess palliative care needs and outcomes; and semi-structured in-depth interviews to explore the patients' experiences of living with ESRD. Data collection will be carried out at 0, 3, 6, 9 and 12 months. DISCUSSION To the best of our knowledge, no similar study has been conducted in sub-Saharan Africa. This will be an important step towards raising awareness of patients' need and preferences and the strengths and limitations of available health care services for ESRD in resource limited settings.
Collapse
Affiliation(s)
- Peace Bagasha
- Department of Internal medicine, Makerere University College of Health Sciences, School of Medicine, P.O. Box 7072, Kampala, Uganda. .,Makerere-Mulago Palliative Care Unit, Clinical Research Building, Mulago hospital site, P.O.Box 7072, Kampala, Uganda.
| | - Mhoira Leng
- Department of Internal medicine, Makerere University College of Health Sciences, School of Medicine, P.O. Box 7072, Kampala, Uganda.,Makerere-Mulago Palliative Care Unit, Clinical Research Building, Mulago hospital site, P.O.Box 7072, Kampala, Uganda
| | - Elly Katabira
- Department of Internal medicine, Makerere University College of Health Sciences, School of Medicine, P.O. Box 7072, Kampala, Uganda
| | - Mila Petrova
- Cambridge Palliative and End of Life Care Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge; Cambridge Institute of Public Health, Forvie Site, Cambridge, CB2 0SR, UK
| |
Collapse
|
12
|
Duri K, Gumbo FZ, Munjoma PT, Chandiwana P, Mhandire K, Ziruma A, Macpherson A, Rusakaniko S, Gomo E, Misselwitz B, Mazengera LR. The University of Zimbabwe College of Health Sciences (UZ-CHS) BIRTH COHORT study: rationale, design and methods. BMC Infect Dis 2020; 20:725. [PMID: 33008316 PMCID: PMC7532096 DOI: 10.1186/s12879-020-05432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes. METHODS Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis. DISCUSSION The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.
Collapse
Affiliation(s)
- Kerina Duri
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe.
| | - Felicity Z Gumbo
- Department of Paediatrics and Child Health, UZ-CHS, Harare, Zimbabwe
| | - Privilege T Munjoma
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| | | | | | - Asaph Ziruma
- Department of Obstetrics and Gynaecology, UZ-CHS, Harare, Zimbabwe
| | - Andrew Macpherson
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | | | - Exnevia Gomo
- UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe
- Department of Medical Laboratory Sciences, UZ-CHS, Harare, Zimbabwe
| | - Benjamin Misselwitz
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Lovemore Ronald Mazengera
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| |
Collapse
|
13
|
Buzibye A, Musaazi J, von Braun A, Nanzigu S, Sekaggya-Wiltshire C, Kambugu A, Fehr J, Lamorde M, Gutteck U, Muller D, Sowinski S, Reynolds SJ, Castelnuovo B. Antiretroviral concentration measurements as an additional tool to manage virologic failure in resource limited settings: a case control study. AIDS Res Ther 2019; 16:39. [PMID: 31810468 PMCID: PMC6898957 DOI: 10.1186/s12981-019-0255-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Several studies demonstrate a correlation between sub-therapeutic concentrations of antiretroviral drugs and virologic failure. We examined the sensitivity, specificity and predictive values of sub-therapeutic drug levels in predicting viralogic failure. Methods This was a case control study with cases being samples of participants with virologic failure, and controls samples of participants with virologic suppression. We analyzed samples obtained from participants that had been on antiretroviral treatment (ART) for at least 6 months. Virologic failure was defined as HIV-RNA viral load ≥ 1000 copies/ml. Sub-therapeutic drug levels were defined according to published reference cutoffs. The diagnostic validity of drug levels for virologic failure was assessed using plasma viral loads as a gold standard. Results Sub-therapeutic ART concentrations explained only 38.2% of virologic failure with a probability of experiencing virologic failure of 0.66 in a patient with low drug levels versus 0.25 for participants with measurements within or above the normal range. Approximately 90% of participants with ART concentrations above the lower clinical cut off did not have virologic failure. Conclusions These results support prior indication for therapeutic drug monitoring in cases of suspected virologic failure.
Collapse
|
14
|
Samaranayake NR, Balasuriya A, Fernando GH, Samaraweera D, Shanika LGT, Wanigasuriya JKP, Wijekoon CN, Wanigatunge CA. 'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus. BMC Geriatr 2019; 19:282. [PMID: 31640572 PMCID: PMC6805460 DOI: 10.1186/s12877-019-1293-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023] Open
Abstract
Background ‘Screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START)’ criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka. Method Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka. Results Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country. Conclusion A list of ‘Modified STOPP/START criteria for Sri Lanka’ was developed. These criteria are currently being validated through a multi-centre study.
