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Zita CS, Villa GG, Matediana E, Tomás P, Pizzol D, Smith L. Successful management of prolonged abdominal pregnancy in low-resource setting: a case report. J Surg Case Rep 2024; 2024:rjae210. [PMID: 38572278 PMCID: PMC10989292 DOI: 10.1093/jscr/rjae210] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Ectopic pregnancy is a life-threatening complication of pregnancy and represents the leading cause of maternal mortality in the first trimester. In developing countries early diagnosis, necessary for favorable outcomes, is often unavailable and women are often not aware of possible conditions and associated complications. Moreover, access to sexual and reproductive health services and antenatal care are limited in such settings. Finally, management options are restricted and often performed in emergency with higher risk of complications and mortality. We report here a 33-year-old woman presenting a 41 weeks abdominal pregnancy successfully managed in a low-resource setting.
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Affiliation(s)
- Cátia Samajo Zita
- Department of Obstetrics and Gynecology, Central Hospital of Beira, 1363 Beira, Mozambique
| | - Gonzalo Gonzáles Villa
- Department of Obstetrics and Gynecology, Central Hospital of Beira, 1363 Beira, Mozambique
| | - Eduardo Matediana
- Department of Obstetrics and Gynecology, Central Hospital of Beira, 1363 Beira, Mozambique
| | - Pita Tomás
- Department of Obstetrics and Gynecology, Central Hospital of Beira, 1363 Beira, Mozambique
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, 1363 Beira, Mozambique
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, CB1 1PT Cambridge, United Kingdom
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Fonkoue L, Tissingh EK, Ngouateu MT, Muluem KO, Ngongang O, Mbouyap P, Ngougni Pokem P, Fotsing K, Bahebeck J, McNally M, Cornu O. The Microbiological Profile and Antibiotic Susceptibility of Fracture Related Infections in a Low Resource Setting Differ from High Resource Settings: A Cohort Study from Cameroon. Antibiotics (Basel) 2024; 13:236. [PMID: 38534671 DOI: 10.3390/antibiotics13030236] [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: 02/05/2024] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Fracture-related infection (FRI) is a common and devastating complication of orthopedic trauma in all settings. Data on the microbiological profile and susceptibility of FRI to antibiotics in low-income countries are scarce. Therefore, this study aimed to investigate the microbial patterns and antimicrobial susceptibility of FRI in a sub-Saharan African setting in order to provide guidance for the formulation of evidence-based empirical antimicrobial regimens. We conducted a retrospective analysis of patients treated for FRI with deep tissue sampling for microbiological culture from January 2016 to August 2023 in four tertiary-level hospitals in Yaoundé, Cameroon. There were 246 infection episodes in 217 patients. Cultures were positive in 209 (84.9%) cases and polymicrobial in 109 (44.3%) cases. A total of 363 microorganisms from 71 different species were identified, of which 239 (65.8%) were Gram-negative. The most commonly isolated pathogens were Staphylococcus aureus (n = 69; 19%), Enterobacter cloacae (n = 43; 11.8%), Klebsiella pneumoniae (n = 35; 9.6%), Escherichia coli (n = 35; 9.6%), and Pseudomonas aeruginosa (n = 27; 7.4%). Coagulase-negative staphylococci (CoNS) were isolated in only 21 (5.9%) cases. Gram-negative bacteria accounted for the majority of the infections in early (70.9%) and delayed (73.2%) FRI, but Gram-positive bacteria were prevalent in late FRI (51.7%) (p < 0.001). Polymicrobial infections were more frequent in the early (55.9%) and delayed (41.9%) groups than in the late group (27.6%) (p < 0.001). Apart from Staphylococcus aureus, there was no significant difference in the proportions of causative pathogens between early, delayed, and late FRI. This study found striking resistance rates of bacteria to commonly used antibiotics. MRSA accounted for 63% of cases. The most effective antibiotics for all Gram-positive bacteria were linezolid (96.4%), vancomycin (92.5%), clindamycin (85.3%), and fucidic acid (89.4%). For Gram-negative bacteria, only three antibiotics displayed a sensitivity >50%: amikacin (80.4%), imipenem (74.4%), and piperacillin + tazobactam (57%). The most effective empirical antibiotic therapy (with local availability) was the combination of vancomycin and amikacin or vancomycin and imipenem. In contrast to the literature from high-resource settings, this study revealed that in a sub-Saharan African context, Gram-negative bacteria are the most common causative microorganisms of FRI. This study revealed striking resistance rates to commonly used antibiotics, which will require urgent action to prevent antimicrobial resistance in low and middle-income countries.
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Affiliation(s)
- Loïc Fonkoue
- Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaounde P.O. Box 5408, Cameroon
- Department of Surgery and Specialties, University of Yaounde 1, Yaounde P.O. Box 1364, Cameroon
- Experimental and Clinical Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Elizabeth K Tissingh
- Royal National Orthopedic Hospital NHS TRUST, London HA7 4LP, UK
- King's Global Health Partnerships, School of Life Course and Population Sciences, King's College London, London SE1 1UL, UK
| | | | - Kennedy Olivier Muluem
- Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaounde P.O. Box 5408, Cameroon
- Department of Surgery and Specialties, University of Yaounde 1, Yaounde P.O. Box 1364, Cameroon
| | - Olivier Ngongang
- Department of Surgery and Specialties, University of Yaounde 1, Yaounde P.O. Box 1364, Cameroon
| | - Pretty Mbouyap
- Department of Microbiology, Centre Pasteur du Cameroun, Yaoundé P.O. Box 1274, Cameroon
| | - Perrin Ngougni Pokem
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
- Department of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Kuetche Fotsing
- Department of Microbiology, Université des Montagnes, Bangante P.O. Box 208, Cameroon
| | - Jean Bahebeck
- Department of Surgery and Specialties, University of Yaounde 1, Yaounde P.O. Box 1364, Cameroon
| | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 7HE, UK
| | - Olivier Cornu
- Experimental and Clinical Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
- Department of Orthopedics and Trauma, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Harb R, Tuggey R, Ladenson JH, Amukele T. Remote support of an external quality assessment program in 10 laboratories in Bhutan, Uganda, and Malawi: Pathologists Overseas experience between 2009 and 2017. Am J Clin Pathol 2024:aqae009. [PMID: 38387037 DOI: 10.1093/ajcp/aqae009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES This article describes Pathologists Overseas (PO) experience supporting external quality assessment (EQA) programs in 10 clinical laboratories across 3 countries between 2009 and 2017. METHODS Laboratories were enrolled in the condensed chemical pathology EQA program provided by the Royal College of Pathologists of Australasia Quality Assurance Program. Participants were given an initial 2- to 4-day in-person training, followed by 1 year of active feedback on performance via emails or phone calls by a PO volunteer. RESULTS There were 2 performance metrics: percentage of reported results as a measure of compliance and percentage of acceptable reported results as a measure of accuracy. Laboratories demonstrated high compliance with result reporting, with medians of 69.9%, 71.7%, and 81.3% before, during, and after feedback, respectively. Concomitant medians for the percentage of acceptable reported results were 41.2%, 57.3%, and 53.5%, respectively. Six laboratories had low performance in terms of accuracy at baseline (<60%). Active feedback improved the percentage of acceptable reported results for these lower-performing laboratories. CONCLUSIONS External quality assessment programs can be successfully adopted long term by laboratories in low-resource settings. Active feedback requires significant time and effort but could be especially beneficial for laboratories with poor baseline performance.
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Affiliation(s)
- Roa Harb
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, US
| | | | - Jack H Ladenson
- Pathologists Overseas, Fullerton, CA, US
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine Washington University School of Medicine, St Louis, MO, US
| | - Timothy Amukele
- Pathologists Overseas, Fullerton, CA, US
- ICON Clinical Laboratories, Farmingdale, NY, US
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Tomobi O, Avoian S, Ekwere I, Waghmare S, Diaban F, Davis G, Sy Y, Ogbonna O, Streete K, Aryee E, Kulasingham V, Sampson JB. A comparative analysis of intravenous infusion methods for low-resource environments. Front Med (Lausanne) 2024; 11:1326144. [PMID: 38444409 PMCID: PMC10912611 DOI: 10.3389/fmed.2024.1326144] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/19/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Intravenous (IV) therapy is a crucial aspect of care for the critically ill patient. Barriers to IV infusion pumps in low-resource settings include high costs, lack of access to electricity, and insufficient technical support. Inaccuracy of traditional drop-counting practices places patients at risk. By conducting a comparative assessment of IV infusion methods, we analyzed the efficacy of different devices and identified one that most effectively bridges the gap between accuracy, cost, and electricity reliance in low-resource environments. Methods In this prospective mixed methods study, nurses, residents, and medical students used drop counting, a manual flow regulator, an infusion pump, a DripAssist, and a DripAssist with manual flow regulator to collect normal saline at goal rates of 240, 120, and 60 mL/h. Participants' station setup time was recorded, and the amount of fluid collected in 10 min was recorded (in milliliters). Participants then filled out a post-trial survey to rate each method (on a scale of 1 to 5) in terms of understandability, time consumption, and operability. Cost-effectiveness for use in low-resource settings was also evaluated. Results The manual flow regulator had the fastest setup time, was the most cost effective, and was rated as the least time consuming to use and the easiest to understand and operate. In contrast, the combination of the DripAssist and manual flow regulator was the most time consuming to use and the hardest to understand and operate. Conclusion The manual flow regulator alone was the least time consuming and easiest to operate. The DripAssist/Manual flow regulator combination increases accuracy, but this combination was the most difficult to operate. In addition, the manual flow regulator was the most cost-effective. Healthcare providers can adapt these devices to their practice environments and improve the safety of rate-sensitive IV medications without significant strain on electricity, time, or personnel resources.
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Affiliation(s)
- Oluwakemi Tomobi
- Department of Anesthesiology, West Virginia University, Morgantown, WV, United States
- Division of Health, Science, and Technology, Howard Community College, Columbia, MD, United States
| | - Samantha Avoian
- University of Texas at Southwestern, Dallas, TX, United States
| | - Ifeoma Ekwere
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Shivani Waghmare
- Howard University College of Medicine, Washington, DC, United States
| | - Fatima Diaban
- Advocate Aurora Health, Downers Grove, IL, United States
| | - Gabrielle Davis
- Howard University College of Medicine, Washington, DC, United States
| | - Yacine Sy
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluchi Ogbonna
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kevin Streete
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ebenezer Aryee
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vasanthini Kulasingham
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - John B. Sampson
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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John A, M J, Rubeshkumar P, Ganeshkumar P, Masanam Sriramulu H, Narnaware M, Singh Bedi G, Kaur P. Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India. JMIR Form Res 2023; 7:e42798. [PMID: 37235721 PMCID: PMC10758940 DOI: 10.2196/42798] [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: 09/19/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.
