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Penzias RE, Bohne C, Ngwala SK, Zimba E, Lufesi N, Rashid E, Gicheha E, Odedere O, Dosunmu O, Tillya R, Shabani J, Cross JH, Liaghati-Mobarhan S, Chiume M, Banda G, Chalira A, Wainaina J, Gathara D, Irimu G, Adudans S, James F, Tongo O, Ezeaka VC, Msemo G, Salim N, Day LT, Powell-Jackson T, Chandna J, Majamanda M, Molyneux EM, Oden M, Richards-Kortum R, Ohuma EO, Paton C, Hailegabriel T, Gupta G, Lawn JE. Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF. BMC Pediatr 2024; 23:655. [PMID: 38454369 PMCID: PMC10921557 DOI: 10.1186/s12887-023-04495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/18/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC). METHODS Health systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. RESULTS Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. CONCLUSION This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.
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Affiliation(s)
- Rebecca E Penzias
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Christine Bohne
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA.
- Ifakara Health Institute, Ifakara, Tanzania.
| | - Samuel K Ngwala
- Research Support Center, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Evelyn Zimba
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | | | - Ekran Rashid
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
- Aga Khan University Hospital, Nairobi, Kenya
| | - Edith Gicheha
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
- APIN Public Health Initiatives, Abuja, Nigeria
| | | | | | | | - James H Cross
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Msandeni Chiume
- Department of Paediatrics, Kamuzu University of Health Sciences (Formerly College of Medicine, University of Malawi), Blantyre, Malawi
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - George Banda
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - John Wainaina
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust, Nairobi, Kenya
| | - David Gathara
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Steve Adudans
- Academy for Novel Channels in Health and Operations Research (ACANOVA) Africa, Nairobi, Kenya
| | - Femi James
- Newborn Branch, Federal Ministry of Health, Abuja, Nigeria
| | - Olukemi Tongo
- FWACP Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Georgina Msemo
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
- Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Louise T Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Maureen Majamanda
- Kamuzu University of Health Sciences (Formerly Kamuzu College of Nursing, University of Malawi), Blantyre, Malawi
| | - Elizabeth M Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences (Formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Maria Oden
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | | | - Eric O Ohuma
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Paton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | | | - Gagan Gupta
- Program Group, Health Programme UNICEF Headquarters, New York, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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Bandiya P, Madappa R, Joshi AR. Etiology, Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn in Resource-limited Settings. Clin Perinatol 2024; 51:237-252. [PMID: 38325944 DOI: 10.1016/j.clp.2023.11.002] [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: 02/09/2024]
Abstract
Persistent Pulmonary Hypertension of the Newborn (PPHN) is more common in Low and middle income countries (LMICs) due to high incidence of sepsis, perinatal asphyxia and meconium aspiration syndrome. Presence of hypoxic respiratory faillure and greater than 5% difference in preductal and post ductal saturation increases clinical sucipision for PPHN. The availability of Inhaled nitric oxide and extracorporaeal membrane oxygenation is limited but pulmonary vasodilators such as sildenafil are readily available in most LMICs.
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Affiliation(s)
- Prathik Bandiya
- Department of Neonatology, Neonatal Unit, 1st Floor, Indira Gandhi Institute of Child Health, South Hospital complex, Dharmaram college Post, Bangalore - 560029
| | - Rajeshwari Madappa
- Department of Pediatrics, SIGMA Hospital, P8/D, Thonachikoppal -Saraswathipuram Road, Mysore -570009 Karnataka, India.
| | - Ajay Raghav Joshi
- Department of Pediatrics, SIGMA Hospital, P8/D, Thonachikoppal -Saraswathipuram Road, Mysore -570009 Karnataka, India
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Manley BJ, Buckmaster AG, Travadi J, Owen LS, Roberts CT, Wright IMR, Davis PG, Arnolda G. Trends in the use of non-invasive respiratory support for term infants in tertiary neonatal units in Australia and New Zealand. Arch Dis Child Fetal Neonatal Ed 2022; 107:572-576. [PMID: 35410897 DOI: 10.1136/archdischild-2021-323581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether the use of non-invasive respiratory support, such as continuous positive airway pressure and nasal high flow, to treat term infants in Australian and New Zealand tertiary neonatal intensive care units (NICUs) has changed over time, and if so, whether there are parallel changes in short-term respiratory morbidities. DESIGN Retrospective database review of patient-level data from the Australian and New Zealand Neonatal Network (ANZNN) from 2010 to 2018. Denominator data on the number of term inborn livebirths in each facility was only available as annual totals. PATIENTS AND SETTING Term, inborn infants cared for in NICUs within the ANZNN. MAIN OUTCOME MEASURES The primary outcome was the annual change in hospital-specific rates of non-invasive respiratory support per 1000 inborn livebirths, expressed as a percentage change. Secondary outcomes were the change in rates of mechanical ventilation, pneumothorax requiring drainage, exogenous surfactant treatment and death before hospital discharge. RESULTS A total of 14 656 term infants from 21 NICUs were included from 2010 to 2018, of whom 12 719 received non-invasive respiratory support. Non-invasive respiratory support use increased on average by 8.7% per year (95% CI: 7.9% to 9.4% per year); the number of term infants receiving non-invasive respiratory support almost doubled from 980 in 2010 (10.8/1000 livebirths) to 1913 in 2018 (20.8/1000). There was no change over time in rate of mechanical ventilation or death. The rate of pneumothorax requiring drainage increased over time, as did surfactant treatment. CONCLUSIONS Non-invasive respiratory support use to treat term infants cared for in NICUs within the ANZNN is increasing over time. Clinicians should be diligent in selecting infants most likely to benefit from treatment with non-invasive respiratory support in this relatively low-risk population of term newborn infants. Analysis of patient-level data by individual NICUs is recommended to control for potential confounding due to changes in population over time.
