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Giriteka T, Bulakali DP, Wendler CB. Essential human and material resources for emergency care in the district hospitals of Burundi. Afr J Emerg Med 2023; 13:300-305. [PMID: 37859728 PMCID: PMC10582767 DOI: 10.1016/j.afjem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Burundi, like many African nations, faces challenges in providing accessible emergency care. The aim of this study was to assess the type of staff training, accessibility to imaging, and availability of essential equipment in the district hospitals of Burundi in order to inform strategic planning for healthcare delivery. Methods In June 2022 an online survey was sent to each district hospital of the country. Complete responses were analysed and, where appropriate, significance determined by chi-square analysis, with p<0.05 considered significant. Results Forty of 45 district hospitals completed the survey, of which 35 were rural (matching national demographics). The majority of district hospitals (21/40) had ready access to ≥4/5 critical drugs while few (5/40) were equipped with ≥4/5 key material. One quarter had 24/7 physician coverage and X-ray available. Only 3 had continuous access to ultrasound studies despite most district hospitals having ultrasound machines. Trained emergency room staff were almost totally absent from the field, with only 6 nurses, 4 generalists, and 1 specialist reported across 9 sites. Even a single EM-trained staff member was significantly correlated with being better equipped for emergencies (p<0.01). Conclusion Burundi needs a strategic investment in emergency preparedness and care. Policy initiatives and technology purchases have demonstrated reasonable penetration down to the district hospital level, however, trained personnel are essential to develop sustainable emergency capacity.
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Affiliation(s)
| | | | - Carlan Bruce Wendler
- Kibuye Hope Hospital, Kibuye, Bukirasazi, Gitega, Burundi
- Hope Africa University, Ngagara II, Bujumbura, Burundi
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2
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Tsegaye AT, Pavlinac PB, Walson JL, Tickell KD. The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002520. [PMID: 37922322 PMCID: PMC10624296 DOI: 10.1371/journal.pgph.0002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/21/2023] [Indexed: 11/05/2023]
Abstract
Dehydration is a major cause of death among children with wasting and diarrhea. We reviewed the evidence for the identification and management of dehydration among these children. Two systematic reviews were conducted to assess 1) the diagnostic performance of clinical signs or algorithms intended to measure dehydration, and 2) the efficacy and safety of low-osmolarity ORS versus ReSoMal on mortality, treatment failure, time to full rehydration, and electrolyte disturbances (management review). We searched PubMed/Medline, Embase, and Global Index Medicus for studies enrolling children 0-60 months old with wasting and diarrhea. The diagnostic review included four studies. Two studies found the Integrated Management of Childhood Illness (IMCI) and the Dehydration: Assessing Kids Accurately (DHAKA) algorithms had similar diagnostic performance, but both algorithms had high false positive rates for moderate (41% and 35%, respectively) and severe (76% and 82%, respectively) dehydration. One further IMCI algorithm study found a 23% false positive rate for moderate dehydration. The management review included six trials. One trial directly compared low osmolarity ORS to ReSoMal and found no difference in treatment failure rates, although ReSoMal had a shorter duration of treatment (16.1 vs. 19.6 hours, p = 0.036) and a higher incidence of hyponatremia. Both fluids failed to correct a substantial number of hypokalemia cases across studies. In conclusion, the IMCI dehydration assessment has comparable performance to other algorithms among wasted children. Low osmolarity ORS may be an alternative to ReSoMal for children with severe wasting, but might require additional potassium to combat hypokalemia.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Patricia B. Pavlinac
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Judd L. Walson
- Departments of Global Health, Medicine (Infectious Diseases), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
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3
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Eze JN, Edelu BO, Ndu IK, Oguonu T. Paediatric emergency medicine practice in Nigeria: a narrative review. BMC Emerg Med 2023; 23:31. [PMID: 36927266 PMCID: PMC10022062 DOI: 10.1186/s12873-023-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood illnesses in emergency settings. Deaths from childhood illnesses presenting as emergencies contribute to overall child mortality rates in Nigeria. This narrative review discusses existing structures, organization, and practice of paediatric emergency in Nigeria. It highlights some of the challenges and suggests ways of surmounting them in order to reduce deaths in the children emergency units in Nigerian hospitals. Important aspects of this review include current capacity and need for capacity development, equipment needs for emergency care, quality of service in the context of inadequate healthcare funding and the need for improvement.