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Affiliation(s)
- Alby John
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Jagadeesan M
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | - Polani Rubeshkumar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | | | | | - Manish Narnaware
- Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India
| | | | - Prabhdeep Kaur
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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6
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Mohamedsharif A, Elfeaki M, Bushra R, Gemperli A. Effectiveness of hospital-to-home transitional care interventions and consultation for implementation in Sudan: a scoping review of systematic reviews. Front Health Serv 2023; 3:1288575. [PMID: 38162192 PMCID: PMC10755884 DOI: 10.3389/frhs.2023.1288575] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
Background Hospital discharge is often associated with a lack of continuity resulting in fragmented care, particularly in low-income countries. As there is limited information about interventions in these countries and no study evaluating the effectiveness of hospital discharge interventions, we conducted a scoping review to identify effective hospital-to-home transitional care interventions and explore their applicability in a low-income country (Sudan). Methods Our scoping review of systematic reviews and meta-analyses classed interventions as effective, ineffective, undesirable, or uncertain, based on the quality of their evidence and their estimated effects on the following outcomes: readmission rates, mortality, costs, quality of life, and adverse outcomes) and certainty of evidence. Our authors from Sudan used the SUPPORT summary tool to determine if three effective interventions could be implemented in Sudan. Results Out of 3,276 articles that were identified, and 72 articles were reviewed, 10 articles has been included in the review. Seven interventions were classified as effective, one as ineffective, and none with undesirable effects. Eight interventions were classified as having an uncertain effect. The effective interventions were composed of home visits, information and communication technology (ICT), case manager models, multidisciplinary teams, and self-management support. Conclusions The finding of this study suggested that a combining two to four interventions can improve enhance hospital-to-home transitional care. Effective interventions are composed of home visits, ICT, case manager models, multidisciplinary teams, and self-management support. The implementation of these interventions in Sudan was found to be undermined by contextual factors such as inadequate human resources, telecommunication instability, and inequality in accessibility. These interventions could be tailored based on an in-depth understanding of the contextual factors in low-income countries that influence implementation. Systematic Review Registration https://osf.io/9eqvr/, doi: 10.17605/OSF.IO/9EQVR.
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Affiliation(s)
- Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mohammed Elfeaki
- Directorate of Quality, Development and Accreditation, Federal Ministry of Health, Khartoum, Sudan
| | - Rayan Bushra
- Department of General Medicine, Ibrahim Malik Teaching Hospital, Khartoum, Sudan
| | - Armin Gemperli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Mossenson A, Upadhye V, Livingston P. Developing simulation educator skills globally through the Vital Anaesthesia Simulation Training community of practice. Br J Anaesth 2023; 131:e190-e192. [PMID: 37858480 DOI: 10.1016/j.bja.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Adam Mossenson
- Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Perth, WA, Australia; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada; Curtin Medical School, Curtin University, Perth, WA, Australia.
| | - Vaibhavi Upadhye
- Department of Anaesthesiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Patricia Livingston
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Katumba JD, Kirenga B, Muwagga Mugagga A, Kalyango JN, Nantanda R, Karamagi C. MICROS: Asthma Control App for School Adolescents in a Low Resource Setting - A Cluster Randomized Controlled Trial Protocol. Patient Prefer Adherence 2023; 17:3125-3133. [PMID: 38053534 PMCID: PMC10695141 DOI: 10.2147/ppa.s438549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Poor asthma control in adolescents is partly attributed to inadequate asthma education for self-management. This study is set to determine the effectiveness of the "KmAsthma" self-management app in improving the control of asthma among adolescents in a low-resource setting. Methods The two-arm 6-month cluster randomized controlled trial, will aim at enrolling 120 day scholars aged 12-19 years in secondary schools with a clinician's diagnosis and self-reported uncontrolled asthma in Kampala City Uganda. The primary endpoint of asthma control will be measured as a change in mean Asthma Control Test (ACT) scores. Asthma quality of life, adherence to medications, and self-efficacy will also be assessed. The iMprovIng the ContROl of aSthma (MICROS) study will employ the "KmAsthma" app for self-management education. The intervention group will receive the app on their smartphones and training on its eight sections: the profile, asthma history, goals, inspirations, reminders, connect, information about asthma, and emergency support. Participants will navigate these sections to set asthma control goals, schedule medication reminders, log daily symptoms, and receive guidance for attacks. All participants will be encouraged to seek routine care. A study nurse will follow up with each participant via the phone six weeks post-intervention. The MICROS study was approved by the Makerere University School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. This protocol is registered on Clinicaltrials.gov (NCT05850806). Conclusion The MICROS study will provide comprehensive insights into how effective a mHealth intervention can be an aid for adolescents in a low-resource setting in managing their asthma. The findings of this study will contribute to filling the gap leading to unsatisfactory asthma control in adolescents.
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Affiliation(s)
- James Davis Katumba
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Nantanda
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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Jensen MA, Bhandarkar AR, Bauman MMJ, Riviere-Cazaux C, Wang K, Carlstrom LP, Graffeo CS, Spinner RJ. The LazyBox Educational Intervention Trial: Can Longitudinal Practice on a Low-Fidelity Microsurgery Simulator Improve Microsurgical Skills? Cureus 2023; 15:e49675. [PMID: 38161921 PMCID: PMC10757503 DOI: 10.7759/cureus.49675] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Every surgical trainee must acquire microsurgical skills within a limited timeframe. Therefore, identifying effective educational strategies to help learners attain these skills is crucial. Objective Establish the effectiveness of a low-fidelity microsurgery simulator to improve the execution and one's perception of the difficulty of basic surgical techniques. Methods From 2021 to 2022, 24 medical students were randomized to either (1) a treatment group (n=12) that engaged in longitudinal practice on a low-fidelity microsurgery simulator (the LazyBox) or (2) a control group (n=12) that did not practice. Students performed vessel loop ligation, catheter macroanastomosis, and synthetic vessel microanastomosis prior to and six weeks after intervention. Both objective metrics and subjective metrics (Swedish Occupational Fatigue Inventory (SOFI) and Surgery Task Load Index (SURG-TLX)) were obtained. Results The treatment and control arms had 1.2 (SD = 2.6) and 2.1 (SD = 2.4) points increase in the vessel loop ligation, respectively (p = 0.39). The treatment and control arms had a 3.4 (SD = 4.1) and 2.9 (SD = 3.6) points increase in the macroanastomosis task, respectively (p = 0.74). In the synthetic vessel microanastomosis task training, the experimental and control arms showed a 5.4 (SD = 8.3) and a 2.9 (SD = 5.6) points increase, respectively (p = 0.30). No differences were found between the groups regarding survey metrics of mental (p = 0.82), temporal (p = 0.23), and physical demands (p = 0.48). Conclusion In our randomized educational intervention, we found no significant difference in objective and subjective metrics of microsurgical task performance between learners who did and did not use the LazyBox simulator.
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Affiliation(s)
- Michael A Jensen
- Neurosurgery, Mayo Clinic Alix School of Medicine, Rochester, USA
| | | | - Megan M J Bauman
- Neurosurgery, Mayo Clinic Alix School of Medicine, Rochester, USA
| | | | - Kimberly Wang
- Neurosurgery, Mayo Clinic Alix School of Medicine, Rochester, USA
| | | | | | - Robert J Spinner
- Neurosurgery, Mayo Clinic Alix School of Medicine, Rochester, USA
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10
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Ward M, Chadwick B, Abraham D. Dropper method for cytology slide staining: An effective and sustainable approach to eliminating cross contamination. Diagn Cytopathol 2023; 51:636-638. [PMID: 37403898 DOI: 10.1002/dc.25191] [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: 04/21/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
Cytopathology laboratories must ensure effective measures to prevent cross-contamination during slide staining. As such, slides with high potential for cross-contamination are usually stained separately, by dipping slides into a series of Romanowsky-type stains, with periodic (usually weekly) filtering and replacement of stains used. Our 5-year experience and a validation study of an alternative dropper method is presented. In this method, cytology slides are placed in a staining rack, a small amount of stain is applied to each using a dropper. Because of the small amount of stain used, this dropper method requires no filtering or reuse of stain, eliminating the possibility of cross contamination and reducing the total amount of stain used. In our 5-year experience, we report a complete elimination of cross contamination due to staining, excellent staining quality, and a slight reduction in overall stain expenditure.
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Affiliation(s)
- Michael Ward
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- Anatomic Pathology Division, ARUP Laboratories, Salt Lake City, Utah, USA
| | - Barbara Chadwick
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- Anatomic Pathology Division, ARUP Laboratories, Salt Lake City, Utah, USA
| | - Dev Abraham
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
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11
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Pokharel P, Jha SK, Adhikari A, Katwal S, Ghimire S, Shrestha AB, Poudel N. Non-adherence to anti-hypertensive medications in a low-resource country Nepal: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:4520-4530. [PMID: 37663734 PMCID: PMC10473346 DOI: 10.1097/ms9.0000000000001088] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background Nepal is a low resource country with cardiovascular diseases being the number one cause of mortality. Despite hypertension being the single most important risk factor for cardiovascular diseases, non-adherence to anti-hypertensive medications has not been assessed systematically. So, this systematic review and meta-analysis aims to analyze the prevalence of non-adherence to anti-hypertensive medications in Nepal. Methodology This systematic review and meta-analysis was piloted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases of Embase, PubMed, Scopus, Web of Science, Cochrane Library, Cinhal Plus, and Google Scholar were searched from inception till 1 February 2023. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate. Results Altogether, 14 studies with a total of 3276 hypertensive patients were included in the meta-analysis. The pooled prevalence of non-adherence to anti-hypertensive medications was 49% (95% CI: 0.37-0.62, I2=98.41%, P<0.001). The non-adherence rate using Morisky Medication Adherence Scale (MMAS) was 55% (95% CI: 0.34-0.76, I2=99.14%, P<0.001), and using Hill-Bone Compliance Scale, the non-adherence rate was 45% (95% CI: 0.37-0.54, I2=84.36%, P<0.001). In subgroup analysis, the non-adherence was higher in rural areas 56% (95% CI: 0.51-0.61, I2=0.0%, P=0.46) compared to urban areas 42% (95% CI: 0.31-0.54, I2=96.90%, P<0.001). The trend of non-adherence was increasing after 2020. Additionally, forgetfulness, carelessness, cost of medications, number of comorbidities, and using an alternate form of medication were common factors associated with non-adherence. Conclusions This meta-analysis showed that half of the hypertensive population of Nepal are non-adherent to their anti-hypertensive medications, thereby posing a significant long-term cardiovascular consequence among Nepali population.
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Affiliation(s)
| | - Saroj Kumar Jha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | | | | | - Sagun Ghimire
- KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | | | - Nahakul Poudel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
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12
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Orsi M, Janneh FM, Sesay A, Bah AK, Tiru NA. A Clinical and Ethical Dilemma: Expectant Management for Ectopic Pregnancy with a Vital Fetus in a Low-Resource Setting. J Clin Med 2023; 12:5642. [PMID: 37685709 PMCID: PMC10488410 DOI: 10.3390/jcm12175642] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Guidelines recommend the prompt surgical removal of any ectopic pregnancy (EP) in the presence of a vital embryo. This treatment impacts future fertility, particularly in low-resource settings where access to assisted reproductive techniques is limited. In addition, growing evidence is reporting live births after conservative management of initially undiagnosed abdominal pregnancies. Therefore, the discussion on the acceptability of expectant management in selected cases has been recently raised. CASE We present and discuss the case of a woman with vital first trimester EP who refused surgical treatment at Princess Christian Maternity Hospital, Freetown, Sierra Leone. She was initially diagnosed with a 12 week pregnancy located in the left adnexal region without hemoperitoneum. She refused both surgical treatment and hospital admission and did not come back to the hospital for antenatal care until 26 weeks of gestational age. Therefore, she was admitted and finally delivered, at 34 weeks of gestation, a 1.9 kg healthy baby which was alive. To disentangle the potential conflict between the ethical principles of medical treatment's beneficence and the patient's autonomy, we provide an update on counselling for a patient with early vital EP in a resource-limited setting and discuss the knowledge gap in this area. CONCLUSIONS Limited access to fertility treatment in low- and middle-income countries may justify the discussion of expectant management as an option in selected cases of uncomplicated vital EP.