Collapse
Affiliation(s)
- N R Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | | | - G H Fernando
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - D Samaraweera
- Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - L G T Shanika
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - J K P Wanigasuriya
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - C N Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - C A Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
15
|
Gabriel OT, Oyebanji O. A Review and Outcome of Adenoidectomy Performed in Resource Limited Settings. Indian J Otolaryngol Head Neck Surg 2019; 71:1-4. [PMID: 31741917 PMCID: PMC6848313 DOI: 10.1007/s12070-014-0789-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022] Open
Abstract
Adenoidectomy remains invaluable in alleviating the obstructive symptoms of adenoid enlargement in children. The aim of this study is to review the conventional method of adenoidectomy with a view to establish its role and success in resource limited setting. A 5-year retrospective review of pediatric patients that had adenoidectomy operations done at two tertiary healthcare facilities was conducted. The clinic, ward, theatre registers and the patients' case files were the sources of information. Patients that had adenoidectomy with other otolaryngological procedures were excluded from the study. Data generated were descriptively analyzed using SPSS version 14.0. A total of 71 patients had adenoidectomy done. Of this, 65 cases were reviewed. There were a total of 45 males and 20 females with age range 11 months-10 years. The main indication for surgery was obstructive nasal symptoms. Conventional adenoidectomy was performed with standard adenoid curette. Intra-operative blood loss was less than 60 ml and none of the patients had blood transfusion. The average duration of admission post-operatively was 1.1 day. Fifty-eight (89 %) of the patients were relieved of their obstructive symptoms postoperatively. Conventional curettage adenoidectomy still have a role to play especially in resource limited setting where newer techniques may be nothing but a luxury. Adequate preoperative work-up, good anesthetic and surgical techniques are sine-qua-none to successful surgical outcome. There is also a need for early referral to otolaryngologists as this will not only ensure optimal intervention but also minimal postoperative complications.
Collapse
Affiliation(s)
- Olajide Toye Gabriel
- Department of Ear, Nose and Throat Surgery, Federal Medical Centre, Ido Ekiti, Ekiti State Nigeria
| | - Olajuyin Oyebanji
- 2Department of Ear, Nose and Throat Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State Nigeria
| |
Collapse
|
16
|
Gatechompol S, Avihingsanon A, Apornpong T, Han WM, Kerr SJ, Ruxrungtham K. Efficacy and improvement of lipid profile after switching to rilpivirine in resource limited setting: real life clinical practice. AIDS Res Ther 2019; 16:7. [PMID: 30953533 PMCID: PMC6451290 DOI: 10.1186/s12981-019-0222-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/27/2019] [Indexed: 01/03/2023] Open
Abstract
Background Long-term success of cART is possible if the regimen is convenient and less-toxic. This study assessed the efficacy and safety of switching from a first-line NNRTI or boosted PI-based regimens to RPV-based regimens among virologically suppressed participants in resource-limited setting (RLS). Methods This is a prospective cohort study. Participants with plasma HIV-RNA < 50 copies/mL receiving cART were switched from a PI- or NNRTI-based, to a RPV-based regimen between January 2011 and April 2018. The primary endpoint was the proportion of patients with plasma HIV-1 RNA level < 50 copies/mL after 12 months of RPV. The secondary endpoint was the virological response at 24 months and safety endpoint (change in lipid profiles and kidney function from baseline to 12 months). Results A total of 320 participants were enrolled into the study. The rationale for switching to RPV was based on toxicity of the current regimen (57%) or desire to simplify cART (41%). Totally, 177 (55%) and 143 (45%) participants were on NNRTI and boosted PI, respectively, prior to switching to RPV. After 12 months, 298 (93%) participants maintained virological suppression. There were significant improvements in the lipid parameters: TC (− 21 (IQR − 47 to 1) mg/dL; p < 0.001), LDL (− 14 (IQR − 37 to 11) mg/dL; p < 0.001) and TG (− 22 (IQR − 74 to 10) mg/dL; p < 0.001). Also, there was a small but statistically significant decrease in eGFR (− 4.3 (IQR − 12 to 1.1) mL/min per 1.73m2; p < 0.001). Conclusions In RLS where integrase inhibitors are not affordable, RPV-based regimens are a good alternative option for PLHIV who cannot tolerate first-line NNRTI or boosted PI regimen, without prior NNRTI/PI resistance. Trial registration HIV-NAT 006 cohort, clinical trial number: NCT00411983
Collapse
|
17
|
Abebe L, Bender A, Pittini R. Building the Case for Nurses' Continuous Professional Development in Ethiopia: A Qualitative Study of the Sick Kids-Ethiopia Paediatrics Perioperative Nursing Training Program. Ethiop J Health Sci 2019; 28:607-614. [PMID: 30607076 PMCID: PMC6308780 DOI: 10.4314/ejhs.v28i5.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study describes the in-service training experience of perioperative nurses from the SickKids-Ethiopia Paediatrics Perioperative Nursing Training Program in Addis Ababa, Ethiopia. The study emphasizes specifically how nurses applied the knowledge and skills gained from the Paediatrics Perioperative Nursing Training program in their subsequent practice and consider the situational factors that facilitated or hindered implementing these new knowledge and skills. Methods The first author led qualitative in-depth interviews with nine perioperative nurses who participated in training in September 2016, and systematically developed descriptive codes and themes to analyze the data. Results The authors found that participants experienced improved knowledge, skills, confidence, and job retention related to perioperative nursing practice after participating in Paediatrics Perioperative Nursing Training. Participants also stressed key challenges including lack of access to ongoing perioperative in-service training and problematic staffing policies that impact perioperative nurses' ability to fully utilize and share new knowledge gained during CPD training. Conclusion The findings highlighted the value of specialized perioperative CPD training for Ethiopian nurses, yet also pointed to multidimensional challenges for knowledge translation and sustainability of best practices. The authors offer recommendations for individual and institutional strategies to address some of them.