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Affiliation(s)
- Joy N Eze
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria.
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
| | - Benedict O Edelu
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, 400001, Nigeria
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
- Enugu State University of Science and Technology Teaching Hospital, Enugu, Nigeria
| | - Tagbo Oguonu
- University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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4
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Santhanam I, Moodley P, Jayaraman B, Yock-Corrales A, Cheema B, Craig S, Jahn HK. Triage and resuscitation tools for low and middle income countries: how to catch the killer? Arch Dis Child Educ Pract Ed 2022; 107:71-76. [PMID: 34112664 DOI: 10.1136/archdischild-2021-321981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/04/2022]
Abstract
Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death.Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction.Following triage, a structured systematic primary survey is critical to ensure the detection of subtle signs of multiorgan dysfunction. Repeated physiological assessments of the child guide subsequent resuscitation management decisions, which depend somewhat on the resources available.It is possible to achieve significant improvements in survival of critically unwell children presenting for emergency care in the resource-limited setting. The three key steps in the patient's journey that we can influence in emergency care are triage, primary survey and initial stabilisation. Resources that address these steps have been developed for all settings. However, these resources were developed in a specific clinical context, and must therefore be adapted to local structures and processes. A systematic approach to triage and resuscitation saves lives.
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Affiliation(s)
- Indumathy Santhanam
- Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Prinetha Moodley
- Department of Paediatrics, Paarl Hospital, Paarl, Western Cape, South Africa.,Department of Paediatrics, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Balaji Jayaraman
- Paediatrics, Government Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India
| | | | - Baljit Cheema
- Department of Paediatrics, University of Cape Town, Rondebosch, Western Cape, South Africa.,Paediatric Retrieval, Specialised Paediatric Retrieval Including Neonatal Transfer (SPRINT) Team, Cape Town, South Africa
| | - Simon Craig
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia.,Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Haiko Kurt Jahn
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia .,Center of Emergency Medicine, Friedrich Schiller University Jena, Jena, Thüringen, Germany
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5
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Ismail H, Chowdhary H, Taira BR, Moiane S, Faruk L, Alface B, Mohole J, Gonçalves O, Hartford EA, Buck WC. Paediatric emergency care at an academic referral hospital in Mozambique. Afr J Emerg Med 2021; 11:410-415. [PMID: 34703732 PMCID: PMC8524113 DOI: 10.1016/j.afjem.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed. Results Data from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.
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Hategeka C, Lynd LD, Kenyon C, Tuyisenge L, Law MR. Impact of a Multifaceted Intervention to Improve Emergency Care on Newborn and Child Health Outcomes in Rwanda. Health Policy Plan 2021; 37:12-21. [PMID: 34459893 DOI: 10.1093/heapol/czab109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/17/2021] [Accepted: 08/28/2021] [Indexed: 11/13/2022] Open
Abstract
Implementing context-appropriate neonatal and pediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and pediatric hospital mortality rate. Each hospital contributed data for 12 and 36 months before and after ETAT+ implementation, respectively. Using controlled interrupted time series analysis and segmented regression model, we estimated longitudinal changes in neonatal and pediatric hospital mortality rate in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+ targeted conditions. Our study cohort consisted of seven intervention hospitals and fourteen matched control hospitals contributing 142,424 neonatal and pediatric hospital admissions. After controlling for secular trends and autocorrelation, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and pediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+ targeted neonatal conditions decreased immediately following implementation by 5% (95% CI: -9.25, -0.77) and over time by 0.8% monthly (95% CI: -1.36, -0.25), in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+ targeted pediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+ targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.,Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Cynthia Kenyon
- Division of Neonatal-Perinatal Medicine, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Lisine Tuyisenge
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Majamanda MD, Joshua Gondwe M, Makwero M, Chalira A, Lufesi N, Dube Q, Desmond N. Capacity Building for Health Care Workers and Support Staff in Pediatric Emergency Triage Assessment and Treatment (ETAT) at Primary Health Care Level in Resource Limited Settings: Experiences from Malawi. Compr Child Adolesc Nurs 2021:1-16. [PMID: 34029495 DOI: 10.1080/24694193.2021.1916127] [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: 01/19/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals.
