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Frechette R, Colas N, Augustin M, Edema N, Pyram G, Louis S, Crevecoeur CE, Mathurin C, Louigne R, Patel B, Humphreys M, Chapital A, Martin M, Ayoub Q, Hottinger D, McCurdy MT, Tran Q, Skupski R, Zimmer D, Walsh M. Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project. Glob Health Action 2023; 16:2180867. [PMID: 36856725 PMCID: PMC9980030 DOI: 10.1080/16549716.2023.2180867] [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] [Indexed: 03/02/2023] Open
Abstract
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
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Affiliation(s)
- Richard Frechette
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Colas
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Marc Augustin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Edema
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Gerson Pyram
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Stanley Louis
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carl Eric Crevecoeur
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carmeline Mathurin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Raphael Louigne
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Bhavesh Patel
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mitchell Humphreys
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Alyssa Chapital
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mallory Martin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Qamarissa Ayoub
- Bamiyan Maternal and Child Health Project and the Andeshgah Library, Kabul, Afghanistan
| | - Daniel Hottinger
- Department of Anesthesia, Metropolitan Anesthesia Network, LLP, Plymouth, MN, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Skupski
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Anesthesia, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Donald Zimmer
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Emergency Medicine, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Mark Walsh
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
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McCurdy MT, Tabatabai A. Harmonizing ICU Admission, Discharge, and Transfer Criteria to Improve Critical Care Capability. Crit Care Med 2023; 51:e275-e276. [PMID: 37971345 DOI: 10.1097/ccm.0000000000006019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
- University of Maryland St. Joseph Medical Center, Baltimore, MD
| | - Ali Tabatabai
- University of Maryland St. Joseph Medical Center, Baltimore, MD
- Division of Education, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Bardosh K, Jean L, Desir L, Yoss S, Poovey B, Beau de Rochars MV, Noland GS. Was lockdown worth it? community perspectives and experiences of the Covid-19 pandemic in remote southwestern Haiti. Soc Sci Med 2023; 331:116076. [PMID: 37441975 DOI: 10.1016/j.socscimed.2023.116076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Public experiences of COVID-19 pandemic lockdown differed dramatically between countries and socio-economic groups. Low-income countries raise unique empirical and ethical concerns about (1) the balance between benefits and social harms and (2) how explanatory disease models and everyday life realities influenced the experience and interpretation of lockdown itself. In this paper, we present qualitative data on community perceptions and experiences of the pandemic from a remote area of Haiti, with a focus on the 2020 lockdown. We conducted in-depth interviews with 30 community leaders in Grand'Anse Department, southwest Haiti, at two time periods: May 2020 and October-December 2021. We divide our results into five sections. First, our analysis showed that lockdown was widely considered ineffective at controlling COVID-19. Despite the lack of testing, community leaders believed most of the local population had caught COVID-19 in the first half of 2020, with limited reported mortality. Public concern about the pandemic largely ended at this time, overtaken by other socio-economic and political crises. Second, we found that popular explanations for the low fatality rate were related to various coping strategies: the strength of people's immune systems, use of natural prophylactic folk teas, beliefs about the virus, spiritual protections and the tropical weather. Third, we found that lockdown was widely seen to have not been appropriate for the Haitian context due to various challenges with compliance in the face of socio-economic vulnerability. Fourth, we found strong negative feelings about the social consequences of lockdown measures, which lasted from March-August 2020, including adverse effects on: food security, household income, education, health, and psychosocial well-being. Finally, these perceptions and experiences reinforced popular ideas that lockdown had been imposed by elites for financial and/or political gain, something that was also reflected in the discourse about the low vaccine acceptance rate. Our study showed that pandemic respiratory virus response in Haiti should better balance restrictive non-pharmaceutical interventions (NPIs) with existing socio-economic vulnerability. Local socio-behavioral dynamics and risk perceptions decrease the overall effectiveness of NPIs in fragile states and alternatives to lockdown, such as shielding the most vulnerable, are likely to be a more appropriate strategy.