Collapse
Affiliation(s)
- Leyouget Abebe
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Amy Bender
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | | |
Collapse
|
18
|
Masango-Muzindutsi Z, Haskins L, Wilford A, Horwood C. Using an action learning methodology to develop skills of health managers: experiences from KwaZulu-Natal, South Africa. BMC Health Serv Res 2018; 18:907. [PMID: 30497470 PMCID: PMC6267842 DOI: 10.1186/s12913-018-3693-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Strong management skills are key to improving performance of health systems. Action learning, a technique to develop management skills, has been used successfully with health managers but not usually among lower level managers or in low and middle-income countries (LMICs). METHODS This study uses a qualitative approach to explore experiences, successes and challenges of using an action learning approach to improve skills of managers in neonatal units in KwaZulu-Natal (KZN), South Africa. Eight action learning groups were convened with neonatal unit managers from all 39 district hospitals in KZN, each group had 4-6 participants. Meetings were conducted by a facilitator trained in action learning techniques, and groups met a minimum of ten times over a one-year period. After completion of the intervention, 14 in-depth interviews were conducted with purposively selected action learning participants. Data was transcribed and analysed using framework analysis. RESULTS Neonatal unit managers found that action learning generated a sense of empowerment in their abilities, trust and confidence among participants was nurtured, problem solving and critical thinking skills were developed, and a continuous support system was created. The action learning process led to several positive changes in neonatal units, which enhanced the quality of care for patients. A number of challenges were also identified, mainly relating to administrative issues such as the provision of a skilled facilitator, permission to attend action learning meetings and logistical issues, including transport and other financial implications. CONCLUSIONS This paper illustrates that action learning can be an effective and practical method to support public health workers to manage their health units despite the challenges associated with the method. Time, energy and financial resources used to facilitate action learning for this cadre of health workers is rewarded by improved skills of managers and better quality of care for patients.
Collapse
Affiliation(s)
- Zandile Masango-Muzindutsi
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, 4001 South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, 4001 South Africa
| | - Aurene Wilford
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, 4001 South Africa
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, 4th Floor, George Campbell Building, Howard College Campus, Durban, 4001 South Africa
| |
Collapse
|
19
|
Diaw MM, Ndiaye M, Riccardi N, Ungaro R, Alagna R, Cirillo DM, Codecasa L, Viscoli C, Nicolini LA, Besozzi G. Implementing TB control in a rural, resource-limited setting: the stop-TB Italia project in Senegal. Multidiscip Respir Med 2018; 13:41. [PMID: 30455883 PMCID: PMC6225657 DOI: 10.1186/s40248-018-0154-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/16/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Since 2013 StopTB Italia Onlus supports the Senegalese National Tuberculosis Programme by improving diagnostic capability with technological interventions, ameliorating educational programs for health care personnel, rising awareness among civil society and providing economical support for patients during treatment. The purpose of our study was to assess the preliminary results of an interventional cooperation project in a peripheral health care facility in Senegal. Methods An observational, retrospective, pre-post study was conducted to compare Tuberculosis (TB) retention in care and outcome between a one-year period before and a four-year period after. Results Overall, 239 patients with active TB were included, 196 (82%) of whom after the starting of the collaboration project. At diagnosis 35/43(81.4%) vs 151/196 (77%) patients were smear sputum positive before and after the beginning of the project, respectively.At 2 months follow up 23/35 (65.7%) patients in 2012 vs. 139/151 (92%) patients in 2013-2016 had negative control AFB stain (p = 0.249), 4/35 (11.4%) vs 12/151 (8%) patients remained AFB stain positive (p = 0.17), 7/35 (20%) vs 0/151 died before the 2 months follow up (p < 0.0001). TB treatment outcome was more frequently favourable after the beginning of cooperation 29/43 (67.4%) vs. 176/196 (89.8%) patients, (p < 0.0001). Patients' mortality during treatment decreased from 8/43 (18.6%) in 2012 to 11/196 (5.6%) patients in the following years (p = 0.009). Conclusion The implementation of diagnostic procedures, if integrated in a socio-economical intervention, impacts favourably on TB retention in care and treatment outcomes.