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Affiliation(s)
- Maureen Daisy Majamanda
- Department of Medical and Surgical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
| | - Mtisunge Joshua Gondwe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Behaviour and Health Group, Malawi-Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Martha Makwero
- Department of Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alfred Chalira
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Norman Lufesi
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nicola Desmond
- Behaviour and Health Group, Malawi-Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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8
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Muttalib F, González-Dambrauskas S, Lee JH, Steere M, Agulnik A, Murthy S, Adhikari NKJ. Pediatric Emergency and Critical Care Resources and Infrastructure in Resource-Limited Settings: A Multicountry Survey. Crit Care Med 2021; 49:671-681. [PMID: 33337665 DOI: 10.1097/ccm.0000000000004769] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the infrastructure and resources for pediatric emergency and critical care delivery in resource-limited settings worldwide. DESIGN Cross-sectional survey with survey items developed through literature review and revised following piloting. SETTING The electronic survey was disseminated internationally in November 2019 via e-mail directories of pediatric intensive care societies and networks and using social media. PATIENTS Healthcare providers who self-identified as working in resource-limited settings. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Results were summarized using descriptive statistics and resource availability was compared across World Bank country income groups. We received 328 responses (238 hospitals, 60 countries), predominantly in Latin America and Sub-Saharan Africa (n = 161, 67.4%). Hospitals were in low-income (28, 11.7%), middle-income (166, 69.5%), and high-income (44, 18.4%) countries. Across 174 PICU and adult ICU admitting children, there were statistically significant differences in the proportion of hospitals reporting consistent resource availability ("often" or "always") between country income groups (p < 0·05). Resources with limited availability in lower income countries included advanced ventilatory support, invasive and noninvasive monitoring, central venous access, renal replacement therapy, advanced imaging, microbiology, biochemistry, blood products, antibiotics, parenteral nutrition, and analgesic/sedative drugs. Seventy-seven ICUs (52.7%) were staffed 24/7 by a pediatric intensivist or anesthetist. The nurse-to-patient ratio was less than 1:2 in 71 ICUs (49.7%). CONCLUSIONS Contemporary data demonstrate significant disparity in the availability of essential and advanced human and material resources for the care of critically ill children in resource-limited settings. Minimum standards for essential pediatric emergency and critical care in resource-limited settings are needed.
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Affiliation(s)
- Fiona Muttalib
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Jan Hau Lee
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Mardi Steere
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Srinivas Murthy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Neill K J Adhikari
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore
- Department of Pediatrics, Duke-NUS Medical School, Singapore
- Pediatric Acute and Critical Care Medicine Asian Network
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Pediatric Emergency and Critical Care Africa
- Royal Flying Doctor Service of Australia, Central Operations, Mile End, SA, Australia
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Kumar H, Bhat AA, Alwadhi V, Khanna R, Neogi SB, Khera A, Deb S. Situational Analysis of Management of Childhood Diarrhea and Pneumonia in 13 District Hospitals in India. Indian Pediatr 2021. [PMID: 33408280 PMCID: PMC8079854 DOI: 10.1007/s13312-021-2191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India. Design Facility-based assessment of district hospitals. Settings 13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Participants Staff nurses and doctors. Intervention None. Methods An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed. Results Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8–10%. There was a 65 percent shortfall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities. Conclusion The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.
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10
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Uwisanze S, Ngabonzima A, Bazirete O, Hategeka C, Kenyon C, Asingizwe D, Kanazayire C, Cechetto D. Mentors' perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study. BMJ Open 2021; 11:e042523. [PMID: 33741662 PMCID: PMC7986684 DOI: 10.1136/bmjopen-2020-042523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify mentors' perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation. DESIGN The study used a qualitative approach with in-depth interviews. SETTING Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda. PARTICIPANTS 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals. RESULTS Mentors' accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme. CONCLUSION The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children.