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Affiliation(s)
- Michele Orsi
- Unit of Obstetrics, Department of Woman Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
| | - Foday Musa Janneh
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra Leone
| | - Amadu Sesay
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra Leone
| | - Abdul Karim Bah
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra Leone
| | - Nitsuh Addis Tiru
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospital Complex, Fourah Bay Road, Freetown 00232, Sierra Leone
- Doctors with Africa CUAMM, Via San Francesco, 126, 35121 Padova, Italy
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13
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ORCA Study Group. Open tibial shaft fractures: treatment patterns in sub-Saharan Africa. OTA Int 2023; 6:e228. [PMID: 36919118 DOI: 10.1097/OI9.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/21/2022] [Accepted: 10/17/2022] [Indexed: 06/18/2023]
Abstract
Objective Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented. Methods A survey was distributed to orthopaedic service providers across sub-Saharan Africa. Information gathered included surgeon and practice setting demographics and treatment preferences for open tibial shaft fractures across 3 domains: initial debridement, antibiotic administration, and fracture stabilization. Responses were grouped according to country income level and were compared between LMICs and upper middle-income countries (UMICs). Results Responses from 261 survey participants from 31 countries were analyzed, with 80% of respondents practicing in LMICs. Most respondents were male practicing orthopaedic surgeons at a tertiary referral hospital. For all respondents, initial debridement occurred most frequently in the operating room (OR) within the first 24 hours, but LMIC surgeons more frequently reported delays due to equipment availability, treatment cost, and OR availability. Compared with their UMIC counterparts, LMIC surgeons less frequently confirmed tetanus vaccination status and more frequently used extended courses of postoperative antibiotics. LMIC surgeons reported lower rates of using internal fixation, particularly for high-grade and late-presenting fractures. Conclusions This study describes management characteristics of open tibial shaft fractures in sub-Saharan Africa. Notably, there were reported differences in wound management, antibiotic administration, and fracture stabilization between LMICs and UMICs. These findings suggest opportunities for standardization where evidence is available and further research where it is lacking. Level of Evidence VI-Cross-Sectional Study.
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Irfanullah EA, Chandra A, Solaiman RH, Siems C, Chethan S, Belani K, Harmon J. Simulation Training in a Lower Middle-Income Country: Supporting a New Center and Developing Low-Cost Models for Critical Skill Acquisition. Cureus 2023; 15:e40950. [PMID: 37503495 PMCID: PMC10368800 DOI: 10.7759/cureus.40950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION There is a demand for surgical simulation training to be made accessible in low-resource countries. We conducted a pilot workshop at a new state-of-the-art simulation center and evaluated two novel low-cost surgical simulation models in a lower middle-income country (LMIC). METHODS A hands-on workshop to train local educators about simulation training was held at a new simulation center. Participant surveys were analyzed following the "training-the-trainer" workshop. Low-cost, hybrid-fidelity pericardiocentesis and thoracic cavity simulation training models were created using locally available materials. These models recreated the pertinent anatomy at a cost under 20 US dollars each. The models were used to train 109 postgraduate anesthesiology trainees during two hands-on medical education workshops. Participant surveys were collected and analyzed. RESULTS Of the local educators who participated in the "training-the-trainer" workshop, 65% "agreed" and 35% "strongly agreed" with the claim that the simulations better prepared the trainees to teach the clinical scenarios. Additionally, 65% of local educators "agreed" and 35% "strongly agreed" that the simulations prepared them to navigate interprofessional care in those scenarios. The low-cost pericardiocentesis simulation was ranked as "good" or "outstanding" by 100% of survey respondents. The low-cost thoracostomy simulation was ranked as "good" or "outstanding" by 64% of survey respondents. Both the pericardiocentesis and thoracostomy simulators were valued for their low-cost design, the recreation of essential anatomy, and immersive design elements. CONCLUSION Our team successfully implemented novel simulators for skill training in an LMIC by working in close collaboration with local experts, with the advancement of local simulation instruction practices. Collaboration is key to increasing access to surgical simulations, particularly in low- to middle-income countries.
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Affiliation(s)
- Eesha A Irfanullah
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Abhishek Chandra
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Rafat H Solaiman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Chesney Siems
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | | | - Kumar Belani
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, USA
| | - James Harmon
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
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Balvanz P, Singh B, Mwikoko G, Yamanis TJ, Kilonzo MN, Conserve DF, Mulawa MI, Kajuna D, Kajula LJ, Maman S. Development and implementation of a process evaluation for intervention quality improvement of a community-based behavioral HIV intervention trial in Tanzania. Z Gesundh Wiss 2023; 31:877-884. [PMID: 37621988 PMCID: PMC10448665 DOI: 10.1007/s10389-021-01618-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Aim Process evaluations for social and behavioral interventions are increasingly important as interventions become more complex and multi-faceted. Conducting process evaluations in low-resource international settings can be challenging. Process evaluations in low-resource international settings can help inform and improve quality of ongoing intervention implementation. We conducted a process evaluation of a cluster-randomized controlled trial to assess the efficacy of a microfinance and health leadership program on sexually transmitted infections and intimate partner violence perpetration among young men in Tanzania. Subject and Methods Our trial included 1,491 participants and the intervention lasted two years. We collected process data on microfinance loan uptake and repayment, and health leaders' health conversations with peers to monitor intervention reach and dose received. We developed a database system that allowed offline data collection and synced to a central database when internet was accessible. Research staff in the U.S. accessed data from the central database to analyze and create regular implementation reports. Results Process graphical reports facilitated identification of implementation challenges and enabled us to resolve issues before they worsened. For example, from a group with low microfinance loan repayment we learned area participants perceived the loan to be a grant, and then we clarified the misinformation with participants. Conclusions The process evaluation helped inform ongoing intervention implementation, including approaches to improve reach and uptake of interventions. Field staff time was protected by systemizing the sharing of data processing and analyses across the global team.
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Affiliation(s)
- Peter Balvanz
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599
| | - Basant Singh
- Independent Consultant, A-14, SKL Elite, Vaishali Estate. Jaipur, India 302012
| | - Gema Mwikoko
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina J. Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016
| | - Mrema N. Kilonzo
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Donaldson F. Conserve
- University of South Carolina, Arnold School of Public Health, Health Promotion, Education, and Behavior. 921 Assembly St, Columbia, SC 29208
| | - Marta I. Mulawa
- Duke Global Health Institute, Duke University, 310 Trent Dr., Box 90519, Durham, NC 27708
| | - Deus Kajuna
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Lusajo J. Kajula
- Muhimbili University of Health and Allied Sciences, Department of Psychiatry and Mental Health, PO Box 65466, Dar es Salaam, Tanzania
| | - Suzanne Maman
- The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Rosenau Hall, CB 7440, Chapel Hill, NC 27599
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Rossi E, Maziku DM, Leluko DE, Guadagno C, Brasili L, Azzimonti G, Putoto G, Pietravalle A, Cavallin F, Trevisanuto D. Rewarming rate of hypothermic neonates in a low-resource setting: a retrospective single-center study. Front Pediatr 2023; 11:1113897. [PMID: 37228438 PMCID: PMC10203202 DOI: 10.3389/fped.2023.1113897] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Hypothermic neonates need to be promptly rewarmed but there is no strong evidence to support a rapid or a slow pace of rewarming. This study aimed to investigate the rewarming rate and its associations with clinical outcomes in hypothermic neonates born in a low-resource setting. Methods This retrospective study evaluated the rewarming rate of hypothermic inborn neonates admitted to the Special Care Unit of Tosamaganga Hospital (Tanzania) in 2019-2020. The rewarming rate was calculated as the difference between the first normothermic value (36.5-37.5°C) and the admission temperature, divided by the time elapsed. Neurodevelopmental status at 1 month of age was assessed using the Hammersmith Neonatal Neurological Examination. Results Median rewarming rate was 0.22°C/h (IQR: 0.11-0.41) in 344/382 (90%) hypothermic inborn infants, and was inversely correlated to admission temperature (correlation coefficient -0.36, p < 0.001). Rewarming rate was not associated with hypoglycemia (p = 0.16), late onset sepsis (p = 0.10), jaundice (p = 0.85), respiratory distress (p = 0.83), seizures (p = 0.34), length of hospital stay (p = 0.22) or mortality (p = 0.17). In 102/307 survivors who returned at follow-up visit at 1 month of age, rewarming rate was not associated with a potential correlate of cerebral palsy risk. Conclusions Our findings did not show any significant association between rewarming rate and mortality, selected complications or abnormal neurologic exam suggestive of cerebral palsy. However, further prospective studies with strong methodological approach are required to provide conclusive evidence on this topic.
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Affiliation(s)
- Elisa Rossi
- Doctors with Africa CUAMM, Dar es Salaam, Tanzania
| | - Donald Micah Maziku
- Maternal and Child Department, Tosamaganga Council Designated Hospital, Ipamba, Tanzania
| | - Dionis Erasto Leluko
- Maternal and Child Department, Tosamaganga Council Designated Hospital, Ipamba, Tanzania
| | | | - Luca Brasili
- Doctors with Africa CUAMM, Dar es Salaam, Tanzania
| | | | - Giovanni Putoto
- Department of Research, Doctors with Africa CUAMM, Padova, Italy
| | | | | | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University Hospital of Padova, Padova, Italy
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Berghoff NM, Wilmshurst JM, Page TA, Wessels M, Schlegel B, Malcolm‐Smith S. Determining the neurocognitive profile of children with tuberous sclerosis complex within the Western Cape region of South Africa. J Intellect Disabil Res 2023; 67:427-446. [PMID: 36788658 PMCID: PMC10952874 DOI: 10.1111/jir.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a multisystem genetic disorder associated with a wide spectrum of cognitive impairments that can often result in impaired academic, social and adaptive functioning. However, studies investigating TSC have found it difficult to determine whether TSC is associated with a distinct cognitive phenotype and more specifically which aspects of functioning are impaired. Furthermore, children with TSC living in low-income and middle-income countries, like South Africa, experience additional burdens due to low socio-economic status, high mortality rates and poor access to health care and education. Hence, the clinical population of South Africa may vary considerably from those populations from high-income countries discussed in the literature. METHODS A comprehensive neuropsychological battery composed of internationally recognised measures examining attention, working memory, language comprehension, learning and memory, areas of executive function and general intellectual functioning was administered to 17 children clinically diagnosed with TSC. RESULTS The exploration of descriptive data indicated generalised cognitive difficulties in most cognitive domains, aside from memory. With only two participants performing in the average to above-average ranges, the rest of the sample showed poor verbal comprehension, perceptual reasoning, working memory, processing speed, disinhibition, and problems with spatial planning, problem solving, frustration tolerance, set shifting and maintaining a set of rules. Furthermore, correlational findings indicated several associations between socio-demographic and cognitive variables. CONCLUSIONS Importantly, this is the first study to comprehensively examine multiple domains of neurocognitive functioning in a low-resource setting sample of children with TSC. Current study findings showed that children with TSC have generalised impairments across several cognitive domains, rather than domain-specific impairments. Therefore, although examining individual aspects of cognition, such as those found in previous literature, is important, this approach is limiting. With a comprehensive assessment, including understanding the associations between domains, appropriate and directed support can be provided to ensure all aspects of development are addressed and considered.
