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Alatise OI, Yibrehu B, Jackman J, Arije O, Olasehinde O, Keli E, Offei A, Jaiteh L, Aderounmu A, Kingham PT. Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment. HPB (Oxford) 2024:S1365-182X(24)01735-0. [PMID: 38862377 DOI: 10.1016/j.hpb.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND West Africa has among the highest rates of hepato-pancreato-biliary (HPB) malignancies in the world. Although surgery is critical for treatment, the availability of HPB surgery in Africa is unknown. This cross-sectional study investigated the current HPB surgical capacity of West African hospitals. METHOD The Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey was modified to include HPB-specific parameters and quantify capacity. The survey was completed by consultant surgeons from West Africa. A PIPES index was calculated, and a higher score corresponded to greater HPB surgical capacity. RESULTS The HPB PIPES survey was completed by 35 institutions from The Gambia, Ghana, Ivory Coast, and Nigeria. Most institutions (94.2%) were tertiary referral centres; five had an HPB-trained surgeon. The most commonly available procedure was an open cholecystectomy (91.4%), followed by gastric bypass (88.6%). Major hepatic resections (14.3%) and the Whipple procedure (17.1%) were rare. ICU capabilities were present at 88.6% of facilities while interventional radiology was present in 25.7%. CONCLUSIONS This is the first HPB capacity assessment in Africa. This study showed the limited availability of HPB surgery in West Africa. These results can be used for regional quality improvement initiatives and as a baseline for future capacity assessments.
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Affiliation(s)
| | - Betel Yibrehu
- Department of Surgery, University of Toronto, Toronto, Canada; Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Julia Jackman
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Elie Keli
- Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Cote d'Ivoire
| | - Asare Offei
- Department of Surgery, Korle Bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana
| | - Lamin Jaiteh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | | | - Peter T Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
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Antwi RS, Galanza JS. Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study. BELITUNG NURSING JOURNAL 2024; 10:134-142. [PMID: 38690302 PMCID: PMC11056842 DOI: 10.33546/bnj.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 05/02/2024] Open
Abstract
Background Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress. Objective This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings. Methods This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman's Correlation. Results The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001). Conclusions Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses' moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.
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Atiase Y, Yorke E, Akpalu J, Reynolds M, Annan OA, Aryee R, Hayfron-Benjamin C, Yawson A. Clinical characteristics and severity of diabetic ketoacidosis: A cross-sectional study from a tertiary hospital in Ghana. Trop Med Int Health 2023; 28:790-796. [PMID: 37537727 DOI: 10.1111/tmi.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) is a common, severe and often fatal complication of diabetes. This study aimed to investigate the clinical characteristics and precipitants of DKA, as well as factors associated with DKA severity in Ghanaian patients. METHODS Cross-sectional study of the medical records of all 70 adult patients >18 years managed for DKA in the adult emergency room of Korle-Bu Teaching Hospital in Ghana from March 2019 to July 2019. DKA diagnosis was based on hyperglycaemia >11.0 mmol/L, ketonuria (more than 2+) plus acidaemia of (pH < 7.3) or bicarbonate (HCO3 - ) <15.0 mmol/L. However, when serum bicarbonate and pH were not available, clinical signs of acidosis, for example, Kussmaul breathing aided in the diagnosis. DKA severity was assessed based on the Joint British Diabetes Societies (JBDS) guidelines of factors suggestive of severe DKA. Multivariable logistic regression was used to determine the factors associated with DKA severity. Odds ratio and 95% confidence interval for factors associated with DKA severity were determined. RESULTS The mean (±standard deviation) age, diabetes duration and blood sugar at admission were 44.06 (±16.23) years, 7.19 (±6.04) years and 26.37 (±6.70) mmol/L, respectively. Females comprised 51.4% of the study population. The