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Affiliation(s)
- Kevin Bardosh
- School of Public Health, University of Washington, Seattle, WA, USA; The Carter Center, Atlanta, GA, USA.
| | | | | | | | | | - Madsen Valerie Beau de Rochars
- The Carter Center, Atlanta, GA, USA; Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Casella Jean-Baptiste M, Millien C, Sainterant O, Dameus KJR, Julmisse M, Julmiste TM, Fanfan JG, Raymonville M. Quality improvement initiative reduces overcrowding on labour and delivery unit in a university hospital in Haiti. BMJ Open Qual 2023; 12:bmjoq-2022-001879. [PMID: 36593071 PMCID: PMC9809254 DOI: 10.1136/bmjoq-2022-001879] [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: 02/25/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Following the first COVID-19 peak in 2020, came the seasonal childbirth peak at Hôpital Universitaire de Mirebalais (HUM). This peak is associated with overcrowding on the labour and delivery (L&D) ward. Lack of sufficient bed-space for sick neonates in the neonatal ICU at HUM, has led to overcrowding and lengthy stays of sick newborns on L&D. These conditions contribute to the subsequent lack of bed-space for newly postpartum mothers and potentially decreases quality of care for both new mothers and neonates. METHODS A Maternity Task Force was created by hospital leadership to address these urgent needs. The team's objective was to eliminate mothers and newborns laying on the floor in L&D. The Six-Sigma/DMAIC quality improvement methodology was used as the problem was urgent, demanded rapid results and centred around the process of patient flow in the institution. Process flow chart and Ishikawa diagrams were used to identify the root causes of the issues. RESULTS An average of 22% of postpartum women did not have a bed preintervention and 0% of postpartum women were laying on the floor post intervention. An average of 33% of newborns received paediatric care on the maternity ward pre-intervention compared with an average of 17% postintervention. The team did not achieve its objective for this second indicator, which was to have less than 10% of sick newborns on the maternity ward receiving paediatric care. CONCLUSION HUM hospital leadership took the vital decision to form the Maternity Task Force to make changes, which consequently led to a sustainable positive and lasting impact on the lives of new mothers and their babies at the institution. The objective of 0 postpartum mothers and newborns on the ground was achieved and fewer newborns receive intensive paediatric care on the maternity ward as a result of our interventions.
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Affiliation(s)
| | - Christophe Millien
- Medical Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Ornella Sainterant
- Medical Education, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | - Marc Julmisse
- Executive Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | | | - Maxi Raymonville
- Executive Direction, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
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Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system. Crit Care 2022; 26:209. [PMID: 35818054 PMCID: PMC9272593 DOI: 10.1186/s13054-022-04046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.
Methods
To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.
Results
A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.
Conclusion
Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.
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Șoitu CT, Grecu SP, Asiminei R. Health Security, Quality of Life and Democracy during the COVID-19 Pandemic: Comparative Approach in the EU-27 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14436. [PMID: 36361316 PMCID: PMC9654764 DOI: 10.3390/ijerph192114436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The aim of this paper is to emphasize the role played by the social, economic and political variables in shaping models of sustainable healthcare systems and strategies able to support and improve the quality of life during and after the COVID-19 pandemic. The context of our research is represented by the medical and socioeconomic crises generated by the COVID-19 pandemic. The current pandemic negatively affects healthcare systems, quality of life and the global economy. In this respect, this paper aims to thoroughly scrutinize the effects of the COVID-19 pandemic on the social and healthcare systems of EU countries, to analyze the impact of human development in the field of the Global Health Security Index and to estimate the relation between resilience and quality of life during the COVID-19 pandemic. The research design is quantitative, resorting to the use of both descriptive and inferential statistics, against the background of a long-term comparative approach to the respective situations in the EU-27 countries. Empirical findings are relevant for emphasizing the fact that human development and social progress are predictors for the dynamics of health security measures. Moreover, the quality of the political regime, particularly in the case of full and flawed democracies, is strongly related to a high level of resilience and could influence the perception of quality of life. All of these empirical results could prove valuable for scholars interested in understanding the relationships between democracy, healthcare systems and quality of life, and for political decision makers involved in the effort of reducing the negative effects of COVID-19 in EU-27 countries.