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Affiliation(s)
- Sandrine Uwisanze
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Oliva Bazirete
- Midwifery Department, College of Medicine and Health Sciences- University of Rwanda, Kigali, Rwanda
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Cynthia Kenyon
- Perinatal Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Domina Asingizwe
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - David Cechetto
- Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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A cross sectional study of the availability of paediatric emergency equipment in South African emergency units. Afr J Emerg Med 2020; 10:197-202. [PMID: 33299748 PMCID: PMC7700969 DOI: 10.1016/j.afjem.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/05/2022] Open
Abstract
Background Despite children representing a significant proportion of Emergency Unit (EU) attendances globally, it is concerning that many healthcare facilities are inadequately equipped to deliver paediatric resuscitation. The rapid availability of a full range of paediatric emergency equipment is critical for delivery of effective, best-practice resuscitation. This study aimed to describe the availability of essential, functional paediatric emergency resuscitation equipment on or close to the resuscitation trolley, in 24-hour EUs in Cape Town, South Africa. Methods A cross sectional study was conducted over a six-month period in government funded hospital EUs, providing 24-hour emergency paediatric care within the Cape Town Metropole. A standardised data collection sheet of essential resuscitation equipment expected to be available in the resuscitation area, was used. Items were considered to be available if at least one piece of equipment was present. Functionality of available equipment was defined as: equipment that hadn't expired, whose original packaging was not outwardly damaged or compromised and all components were present and intact. Results Overall, a mean of 43% (30/69) of equipment was available on the resuscitation trolley across all hospitals. The overall mean availability of equipment in the resuscitation area was 49% (34/69) across all hospitals. Mean availability of functional equipment was 42% (29/69) overall, 41% (28/69) at district-level hospitals, and 45% (31/69) at regional/tertiary hospitals. Conclusion Essential resuscitation equipment for children is insufficiently available at district-level and higher hospitals in the Cape Town Metropole. This is a modifiable barrier to the provision of high-quality paediatric emergency care.
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Brugnolaro V, Fovino LN, Calgaro S, Putoto G, Muhelo AR, Gregori D, Azzolina D, Bressan S, Da Dalt L. Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique. PLoS One 2020; 15:e0241209. [PMID: 33147242 PMCID: PMC7641453 DOI: 10.1371/journal.pone.0241209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background An effective pediatric emergency care (PEC) system is key to reduce pediatric mortality in low-income countries. While data on pediatric emergencies from these countries can drive the development and adjustment of such a system, they are very scant, especially from Africa. We aimed to describe the characteristics and outcomes of presentations to a tertiary-care Pediatric Emergency Department (PED) in Mozambique. Methods We retrospectively reviewed PED presentations to the "Hospital Central da Beira" between April 2017 and March 2018. Multivariable logistic regression was used to identify predictors of hospitalization and death. Results We retrieved 24,844 presentations. The median age was 3 years (IQR 1-7 years), and 92% lived in the urban area. Complaints were injury-related in 33% of cases and medical in 67%. Data on presenting complaints (retrieved from hospital paper-based registries) were available for 14,204 (57.2%) records. Of these, respiratory diseases (29.3%), fever (26.7%), and gastrointestinal disorders (14.2%) were the most common. Overall, 4,997 (20.1%) encounters resulted in hospitalization. Mortality in the PED was 1.6% (62% ≤4 hours from arrival) and was the highest in neonates (16%; 89% ≤4 hours from arrival). A younger age, especially younger than 28 days, living in the extra-urban area and being referred to the PED by a health care provider were all significantly associated with both hospitalization and death in the PED at the multivariable analysis. Conclusions Injuries were a common presentation to a referral PED in Mozambique. Hospitalization rate and mortality in the PED were high, with neonates being the most vulnerable. Optimization of data registration will be key to obtain more accurate data to learn from and guide the development of PEC in Mozambique. Our data can help build an effective PEC system tailored to the local needs.