most common presenting symptoms were generalised weakness (30.0%) and fever (14.3%). The major precipitants were infection (70.0%) and non-compliance (22.9%). Overall, 71.4% of participants had features suggestive of severe DKA. In a multivariable regression model, Type 2 diabetes was associated with over fourfold decreased odds of severe DKA (OR 0.23, 95% CI [0.07-0.76], p = 0.016). Patient education on prevention of DKA was documented for only 18.6% of patients before being discharged. CONCLUSION In this study, more than 70% of the study participants had features suggestive of severe DKA, with infection being the most common precipitant of DKA. 51.4% of patients had Type 2 diabetes which was associated with a statistically lower risk of severe DKA. Female sex tended to be positively associated with DKA severity. In a setting where the venous/arterial pH and bicarbonate levels may be inaccessible and/or unaffordable, using clinical features as found in the JBDS guidelines may help categorise patients and escalate care when needed. Indeed it may be useful to validate the use of the JBDS criteria for use in such settings.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Margaret Reynolds
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | | | - Robert Aryee
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Cardiology, University of Ghana Medical Center, Accra, Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesia, University of Ghana Medical School, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
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Littlejohns A, Please H, Musasizi R, Murdoch S, Nampiina G, Waters I, Birch WD, de Boer G, Kapur N, Ambrozi T, Carol N, Noel N, Parmar J, Culmer P, Lawton T, Namulema E. Descriptive account of the first use of the LeVe CPAP System, a new frugal CPAP System, in adult patients with COVID-19 Pneumonitis in Uganda. Trop Med Health 2023; 51:42. [PMID: 37545001 PMCID: PMC10405477 DOI: 10.1186/s41182-023-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has been a key treatment modality for Coronavirus Disease 2019 (COVID-19) worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP System was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. Prior to formal trial approval, received in November 2021, these devices were used in extremis to support critically unwell adult patients requiring non-invasive ventilatory support. METHODS This is a retrospective descriptive review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Uganda. Patients were treated with the LeVe CPAP System, Elisa CPAP and/or AIRVO™ HFNO. Treatment was escalated per standard local protocols for respiratory failure, and CPAP was the maximum respiratory support available. Data were collected on patient characteristics, length of time of treatment, clinical outcome, and any adverse events. RESULTS Overall 333 patients were identified as COVID-19 positive, 44 received CPAP ± HFNO of which 43 were included in the study. The median age was 58 years (range 28-91 years) and 58% were female. The median duration of advanced respiratory support was 7 days (range 1-18 days). Overall (all device) mortality was 49% and this was similar between those started on the LeVe CPAP System and those started non-LeVe CPAP System devices (50% vs 47%). CONCLUSIONS The LeVe CPAP system was the most used CPAP device during the pandemic, bringing the hospital's number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well-tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP System; therefore, formal comparative studies are required to inform further use.
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Affiliation(s)
- Anna Littlejohns
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Helen Please
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Racheal Musasizi
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Stuart Murdoch
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Gorret Nampiina
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Ian Waters
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | - Nikil Kapur
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Tumwesigye Ambrozi
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Ninsiima Carol
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Nakigudde Noel
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Jiten Parmar
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Peter Culmer
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Tom Lawton
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Ln, Bradford, BD9 6RJ, UK
| | - Edith Namulema
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda.