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Affiliation(s)
- N. M. Berghoff
- Psychology DepartmentUniversity of Cape TownCape TownSouth Africa
| | - J. M. Wilmshurst
- Department of Paediatric NeurologyUniversity of Cape Town and Red Cross War Memorial Children's HospitalCape TownSouth Africa
| | - T. A. Page
- Psychology DepartmentUniversity of Cape TownCape TownSouth Africa
| | - M. Wessels
- Department of Paediatric NeurologyUniversity of Cape Town and Red Cross War Memorial Children's HospitalCape TownSouth Africa
| | | | - S. Malcolm‐Smith
- Psychology DepartmentUniversity of Cape TownCape TownSouth Africa
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Ulasi II, Awobusuyi O, Nayak S, Ramachandran R, Musso CG, Depine SA, Aroca-Martinez G, Solarin AU, Onuigbo M, Luyckx VA, Ijoma CK. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol 2023; 42:151336. [PMID: 37058859 DOI: 10.1016/j.semnephrol.2023.151336] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The burden of chronic kidney disease (CKD) has increased exponentially worldwide but more so in low- and middle-income countries. Specific risk factors in these regions expose their populations to an increased risk of CKD, such as genetic risk with APOL1 among populations of West African heritage or farmers with CKD of unknown etiology that spans various countries across several continents to immigrant/indigenous populations in both low- and high-income countries. Low- and middle-income economies also have the double burden of communicable and noncommunicable diseases, both contributing to the high prevalence of CKD. The economies are characterized by low health expenditure, sparse or nonexistent health insurance and welfare programs, and predominant out-of-pocket spending for medical care. This review highlights the challenges in populations with CKD from low-resource settings globally and explores how health systems can help ameliorate the CKD burden.
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Affiliation(s)
- Ifeoma I Ulasi
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; Renal Unit, Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Olugbenga Awobusuyi
- Department of Medicine, Faculty of Clinical Sciences, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Saurabh Nayak
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), Bhatinda, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Carlos G Musso
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia
| | - Santos A Depine
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Confederation of Dialysis Associations of the Argentine Republic (CADRA), Buenos Aires, Argentina
| | - Gustavo Aroca-Martinez
- Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Facultad de Ciencias de la Salud, Universidad Simón Bolivar, Barranquilla, Colombia; Facultad de Ciencias de la Salud, Universidad del Norte, Barranquilla, Colombia
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont, USA; College of Business, University of Wisconsin MBA Consortium, Eau Claire, Wisconsin, USA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie A Luyckx
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Chinwuba K Ijoma
- Renal Unit, Department of Medicine, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Shetty T, Ganesan S, Johari A, Mullerpatan R. Gross motor function profile of children with cerebral palsy in a low-resource setting: A call for reflection on the model of care. J Pediatr Rehabil Med 2023; 16:211-218. [PMID: 36872801 DOI: 10.3233/prm-220039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
PURPOSE The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. METHODS Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. RESULTS Children with CP in a low-resource setting had 12-44% lower GMFM scores in dimensions of standing, walking, running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were 'sitting on a large and small bench from floor,' 'arm-free squatting,' 'half-kneeling,' 'kneel-walking,' and 'single-limb hop'. CONCLUSION Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future.
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Affiliation(s)
- Triveni Shetty
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Sailakshmi Ganesan
- Department of Neurophysiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | | | - Rajani Mullerpatan
- MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Wanyenze EW, Nalwadda GK, Byamugisha JK, Muwanguzi PA, Tumwesigye NM. Effect of Midwife-Provided Orientation of Birth Companions on Maternal Anxiety and Coping during Labor: A Stepped Wedge Cluster Randomized Control Trial in Eastern Uganda. Int J Environ Res Public Health 2023; 20:1549. [PMID: 36674304 PMCID: PMC9866548 DOI: 10.3390/ijerph20021549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/02/2022] [Accepted: 01/12/2023] [Indexed: 05/16/2023]
Abstract
The study aimed to assess the effect of midwife-provided orientation of birth companions on maternal anxiety and coping during labor. A stepped wedge cluster randomized trial design was conducted among 475 participants (control n = 240), intervention n = 235) from four clusters. Midwives in the intervention period provided an orientation session for the birth companions on supportive labor techniques. Coping was assessed throughout labor and anxiety scores were measured after birth. Independent t-test and Chi-Square tests were used to assess the differences by study period. Anxiety scores were reduced among women in the intervention period (p = 0.001). The proportion of women able to cope during early active labor was higher during the intervention period (p = 0.031). Women in the intervention period had 80% higher odds of coping (p = 0.032) compared to those in the control period. Notable differences in anxiety and coping with labor were observed among first-time mothers, younger women, and when siblings provided support. Midwife-provided orientation of birth companions on labor support lowers maternal anxiety and improves coping during labor. Findings could inform the planning and development of policies for the implementation of the presence of birth companions in similar low-resource settings.
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Affiliation(s)
- Eva Wodeya Wanyenze
- Department of Nursing, Mbarara University of Science and Technology, Mbarara 403, Uganda
| | - Gorrette K. Nalwadda
- Department of Nursing, College of Health Sciences, Makerere University, Kampala 101, Uganda
| | - Josaphat K. Byamugisha
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala 101, Uganda
| | - Patience A. Muwanguzi
- Department of Nursing, College of Health Sciences, Makerere University, Kampala 101, Uganda
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala 101, Uganda
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Leung T, Srivastava S, Missenye AM, Rwezaula EJ, Stoermer M, De Allegri M. Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff. J Med Internet Res 2023; 25:e38818. [PMID: 36607708 PMCID: PMC9862332 DOI: 10.2196/38818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. OBJECTIVE This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. METHODS We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. RESULTS Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. CONCLUSIONS Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage.
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Affiliation(s)
| | - Siddharth Srivastava
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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22
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Kumar Yadav S, Sharma D, Bala Sharma D, Mishra A, Agarwal P. Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study. Trop Doct 2023; 53:81-84. [PMID: 36426550 DOI: 10.1177/00494755221141932] [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] [Indexed: 11/27/2022]
Abstract
We present the results of incorporation of low-cost solutions to provide a standard surgical care for early breast cancer (EBC) patients. This surgical pathway consists of a low-cost vacuum-assisted core needle biopsy, sentinel lymph node biopsy (SLNB) using low-cost methylene blue and fluorescin dyes under local anesthesia and oncoplastic breast surgery. Patients assessed as clinically node-negative axilla underwent such treatment. SLNB using low-cost dyes was performed without any complication. Oncoplastic surgical techniques were opted for in 32 patients, and the lumps were all excised with a ∼1-cm all-around margin on the final histopathological examination. Standard breast cancer surgery can be provided in low-resource settings to eligible EBC patients with low-cost solutions.
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Affiliation(s)
| | | | | | - Arpan Mishra
- 534313Department of Surgery, NSCB Medical College, Jabalpur, India
| | - Pawan Agarwal
- 534313Department of Surgery, NSCB Medical College, Jabalpur, India
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23
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Urva M, Donnelley CA, Challa ST, Haonga BT, Morshed S, Shearer DW, Razani N. Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives. Afr J Disabil 2023; 12:1084. [PMID: 36876024 PMCID: PMC9982473 DOI: 10.4102/ajod.v12i0.1084] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 02/15/2023] Open
Abstract
Background The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers. Objectives To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania. Method Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A coding schema and thematic framework were established from interviews using inductive thematic analysis. Results All participants noted financial and psychosocial burdens of amputation, and perceived prostheses as an opportunity for return to normality and independence. Patients worried about prosthesis longevity. Healthcare providers noted significant obstacles to prosthesis provision, including infrastructural and environmental barriers, limited access to prosthetic services, mismatched patient expectations and inadequate coordination of care. Conclusion This qualitative analysis identifies factors influencing prosthesis-related care for patients with TFA in Tanzania which are lacking in the literature. Persons with TFA and their caregivers experience numerous hardships exacerbated by limited financial, social and institutional support. Contribution This qualitative analysis informs future directions for research into improving prosthesis-related care for patients with TFA in Tanzania.
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Affiliation(s)
- Mayur Urva
- Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Claire A Donnelley
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, United States
| | - Sravya T Challa
- Department of Orthopaedic Surgery, Harvard University, Boston, United States
| | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania
| | - Saam Morshed
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - David W Shearer
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Nooshin Razani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
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24
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Abstract
INTRODUCTION There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. METHODS A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). RESULTS Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. CONCLUSION PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.
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Affiliation(s)
- Amber Bidner
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- CONTACT Amber Bidner Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
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25
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Li L, Ma Y, Li W, Tang G, Jiang Y, Li H, Jiang S, Zhou Y, Yang Y, Zhang T, Yang W, Ma L, Feng L. Caregiver Willingness to Vaccinate Children with Pneumococcal Vaccines and to Pay in a Low-Resource Setting in China: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:1897. [PMID: 36366405 PMCID: PMC9694362 DOI: 10.3390/vaccines10111897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2023] Open
Abstract
To determine the vaccine hesitancy of pneumococcal conjugate vaccines (PCVs) in a low-resource setting in China and to identify associated factors, a face-to-face questionnaire survey was conducted in the city of Guilin, China, from December 2021 to March 2022, which comprised sociodemographic information, attitudes toward vaccines and pneumonia, and PCV13 vaccination willingness and willingness to pay (WTP). Stepwise logistic regression and Tobit regression models were fitted to identify factors associated with PCV13 vaccination willingness and WTP, respectively. In total, 1254 questionnaires were included, of which 899, 254, and 101 participants showed acceptance, hesitancy, and refusal to vaccinate their children with PCV13, respectively. Only 39.07% of participants knew about PCV13 before this survey. A total of 558 (48.40%) participants accepted the full payment of vaccination, and 477 (41.37%) other participants accepted the partial payment, with a median cost of CNY 920.00. Demographics, social and psychological context, and attitudes toward vaccines were all associated with PCV13 vaccination but varied for hesitators and refusers. There is a substantial local demand for vaccinating children with PCV13 and partial payment is widely accepted. More publicity and educational efforts and a socially supportive environment are required to alleviate vaccine hesitancy.
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Affiliation(s)
- Linqiao Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Yuan Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wei Li
- Center for Applied Statistics and School of Statistics, Renmin University of China, Beijing 100872, China
| | - Guorong Tang
- Guilin Center for Disease Control and Prevention, Guilin 541001, China
| | - Yan Jiang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Huangcui Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Shuxiang Jiang
- Guilin Center for Disease Control and Prevention, Guilin 541001, China
| | - Yun Zhou
- Guilin Center for Disease Control and Prevention, Guilin 541001, China
| | - Yuan Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ting Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Libing Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Boatman S, Nalluri H, Gaertner WB. Colon and Rectal Cancer Management in Low-Resource Settings. Clin Colon Rectal Surg 2022; 35:402-409. [PMID: 36111080 PMCID: PMC9470288 DOI: 10.1055/s-0042-1746189] [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] [Indexed: 12/09/2022]
Abstract
Colorectal cancer (CRC) incidence is rising in low- and middle-income countries, which also face disproportionate mortality from CRC, mainly due to diagnosis at late stages. Various challenges to CRC care exist at multiple societal levels in underserved populations. In this article, barriers to CRC care, strategies for screening, and treatment in resource-limited settings, and future directions are discussed within a global context.
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Affiliation(s)
- Sonja Boatman
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Harika Nalluri
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Wolfgang B. Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Ghosh R, Healy A, Prabhune A, Mallavaram A, Raju S, Chockalingam N. Provision of rehabilitation and assistive technology services in a low resource setting during the COVID-19 pandemic and introduction of telehealth: service users' and providers' perspectives. Assist Technol 2022:1-7. [PMID: 35857654 DOI: 10.1080/10400435.2022.2095582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
Abstract
The COVID-19 pandemic created a challenge for providing assistive technology (AT) and rehabilitation services, with many service providers implementing telehealth service provision for the first time. The objective of this study was to explore the experiences of people accessing and providing AT and rehabilitation services during the pandemic and to assess the implementation of telehealth service delivery at an assistive technology and rehabilitation center in India. A mixed-methods design, combining analysis of clinical data and semi-structured interviews, was utilized. A descriptive analysis of demographics and clinical characteristics of service users accessing services through telehealth, or in-person mode was completed. In addition, service users were interviewed to explore their experiences of accessing services during the pandemic. Service providers were also interviewed to gather their opinions on telehealth service delivery during the pandemic. Findings showed that telehealth was an alternative tool in the pandemic for continuing to deliver services in a low-resource setting. However, not all types of services could be successfully delivered via telehealth. There are barriers to the delivery of telehealth services that need to be considered and addressed to allow successful implementation, and it is important to consider that telehealth consultations are not suitable for all service users.
