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Tapia JL, Toso A, Vaz Ferreira C, Fabres J, Musante G, Mariani G, Herrera TI, D'Apremont I. The unfinished work of neonatal very low birthweight infants quality improvement: Improving outcomes at a continental level in South America. Semin Fetal Neonatal Med 2021; 26:101193. [PMID: 33478876 DOI: 10.1016/j.siny.2021.101193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neonatal mortality rate varies between 4.2 and 18.6 per thousand by country in South America. There is little information regarding the outcomes of very low birth weight infants in the region and mortality rates are extremely variable ranging from 6% to over 50%. This group may represent up to 50-70% of the neonatal mortality and approximately 25-30% of infant mortality. Some initiatives, like the NEOCOSUR Network, have systematically collected and analyzed epidemiological information on VLBW infants' outcomes in the region. Over a 16-year period, survival without major morbidity improved from 37 to 44%. However, mortality has remained almost unchanged at approximately 27%, despite an increase in the implementation of the best available evidence in perinatal practices over time. Implementing quality improvement initiatives in the continent is particularly challenging but represents a great opportunity considering that there is a wide margin for progress in both care and outcomes.
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Affiliation(s)
- J L Tapia
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - A Toso
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - C Vaz Ferreira
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de La República, Montevideo, Uruguay.
| | - J Fabres
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - G Musante
- Department of Maternal and Child Health, Hospital Universitario Austral, Pilar, Argentina.
| | - G Mariani
- Department of Pediatrics, Division of Neonatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - T I Herrera
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de La República, Montevideo, Uruguay.
| | - I D'Apremont
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Gladding SP, McGann PT, Summer A, Russ CM, Uwemedimo OT, Matamoros Aguilar M, Chakraborty R, Moore M, Lieh-Lai M, Opoka R, Howard C, John CC. The Collaborative Role of North American Departments of Pediatrics in Global Child Health. Pediatrics 2018; 142:peds.2017-2966. [PMID: 29895523 DOI: 10.1542/peds.2017-2966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Appeals for health equity call for departments of pediatrics to improve the health of all children including those from underserved communities in North America and around the world. Consequently, North American (NA) departments of pediatrics have a role in global child health (GCH) which focuses on providing health care to underserved children worldwide. In this review, we describe how NA departments of pediatrics can collaboratively engage in GCH education, clinical practice, research, and advocacy and summarize best practices, challenges, and next steps for engaging in GCH in each of these areas. For GCH in low- and middle-income countries (LMICs), best practices start with the establishment of ethical, equitable, and collaborative partnerships with LMIC communities, organizations, and institutions engaged in GCH who are responsible for the vast majority of work done in GCH. Other best practices include adequate preparation of trainees and clinicians for GCH experiences; alignment with local clinical and research priorities; contributions to local professional development and ongoing monitoring and evaluation. Challenges for departments include generating funding for GCH activities; recruitment and retention of GCH-focused faculty members; and challenges meeting best practices, particularly adequate preparation of trainees and clinicians and ensuring mutual benefit and reciprocity in NA-LMIC collaborations. We provide examples of how departments have overcome these challenges and suggest next steps for development of the role of NA departments of pediatrics in GCH. Collaborative implementation of best practices in GCH by LMIC-NA partnerships can contribute to reductions of child mortality and morbidity globally.
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Affiliation(s)
- Sophia P Gladding
- Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, Minnesota;
| | | | - Andrea Summer
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Christiana M Russ
- Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Omolara T Uwemedimo
- Department of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
| | | | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Molly Moore
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Vermont, Burlington, Vermont
| | - Mary Lieh-Lai
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Robert Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cynthia Howard
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
| | - Chandy C John
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Department of Pediatrics, Indiana University of Medicine, Bloomington, Indiana
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Walker RJ, Campbell JA, Egede LE. Effective strategies for global health research, training and clinical care: a narrative review. Glob J Health Sci 2014; 7:119-39. [PMID: 25716404 PMCID: PMC4796426 DOI: 10.5539/gjhs.v7n2p119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 11/12/2022] Open
Abstract
The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical care. Global health program development should be completed within the framework of a larger institutional commitment or partnership. Support from leadership in the university or NGO, and an engaged local community are both integral to success and sustainability of efforts. It is also important for program development to engage local partners from the onset, jointly exploring issues and developing goals and objectives. Evaluation is a recommended way to determine if goals are being met, and should include considerations of sustainability, partnership building, and capacity. Global health research programs should consider details regarding the research process, context of research, partnerships, and community relationships. Training for global health should involve mentorship, pre-departure preparation of students, and elements developed to increase impact. Clinical care programs should focus on collaboration, sustainability, meeting local needs, and appropriate process considerations.
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Fottrell E, Kanhonou L, Goufodji S, Béhague DP, Marshall T, Patel V, Filippi V. Risk of psychological distress following severe obstetric complications in Benin: the role of economics, physical health and spousal abuse. Br J Psychiatry 2010; 196:18-25. [PMID: 20044654 PMCID: PMC2802511 DOI: 10.1192/bjp.bp.108.062489] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the impact of life-threatening obstetric complications ('near miss') on women's mental health in low- and middle-income countries. AIMS To examine the relationships between near miss and postpartum psychological distress in the Republic of Benin. METHOD One-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities. RESULTS In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth. CONCLUSIONS A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.
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Affiliation(s)
- Edward Fottrell
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 7HT, UK.
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