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Sonenthal PD, Kasomekera N, Connolly E, Wroe EB, Katete M, Minyaliwa T, Marsh RH, Banda-Katha G, Nyirenda M, Scott KW, Bukhman A, Mukherjee J, Rouhani SA. Critical Care Units in Malawi: A Cross-Sectional Study. Ann Glob Health 2023; 89:51. [PMID: 37547484 PMCID: PMC10402812 DOI: 10.5334/aogh.4053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A lack of data limits attempts to understand and address the drivers of critical care outcomes outside high-income countries. Objectives We aim to characterize the organization, available resources, and service capacity of public sector critical care units in Malawi and identify barriers to improving care. Methods We conducted a secondary analysis of the Malawi Emergency and Critical Care Survey, a cross-sectional study performed from January to February 2020 at all four central hospitals and a simple random sample of nine out of 24 public sector district hospitals in Malawi, a predominantly rural, low-income country of 19.6 million in southern Africa. Data from critical care units were used to characterize resources, processes, and barriers to care. Findings There were four HDUs and four ICUs across the 13 hospitals in the Malawi Emergency and Critical Care Survey sample. The median critical care beds per 1,000,000 catchment was 1.4 (IQR: 0.9 to 6.7). Absent equipment was the most common barrier in HDUs (46% [95% CI: 32% to 60%]). Stockouts was the most common barriers in ICUs (48% [CI: 38% to 58%]). ICUs had a median 3.0 (range: 2 to 8) functional ventilators per unit and reported an ability to perform several quality mechanical ventilation interventions. Conclusions Although significant gaps exist, Malawian critical care units report the ability to perform several complex clinical processes. Our results highlight regional inequalities in access to care and support the use of process-oriented questions to assess critical care capacity. Future efforts should focus on basic critical care capacity outside of urban areas and quantify the impact of context-specific variables on critical care mortality.
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Affiliation(s)
- Paul D. Sonenthal
- Brigham and Women’s Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St, Suite 300, Boston, MA 02199, USA
| | - Noel Kasomekera
- Ministry of Health, P.O. Box 30377, Lilongwe 3, MW
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, MW
| | - Emilia Connolly
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, MW
- University of Cincinnati College of Medicine, Division of Pediatrics, 3230 Eden Ave, Cincinnati, OH 45267, USA
- Cincinnati Children’s Hospital Medical Center, Division of Hospital Medicine, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Emily B. Wroe
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, MW
- Brigham and Women’s Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA 02115, USA
| | - Martha Katete
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, MW
| | | | - Regan H. Marsh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St, Suite 300, Boston, MA 02199, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Grace Banda-Katha
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, MW
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, MW
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, MW
| | - Kirstin W. Scott
- University of Washington, Department of Emergency Medicine, 325 Ninth Street, Seattle, WA, 98104, USA
| | - Alice Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA 02115, USA
| | - Joia Mukherjee
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St, Suite 300, Boston, MA 02199, USA
| | - Shada A. Rouhani
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St, Suite 300, Boston, MA 02199, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA 02115, USA
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Mwangi W, Kaddu R, Njoki Muiru C, Simiyu N, Patel V, Sulemanji D, Otieno D, Okelo S, Chikophe I, Pisani L, Dona DPG, Beane A, Haniffa R, Misango D, Waweru-Siika W. Organisation, staffing and resources of critical care units in Kenya. PLoS One 2023; 18:e0284245. [PMID: 37498872 PMCID: PMC10374136 DOI: 10.1371/journal.pone.0284245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/27/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors. MATERIALS AND METHODS An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care. RESULTS The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow. CONCLUSION This study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers.
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Affiliation(s)
- Wambui Mwangi
- Department of Anesthesia and Intensive Care, Nyeri County Referral Hospital, Nyeri, Kenya
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Ronnie Kaddu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Intensive Care Unit, Aga Khan Mombasa Hospital, Mombasa, Kenya
| | - Carolyne Njoki Muiru
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Egerton University Surgery Department, Nakuru Level V ICU, Nakuru, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Nabukwangwa Simiyu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Intensive Care, Kisii County Referral Hospital, Kisii, Kenya
| | - Vishal Patel
- Department of Anesthesia and Intensive Care, MP Shah Hospital, Nairobi, Kenya
| | - Demet Sulemanji
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Dorothy Otieno
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Stephen Okelo
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Maseno University, Maseno, Kenya
| | - Idris Chikophe
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Kenyatta National Hospital, Nairobi, Kenya
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - David Misango
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Wangari Waweru-Siika
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system. Crit Care 2022; 26:209. [PMID: 35818054 PMCID: PMC9272593 DOI: 10.1186/s13054-022-04046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.
Methods
To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.
Results
A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.