Collapse
Affiliation(s)
- Mama Moussa Diaw
- Médecin coordonnateur lutte contre la TB, Région médicale de Thiès, Thiès, Sénégal.,Bureau Régional Immunisation et Surveillance Epidemiologique de Thiès, Avenue Malick SY prolongée BP 34A, Thiès, RP Sénégal
| | - Mamoudou Ndiaye
- District Sanitaire de Diofior/Département de Fatick, Diofior, Sénégal
| | - Niccolò Riccardi
- 3Infectious Diseases Clinic, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Riccardo Ungaro
- 3Infectious Diseases Clinic, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Riccardo Alagna
- 4TB Supranational Reference Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Maria Cirillo
- 4TB Supranational Reference Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Codecasa
- 5Regional TB Reference Centre, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, Italy
| | - Claudio Viscoli
- 3Infectious Diseases Clinic, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Laura Ambra Nicolini
- 3Infectious Diseases Clinic, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | | |
Collapse
|
20
|
Älgå A, Wong S, Shoaib M, Lundgren K, Giske CG, von Schreeb J, Malmstedt J. Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan. BMC Infect Dis 2018; 18:233. [PMID: 29788910 PMCID: PMC5964734 DOI: 10.1186/s12879-018-3149-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background Armed conflicts are a major contributor to injury and death globally. Conflict-related injuries are associated with a high risk of wound infection, but it is unknown to what extent infection directly relates to sustainment of life and restoration of function. The aim of this study was to investigate the outcome and resource consumption among civilians receiving acute surgical treatment due to conflict-related injuries. Patients with and without wound infections were compared. Methods We performed a cohort study using routinely collected data from 457 consecutive Syrian civilians that received surgical treatment for acute conflict-related injuries during 2014–2016 at a Jordanian hospital supported by Médecins Sans Frontières. We defined wound infection as clinical signs of infection verified by a positive culture. We used logistic regression models to evaluate infection-related differences in outcome and resource consumption. Results Wound infection was verified in 49/457 (11%) patients. Multidrug-resistance (MDR) was detected in 36/49 (73%) of patients with infection. Among patients with infection, 11/49 (22%) were amputated, compared to 37/408 (9%) without infection, crude relative risk = 2.62 (95% confidence interval 1.42–4.81). Infected patients needed 12 surgeries on average, compared to five in non-infected patients (p < .00001). Mean length of stay was 77 days for patients with infection, and 35 days for patients without infection (p = .000001). Conclusions Among Syrian civilians, infected conflict-related wounds had a high prevalence of MDR bacteria. Wound infection was associated with poor outcomes and high resource consumption. These results could guide the development of antibiotic protocols and adaptations of surgical management to improve care for wound infections in conflict-related injuries. Trial registration ClinicalTrials.gov (NCT02744144). Registered April 13, 2016. Retrospectively registered.
Collapse
Affiliation(s)
- Andreas Älgå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Sidney Wong
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | | | - Kalle Lundgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Johan von Schreeb
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Malmstedt
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
21
|
Guttikonda SNR, Vadapalli K. Approach to undifferentiated dyspnea in emergency department: aids in rapid clinical decision-making. Int J Emerg Med 2018; 11:21. [PMID: 29619581 PMCID: PMC5884754 DOI: 10.1186/s12245-018-0181-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/02/2017] [Accepted: 03/23/2018] [Indexed: 01/06/2023] Open
Abstract
Background Diagnosis and management of patients presenting with acute dyspnea is one of the major challenges for physicians in emergency department (ED). A correct diagnosis is frequently delayed and difficult to ascertain, and clinical uncertainty is common, explaining the need for rapid diagnosis and a management plan. The primary aim of our study is to assess a diagnostic strategy using multiorgan point of care ultrasonography (USG) to differentiate patients presenting with acute dyspnea to ED into different diagnostic categories for timely management in a resource-limited setting. Methods This is a prospective cohort study which assessed the diagnostic performance of a strategy in evaluating patients presenting with undifferentiated dyspnea as primary predominant complaint to ED. Focused multiorgan USG which includes cardiac USG for left ventricle systolic function, right ventricle enlargement, and pericardial effusion, inferior vena cava (IVC) diameter and collapsibility, lung USG to identify various patterns (acute interstitial syndrome, pneumothorax, pleural effusion, consolidation, etc.) and renal USG to assess kidney size and echotexture was performed. Later, patients were grouped into one of ten clinical syndromes defined in the study based on USG and clinical patterns. Emergency diagnosis was compared with final hospital diagnosis to assess the accuracy of this strategy. Results Concordance between ED diagnosis of dyspnea using the diagnostic strategy proposed in the study with final hospital diagnosis was high with agreement in 88% of patients (Kappa statistic = .805, p = .000) which is statistically significant. The most common diagnosis was acute decompensated heart failure (ADHF). Sensitivity and specificity of the diagnostic strategy used in this study to identify ADHF was 97.3 and 93.3%, respectively. On multivariate analysis, jugular venous distension, fever and cough, ejection fraction (by eyeball method), dilated IVC, absent to decreased lung sliding showed independent association in predicting cardiac and non-cardiac diagnosis. Conclusions The present study concludes that integrating focused multiorgan USG by lung-cardiac-IVC and renal ultrasound into routine clinical evaluation of patients with dyspnea has a higher accuracy for differentiating causes of dyspnea in emergency department. This strategy can be adopted even in resource limited setting.