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Affiliation(s)
- Valentina Brugnolaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- * E-mail:
| | - Laura Nai Fovino
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Serena Calgaro
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | | | | | - Dario Gregori
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Liviana Da Dalt
- Pediatric Residency Program, Department of Woman's and Child's Health, University of Padova, Padova, Italy
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University of Padova, Padova, Italy
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13
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Hategeka C, Arsenault C, Kruk ME. Temporal trends in coverage, quality and equity of maternal and child health services in Rwanda, 2000-2015. BMJ Glob Health 2020; 5:e002768. [PMID: 33187962 PMCID: PMC7668303 DOI: 10.1136/bmjgh-2020-002768] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/11/2020] [Accepted: 09/30/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Achieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective coverage and equity of MCH services in Rwanda in the Millennium Development Goal (MDG) era to help guide policy decisions to improve equitable health gains in the SDG era and beyond. METHODS Using four rounds of Rwanda demographic and health surveys conducted from 2000 to 2015, we identified coverage and quality indicators for five MCH services: antenatal care (ANC), delivery care, and care for child diarrhoea, suspected pneumonia and fever. We calculated crude coverage and quality in each survey and used these to estimate effective coverage. The effective coverage should be regarded as an upper bound because there were few available quality measures. We also described equity in effective coverage of these five MCH services over time across the wealth index, area of residence and maternal education using equiplots. RESULTS A total of 48 910 women aged 15-49 years and 33 429 children under 5 years were included across the four survey rounds. In 2015, average effective coverage was 33.2% (range 19.9%-44.2%) across all five MCH services, 30.1% (range 19.9%-40.2%) for maternal health services (average of ANC and delivery) and 35.3% (range 27.3%-44.2%) for sick child care (diarrhoea, pneumonia and fever). This is in contrast to crude coverage which averaged 56.5% (range 43.6%-90.7%) across all five MCH services, 67.3% (range 43.9%-90.7%) for maternal health services and 49.2% (range 43.6%-53.9%) for sick child care. Between 2010 and 2015 effective coverage increased by 154.2% (range 127.3%-170.0%) for maternal health services and by 27.4% (range 4.2%-79.6%) for sick child care. These increases were associated with widening socioeconomic inequalities in effective coverage for maternal health services, and narrowing inequalities in effective coverage for sick child care. CONCLUSION While effective coverage of common MCH services generally improved in the MDG era, it still lagged substantially behind crude coverage for the same services due to low-quality care. Overall, effective coverage of MCH services remained suboptimal and inequitable. Policies should focus on improving effective coverage of these services and reducing inequities.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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14
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Pediatric Readiness in the Emergency Department and Its Association With Patient Outcomes in Critical Care: A Prospective Cohort Study. Pediatr Crit Care Med 2020; 21:e213-e220. [PMID: 32132503 DOI: 10.1097/pcc.0000000000002255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric mortality in Latvia remains one of the highest among Europe. The purpose of this study was to assess the quality of pediatric acute care and pediatric readiness and determine their association with patient outcomes using a patient registry. DESIGN This was a prospective cohort study. Pediatric readiness was measured using the weighted pediatric readiness score based on a 100-point scale. The processes of care were measured using in situ simulations to generate a composite quality score. Clinical outcome data-including PICU and hospital length of stay as well as 6-month mortality-were collected from the Pediatric Intensive Care Audit Network registry. The associations between composite quality score and weighted pediatric readiness score on patient outcomes were explored with mixed-effects regressions. SETTING This study was conducted in all Latvian Emergency Departments and in the national PICU. PATIENTS All patients who were transferred into the national PICU were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All (16/16) Latvian Emergency Departments participated with a mean composite quality score of 35.3 of 100 and a median weighted pediatric readiness score of 31 of 100. A total of 254 patients were included in the study and followed up for a mean of 436 days, of which nine died (3.5%). Higher weighted pediatric readiness score was associated significantly with lower length of stay in both the PICU and hospital (adjusted ß, -0.06; p = 0.021 and -0.36; p = 0.011, respectively) and lower 6-month mortality (adjusted odds ratio, 0.93; 95% CI, 0.88-0.98). CONCLUSIONS These data provide a national assessment of pediatric emergency care in a European country. Pediatric readiness in the emergency department was associated with patient outcomes in this population of pediatric patients transferred to the national PICU.