Conclusion
Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.
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The unmet need for critical care at a quaternary paediatric intensive care unit in South Africa. S Afr Med J 2022; 112:871-878. [DOI: 10.7196/samj.2022.v112i11.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background. Paediatric intensive care, a valuable resource that improves the outcomes of critically ill children, is often scarce.
Objective. To evaluate the need for paediatric intensive care beds and compare the outcomes of admitted and non-admitted deserving cases.
Methods. A prospective evaluation of all bed requests, in terms of need for intensive care and outcomes of those admitted and not admitted to a paediatric intensive care unit (PICU), was performed between July 2017 and June 2018. Factors for refusal and for poor outcomes were evaluated.
Results. Of the 811 bed requests, 32.6% (n=264, p<0.001) were denied access. Of the 231 deserving cases who were denied access, 85.7% (n=198) were due to unavailability of a PICU bed. Patients not admitted to PICU had a twofold increased risk of dying compared with those admitted (34.4% v. 15.5% respectively, p<0.001), even though the patient characteristics of both groups were similar (age, gender and nutritional status). In those admitted, risk factors for mortality were requiring transfusion of blood and platelets (56.0%, p<0.001), requiring two or more inotropes (52.5%, p<0.001), instability on admission (41.3%, p<0.001), prior cardiac arrest (32.0%, p=0.021), severe acute malnutrition (26.9%, p=0.043), fungal infection (22.2%, p=0.004) and emergency admission (18.0%, p<0.001). In those not admitted, prior cardiac arrest (100%, p<0.001) and emergency referral (42.3%, p<0.001) were associated with adverse outcomes.
Conclusion. The need for PICU beds exceeds availability, with a consequent twofold increase in mortality among cases not admitted to PICU. Paediatric critical care services have increased at appropriate sites of need following completion of this study.
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10
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Ocansey BK, Dadzie EA, Eduful SK, Agyei M, Osei MM, Puplampu P, Asamoah I, Oladele RO, Osaigbovo II, Afriyie-Mensah J, Opintan JA, Essien-Baidoo S, Chakrabarti A, Hoenigl M, Denning DW, Richardson MD. Improving Awareness, Diagnosis and Management of Invasive Fungal Infections in Ghana: Establishment of the Ghana Medical Mycology Society. Med Mycol 2022; 60:6694000. [PMID: 36073757 PMCID: PMC9521337 DOI: 10.1093/mmy/myac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Invasive fungal infections (IFIs) and medical mycology receive little attention in Ghana. However, the present evolution of biomarker assays for IFIs, offers an opportunity for an increased access to fungal laboratory testing in resource-limited settings, and probably make a case for availability of essential antifungal agents. Using surveys and personal communications, the state of medical mycology and IFI in Ghana were highlighted. Inadequate awareness and insufficient access to fungal diagnostics and therapeutics were identified as the key challenges, the establishment of the Ghana Medical Mycology Society was discussed, and recommendations were made to improve the status quo.