Collapse
Affiliation(s)
- Siva Nageswara Rao Guttikonda
- Department of Internal Medicine, Rangaraya Medical College, Government General Hospital, Raja Ram Mohan Rai road, Kakinada, Andhra Pradesh, 533001, India.
| | - Kiran Vadapalli
- Department of Internal Medicine, Rangaraya Medical College, Government General Hospital, Raja Ram Mohan Rai road, Kakinada, Andhra Pradesh, 533001, India
| |
Collapse
|
22
|
Rachel M, Barbara C, Murphy C, Komujuni C, Nyakato P, Ocama P, Lamorde M, Easterbrook P, Ratanshi RP. Uptake of hepatitis B-HIV co-infection screening and management in a resource limited setting. Hepatol Med Policy 2018; 3:3. [PMID: 30288326 PMCID: PMC5918698 DOI: 10.1186/s41124-017-0030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
Background WHO hepatitis B guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for hepatitis B with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of hepatitis B screening and management of patients with hepatitis B and HIV con-infection after the implementation. Methods Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test. Statistical analysis was performed using STATA version 13. The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml. Results Number of hepatitis B screening tests increased from 800 by 2012 to 1400 in 2015. By 2015 8042/8604(93.5%) patients had been screened for hepatitis B. Overall hepatitis B positive were 359 (4.6%). 166 (81.4%) hepatitis B positives were switched to a tenofovir (TDF) containing regimen. Conclusion Our study confirms the importance of screening for hepatitis B and of using ART regimens containing tenofovir in hepatitis B co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with hepatitis B were not on tenofovir regimens, 98.1% had no hepatitis B viral loads done. Clinicians should recognize the potential for hepatitis B in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up.
Collapse
Affiliation(s)
- Musomba Rachel
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Castelnuovo Barbara
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Claire Murphy
- Centre for Communicable Diseases, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Charlene Komujuni
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Patience Nyakato
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Ponsiano Ocama
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda
| | | | | |
Collapse
|
23
|
Samuel AE, Krishna RB. Ultrasound-Guided Emergency Pericardiocentesis of a Patient with Multiple Myeloma in a Resource Limited Setting. Adv J Emerg Med 2018; 2:e9. [PMID: 31172072 DOI: 10.22114/AJEM.v0i0.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Cardiac tamponade, a variant of cardiogenic shock, is a medical emergency. A traumatic cardiac tamponade is an expected phenomenon; however, in non-traumatic events such as malignant pathology, it is usually less dramatic and takes several days or weeks to manifest. Occurrence of tamponade physiology due to pericardial effusion in a patient with multiple myeloma is a distinctly unusual entity. The involvement of a serous cavity in multiple myeloma is rare and pericardial effusion in such a case is due to restrictive cardiomyopathy or amyloidosis, a presentation late in the course of the disease that carries a grave prognosis. Case presentation: We present to you a case of a 60-year-old patient with cardiac tamponade due to pericardial effusion secondary to an advanced multiple myeloma. Due to the early diagnosis, she underwent a successful emergency pericardiocentesis with a central venous catheter under ultrasound guidance even in a resource limited emergency department (ED) of a district in southern India. She also showed marked improvement after the procedure and was transferred to the intensive care unit for further management. Conclusion: Cardiac tamponade is not an “all or none” phenomenon, but rather a continuum of findings. A high index of suspicion and timely clinical decision-making is the key for an emergency physician. Although there are several mimics for cardiac tamponade in ED, it is important for an emergency physician to be aware of such varied presentations of a disease spectrum owing to its rarity and clinical importance.