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15
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Ruton H, Musabyimana A, Gaju E, Berhe A, Grépin KA, Ngenzi J, Nzabonimana E, Law MR. The impact of an mHealth monitoring system on health care utilization by mothers and children: an evaluation using routine health information in Rwanda. Health Policy Plan 2018; 33:920-927. [PMID: 30169638 PMCID: PMC6172419 DOI: 10.1093/heapol/czy066] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Abstract
Maternal and child mortality rates remain unacceptably high globally, particularly in sub-Saharan Africa. A popular approach to counter these high rates is interventions delivered using mobile phones (mHealth). However, few mHealth interventions have been implemented nationwide and there has been little evaluation of their effectiveness, particularly at scale. Therefore, we evaluated the Rwanda RapidSMS programme—one of the few mHealth programmes in Africa that is currently operating nationwide. Using interrupted time series analysis and monthly data routinely reported by public health centres (n = 461) between 2012 and 2016, we studied the impact of RapidSMS on four indicators: completion of four antenatal care visits, deliveries in a health facility, postnatal care visits and malnutrition screening. We stratified all analyses based on whether the district received concurrent additional supports, including staff and equipment (10 out of 30 Districts). We found that community health workers in Rwanda sent more than 9.3 million messages using RapidSMS, suggesting the programme was successfully implemented. We found that the implementation of the RapidSMS system combined with additional support including training, supervision and equipment provision increased the use of maternal and child health services. In contrast, implementing the RapidSMS system alone was ineffective. This suggests that mHealth programmes alone may be insufficient to improve the use of health services. Instead, they should be considered as a part of more comprehensive interventions that provide the necessary equipment and health system capacity to support them.
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Affiliation(s)
- Hinda Ruton
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Angele Musabyimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Karen A Grépin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Joseph Ngenzi
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Nzabonimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Michael R Law
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA
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16
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Costa IKF, Tibúrcio MP, Costa IKF, Dantas RAN, Galvão RN, Torres GDV. Development of a virtual simulation game on basic life support. Rev Esc Enferm USP 2018; 52:e03382. [PMID: 30403269 DOI: 10.1590/s1980-220x2017047903382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/22/2018] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To validate the content of a virtual learning object in the format of a Role Playing Game - educational simulation game about basic life support, aimed at academics and health professionals. METHOD Methodological, construction and validation study with qualitative data approach on the content of a virtual learning object, conducted between August and September 2016. RESULTS The game was developed in 13 screens, of which nine presented contents of basic life support, and the others presented general guidelines for progress in the game. The five suggestions of the experts were accepted by the researchers, and were mostly related to organization, clarity and vocabulary. No item was considered inappropriate by the judges, and the game had a mean content validity index of 0.96 and a Kappa value of 0.92. In the Likert scale evaluation, the game was considered in all analyzes as an excellent content for a virtual learning object. CONCLUSION This learning technology is expected to support teaching of basic life support techniques for academics and health professionals, and to stimulate the development of similar teaching strategies in other scenarios, in order to bring advancements to the design of health training processes.