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Affiliation(s)
- Ritu Ghosh
- Mobility India Rehabilitation Research & Training Centre, Bangalore, Karnataka, India
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Akash Prabhune
- Institute of Health Management Research Bangalore, Bengaluru, Karnataka, India
| | | | - Sama Raju
- Mobility India Rehabilitation Research & Training Centre, Bangalore, Karnataka, India
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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28
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Cavallin F, Balestri E, Calia M, Biasci F, Tolera J, Pietravalle A, Manenti F, Trevisanuto D. Training on the Silverman and Andersen score improved how special care unit nurses assessed neonatal respiratory distress in a low-resource setting. Acta Paediatr 2022; 111:1866-1869. [PMID: 35700104 DOI: 10.1111/apa.16450] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
AIM Identifying the severity of neonatal respiratory distress (RD) is essential, so that resources can be appropriately allocated. We assessed the ability of nurses to grade neonatal RD in a low-resource setting before and after they were trained to use a dedicated scoring tool. METHODS The study was conducted in the Special Care Unit of St Luke Wolisso Hospital, Ethiopia. Ten nurses reviewed nine local video recordings and graded neonatal RD without a standardised method, which was current practice, and then after they were trained to use the Silverman and Andersen score. The data were analysed using the McNemar test and Cohen's kappa. RESULTS Training increased the identification of mild RD from 63% to 93% (p = 0.008) and moderate RD from 40% to 73% (p = 0.03). Severe RD was 93% before and 90% after training (p = 0.99). Overall, the agreement improved from kappa 0.59 to 0.84, mainly by reducing the overestimation of milder degrees of RD. CONCLUSION Being trained on how to use the Silverman and Andersen score improved the ability of nurses to identify mild and moderate neonatal RD. This improvement has the potential to optimise the use of equipment, staff and time.
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Affiliation(s)
| | - Eleonora Balestri
- Doctors with Africa CUAMM Ethiopia, Wolisso, Ethiopia.,Neonatal Intensive Care Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Jiksa Tolera
- St Luke Catholic Hospital & College of Nursing and Midwifery, Wolisso, Ethiopia
| | | | - Fabio Manenti
- St Luke Catholic Hospital & College of Nursing and Midwifery, Wolisso, Ethiopia.,Doctors with Africa CUAMM, Padua, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Salifu DA, Christmals CD, Reitsma GM. Frameworks for the design, implementation, and evaluation of simulation-based nursing education: A scoping review. Nurs Health Sci 2022; 24:545-563. [PMID: 35596536 PMCID: PMC9540896 DOI: 10.1111/nhs.12955] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/12/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
This scoping review was conducted to identify and describe constructs of frameworks and theories used to guide the design, implementation, and evaluation of simulation in nursing education globally, with a focus on their applicability in low-resource settings. Six electronic databases, three of which were on EBSCO Host (CINAHL, MEDLINE, ERIC), PubMed, Scopus, and ProQuest, as well as Google Scholar, were searched to retrieve studies published in the English language between 2012 and February 2022. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist, and was guided by Arksey and O'Malley's five-step scoping review methodological framework. Data were extracted from five studies (four frameworks and a theory) and narratively synthesized. Hence, seven constructs were identified and described: context, background, simulation design, educational practices, facilitator, participant, and outcomes. The four frameworks and theory were developed in the context of developed countries, which reveals the lack of a context-specific framework to guide the design, implementation, and evaluation of simulation in nursing education in low-resource settings. Given resource limitations and the apparent gaps in applying simulation-based framework(s) developed in developed countries to low-resource settings, the findings of this review underscored the need for a context-specific framework that is locally tailored to the needs and resources of low-resource settings, to promote access to and use of simulation in enhancing student learning, and the development of clinical competence.
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Affiliation(s)
- David Abdulai Salifu
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.,School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Gerda Marie Reitsma
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Abstract
INTRODUCTION Globally, haemorrhage is the leading cause of both maternal mortality and preventable trauma death. For patients suffering from haemorrhage, prompt blood transfusion can be life-saving; however, safe and sufficient blood is often lacking in low-resource settings (LRS). Autotransfusion (AT), in which the patient's own blood is collected and transfused back, is an established alternative to donor blood transfusions, although one that is primarily performed with advanced AT systems. Research on basic AT in LRS is scarce. Therefore, we aimed to consolidate all available information on the current use of basic AT in LRS and to identify AT techniques and devices described for use in such settings. DESIGN Scoping review. METHODS We systematically searched four key databases: PubMed, Web of Science, Global Health and Cochrane Library as well as several grey literature databases and databases of relevant organisations. The final search was conducted on 22 April 2019. We included all types of studies referring to any information on basic AT used or sought to be used in LRS, published in English and dated after 31 December 2008. We synthesised the data from the included studies, results were charted or summarised narratively. RESULTS Some 370 records were reviewed, yielding 38 included documents. We found a paucity of scientific evidence as well as contradictory information on the extent of AT use and that AT use is largely undocumented. The most commonly described indications were haemoperitoneum (primarily among obstetric patients) and haemothorax. We identified three AT techniques used in LRS. Additionally, two new devices and one filter are described for potential use in LRS. CONCLUSIONS Basic AT is practiced for certain obstetric and trauma indications. However, context-specific studies are needed to determine the technique's safety and effectiveness. Extent of use is difficult to assess, but our results indicate that basic AT is not a widely established practice in LRS. Future research should address the bottlenecks hampering basic AT availability. New AT devices for use in LRS are described, but their utility and cost-effectiveness remain to be assessed.
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Affiliation(s)
- Maria Palmqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Älgå
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Nnakenyi ID, Nnakenyi EF, Parker EJ, Uchendu NO, Anaduaka EG, Ezeanyika LU. Relationship between glycaemic control and lipid profile in type 2 diabetes mellitus patients in a low-resource setting. Pan Afr Med J 2022; 41:281. [PMID: 35855025 PMCID: PMC9250661 DOI: 10.11604/pamj.2022.41.281.33802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction diabetes mellitus can lead to complications including cardiovascular disease (CVD). Glycated haemoglobin (HbA1C) is a test of glycaemic control in T2DM patients, and its association with CVD can be mediated through modulation of risk factors such as dyslipidaemia. It is suggested that correlation of HbA1c with blood lipids may enable its use as a dual marker for glycaemic status and dyslipidaemia. The aim of this study was to determine the relationship between glycaemic control and blood lipid concentrations in T2DM patients. Methods a cross-sectional study of T2DM patients at Enugu, Nigeria. After obtaining informed consent, questionnaires were administered, and then venous blood was collected for determination of HbA1c and fasting lipid profile. Student T-test was used to compare mean results of two groups and Pearson correlation coefficient was used to determine relationships. A p-value <0.05 was considered to be statistically significant. Results fifty -five (55) T2DM patients comprising of 24 females and 31 males, with mean±SD age 57±12 years were studied. Prevalence of patients with poor glycaemic control (HbA1c≥7%) was 34 (61.8%). More males (36.4%) than females (25.4%) had poor glycaemic control. There was a positive, statistically significant correlation between HbA1c and TC (r=0.406); Low-Density Lipoprotein Cholesterol (LDL-C) (r=0.409); and triglyceride (TG) (r=0.273), p<0.05. Correlation between HbA1c and HDL-C was negative (r=-0.269, p<0.05). Conclusion the significant correlation between HbA1c and various lipid parameters may suggest the importance of glycaemic control as well as managing dyslipidaemia in the reduction of risk for CVD in T2DM patients, for which HbA1c may be used to monitor both, thereby reducing cost.
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Affiliation(s)
- Ifeyinwa Dorothy Nnakenyi
- Department of Chemical Pathology, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Emeka Francis Nnakenyi
- Department of Morbid Anatomy, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Pham MD, Stoove M, Crowe S, Luchters S, Anderson D. A profile of the Visitect® CD4 and Visitect® CD4 advanced disease for management of people living with HIV. Expert Rev Mol Diagn 2022; 22:247-252. [PMID: 35226590 DOI: 10.1080/14737159.2022.2048372] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION CD4 testing plays an important role in clinical management and epidemiological surveillance of HIV disease. Rapid, point-of-care (POC) CD4 tests can improve patients' access to CD4 testing, enabling decentralization of HIV services. AREAS COVERED We conducted a profile review of the Visitect®CD4 and the Visitect®CD4 Advanced Disease (Omega Diagnostics, UK) - the two lateral flow, equipment-free POC CD4 tests, which can be used to identify people with HIV who have CD4 of less than 350 and 200 cells/μl, respectively. Using published data from independent studies, we discussed the performance and utility of these tests, highlighting the advantages as well as their limitations. EXPERT OPINION The tests are user-friendly, acceptable to health care workers, and feasible to implement in primary health care settings and can provide reliable results for clinical decision-making. Hands-on training with pictorial instructions for use is needed to enhance test's operator confidence in interpretation of test results. Quality assurance program should be in place to ensure the quality of testing. Development of a next-generation test with a cutoff of 100 cells/μl is recommended to identify patients with advanced immunosuppression for initiation of prophylaxis to reduce HIV-related death. Operational research is also needed to identify cost-effective implementation strategies in real-world settings.
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Affiliation(s)
- Minh D Pham
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia
| | - Suzanne Crowe
- Burnet Institute, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Stanley Luchters
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria Australia.,Institute of Human Development, Aga Khan University, Kenya.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - David Anderson
- Burnet Institute, Melbourne, Australia.,Department of Microbiology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Abstract
LAY ABSTRACT Parents of children with autism are known to experience severe hardships related to raising their children. These hardships are exacerbated in low-resource settings internationally where there is very little resource for children and their families, including professionals who provide evidence-based treatment. Mongolia was chosen as an example of such low-resource settings in this single-case research, and four parent mentors and five parent peers and their children with autism participated and completed the study. A local parent group, the Autism Association of Mongolia, was actively involved in this study and helped with recruitment, development, adaptation, and implementation of the intervention to increase acceptability and feasibility. In addition, a local bilingual research assistant was also utilized as the purpose of this study was to build capacity of diverse stakeholders of children with autism in Mongolia. The research assistant was trained and coached by the research team on both content (communication teaching strategies and behavior management) and delivery (coaching adults), who then provided coaching to parent mentors via live videoconferencing in Mongolian. Parent mentors then similarly provided coaching to parent peers after observing the interactions with their children with autism. The findings suggest that parents can effectively deliver high-fidelity coaching to disseminate evidence-based treatment in low-resource settings when given proper training and coaching. Further examination on scalability and sustainment of effects is suggested.