Collapse
|
24
|
Ngo-Malabo ET, Ngoupo T PA, Zekeng M, Ngono V, Ngono L, Sadeuh-Mba SA, Njouom R, Kfutwah A. A cheap and open HIV viral load technique applicable in routine analysis in a resource limited setting with a wide HIV genetic diversity. Virol J 2017; 14:224. [PMID: 29137673 PMCID: PMC5686852 DOI: 10.1186/s12985-017-0893-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/11/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV infection in Cameroon is characterized by a great viral diversity with all HIV-1 groups (M, N, O, and P) and HIV-2 in circulation. HIV group determination is very important if tailored viral load analysis and treatments are to be applied. In our laboratory, HIV viral load is carried out using two platforms; Biocentric and Abbott depending on the HIV group identified. Biocentric which quantifies HIV-1 group M is a cheap and open system useful in resource limited settings. The objective of this study was to compare the viral load analyses of serologically group-indeterminate HIV samples using the two platforms with the view of reducing cost. METHODS Consecutive samples received between March and May 2014, and between August and September 2014 in our laboratory for HIV viral load analysis were included. All these samples were analyzed for their HIV groups using an in-house ELISA serotyping test. All HIV-1 group M samples were quantified using the Biocentric test while all other known atypical samples (HIV-1 groups N, O and P) were analyzed using the Abbott technique. HIV group-indeterminate samples (by serotyping) were quantified with both techniques. RESULTS Among the 6355 plasma samples received, HIV-1 group M was identified in 6026 (94.82%) cases; HIV-1 group O, in 20 (0.31%); HIV-1 group M + O, in 3 (0.05%) and HIV-2, in 3 (0.05%) case. HIV-group indeterminate samples represented about 4.76% (303/6355) and only 231 of them were available for analysis by Abbott Real-Time HIV-1 and Generic HIV Viral Load techniques. Results showed that 188 (81.39%) samples had undetectable viral load in both techniques. All the detectable samples showed high viral load, with a mean of 4.5 log copies/ml (range 2.1-6.5) for Abbott Real-Time and 4.5 log copies/ml (range 2-6.4) for Generic HIV Viral Load. The mean viral load difference between the two techniques was 0.03 log10 copies/ml and a good correlation was obtained (r 2 = 0.89; P < 0.001). CONCLUSION Our results suggest that cheaper and open techniques such as Biocentric could be useful alternatives for HIV viral load follow-up quantification in resource limited settings like Cameroon; even with its high viral diversity.
Collapse
Affiliation(s)
| | - Paul Alain Ngoupo T
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Martin Zekeng
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Valérie Ngono
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Laure Ngono
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon.
| | - Anfumbom Kfutwah
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| |
Collapse
|
25
|
Phiri S, Neuhann F, Glaser N, Gass T, Chaweza T, Tweya H. The path from a volunteer initiative to an established institution: evaluating 15 years of the development and contribution of the Lighthouse trust to the Malawian HIV response. BMC Health Serv Res 2017; 17:548. [PMID: 28793895 PMCID: PMC5551033 DOI: 10.1186/s12913-017-2466-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/11/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The HIV epidemic has triggered the development of new health institutions with a special focus on HIV care. The role of these relatively new institutions within the health systems of low-income countries like Malawi is not clearly determined. We evaluate and describe the development of one example, the Lighthouse Trust (Lighthouse), over a period of 15 years (2000–2015). Methods Data from multiple sources, including a document review, participatory observation and interviews were analysed, triangulated and synthesized. The institution’s development, function, cooperation, financing, research and training were analysed using institutional administrative documents, annual reviews, project reports. For the assessment of the research activities, all publications that the Lighthouse contributed to were retrieved and categorized. Participatory observation and interviews with key Lighthouse staff members and external stakeholders were conducted. Results Established in 1997 as a volunteer initiative for home-based care, the Lighthouse has developed considerably. Major steps include being registered as a trust, moving into their own buildings, expanding clinical services, becoming a centre for clinical service, training and research working with close to 300 employees. As an independent legal entity, Lighthouse Trust works in close cooperation with Malawian public health services and plays an important role in the government’s HIV programme. Funding comes from various sources with a lion’s share from the US Centers for Disease Control and Prevention. Throughout 2015, the Lighthouse performed 58,210 HIV testing and counselling encounters and by year’s end, 28,302 patients were alive and on ART. From 2000 to 2015 Lighthouse staff contributed to 94 peer-reviewed publications. Conclusion Novel institutions like the Lighthouse have been developed in the response to HIV. The Lighthouse has demonstrated its capacity to deliver health services and contributed significantly to the current level of success in addressing the disease. However, this kind of institution’s position in local health care systems is still developing. The Lighthouse will need to continue to work on well-planned strategies that consider the changing landscape of health needs, health care provision and financing. Independent institutions like the Lighthouse can contribute to the development of health systems in countries like Malawi that improve health care responsiveness and quality for the entire population. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2466-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA.,Department of Public Health, University of Malawi, College of Medicine, School of Public Health and Family Medicine, Lilongwe, Malawi
| | - Florian Neuhann
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Nicola Glaser
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Vivantes Klinikum Neukölln, Kinder- und Jugendmedizin - Perinatalzentrum, Berlin, Germany
| | - Thomas Gass
- Swiss Red Cross, Bern, Switzerland.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Hannock Tweya
- Lighthouse Trust, Lilongwe, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
26
|
Stephens T, De Silva AP, Beane A, Welch J, Sigera C, De Alwis S, Athapattu P, Dharmagunawardene D, Peiris L, Siriwardana S, Abeynayaka A, Jayasinghe KSA, Mahipala PG, Dondorp A, Haniffa R. Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka. Intensive Crit Care Nurs 2016; 39:28-36. [PMID: 27890305 DOI: 10.1016/j.iccn.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/12/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity. RESEARCH METHODOLOGY A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatrick's Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014. SETTING Sri Lanka. MAIN OUTCOME MEASURES Participant learning assessed through pre/post course Multi-Choice Questionnaires. RESULTS A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p≤0.0001) in MCQ scores. There was no significant difference MCQ scores (p=0.186) between overseas faculty led and local faculty led courses. CONCLUSIONS In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability.