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Affiliation(s)
| | - Manuela Pinto Tibúrcio
- Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil
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17
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Advocating For Pediatric Rapid Response Worldwide. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Hategeka C, Shoveller J, Tuyisenge L, Lynd LD. Assessing process of paediatric care in a resource-limited setting: a cross-sectional audit of district hospitals in Rwanda. Paediatr Int Child Health 2018; 38:137-145. [PMID: 28346109 DOI: 10.1080/20469047.2017.1303017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Routine assessment of quality of care helps identify deficiencies which need to be improved. While gaps in the emergency care of children have been documented across sub-Saharan Africa, data from Rwanda are lacking. OBJECTIVE To assess the care of sick infants and children admitted to Rwandan district hospitals and the extent to which it follows currently recommended clinical practice guidelines in Rwanda. METHODS Data were gathered during a retrospective cross-sectional audit of eight district hospitals across Rwanda in 2012/2013. Medical records were randomly selected from each hospital and were reviewed to assess the process of care, focusing on the leading causes of under-5 mortality, including neonatal conditions, pneumonia, malaria and dehydration/diarrhoea. RESULTS Altogether, 522 medical records were reviewed. Overall completion of a structured neonatal admission record was above 85% (range 78.6-90.0%) and its use was associated with better documentation of key neonatal signs (median score 6/8 and 2/8 when used and not used, respectively). Deficiencies in the processes of care were identified across hospitals and there were rural/urban disparities for some indicators. For example, neonates admitted to urban district hospitals were more likely to receive treatment consistent with currently recommended guidelines [e.g. gentamicin (OR 2.52, 95% CI 1.03-6.43) and fluids (OR 2.69, 95% CI 1.2-6.2)] than those in rural hospitals. Likewise, children with pneumonia admitted to urban hospitals were more likely to receive the correct dosage of gentamicin (OR 4.47, 95% CI 1.21-25.1) and to have their treatment monitored (OR 3.75, 95% CI 1.57-8.3) than in rural hospitals. Furthermore, children diagnosed with malaria and admitted to urban hospitals were more likely to have their treatment (OR 2.7, 95% CI 1.15-6.41) monitored than those in rural hospitals. CONCLUSIONS Substantial gaps were identified in the process of neonatal and paediatric care across district hospitals in Rwanda. There is a need to (i) train health care professionals in providing neonatal and paediatric care according to nationally adopted clinical practice guidelines (e.g. ETAT+); (ii) establish a supervision and mentoring programme to ensure that the guidelines are available and used appropriately in district hospitals; and (iii) use admission checklists (e.g. neonatal and paediatric admission records) in district hospitals.
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Affiliation(s)
- Celestin Hategeka
- a Faculty of Medicine, School of Population and Public Health , University of British Columbia , Vancouver , Canada.,b Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation , University of British Columbia , Vancouver , Canada
| | - Jeannie Shoveller
- a Faculty of Medicine, School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Lisine Tuyisenge
- c Department of Pediatrics , University Teaching Hospital of Kigali , Kigali , Rwanda
| | - Larry D Lynd
- b Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation , University of British Columbia , Vancouver , Canada.,d Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute , Vancouver , Canada
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19
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Fitzgerald E, Mlotha-Mitole R, Ciccone EJ, Tilly AE, Montijo JM, Lang HJ, Eckerle M. A pediatric death audit in a large referral hospital in Malawi. BMC Pediatr 2018; 18:75. [PMID: 29466967 PMCID: PMC5822526 DOI: 10.1186/s12887-018-1051-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/06/2018] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Death audits have been used to describe pediatric mortality in under-resourced settings, where record keeping is often a challenge. This information provides the cornerstone for the foundation of quality improvement initiatives. Malawi, located in sub-Saharan Africa, currently has an Under-5 mortality rate of 64/1000. Kamuzu Central Hospital, in the capital city Lilongwe, is a busy government referral hospital, which admits up to 3000 children per month. A study published in 2013 reported mortality rates as high as 9%. This is the first known audit of pediatric death files conducted at this hospital. METHODS A retrospective chart review on all pediatric deaths that occurred at Kamuzu Central Hospital (excluding deaths in the neonatal nursery) during a 13-month period was done using a standardized death audit form. A descriptive analysis was completed, including patient demographics, HIV and nutritional status, and cause of death. Modifiable factors were identified that may have contributed to mortality, including a lack of vital sign collection, poor documentation, and delays in the procurement or results of tests, studies, and specialist review. RESULTS Seven hundred forty three total pediatric deaths were recorded and 700 deceased patient files were reviewed. The mortality rate by month ranged from a low of 2.2% to a high of 4.4%. Forty-four percent of deaths occurred within the first 24 h of admission, and 59% occurred within the first 48 h. The most common causes of death were malaria, malnutrition, HIV-related illnesses, and sepsis. CONCLUSIONS The mortality rate for this pediatric referral center has dramatically decreased in the 6 years since the last published mortality data, but remains high. Areas identified for continued development include improved record keeping, improved patient assessment and monitoring, and more timely and reliable provision of testing and treatment. This study demonstrates that in low-resource settings, where reliable record keeping is often difficult, death audits are useful tools to describe the sickest patient population and determine factors possibly contributing to mortality that may be amenable to quality improvement interventions.