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Huhn S, Axt M, Gunga HC, Maggioni MA, Munga S, Obor D, Sié A, Boudo V, Bunker A, Sauerborn R, Bärnighausen T, Barteit S. The Impact of Wearable Technologies in Health Research: Scoping Review. JMIR Mhealth Uhealth 2022; 10:e34384. [PMID: 35076409 PMCID: PMC8826148 DOI: 10.2196/34384] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Wearable devices hold great promise, particularly for data generation for cutting-edge health research, and their demand has risen substantially in recent years. However, there is a shortage of aggregated insights into how wearables have been used in health research. Objective In this review, we aim to broadly overview and categorize the current research conducted with affordable wearable devices for health research. Methods We performed a scoping review to understand the use of affordable, consumer-grade wearables for health research from a population health perspective using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A total of 7499 articles were found in 4 medical databases (PubMed, Ovid, Web of Science, and CINAHL). Studies were eligible if they used noninvasive wearables: worn on the wrist, arm, hip, and chest; measured vital signs; and analyzed the collected data quantitatively. We excluded studies that did not use wearables for outcome assessment and prototype studies, devices that cost >€500 (US $570), or obtrusive smart clothing. Results We included 179 studies using 189 wearable devices covering 10,835,733 participants. Most studies were observational (128/179, 71.5%), conducted in 2020 (56/179, 31.3%) and in North America (94/179, 52.5%), and 93% (10,104,217/10,835,733) of the participants were part of global health studies. The most popular wearables were fitness trackers (86/189, 45.5%) and accelerometer wearables, which primarily measure movement (49/189, 25.9%). Typical measurements included steps (95/179, 53.1%), heart rate (HR; 55/179, 30.7%), and sleep duration (51/179, 28.5%). Other devices measured blood pressure (3/179, 1.7%), skin temperature (3/179, 1.7%), oximetry (3/179, 1.7%), or respiratory rate (2/179, 1.1%). The wearables were mostly worn on the wrist (138/189, 73%) and cost <€200 (US $228; 120/189, 63.5%). The aims and approaches of all 179 studies revealed six prominent uses for wearables, comprising correlations—wearable and other physiological data (40/179, 22.3%), method evaluations (with subgroups; 40/179, 22.3%), population-based research (31/179, 17.3%), experimental outcome assessment (30/179, 16.8%), prognostic forecasting (28/179, 15.6%), and explorative analysis of big data sets (10/179, 5.6%). The most frequent strengths of affordable wearables were validation, accuracy, and clinical certification (104/179, 58.1%). Conclusions Wearables showed an increasingly diverse field of application such as COVID-19 prediction, fertility tracking, heat-related illness, drug effects, and psychological interventions; they also included underrepresented populations, such as individuals with rare diseases. There is a lack of research on wearable devices in low-resource contexts. Fueled by the COVID-19 pandemic, we see a shift toward more large-sized, web-based studies where wearables increased insights into the developing pandemic, including forecasting models and the effects of the pandemic. Some studies have indicated that big data extracted from wearables may potentially transform the understanding of population health dynamics and the ability to forecast health trends.
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Affiliation(s)
- Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Miriam Axt
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Centre de Recherche en Santé Nouna, Nouna, Burkina Faso
| | | | - Aditi Bunker
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.,Harvard Center for Population and Development Studies, Cambridge, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Ghafuri DL, Abdullahi SU, Dambatta AH, Galadanci J, Tabari MA, Bello-Manga H, Idris N, Inuwa H, Tijjani A, Suleiman AA, Jibir BW, Gambo S, Gambo AI, Khalifa Y, Haliru L, Abdulrasheed S, Zakari MA, Greene BC, Trevathan E, Jordan LC, Aliyu MH, Baumann AA, DeBaun MR. Establishing Sickle Cell Disease Stroke Prevention Teams in Africa is Feasible: Program Evaluation Using the RE-AIM Framework. J Pediatr Hematol Oncol 2022; 44:e56-e61. [PMID: 34001783 PMCID: PMC8728755 DOI: 10.1097/mph.0000000000002179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate a Stroke Prevention Team's readiness to prevent strokes in children with sickle cell anemia living in northern Nigeria. The NIH sponsored Stroke Prevention Trial in Nigeria included a goal of a sustainable stroke prevention program. The program's 1-year reach for transcranial Doppler screening was 14.7% (4710/32,000) of which 6.0% (281/4710) had abnormal velocities (≥200 cm/s). All participants with abnormal transcranial Doppler velocities were started on hydroxyurea (effectiveness). The leaders of all 5 hospitals agreed to adopt the program. After 1 year, program-implementation and maintenance rates were 100%, demonstrating the program's feasibility and short-term sustainability.
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Affiliation(s)
- Djamila L. Ghafuri
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | | | | | | | | | | | | | | | | | | | | | - Safiya Gambo
- Pediatrics, Murtala Mohammed Specialist Hospital
| | | | - Yusuf Khalifa
- Department of Administration, Aminu Kano Teaching Hospital, Kano
| | - Lawal Haliru
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | - Sani Abdulrasheed
- Department of Pediatrics, Barau Dikko Teaching Hospital/Kaduna State University, Kaduna, Nigeria
| | | | - Brittany C. Greene
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
| | - Edwin Trevathan
- Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology
| | - Muktar H. Aliyu
- Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center
| | - Ana A. Baumann
- Brown School of Social Work, Washington University of St. Louis, St. Louis, MO
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease
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36
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Michaelis IA, Krägeloh-Mann I, Mazinu M, Jordaan E. Growth of a cohort of very low birth weight and preterm infants born at a single tertiary health care center in South Africa. Front Pediatr 2022; 10:1075645. [PMID: 36741095 PMCID: PMC9889837 DOI: 10.3389/fped.2022.1075645] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Very low birth weight (VLBW) and extremely low birth weight (ELBW) infants are known to be at high risk of growth failure and developmental delay later in life. The majority of those infants are born in low and middle income countries. AIM Growth monitoring in a cohort of infants born with a VLBW up to 18 months corrected age was conducted in a low resource setting tertiary hospital. METHODS In this prospective cohort study, 173 infants with a birth weight below 1,501 g admitted within their first 24 h of life were recruited and the 115 surviving until discharged were asked to follow up at 1, 3, 6, 12 and 18 months. Weight, height and head circumferences were recorded and plotted on WHO Z-score growth charts. RESULTS Of the 115 discharged infants 89 were followed up at any given follow-up point (1, 3, 6, 12 and/or 18 months). By 12 months of corrected age another 15 infants had demised (13.0%). The infants' trends in weight-for-age z-scores (WAZ) for corrected age was on average below the norm up to 12 months (average estimated z-score at 12 months = -0.44; 95% CI, -0.77 to -0.11), but had reached a normal range on average at 18 months = -0.24; 95% CI, -0.65 to 0.19) with no overall difference in WAZ scores weight between males and female' infants (p > 0.7). Similar results were seen for height at 12 months corrected age with height-for-age z-scores (HAZ) of the study subjects being within normal limits (-0.24; 95% CI, -0.63 to 0.14). The mean head circumference z-scores (HCZ) initially plotted below -1.5 standard deviations (S.D.), but after 6 months the z-scores were within normal limits (mean z-score at 7 months = -0.19; 95% CI, -0.45 to 0.06). CONCLUSION Weight gain, length and head circumferences in infants with VLBW discharged showed a catch-up growth within the first 6-18 months of corrected age, with head circumference recovering best. This confirms findings in other studies on a global scale, which may be reassuring for health systems such as those in South Africa with a high burden of children born with low birth weights.
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Affiliation(s)
| | | | - Mikateko Mazinu
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
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von Saint Andre-von Arnim AO, Kumar RK, Clark JD, Wilfond BS, Nguyen QUP, Mutonga DM, Zimmerman JJ, Oron AP, Walson JL. Family-Assisted Severity of Illness Monitoring for Hospitalized Children in Low-Resource Settings-A Two-Arm Interventional Feasibility Study. Front Pediatr 2022; 10:804346. [PMID: 35676898 PMCID: PMC9169086 DOI: 10.3389/fped.2022.804346] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/15/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Pediatric mortality remains unacceptably high in many low-resource settings, with inpatient deaths often associated with delayed recognition of clinical deterioration. The Family-Assisted Severe Febrile Illness ThERapy (FASTER) tool has been developed for caregivers to assist in monitoring their hospitalized children and alert clinicians. This study evaluates feasibility of implementation by caregivers and clinicians. METHODS Randomized controlled feasibility study at Kenyatta National Hospital, Kenya. Children hospitalized with acute febrile illness with caregivers at the bedside for 24 h were enrolled. Caregivers were trained using the FASTER tool. The primary outcome was the frequency of clinician reassessments between intervention (FASTER) and standard care arms. Poisson regression with random intercept for grouping by patient was used, adjusting for admission pediatric early warning score, age, gender. Secondary outcomes included survey assessments of clinician and caregiver experiences with FASTER. RESULTS One hundred and fifty patient/caregiver pairs were enrolled, 139 included in the analysis, 74 in the intervention, 65 in the control arm. Patients' median age was 0.9 (range 0.2-10) and 1.1 years (range 0.2-12) in intervention vs. control arms. The most common diagnoses were pneumonia (80[58%]), meningitis (58[38%]) and malaria (34 [24%]). 134 (96%) caregivers were patients' mothers. Clinician visits/hour increased with patients' illness severity in both arms, but without difference in frequency between arms (point estimate for difference -0.9%, p = 0.97). Of the 16 deaths, 8 (four/arm) occurred within 2 days of enrollment. Forty clinicians were surveyed, 33 (82%) reporting that FASTER could improve outcomes of very sick children in low-resource settings; 26 (65%) rating caregivers as able to adequately capture patients' severity of illness. Of 70 caregivers surveyed, 63 (90%) reported that FASTER training was easy to understand; all (100%) agreed that the intervention would improve care of hospitalized children and help identify sick children in their community. DISCUSSION We observed no difference in recorded frequency of clinician visits with FASTER monitoring. However, the tool was rated positively by caregivers and clinicians., Implementation appears feasible but requires optimization. These feasibility data may inform a larger trial powered to measure morbidity and mortality outcomes to determine the utility of FASTER in detecting and responding to clinical deterioration in low-resource settings. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT03513861.
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Affiliation(s)
- Amelie O von Saint Andre-von Arnim
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rashmi K Kumar
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jonna D Clark
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA, United States.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, United States
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, United States.,Divisions of Bioethics & Palliative Care and Pulmonary & Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Quynh-Uyen P Nguyen
- Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA, United States
| | - Daniel M Mutonga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's, Seattle, WA, United States
| | - Assaf P Oron
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Judd L Walson
- Departments of Global Health, Epidemiology, Infectious Disease, University of Washington, Seattle, WA, United States.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
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Sampath R, Nayak R, Gladston S, Ebenezer K, Mudd SS, Peck J, Brenner MJ, Pandian V. Sleep disturbance and psychological distress among hospitalized children in India: Parental perceptions on pediatric inpatient experiences. J SPEC PEDIATR NURS 2022; 27:e12361. [PMID: 34676682 DOI: 10.1111/jspn.12361] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Investigate parental perceptions of children's sleep disturbance and psychological distress associated with an inpatient stay in a low-resource hospital setting. DESIGN AND METHODS Demographic and validated survey instruments were adapted for administration to parents of children in the medical wards of a tertiary hospital in India. Parents proficient in English, Hindi, Tamil, or Telugu with a child age 4-12 years admitted for at least 48 h were eligible to participate. All respondents completed the Factors Affecting Sleep Disturbance Scale, Sleep Duration Questionnaire, Sleep Disturbance Scale, and Kessler Psychological Distress Scale. Data analysis entailed descriptive statistics, correlations, and multivariate regressions to analyze relationships across responses on demographics, sleep disturbance, and psychological distress. RESULTS Among 105 parents with hospitalized children, most had children 4-6 years old (54%), including 65% boys and 35% girls. Parents reported that their children slept overnight in the hospital for a mean of 8.3 ± 1.6 h. Children 4-6 year old (relative risk ratio [RRR] = 0.63, p = .004), dyspnea (RRR = 8.73, p = .04), previous hospitalization (RRR = 9.17, p = .03), nighttime procedures (RRR = 2.97, p = .03, and missing home (RRR = 6.78, p < .001) were the factors affecting sleep. Factors affecting psychological distress was nighttime medication administration (RRR = 4.92, p = .01). Sleep disturbances correlated with psychological distress (r = 0.56; p < .01). CONCLUSION Sleep disturbance and associated psychological distress in hospitalized children were widely reported by parents queried in this low-resource hospital setting. PRACTICAL IMPLICATIONS Nurses can lead efforts in ameliorating sleep in hospitalized children, including partnering with stakeholders on measures to reduce sleep disruption. Child-centered interventions may improve sleep hygiene and decrease psychological distress among children.