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Affiliation(s)
- Conțiu Tiberiu Șoitu
- Department of Sociology and Social Work, “Alexandru Ioan Cuza” University of Iași, 700506 Iași, Romania
| | - Silviu-Petru Grecu
- Department of Political Sciences, International Relations and European Studies, “Alexandru Ioan Cuza” University of Iași, 700506 Iași, Romania
| | - Romeo Asiminei
- Department of Sociology and Social Work, “Alexandru Ioan Cuza” University of Iași, 700506 Iași, Romania
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Pacheco‐Barrios K, Giannoni‐Luza S, Navarro‐Flores A, Rebello‐Sanchez I, Parente J, Balbuena A, de Melo PS, Otiniano‐Sifuentes R, Rivera‐Torrejón O, Abanto C, Alva‐Diaz C, Musolino PL, Fregni F. Burden of Stroke and Population‐Attributable Fractions of Risk Factors in Latin America and the Caribbean. J Am Heart Assoc 2022; 11:e027044. [DOI: 10.1161/jaha.122.027044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Stroke burden characterization studies in low‐ and middle‐income countries are scarce. We estimated the burden of stroke and its risk factors in Latin America and the Caribbean (LAC).
Methods and Results
We extracted GBD (Global Burden of Disease) study 2019 data on overall stroke and 3 subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) for 20 LAC countries. We estimated absolute and age‐standardized rates of disability‐adjusted life years, years of life lost, years lived with disability, and deaths. The population‐attributable fractions of 17 risk factors were estimated. All analyses were performed at regional and national levels by stroke subtype, sex, and age subgroups. In 2019, the LAC region had the fourth largest stroke burden worldwide (6.8 million disability‐adjusted life years), predominantly attributable to premature deaths (89.5% of disability‐adjusted life years). Intracerebral hemorrhage was the primary cause of the overall stroke burden (42% of disability‐adjusted life years), but ischemic stroke was the leading cause of disability (69% of total years lived with disability). Haiti and Honduras had the highest age‐standardized rates. Older adults and men had the largest burdens, although women had the highest rate of disability. Socioeconomic development level did not influence the burden. The major risk factor clusters were metabolic (high systolic blood pressure [population‐attributable fraction=53%] and high body mass index [population‐attributable fraction=37%]), which were more influential in hemorrhagic events, women, and older adults. Household air pollution was an important risk factor in low‐income countries in LAC.
Conclusions
The stroke burden and stroke‐related mortality in LAC are higher than the worldwide averages. However, stroke is a highly preventable disease in this region. Up to 90% of the burden could be reduced by targeting 2 modifiable factors: blood pressure and body mass index. Further research and implementation of primary and secondary prevention interventions are needed, as well as integrated national stroke care programs for acute, subacute, and rehabilitation management in LAC.
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Affiliation(s)
- Kevin Pacheco‐Barrios
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud Lima Peru
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Stefano Giannoni‐Luza
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Alba Navarro‐Flores
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- International Max Planck Research School for Neurosciences, Georg‐August‐University Göttingen Göttingen Germany
| | - Ingrid Rebello‐Sanchez
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Ana Balbuena
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | | | - Oscar Rivera‐Torrejón
- Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Carlos Alva‐Diaz
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
- Universidad Señor de Sipán Chiclayo Peru
| | - Patricia L. Musolino
- Department of Neurology Massachusetts General Hospital, Harvard Medical School Boston MA
- Center for Genomic Medicine, Center for Rare Neurological Disorders Massachusetts General Hospital, Harvard Medical School Boston
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
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Faure JA, Wang CW, Chen CHS, Chan CC. Assessment of the Functional Capacity and Preparedness of the Haitian Healthcare System to Fight against the COVID-19 Pandemic: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10081428. [PMID: 36011085 PMCID: PMC9407763 DOI: 10.3390/healthcare10081428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Low-income countries, such as Haiti, are facing challenges in fighting the COVID-19 pandemic due to resource shortages and fragile healthcare systems. This study assessed the functional capacity and preparedness of the Haitian healthcare system regarding the COVID-19 pandemic. It employed a narrative review approach to analyze secondary data and used the Donabedian model and the global health security index as the theoretical frameworks to evaluate preparedness. The findings reveal that Haiti faces challenges in tackling the COVID-19 pandemic due to a lack of biosafety and biosecurity regulations, inadequate laboratory systems for COVID-19 testing, and shortages of human resources and personal protective equipment. Moreover, poverty remains widespread, and people lack access to clean water and sanitation services, resulting in a high risk of COVID-19 infection. Furthermore, a lack of communication, rumors, the circulation of fake news regarding COVID-19, and stigmatization cause distrust and reduce the number of people seeking healthcare services. Haiti faces challenges with respect to tackling the pandemic. The Haitian government can strengthen and improve the capacity of the healthcare system to fight against the COVID-19 pandemic and infectious diseases emerging in the future.