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Affiliation(s)
- Bright K Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Edmund A Dadzie
- Department of Health and Allied Sciences, Baldwin University College, Accra, Ghana
| | - Stephen K Eduful
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Martin Agyei
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana.,Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Isabella Asamoah
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Rita O Oladele
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Jane Afriyie-Mensah
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana.,Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Japheth A Opintan
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Essien-Baidoo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - David W Denning
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Malcolm D Richardson
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Mycology Reference Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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11
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Investigation of possible preventable causes of COVID-19 deaths in the Kampala Metropolitan Area, Uganda, 2020-2021. Int J Infect Dis 2022; 122:10-14. [PMID: 35595020 PMCID: PMC9110304 DOI: 10.1016/j.ijid.2022.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Identifying preventable causes of COVID-19 deaths is key to reducing mortality. We investigated possible preventable causes of COVID-19 deaths over a six-month period in Uganda. METHODS A case-patient was a person testing reverse transcription polymerase chain reaction-positive for SARS-CoV-2 who died in Kampala Metropolitan Area hospitals from August 2020 to February 2021. We reviewed records and interviewed health workers and case-patient caretakers. RESULTS We investigated 126 (65%) of 195 reported COVID-19 deaths during the investigation period; 89 (71%) were male, and the median age was 61 years. A total of 98 (78%) had underlying medical conditions. Most (118, 94%) had advanced disease at admission to the hospital where they died. A total of 44 (35%) did not receive a COVID-19 test at their first presentation to a health facility despite having consistent symptoms. A total of 95 (75%) needed intensive care unit admission, of whom 45 (47%) received it; 74 (59%) needed mechanical ventilation, of whom 47 (64%) received it. CONCLUSION Among hospitalized patients with COVID-19 who died in this investigation, early opportunities for diagnosis were frequently missed, and there was inadequate intensive care unit capacity. Emphasis is needed on COVID-19 as a differential diagnosis, early testing, and care-seeking at specialized facilities before the illness reaches a critical stage. Increased capacity for intensive care is needed.
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12
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Novignon J, Tabiri KG. Leveraging COVID-19 pandemic response for improved health system financing: Lessons from Ghana. Int J Health Plann Manage 2022; 37:2211-2223. [PMID: 35365905 PMCID: PMC9087395 DOI: 10.1002/hpm.3462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/01/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022] Open
Abstract
The COVID-19 pandemic has exposed health system funding challenges across many developing countries. The needed infrastructure to effectively respond to the pandemic was absent in many developing countries. This has resulted in policymakers resorting to various strategies to mobilise sufficient resources in response to the pandemic, especially in the early stages. This paper reviewed Ghana's efforts to mobilise domestic and external resources for the health sector in response to the pandemic. The paper also assessed lessons from these strategies and highlights how these lessons could be leveraged to sustain financing for the health sector. Using evidence from desk reviews, we demonstrate the existence of fiscal space through external sources, partnership with non-state actors, and effective public financial management (budget space). We also show that the COVID-19 pandemic presents an important momentum to drive future investment in health infrastructure across developing countries.
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Affiliation(s)
- Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwasi Gyabaa Tabiri
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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13
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Nachega JB, Sam-Agudu NA, Machekano RN, Rabie H, van der Zalm MM, Redfern A, Dramowski A, O’Connell N, Pipo MT, Tshilanda MB, Byamungu LN, Masekela R, Jeena PM, Pillay A, Gachuno OW, Kinuthia J, Ishoso DK, Amoako E, Agyare E, Agbeno EK, Martyn-Dickens C, Sylverken J, Enimil A, Jibril AM, Abdullahi AM, Amadi O, Umar UM, Sigwadhi LN, Hermans MP, Otokoye JO, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Zumla A, Sewankambo NK, Aanyu HT, Musoke P, Suleman F, Adejumo P, Noormahomed EV, Deckelbaum RJ, Fowler MG, Tshilolo L, Smith G, Mills EJ, Umar LW, Siedner MJ, Kruger M, Rosenthal PJ, Mellors JW, Mofenson LM. Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries. JAMA Pediatr 2022; 176:e216436. [PMID: 35044430 PMCID: PMC8771438 DOI: 10.1001/jamapediatrics.2021.6436] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
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Affiliation(s)
- Jean B. Nachega
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria,Institute of Human Virology, University of Maryland School of Medicine, Baltimore,Department of Pediatrics, University of Maryland School of Medicine, Baltimore,Department of Pediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Rhoderick N. Machekano
- Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Helena Rabie
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Natasha O’Connell
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Michel Tshiasuma Pipo
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Marc B. Tshilanda
- Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Liliane Nsuli Byamungu
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Prakash Mohan Jeena
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Onesmus W. Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Katuashi Ishoso
- Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Emmanuella Amoako
- Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Evans K. Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Justice Sylverken
- Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana,Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Enimil
- Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana,Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aishatu Mohammed Jibril
- Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Asara M. Abdullahi
- Department of Internal Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Oma Amadi
- Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria
| | - Umar Mohammed Umar
- Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Michel P. Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - John Otshudiema Otokoye
- Health Emergencies Program, COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe-Tamfum
- National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Services Foundation Trust, London, United Kingdom
| | - Nelson K. Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Philippa Musoke
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | | | - Richard J. Deckelbaum
- Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Léon Tshilolo
- Department of Pediatrics, Official University of Mbuji-Mayi, Kinshasa, Democratic Republic of the Congo,Le Centre de Formation et d'Appui Sanitaire, Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Gerald Smith
- Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada
| | - Edward J. Mills
- Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawal W. Umar
- Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Mark J. Siedner
- Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, Boston,Department of Medicine, School of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mariana Kruger
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Philip J. Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco
| | - John W. Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
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14
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Anane-Fenin B, Agbeno EK, Osarfo J, Opoku Anning DA, Boateng AS, Ken-Amoah S, Amanfo AO, Derkyi-Kwarteng L, Mouhajer M, Amoo SA, Ashong J, Jeffery E. A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country. PLoS One 2022; 16:e0261974. [PMID: 34972184 PMCID: PMC8719704 DOI: 10.1371/journal.pone.0261974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.
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Affiliation(s)
- Betty Anane-Fenin
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
- * E-mail:
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | - Abigail Serwaa Boateng
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Anthony Ofori Amanfo
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Pathology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Mohammed Mouhajer
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Sarah Ama Amoo
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joycelyn Ashong
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Ernestina Jeffery
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
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15
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Ackah M, Gazali Salifu M, Osei Yeboah C. Estimated incidence and case fatality rate of traumatic brain injury among children (0-18 years) in Sub-Saharan Africa. A systematic review and meta-analysis. PLoS One 2021; 16:e0261831. [PMID: 34968399 PMCID: PMC8717989 DOI: 10.1371/journal.pone.0261831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0-18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA. METHODS Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie's method. RESULTS Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children's TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo. CONCLUSION TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0-18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.
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Affiliation(s)
- Martin Ackah
- Department of Physiotherapy, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Mohammed Gazali Salifu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- Policy Planning Budgeting Monitoring and Evaluation Directorate, Ministry of Health, Accra, Ghana
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16
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Abiodun MT, Eki-Udoko FE. Evaluation of Paediatric Critical Care Needs and Practice in Nigeria: Paediatric Residents' Perspective. Crit Care Res Pract 2021; 2021:2000140. [PMID: 34513090 PMCID: PMC8426102 DOI: 10.1155/2021/2000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a dire need for paediatric critical care (PCC) services, but their availability in tertiary hospitals in Nigeria is not well defined. OBJECTIVE We evaluated self-reported PCC practice, resources, and perceived challenges in various zones of the country, using paediatric residents' perspective. METHODS This is a descriptive cross-sectional survey, carried out at an Intensive Course in Paediatrics at the University of Benin Teaching Hospital, Nigeria. Participants' PCC practice and perceived adequacy of PCC resources and services were assessed using a 100 mm uncalibrated visual analogue scale (VAS). A comparison between northern and southern zones was done. A 2-sided p value < 0.05 was considered significant. RESULTS A total of 143 residents participated in the study, 37.1% of them were male, and 62.9% were female. Their mean age was 34.6 ± 3.2 years. They were mainly (86.7%) from federal institutions across the country. Less than a half (46.7%) of the trainees attended to critically ill children daily, but only 4 out of every 10 respondents stated that such severely ill children survived till hospital discharge; 12.1% of the trainees had PICUs in their institutions. Financial constraints hindered PICU admissions. PCC staff were relatively fewer in northern zones than southern zones (p < 0.05). Their perceived adequacy of PCC equipment and services were low (VAS scores 32.7 ± 2.6 and 30.9 ± 2.8, respectively) with a strong positive correlation between the two measurements (r = 0.839; p < 0.001). CONCLUSION There is an unmet need for PCC practice in Nigerian tertiary hospitals with a resultant low survival rate of critically ill children. PCC training curricula and improved critical care resources are desirable in the setting.