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Affiliation(s)
- Ramya Sampath
- Critical Care Nurse, Pediatric Intensive Care Unit, Inova Fairfax Hospital, Falls church, Virginia, USA
| | - Ruma Nayak
- Department of Pediatric Nursing, College of Nursing, Christian Medical College, Vellore, India
| | - Shanthi Gladston
- Department of Pediatric Nursing, College of Nursing, Christian Medical College, Vellore, India
| | - Kala Ebenezer
- Department of Pediatrics, Christian Medical College and Hospital, Vellore, India
| | - Shawna S Mudd
- Department of Nursing Faculty, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Jessica Peck
- Department of Nursing, Baylor University Louise Herrington School of Nursing, Dallas, Texas, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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Seetahal-Maraj P, Ramnarine N. Clipping of Posterior Circulation Intracranial Aneurysms: Maintenance of a Necessary Skill in Low-Resource Settings. Cureus 2021; 13:e19170. [PMID: 34873513 PMCID: PMC8636189 DOI: 10.7759/cureus.19170] [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] [Accepted: 10/31/2021] [Indexed: 11/18/2022] Open
Abstract
The treatment paradigm for intracranial aneurysms has evolved with technological advancements, resulting in improved patient outcomes. In particular, the management of posterior circulation aneurysms has shifted to favor endovascular therapy (EVT). However, this modality is not always accessible in low-resource settings. In our country (Trinidad and Tobago), neuroendovascular services are not readily available. We report a case of a patient with a ruptured left posterior inferior cerebellar artery (PICA) aneurysm (Fisher grade 4) who underwent a far-lateral craniotomy and clip ligation. It was done by a fellowship-trained vascular neurosurgeon in a public hospital and resulted in an excellent patient outcome. This highlights the need to maintain this surgical skill set in resource-poor countries, in spite of the increasing popularity of endovascular therapy.
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Affiliation(s)
- Panduranga Seetahal-Maraj
- Neurosurgery, San Fernando General Hospital, San Fernando, TTO.,Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
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40
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Sultana E, Hasan MT, Mahmood HR, Ansar A, Podder V, Emrul K, Ali MY. Budd-Chiari syndrome in small hepatic veins: A diagnostic and therapeutic challenge in a low resource setting. J Family Med Prim Care 2021; 10:3154-3158. [PMID: 34660462 PMCID: PMC8483139 DOI: 10.4103/jfmpc.jfmpc_2213_20] [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: 10/27/2020] [Revised: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Budd-Chiari syndrome (BCS) is a rare condition affecting one in a million adults. BCS involves outflow obstruction in the hepatic venous system, which can occur anywhere between the small hepatic veins and the atrio-caval junction and cannot be due to heart, pericardial, or hepatic veno-occlusive disease. Case Presentation We report an exceedingly rare form of BCS with less common initial clinical features in a young poor adult male patient which ignited a diagnostic uncertainty and a therapeutic challenge. The presence of the classical triad of BCS in the absence of major hepatic vein obstruction prompted the medical team to consider that the patient had a rare form of BCS. In this case, the financial condition of the patient and limited resources available restricted our ability to advance into the specific investigations. However, the patient was given symptomatic medical treatment and was followed up monthly. We also provided the patient with a statement that reaffirmed our inability to provide affordable surgical management options and called for an optimized national clinical guideline that could help the physicians deal with the challenges. Conclusion An uncommon form of BCS in this patient provided a diagnostic challenge and therapeutic uncertainty in the low-resource settings. Primary care physicians should commence evidenced medical management based on clinical suspicion acknowledging the fact that obstruction of small hepatic veins is often not detected on an ultrasound.
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Affiliation(s)
- Emiko Sultana
- General Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - M Tasdik Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Hassan Rushekh Mahmood
- Maternal and Child Health Division, International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Adnan Ansar
- College of Science, Health and Engineering, Austin Health Clinical School of Nursing, La Trobe University, Melbourne, Victoria, Australia
| | - Vivek Podder
- General Medicine, Tairunnessa Memorial Medical College and Hospital, Gazipur, Bangladesh
| | - Khan Emrul
- General Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh
| | - Md Yusuf Ali
- Internal Medicine, Diabetic Association Medical College, Faridpur, Bangladesh
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Swanson MA, Auslander A, Morales T, Jedrzejewski B, Magee WP, Siu A, Ayala R, Swanson JW. Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua. Cleft Palate Craniofac J 2021; 59:1452-1460. [PMID: 34658290 DOI: 10.1177/10556656211046810] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country. DESIGN Prospective outcomes study. SETTING Comprehensive Cleft Care Center. PATIENTS Candidate patients presenting for cleft lip or palate repair or revision. INTERVENTIONS Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals. MAIN OUTCOME MEASURES Complication was defined as fistula, dehiscence and/or infection. RESULTS Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p < 0.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR = 3.03, p = 0.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery. CONCLUSIONS Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.
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Affiliation(s)
- Marco A Swanson
- School of Medicine, 24575Case Western Reserve University, Cleveland, OH.,20313Operation Smile International, Virginia Beach, VA
| | - Allyn Auslander
- Institute for Global Health, 5116University of Southern California, Los Angeles, CA
| | | | | | - William P Magee
- Institute for Global Health, 5116University of Southern California, Los Angeles, CA.,5150Children's Hospital Los Angeles, Los Angeles, CA
| | - Armando Siu
- 2569Operación Sonrisa Nicaragua, Managua, Nicaragua
| | - Ruben Ayala
- 20313Operation Smile International, Virginia Beach, VA
| | - Jordan W Swanson
- 5150Children's Hospital Los Angeles, Los Angeles, CA.,20313Operation Smile International, Virginia Beach, VA.,Perelman School of Medicine, 6567Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Kunde F, Thomas S, Sudhakar A, Kunjikutty R, Kumar RK, Vaidyanathan B. Prenatal diagnosis and planned peripartum care improve perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum in low-resource settings. Ultrasound Obstet Gynecol 2021; 58:398-404. [PMID: 33030746 DOI: 10.1002/uog.23146] [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] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To report on the feasibility of establishing a regional prenatal referral network for critical congenital heart defects (CHDs) and its impact on perinatal outcome of fetuses with transposition of the great arteries and intact ventricular septum (TGA-IVS) in low-resource settings. METHODS This was a retrospective study of consecutive fetuses with a diagnosis of TGA-IVS between January 2011 and December 2019 in Kochi, Kerala, India. A regional network for prenatal diagnosis and referral of patients with critical CHDs was initiated in 2011. Pregnancy and early neonatal outcomes were reported. The impact of the timing of diagnosis (prenatal or after birth) on age at surgery, perinatal mortality and postoperative recovery was evaluated. RESULTS A total of 82 fetuses with TGA-IVS were included. Diagnosis typically occurred later on in gestation, at a median of 25 (interquartile range (IQR), 21-32) weeks. The majority (78.0%) of affected pregnancies resulted in live birth, most (84.4%) of which occurred in a specialist pediatric cardiac centers. Delivery in a specialist center, compared with delivery in a local maternity center, was associated with a significantly higher rate of surgical correction (98.1% vs 70.0%; P = 0.01) and overall lower neonatal mortality (3.7% vs 50%; P = 0.001). The proportion of cases undergoing arterial switch operation after prenatal diagnosis of TGA-IVS increased significantly, along with the prenatal detection rate, over the study period (2011-2015, 11.1% vs 2016-2019, 29.4%; P = 0.001). Median age at surgery was significantly lower in the prenatally diagnosed group than that in the postnatally diagnosed group (4 days (IQR, 1-23 days) vs 10 days (IQR, 1-91 days); P < 0.001). There was no significant difference in postoperative mortality (2.0% vs 3.6%; P = 0.49) between the two groups. CONCLUSIONS This study demonstrates the feasibility of creating a network for prenatal diagnosis and referral of patients with critical CHDs, such as TGA, in low-resource settings, that enables planned peripartum care in specialist pediatric cardiac centers and improved neonatal survival. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Kunde
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - S Thomas
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - A Sudhakar
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Kunjikutty
- Department of Obstetrics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R K Kumar
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Vaidyanathan
- Fetal Cardiology Division, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Mencia MM, Beharry A, Hernandez Cruz PP. Revision Total Hip Arthroplasty in Jehovah's Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting. Cureus 2021; 13:e15761. [PMID: 34290937 PMCID: PMC8289400 DOI: 10.7759/cureus.15761] [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] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
Revision total hip arthroplasty (THA) is a major reconstructive procedure traditionally associated with significant blood loss. Jehovah’s Witnesses (JW) do not accept blood or blood product transfusions because of their religious beliefs. When confronted with a JW patient requiring a complex arthroplasty procedure, surgeons face moral and ethical questions and may be reluctant to perform surgery. A successful outcome depends on several factors including surgical and anesthetic expertise, a range of revision implants, and a multimodal blood management protocol. While these resources are readily available in a developed country, in many of the developing Caribbean islands, the healthcare system is underfunded and under-resourced. Here, we describe our experience performing a revision THA on a JW patient in the Caribbean. Through this case report, we aim to illustrate our approach to blood management by exploring the fundamental elements that were employed in a low-resource setting. We believe that the extrapolation of these crucial principles to the broader category of primary arthroplasty in the general population can be used to reduce the rate of blood transfusion, increase access to surgery, and improve outcomes.
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Affiliation(s)
- Marlon M Mencia
- Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Allan Beharry
- Department of Surgery, Port of Spain General Hospital, Port of Spain, TTO
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Dean D, Swaminathan S, Kama M, Goemans S, Faktaufon D, Alnabelseya N, Spelke D, Kahrizi K, Black M, Mitra D. Development and Evaluation of a Point-of-Care Test in a Low-Resource Setting with High Rates of Chlamydia trachomatis Urogenital Infections in Fiji. J Clin Microbiol 2021; 59:e0018221. [PMID: 33910964 DOI: 10.1128/JCM.00182-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 12/11/2022] Open
Abstract
Rapid and precise detection of Chlamydia trachomatis, the leading global cause of sexually transmitted infections (STI), at the point of care (POC) is required for treatment decisions to prevent transmission and sequelae, including pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, and preterm birth. We developed a rapid POC test (POCT), termed LH-POCT, which uses loop-mediated amplification (LAMP) of nucleic acids. We performed a head-to-head comparison with the Cepheid Xpert CT/NG assay using clinician-collected, deidentified paired vaginal samples from a parent study that consecutively enrolled symptomatic and asymptomatic females over 18 years of age from the Ministry of Health and Medical Services Health Centers in Fiji. Samples were processed by the Xpert CT/NG assay and LH-POCT, blinded to the comparator. Discrepant samples were resolved by quantitative PCR. Deidentified clinical data and tests for Trichomonas vaginalis, Candida, and bacterial vaginosis (BV) were provided. There were a total of 353 samples from 327 females. C. trachomatis positivity was 16.7% (59/353), while the prevalence was 16.82% (55/327) after discrepant resolution. Seven discrepant samples resolved to four false negatives, two false positives, and one true positive for the LH-POCT. The sensitivity of the LH-POCT was 93.65% (95% confidence interval [CI], 84.53% to 98.24%), and specificity was 99.31% (95% CI, 97.53% to 99.92%). Discrepant samples clustered among women with vaginal discharge and/or BV. The prototype LH-POCT workflow has excellent performance, meeting many World Health Organization ASSURED criteria for POC tests, including a sample-to-result time of 35 min. Our LH-POCT holds promise for improving clinical practice to prevent and control C. trachomatis STIs in diverse health care settings globally.