Collapse
Affiliation(s)
- Tim Stephens
- Critical Care Research Team, Royal London Hospital, London, United Kingdom; William Harvey Institute, Queen Mary University of London, London, United Kingdom.
| | - A Pubudu De Silva
- National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka; Intensive Care National Audit and Research Centre, London, United Kingdom.
| | - Abi Beane
- Adult Critical Care Unit, Royal London Hospital, London, United Kingdom.
| | - John Welch
- Critical Care Department, University College Hospital, London, United Kingdom.
| | - Chathurani Sigera
- National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka.
| | - Sunil De Alwis
- Office of Deputy Director General (Education, Training and Research), Ministry of Health, Colombo, Sri Lanka.
| | - Priyantha Athapattu
- National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka; Office of Director Tertiary Care Health, Ministry of Health, Colombo, Sri Lanka.
| | - Dilantha Dharmagunawardene
- Office of Deputy Director General (Education, Training and Research), Ministry of Health, Colombo, Sri Lanka.
| | - Lalitha Peiris
- Post Basic College of Nursing, Ministry of Health, Colombo, Sri Lanka.
| | - Somalatha Siriwardana
- Office of Deputy Director General (Education, Training and Research), Ministry of Health, Colombo, Sri Lanka.
| | - Ashoka Abeynayaka
- Post Basic College of Nursing, Ministry of Health, Colombo, Sri Lanka.
| | | | - Palitha G Mahipala
- Office of Director General of Health Services, Ministry of Health, Colombo, Sri Lanka.
| | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.
| | - Rashan Haniffa
- National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka; Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.
| | | |
Collapse
|
27
|
Huson MAM, Kalkman R, Grobusch MP, van der Poll T. Predictive value of the qSOFA score in patients with suspected infection in a resource limited setting in Gabon. Travel Med Infect Dis 2016; 15:76-77. [PMID: 27826072 DOI: 10.1016/j.tmaid.2016.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Michaëla A M Huson
- Center of Experimental and Molecular Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre des Recherches Médicales de Lambaréné, Lambaréné, Gabon.
| | - Rachel Kalkman
- Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre des Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
28
|
Bigna JJR, Plottel CS, Koulla-Shiro S. Challenges in initiating antiretroviral therapy for all HIV-infected people regardless of CD4 cell count. Infect Dis Poverty 2016; 5:85. [PMID: 27593965 PMCID: PMC5011352 DOI: 10.1186/s40249-016-0179-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
Introduction Recently published large randomized controlled trials, START, TEMPRANO and HPTN 052 show the clinical benefit of early initiation of antiretroviral treatment (ART) in HIV-infected persons and in reducing HIV transmission. The trials influenced the World Health Organization (WHO) decision to issue updated recommendations to prescribe ART to all individuals living with HIV, irrespective of age and CD4 cell count. Discussion It is clear that the new 2015 WHO recommendations if followed, will change the face of the HIV epidemic and probably curb its burden over time. Implementation however, requires that health systems, especially those in low and middle-income settings, be ready to face this challenge on a large scale. HIV prevention and treatment are easy in theory yet hard in practice. The new WHO guidelines for initiation of ART regardless of CD4 cell count will lead to upfront increases in the costs of healthcare delivery as the goal is to treat all those now newly eligible for ART. Around 22 million people living with HIV qualify and will therefore require ART. Related challenges immediately follow: firstly, that everyone must be tested for HIV; secondly, that anyone who has had an HIV test should know their result and understand its significance; and, thirdly, that every person identified as HIV-positive should receive and remain on ART. The emergence of HIV drug resistant strains when treatment is started at higher CD4 cell count thresholds is a further concern as persons on HIV treatment for longer periods of time are at increased risk of intermittent medication adherence. Conclusions The new WHO recommendations for ART are welcome, but lacking as they fail to consider meaningful solutions to the challenges inherent to implementation. They fail to incorporate actual strategies on how to disseminate and adopt these far-reaching guidelines, especially in sub-Saharan Africa, an area with weak healthcare infrastructures. Well-designed, high-quality research is needed to assess the feasibility, safety, acceptability, impact, and cost of innovations such as the universal voluntary testing and immediate treatment approaches, and broad consultation must address community, human rights, ethical, and political concerns. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0179-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jean Joel R Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, 451, Rue 2005, P.O. Box 1274, Yaounde, Cameroon. .,Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France.