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Affiliation(s)
- Josemyrne Ashley Faure
- Global Health Program, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
| | - Chia-Wen Wang
- Innovation and Policy Centre for Population Health and Sustainable Environment (Population Health Research Centre, PHRC), College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
| | - Chi-Hsin Sally Chen
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
| | - Chang-Chuan Chan
- Global Health Program, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
- Innovation and Policy Centre for Population Health and Sustainable Environment (Population Health Research Centre, PHRC), College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan;
- Correspondence:
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Lingas EC. Empiric Antibiotics in COVID 19: A Narrative Review. Cureus 2022; 14:e25596. [PMID: 35795519 PMCID: PMC9250242 DOI: 10.7759/cureus.25596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
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10
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Jones RP. A pragmatic method to compare international critical care beds: Implications to pandemic preparedness and non-pandemic planning. Int J Health Plann Manage 2022; 37:2167-2182. [PMID: 35332580 DOI: 10.1002/hpm.3458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 01/22/2022] [Accepted: 03/08/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current method for assessing critical care (CCU) bed numbers between countries is unreliable. METHODS A pragmatic method is presented using a logarithmic relationship between CCU beds per 1000 deaths and deaths per 1000 population, both of which are readily available. The method relies on the importance of the nearness to death effect, and on the effect of population size. RESULTS The method was tested using CCU bed numbers from 65 countries. A series of logarithmic relationships can be seen. High versus low countries can be distinguished by adjusting all countries to a common crude mortality rate. Hence at 9.5 deaths per 1000 population 'high' CCU bed countries average of around 30 CCU beds per 1000 deaths, while 'very low' countries only average 3 CCU beds per 1000 deaths. The United Kingdom falls among countries with low critical care provision with an average of 8 CCU beds per 1000 deaths, and during the COVID-19 epidemic UK industry intervened to rapidly manufacture various types of ventilators to avoid a catastrophe. CCU bed numbers in India are around 8.1 per 1000 deaths, which places it in the low category. However, such beds are inequitably distributed with the poorest states all in the 'very low' category. In India only around 50% of CCU beds have a ventilator. CONCLUSION A feasible region is defined for the optimum number of CCU beds.
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Lee SY, Chang CY. Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study. J Nurs Manag 2022; 30:2889-2896. [PMID: 35293063 DOI: 10.1111/jonm.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 12/11/2022]
Abstract
AIM To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency. BACKGROUND Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice. METHODS A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality. RESULTS After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care. CONCLUSION The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability. IMPLICATIONS FOR NURSING MANAGEMENT A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.