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45
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Lewis JM, Abouyannis M, Katha G, Nyirenda M, Chatsika G, Feasey NA, Rylance J. Population Incidence and Mortality of Sepsis in an Urban African Setting, 2013-2016. Clin Infect Dis 2021; 71:2547-2552. [PMID: 31725849 PMCID: PMC7744994 DOI: 10.1093/cid/ciz1119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/05/2019] [Accepted: 11/12/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sepsis is an important cause of mortality globally, although population incidence estimates from low-income settings, including sub-Saharan Africa, are absent. We aimed to estimate sepsis incidence burden using routinely available data from a large urban hospital in Malawi. METHODS We linked routine-care databases at Queen Elizabeth Central Hospital, Blantyre, Malawi, to provide admission and discharge data for 217 149 adults from 2013-2016. Using a definition of sepsis based on systemic inflammatory response syndrome criteria and Blantyre census population data, we calculated population incidence estimates of sepsis and severe sepsis and used negative binomial regression to assess for trends over time. Missing data were multiply imputed with chained equations. RESULTS We estimate that the incidence rate of emergency department-attending sepsis and severe sepsis in adults was 1772 per 100 000 person-years (95% confidence interval [CI], 1754-1789) and 303 per 100 000 person-years (95% CI, 295-310), respectively, between 2013 and 2016, with a year-on-year decrease in incidence. In-hospital mortality for patients admitted to the hospital with sepsis and severe sepsis was 23.7% (95% CI, 22.7-24.7%) and 28.1% (95% CI, 26.1 - 30.0%), respectively, with no clear change over time. CONCLUSIONS Sepsis incidence is higher in Blantyre, Malawi, than in high-income settings, from where the majority of sepsis incidence data are derived. Worldwide sepsis burden is likely to be underestimated, and data from low-income countries are needed to inform the public health response.
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Affiliation(s)
- Joseph M Lewis
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Grace Katha
- Adult Emergency and Trauma Center, Queen Elizabeth Central Hospital, Blantyre, Malawi.,University of Malawi, College of Medicine, Blantyre, Malawi
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Center, Queen Elizabeth Central Hospital, Blantyre, Malawi.,University of Malawi, College of Medicine, Blantyre, Malawi
| | - Grace Chatsika
- Adult Emergency and Trauma Center, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nicholas A Feasey
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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46
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Cavaliere E, Trevisanuto D, Da Dalt L, Putoto G, Pizzol D, Muhelo AR, Cavallin F. Congenital malformations in neonates admitted to a neonatal intensive care unit in a low-resource setting. J Matern Fetal Neonatal Med 2021; 35:6363-6367. [PMID: 33902403 DOI: 10.1080/14767058.2021.1912003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
INTRODUCTION Congenital malformations (CMs) are among the major causes of infant mortality in middle- and low-resource countries. This is the first study describing CMs in neonates admitted to the Neonatal Intensive Care Unit (NICU) of a referral hospital in Mozambique. METHODS We included all neonates with CMs admitted to the NICU of Beira Central Hospital from January 2015 to December 2016. CMs were classified according to the International Classification of Disease (ICD-10). All data were retrieved from medical charts. RESULTS CMs were found in 143/4767 (3%) neonates admitted to the NICU. The most frequent CMs were musculoskeletal (31%), neurological (18%), multiple congenital anomalies (12%), chromosomopathies (11%), cardiovascular (10%), and gastrointestinal (8%). Forty-three patients (30%) underwent corrective surgery. Overall mortality rate was 50%. CONCLUSIONS The prevalence of CMs was 3%, with a mortality rate of 50%. Alongside implementation of antenatal screening programs, improvement on expertise and postnatal care of CMs are warranted.
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Affiliation(s)
- Elena Cavaliere
- Department of Woman's and Child's Health, University of Padova, Padova, Italy.,Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa, CUAMM, Padova, Italy
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Dakum P, Avong YK, Okuma J, Sorungbe T, Jatau B, Nedmbi N, Odutola MK, Abimiku A, Mensah CO, Kayode GA. Prevalence and risk factors for obesity among elderly patients living with HIV/AIDS in a low-resource setting. Medicine (Baltimore) 2021; 100:e25399. [PMID: 33847636 PMCID: PMC8052014 DOI: 10.1097/md.0000000000025399] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 01/04/2023] Open
Abstract
Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting.This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index [BMI] ≥30 kg/m2) and the prespecified potential risk factors.Of the 134,652 in HIV cohort, 19,566 (14.5%) were EPLHIV: 12,967 (66.3%) were normal weight (18.5 ≤ BMI < 25), 4548 (23.2%) were overweight (25 ≤ BMI < 30), while 2,051 (10.5%) were obese (BMI ≥30). The average age the normal weight (57.1; standard deviation 6.6) and the obese (56.5; standard deviation 5.5) was similar. We observed that being an employed (relative risk [RR] 1.71; 95% confidence interval [CI] 1.48-2.00; P < .001), educated (RR 1.93; 95% CI 1.54-2.41; P < .001), and presence of hypertension (RR 1.78; 95% CI 1.44-2.20; P < .001), increased the risk of obesity. Also, being male (RR 0.38; 95% CI 0.33-0.44; P < .001), stages III/IV of the World Health Organization clinical stages of HIV (RR 0.58; 95% CI 0.50-0.68; P < .001), tenofovir-based regimen (RR 0.84; 95% CI 0.73-0.96, P < .001), and low CD4 count (RR 0.56; 95% CI 0.44-0.71; P < .001) were inversely associated with obesity.This study demonstrates that multiple factors are driving obesity prevalence in EPLHIV. The study provides vital information for policy-makers and HIV program implementers in implementing targeted-interventions to address obesity in EPLHIV. Its findings would assist in the implementation of a one-stop-shop model for the management of HIV and other comorbid medical conditions in EPLHIV.
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Kanagasabai U, Enriquez K, Gelting R, Malpiedi P, Zayzay C, Kendor J, Fahnbulleh S, Cooper C, Gibson W, Brown R, Nador N, Williams DE, Chiriboga D, Niescierenko M. The Impact of Water Sanitation and Hygiene (WASH) Improvements on Hand Hygiene at Two Liberian Hospitals during the Recovery Phase of an Ebola Epidemic. Int J Environ Res Public Health 2021; 18:3409. [PMID: 33806086 DOI: 10.3390/ijerph18073409] [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] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
Fourteen years of civil war left Liberia with crumbling infrastructure and one of the weakest health systems in the world. The 2014-2015 Ebola virus disease (EVD) outbreak exposed the vulnerabilities of the Liberian health system. Findings from the EVD outbreak highlighted the lack of infection prevention and control (IPC) practices, exacerbated by a lack of essential services such as water, sanitation, and hygiene (WASH) in healthcare facilities. The objective of this intervention was to improve IPC practice through comprehensive WASH renovations conducted at two hospitals in Liberia, prioritized by the Ministry of Health (MOH). The completion of renovations was tracked along with the impact of improvements on hand hygiene (HH) practice audits of healthcare workers pre- and post-intervention. An occurrence of overall HH practice was defined as the healthcare worker practicing compliant HH before and after the care for a single patient encounter. Liberia Government Hospital Bomi (LGH Bomi) and St. Timothy Government Hospital (St. Timothy) achieved World Health Organization (WHO) minimum global standards for environmental health in healthcare facilities as well as Liberian national standards. Healthcare worker (HCW) overall hand hygiene compliance improved from 36% (2016) to 89% (2018) at LGH Bomi hospital and from 86% (2016) to 88% (2018) at St. Timothy hospital. Improved WASH services and IPC practices in resource-limited healthcare settings are possible if significant holistic WASH infrastructure investments are made in these settings.
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Abuto W, Abera A, Gobena T, Dingeta T, Markos M. Survival and Predictors of Mortality Among HIV Positive Adult Patients on Highly Active Antiretroviral Therapy in Public Hospitals of Kambata Tambaro Zone, Southern Ethiopia: A Retrospective Cohort Study. HIV AIDS (Auckl) 2021; 13:271-281. [PMID: 33737838 PMCID: PMC7966412 DOI: 10.2147/hiv.s299219] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
Background Human Immune Deficiency Virus (HIV) infection remains the leading cause of morbidity and mortality. In Ethiopia, despite test and treat all HIV positives are adopted, a significant number of people eligible for Anti-Retroviral Therapy (ART) show up with advanced disease and at lower CD4 count. There is currently paucity of studies conducted that investigate predictors of mortality among adults on ART in the study area. Objective To explore Survival and predictors of mortality among adult HIV-positive patients on ART in Kambata Tambaro Zone, Ethiopia, from August 2013 to February 2019. Methods A health facility-based retrospective cohort study was conducted among records of 467 adult HIV-positive patients on ART selected using simple random sampling. Data were collected using standardized abstraction tool. Kaplan–Meier, Log rank tests and Cox regression model was applied to estimate survival status and identify predictors of mortality, respectively. Results Of the total 467 study subjects, 59 (12.63%) of them died in the study period. The median follow-up time of the cohort was 40.1 (IQR=13.6–59.0) months. The mortality rate of the cohort was 4.1 per 100 PYO. The overall survival probability of the cohort was 84.38% (95 CI=80.08–87.82) at 66 months. Bedridden function AHR=3.0 (95% CI, 1.44–6.64), Fair-adherence AHR=3.3 (95% CI, 1.50–7.07), Poor-adherence AHR=3.8 (95% CI, 1.88–7.96), presence of OIs AHR=4.2 (95% CI, 1.98–8.50), Late diagnosis (CD4 count >/=350) AHR=3.0 (95% CI, 1.91–6.42) and Immunologic failure AHR=3.5 (95% CI, 1.41–6.29) were independent predictors of time to death in Cox-Regression. Conclusion Late Diagnosis, poor adherence, being bedridden, having OI and Immunologic failure were independently associated with time to death. Early diagnosis to start treatment and emphasizing on close follow-up care to improve treatment adherence should be given special emphasis.
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Affiliation(s)
- Wondimu Abuto
- Public Health Emergency Management, Kembata Tembaro Zonal Health Department, Durame, Southern Nations Nationalities Peoples' Region, Ethiopia
| | - Admas Abera
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Melese Markos
- Department of Public Health, Dire Dawa University, Dire Dawa, Ethiopia
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50
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Cheshire J, Jones L, Munthali L, Kamphinga C, Liyaya H, Phiri T, Parry-Smith W, Dunlop C, Makwenda C, Devall AJ, Tobias A, Nambiar B, Merriel A, Williams HM, Gallos I, Wilson A, Coomarasamy A, Lissauer D. The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings: a multi-site evaluation. BJOG 2021; 128:1324-1333. [PMID: 33539610 DOI: 10.1111/1471-0528.16658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting. DESIGN A before-and-after design. SETTING Fifteen government healthcare facilities in Malawi. POPULATION Women suspected of having maternal sepsis. METHODS The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility. MAIN OUTCOME RESULT Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle. RESULTS Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. CONCLUSION Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi. TWEETABLE ABSTRACT Implementation of a sepsis care bundle for low-resources improved recognition & management of maternal sepsis.
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Affiliation(s)
- J Cheshire
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - L Munthali
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - C Kamphinga
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - H Liyaya
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - T Phiri
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - W Parry-Smith
- World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK.,Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, The Princess Royal Hospital, Telford, UK
| | - C Dunlop
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - C Makwenda
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - A J Devall
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - A Tobias
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - B Nambiar
- Institute for Global Child Health, University College London, London, UK
| | - A Merriel
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - H M Williams
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - I Gallos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - A Wilson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,World Health Organization Collaborating Centre for Global Women's Health Research, University of Birmingham, Birmingham, UK
| | - D Lissauer
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,College of Medicine, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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