| | - Claudia S Plottel
- Department of Medicine, Division of Translational Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Sinata Koulla-Shiro
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon.,Infectious Diseases Unit, Yaounde Central Hospital, Yaounde, Cameroon
| |
Collapse
|
29
|
Park E, Masupe T, Joseph J, Ho-Foster A, Chavez A, Jammalamadugu S, Marek A, Arumala R, Ketshogileng D, Littman-Quinn R, Kovarik C. Information needs of Botswana health care workers and perceptions of wikipedia. Int J Med Inform 2016; 95:8-16. [PMID: 27697235 DOI: 10.1016/j.ijmedinf.2016.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Since the UN Human Rights Council's recognition on the subject in 2011, the right to access the Internet and information is now considered one of the most basic human rights of global citizens [1,2]. Despite this, an information gap between developed and resource-limited countries remains, and there is scant research on actual information needs of workers themselves. The Republic of Botswana represents a fertile ground to address existing gaps in research, policy, and practice, due to its demonstrated gap in access to information and specialists among rural health care workers (HCWs), burgeoning mHealth capacity, and a timely offer from Orange Telecommunications to access Wikipedia for free on mobile platforms for Botswana subscribers. OBJECTIVES In this study, we sought to identify clinical information needs of HCWs of Botswana and their perception of Wikipedia as a clinical tool. METHODS Twenty-eight facilitated focus groups, consisting of 113 HCWs of various cadres based at district hospitals, clinics, and health posts around Botswana, were employed. Transcription and thematic analysis were performed for those groups. RESULTS Access to the Internet is limited at most facilities. Most HCWs placed high importance upon using Botswana Ministry of Health (MoH) resources for obtaining credible clinical information. However, the clinical applicability of these materials was limited due to discrepancies amongst sources, potentially outdated information, and poor optimization for time-sensitive circumstances. As a result, HCWs faced challenges, such as loss of patient trust and compromises in patient care. Potential solutions posed by HCWs to address these issues included: multifaceted improvements in Internet infrastructure, access to up-to-date information, transfer of knowledge from MoH to HCW, and improving content and applicability of currently available information. Topics of clinical information needs were broad and encompassed: HIV, TB (Tuberculosis), OB/GYN (Obstetrics and Gynecology), and Pediatrics. HCW attitudes towards Wikipedia were variable; some trusted Wikipedia as a reliable point of care information resource whereas others thought that its use should be restricted and monitored by the MoH. CONCLUSIONS There is a demonstrated need for accessible, reliable, and up-to-date information to aid clinical practice in Botswana. Attitudes towards Wikipedia as an open information resource tool are at best, split. Therefore, future studies are necessary to determine the accuracy, currency, and relevancy of Wikipedia articles on the health topics identified by health care workers as areas of information need. More broadly speaking, future efforts should be dedicated to configure a quality-controlled, readily accessible mobile platform based clinical information application tool fitting for Botswana.
Collapse
|
30
|
Takuva S, Evans D, Zuma K, Okello V, Louwagie G. Comparative durability of nevirapine versus efavirenz in first-line regimens during the first year of initiating antiretroviral therapy among Swaziland HIV-infected adults. Pan Afr Med J 2013; 15:5. [PMID: 23847702 PMCID: PMC3708322 DOI: 10.11604/pamj.2013.15.5.1889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/03/2013] [Indexed: 11/11/2022] Open
Abstract
Nevirapine (NVP) and Efavirenz (EFV) have generally comparable clinical and virologic efficacy. However, data comparing NVP durability to EFV are imprecise. We analyzed cohort data to compare durability of NVP to EFV among patients initiating ART in Mbabane, Swaziland. The primary outcome was poor regimen durability defined as any modification of NVP or EFV to the ART regimen. Multivariate Cox proportional hazards models were employed to estimate the risk of poor regimen durability (all-cause) for the two regimens and also separately to estimate risk of drug-related toxicity. We analyzed records for 769 patients initiating ART in Mbabane, Swaziland from March 2006 to December 2007. 30 patients (3.9%) changed their NVP or EFV-based regimen during follow up. Cumulative incidence for poor regimen durability was 5.3% and 2.7% for NVP and EFV, respectively. Cumulative incidence for drug-related toxicity was 1.9% and 2.7% for NVP and EFV, respectively. Burden of TB was high and 14 (46.7%) modifications were due to patients substituting NVP due to beginning TB treatment. Though the estimates were imprecise, use of NVP - based regimens seemed to be associated with higher risk of modifications compared to use of EFV - based regimens (HR 2.03 95%CI 0.58 - 7.05) and NVP - based regimens had a small advantage over EFV - based regimens with regard to toxicity - related modifications (HR 0.87 95%CI 0.26 - 2.90). Due to the high burden of TB and a significant proportion of patients changing their ART regimen after starting TB treatment, use of EFV as the preferred NNRTI over NVP in high TB endemic settings may result in improved first-line regimen tolerance. Further studies comparing the cost-effectiveness of delivering these two NNRTIs in light of their different limitations are required.
Collapse
Affiliation(s)
- Simbarashe Takuva
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | | | | | | |
Collapse
|