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Affiliation(s)
- Brett J Manley
- Department of Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia .,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Adam G Buckmaster
- Women, Children and Families, Central Coast Local Health District, Gosford, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Javeed Travadi
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise S Owen
- Department of Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Calum T Roberts
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ian M R Wright
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Peter G Davis
- Department of Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Li F, Gong Q, Lu Y. Effects of continuous nursing on rehabilitation compliance, living quality and daily living ability of patients with acute ischemic stroke. Am J Transl Res 2022; 14:381-388. [PMID: 35173856 PMCID: PMC8829598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the effect of continuous nursing on rehabilitation of patients with acute ischemic stroke (AIS). METHODS In this prospective study, 150 patients were treated for AIS at our hospital from January 2017 to December 2019. The patients were separated into two groups: the conventional group (n = 75) that received conventional nursing and the continuous nursing group (n = 75) were treated with continuous nursing intervention. Patients were followed up for compliance, negative mood, living quality, nursing satisfaction, and daily living abilities. RESULTS The compliance rate of the continuous nursing group (93.33%) was obviously higher than that of the conventional nursing group (85.33%, P<0.05). There was no obvious difference in the negative mood scores between the two groups before intervention (P>0.05); however, the negative mood scores of the two groups decreased after intervention. In particular, the scores in continuous nursing group were obviously lower than that in the conventional nursing group (P<0.05). After intervention, the living quality scores in the continuous nursing group were obviously higher than that in the conventional nursing group (P<0.05). The satisfaction of nurses in the continuous nursing (96.00%) was obviously higher than that in the conventional nursing group (70.00%, P<0.05). The Barthel index (BI) scores in the continuous nursing group were obviously higher than those in the conventional nursing at 1 d, 7 d, and 30 d after intervention (P<0.05). CONCLUSIONS The results demonstrated that continuous nursing can enhance the rehabilitation compliance of patients with AIS, alleviate the negative mood of patients, enhance the living quality and daily living ability of patients.
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Affiliation(s)
- Fang Li
- Department of Rehabilitation Medicine, Jinhua Traditional Chinese Medicine Affiliated Hospital of Zhejiang Chinese Medical UniversityJinhua City 321017, Zhejiang Province, China
| | - Qingmei Gong
- Department of Neurology, The Third Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310012, Zhejiang, China
| | - Ying Lu
- Department of Cardiopulmonary Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310012, Zhejiang, China
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L Dundek M, Ng EK, M Brazil A, DiBlasi RM, Poli JA, Burke TF. Evaluation of a Bubble CPAP System for Low Resource Settings. Respir Care 2021; 66:1572-1581. [PMID: 33824173 PMCID: PMC9993569 DOI: 10.4187/respcare.08948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite its established safety, efficacy, and relative simplicity, CPAP treatment is not widely available for newborns and infants in low- and middle-income settings. A novel bubble CPAP system was designed to address the gaps in quality and accessibility of existing CPAP systems by providing blended, humidified, and pressurized gases without the need for electricity, compressed air, or manual power. This was the first study that tested the performance of the system with a simulated patient model. METHODS: In a spontaneously breathing 3-dimensional printed nasal airway model of a preterm neonate, CPAP performance was assessed based on delivered pressure, oxygen level, and humidity at different settings. RESULTS: Preliminary device performance characteristics were within 5% among 3 separate devices. Performance testing showed accurate control of CPAP and oxygen concentration at all settings with the bubble CPAP system. Lung model pressure and oxygen concentration were shown to stay within ±0.5 cm H2O and ±4% of full scale of the device settings, respectively, with relative humidity > 80%. CONCLUSIONS: Performance testing of the bubble CPAP system demonstrated accurate control of CPAP and oxygen concentration with humidity levels suitable for premature newborns on noninvasive support.
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Affiliation(s)
- Michelle L Dundek
- Vayu Global Health Foundation, Boston, Massachusetts.
- Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ellie K Ng
- Vayu Global Health Foundation, Boston, Massachusetts
| | | | - Robert M DiBlasi
- Department of Respiratory Care Therapy, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | - Jonathan A Poli
- Department of Respiratory Care Therapy, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington
| | - Thomas F Burke
- Vayu Global Health Foundation, Boston, Massachusetts
- Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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6
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Dada S, Ashworth H, Sobitschka A, Raguveer V, Sharma R, Hamilton RL, Burke T. Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review. PLoS One 2021; 16:e0252718. [PMID: 34115776 PMCID: PMC8195417 DOI: 10.1371/journal.pone.0252718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. Objective To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. Methods A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. Findings 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Conclusion Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.
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Affiliation(s)
- Sara Dada
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- * E-mail:
| | - Henry Ashworth
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alina Sobitschka
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of Göttingen, Göttingen, Germany
| | - Vanitha Raguveer
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Rupam Sharma
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of California Los Angeles Kern Medical Center, Bakersfield, California, United States of America
| | - Rebecca L. Hamilton
- Massachusetts General Hospital, Department of Anesthesiology, Boston, Massachusetts, United States of America
- Karolinska Institute, Department of Cell and Molecular Biology, Solna, Sweden
| | - Thomas Burke
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Global Health Innovation Lab, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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