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Affiliation(s)
- Elizabeth Fitzgerald
- Assistant Professor of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | - Emily J Ciccone
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Alyssa E Tilly
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Hans-Joerg Lang
- Médecins sans Frontières - Belgium, Paediatric Referent, Brussels, Belgium
| | - Michelle Eckerle
- Assistant Professor of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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20
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Costa IKF, Tibúrcio MP, Melo GDSM, Leite JEL, Dantas RAN, Torres GDV. Construction and validation of a distance Basic Life Support Course. Rev Bras Enferm 2018; 71:2698-2705. [DOI: 10.1590/0034-7167-2018-0122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/25/2018] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to describe the content construction and validation process of the Distance Education Basic Life Support Course. Method: methodological study, developed through literature review, outlined in the light of the Bloom's Taxonomy and Ausubel's Meaningful Learning Theory. For validation, the analysis was performed with judges, using a structured tool. Results: the construction of the distance course was complex and challenging, since it was tried to develop it with logical-methodological coherence, considering the constructivist perspective, representing an advance in the process of dissemination of the Urgency and Emergency teaching culture. As for the content validation process, it was verified that of the 16 suggestions made by the judges, 14 were accepted and two rejected. Conclusion: the course had its contents validated by experts.
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Hategeka C, Mwai L, Tuyisenge L. Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers' perspectives on relevance and challenges. BMC Health Serv Res 2017; 17:256. [PMID: 28388951 PMCID: PMC5385061 DOI: 10.1186/s12913-017-2193-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/28/2017] [Indexed: 02/01/2023] Open
Abstract
Background An emergency triage, assessment and treatment plus admission care (ETAT+) intervention was implemented in Rwandan district hospitals to improve hospital care for severely ill infants and children. Many interventions are rarely implemented with perfect fidelity under real-world conditions. Thus, evaluations of the real-world experiences of implementing ETAT+ are important in terms of identifying potential barriers to successful implementation. This study explored the perspectives of Rwandan healthcare workers (HCWs) on the relevance of ETAT+ and documented potential barriers to its successful implementation. Methods HCWs enrolled in the ETAT+ training were asked, immediately after the training, their perspective regarding (i) relevance of the ETAT+ training to Rwandan district hospitals; (ii) if attending the training would bring about change in their work; and (iii) challenges that they encountered during the training, as well as those they anticipated to hamper their ability to translate the knowledge and skills learned in the ETAT+ training into practice in order to improve care for severely ill infants and children in their hospitals. They wrote their perspectives in French, Kinyarwanda, or English and sometimes a mixture of all these languages that are official in the post-genocide Rwanda. Their notes were translated to (if not already in) English and transcribed, and transcripts were analyzed using thematic content analysis. Results One hundred seventy-one HCWs were included in our analysis. Nearly all these HCWs stated that the training was highly relevant to the district hospitals and that it aligned with their work expectation. However, some midwives believed that the “neonatal resuscitation and feeding” components of the training were more relevant to them than other components. Many HCWs anticipated to change practice by initiating a triage system in their hospital and by using job aids including guidelines for prescription and feeding. Most of the challenges stemmed from the mode of the ETAT+ training delivery (e.g., language barriers, intense training schedule); while others were more related to uptake of guidelines in the district hospitals (e.g., staff turnover, reluctance to change, limited resources, conflicting protocols). Conclusion This study highlights potential challenges to successful implementation of the ETAT+ clinical practice guidelines in order to improve quality of hospital care in Rwandan district hospitals. Understanding these challenges, especially from HCWs perspective, can guide efforts to improve uptake of clinical practice guidelines including ETAT+ in Rwanda. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Celestin Hategeka
- ETAT+ Program, Rwanda Paediatric Association, Kigali, Rwanda. .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Leah Mwai
- Maternal and Child Health Program, International Development Research Centre, Ottawa, ON, Canada.,Afya Research Africa, Nairobi, Kenya
| | - Lisine Tuyisenge
- ETAT+ Program, Rwanda Paediatric Association, Kigali, Rwanda.,Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
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