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Affiliation(s)
- Moses Temidayo Abiodun
- Paediatric Emergency & Critical Care Division, Department of Child Health, University of Benin Teaching Hospital, & School of Medicine, University of Benin, Benin City, Nigeria
| | - Fidelis E. Eki-Udoko
- Paediatric Emergency & Critical Care Division, Department of Child Health, University of Benin Teaching Hospital, & School of Medicine, University of Benin, Benin City, Nigeria
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Dzando G, Salifu S, Donyi AB, Akpeke H, Kumah A, Dordunu R, Nonoh EA. Healthcare in Ghana amidst the coronavirus pandemic: a narrative literature review. J Public Health Res 2021; 11. [PMID: 34351103 PMCID: PMC8847958 DOI: 10.4081/jphr.2021.2448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022] Open
Abstract
The Coronavirus pandemic has caused more deaths than any other single disease since the outbreak was confirmed. The World Health Organization in collaboration with national and international health agencies continues to lead the way in bracing global healthcare systems to fight the pandemic. There are variations in national capacities towards the preparedness and management of the pandemic. The Government of Ghana, through the Ministry of Health and Ghana Health Service, continues to provide policy and operational directions towards the containment of the pandemic. The purpose of this study is to review the setup of the healthcare sector in Ghana in light of the ongoing pandemic. This study is a narrative literature review in which data was extracted from electronic databases such as PubMed, Google Scholar, Scopus and Ebscohost that published Covid-19 research articles from Ghana. Literature was analysed and discussed based on the structures and systems available in the healthcare sector, as well as trends available from the global perspective. The healthcare sector in Ghana continues to support the citizenry in the wake of the Coronavirus pandemic. The government provides regular updates and continue to pledge their support in dealing with the effects of the pandemic. Challenges with accessibility, workforce, funding, and infrastructure remain the major hindrances in fighting the pandemic. The government and healthcare partners need to continually reform the healthcare system to meet the increasing demand for healthcare during the pandemic. Significance for public health The Coronavirus pandemic continues to test healthcare systems globally. Developing countries with low resources and poor healthcare systems stand a risk of succumbing to the devastating effects of the pandemic. This study provides a brief insight into existing systematic healthcare gaps in the Ghanaian healthcare system and can serve as a wake-up call to policymakers to re-evaluate and augment the current systems to provide quality healthcare to the citizenry during the pandemic.
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Affiliation(s)
- Gideon Dzando
- College of Nursing and Health Sciences, Flinders University, Adelaide.
| | - Seidu Salifu
- KAAF University College, Budumburam, Gomoa East District.
| | | | - Hope Akpeke
- Department of Nursing, Jasikan District Hospital, Jasikan.
| | - Augustine Kumah
- Department of Quality and Public Health, Nyaho Medical Centre, Accra.
| | - Rebecca Dordunu
- School of Nursing and Midwifery, University of Ghana, Legon.
| | - Elisha A Nonoh
- Holy Family Nursing and Midwifery Training College, Berekum.
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18
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Quakyi NK, Agyemang Asante NA, Nartey YA, Bediako Y, Sam-Agudu NA. Ghana's COVID-19 response: the Black Star can do even better. BMJ Glob Health 2021; 6:bmjgh-2021-005569. [PMID: 33712435 PMCID: PMC7958583 DOI: 10.1136/bmjgh-2021-005569] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nana Kofi Quakyi
- Department of Health Policy and Management, School of Global Public Health, New York University, New York, New York, USA
| | | | - Yvonne Ayerki Nartey
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
- Department of Medicine, Cape Coast Teaching Hospital, Cape Coast, Central Region, Ghana
| | - Yaw Bediako
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Nadia Adjoa Sam-Agudu
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Paediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Central Region, Ghana
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
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