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Affiliation(s)
- Shu-Yen Lee
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University, Taiwan
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Jackson P, Siddharthan T, Cordoba Torres IT, Green BA, Policard CJP, Degraff J, Padalkar R, Logothetis KB, Gold JA, Fort AC. Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic. ATS Sch 2022; 3:112-124. [PMID: 35634008 PMCID: PMC9130714 DOI: 10.34197/ats-scholar.2021-0070oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Background Noninvasive ventilation (NIV) is an important component of respiratory therapy for a range of cardiopulmonary conditions. The World Health Organization recommends NIV use to decrease the use of intensive care unit resources and improve outcomes among patients with respiratory failure during periods of high patient capacity from coronavirus disease (COVID-19). However, healthcare providers in many low- and middle-income countries, including Haiti, do not have experience with NIV. We conducted NIV training and evaluation in Port-au-Prince, Haiti. Objectives To design and implement a multimodal NIV training program in Haiti that would improve confidence and knowledge of NIV use for respiratory failure. Methods In January 2021, we conducted a 3-day multimodal NIV training consisting of didactic sessions, team-based learning, and multistation simulation for 36 Haitian healthcare workers. The course included 5 didactic session and 10 problem-based and simulation sessions. All course material was independently created by the study team on the basis of Accreditation Council for Continuing Medical Education-approved content and review of available evidence. All participants completed pre- and post-training knowledge-based examinations and confidence surveys, which used a 5-point Likert scale. Results A total of 36 participants were included in the training and analysis, mean age was 39.94 years (standard deviation [SD] = 9.45), and participants had an average of 14.32 years (SD = 1.21) of clinical experience. Most trainees (75%, n = 27) were physicians. Other specialties included nursing (19%, n = 7), nurse anesthesia (3%, n = 1), and respiratory therapy (3%, n = 1). Fifty percent (n = 18) of participants stated they had previous experience with NIV. The majority of trainees (77%) had an increase in confidence survey score; the mean confidence survey score increased significantly after training from 2.75 (SD = 0.77) to 3.70 (SD = 0.85) (P < 0.05). The mean knowledge examination score increased by 39.63% (SD = 15.99%) after training, which was also significant (P < 0.001). Conclusion This multimodal NIV training, which included didactic, simulation, and team-based learning, was feasible and resulted in significant increases in trainee confidence and knowledge with NIV. This curriculum has the potential to provide NIV training to numerous low- and middle-income countries as they manage the ongoing COVID-19 pandemic and rising burden of noncommunicable disease. Further research is necessary to ensure the sustainability of these improvements and adaptability to other low- and middle-income settings.
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Affiliation(s)
- Peter Jackson
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Barth A. Green
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Roma Padalkar
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey; and
| | - Kathryn B. Logothetis
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia
| | - Jeffrey A. Gold
- Department of Pulmonary and Critical Care, Oregon Health & Science University, Portland, Oregon
| | - Alexander C. Fort
- Department of Anesthesiology, Perioperative Medicine and Pain Management, and
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Sonenthal PD, Nyirenda M, Kasomekera N, Marsh RH, Wroe EB, Scott KW, Bukhman A, Connolly E, Minyaliwa T, Katete M, Banda-Katha G, Mukherjee JS, Rouhani SA. The Malawi emergency and critical care survey: A cross-sectional national facility assessment. EClinicalMedicine 2022; 44:101245. [PMID: 35072017 PMCID: PMC8762065 DOI: 10.1016/j.eclinm.2021.101245] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. METHODS We developed a novel research instrument to assess public sector ECC capacity and service readiness in LICs. From January 20th to February 18th, 2020 we administered the instrument at all four central hospitals and a simple random sample of nine of 24 district hospitals in Malawi, a landlocked and predominantly rural LIC of 19·1 million people in Southern Africa. The instrument contained questions on the availability of key resources across three domains and was administered to hospital administrators and clinicians from outpatient departments, emergency departments, and inpatient units. Results were used to generate an ECC Readiness Score, with a possible range of 0 to 1, for each facility. FINDINGS A total of 114 staff members across 13 hospitals completed interviews for this study. Three (33%) district hospitals and all four central hospitals had ECC Readiness Scores above 0·5 (p-value 0·070). Absent equipment was identified as the most common barrier to ECC Readiness. Central hospitals had higher median ECC Readiness Scores with less variability 0·82 (interquartile range: 0·80-0·89) than district hospitals (0·33, 0·23 to 0·50, p-value 0·021). INTERPRETATION This is the first study to employ a systematic approach to assessing ECC capacity and service readiness at both district and central hospitals in Malawi and provides a framework for measuring ECC capacity in other LICs. Prior ECC assessments potentially overestimated equipment availability and our methodology may provide a more accurate approach. There is an urgent need for investments in ECC services, particularly at district hospitals which are more accessible to Malawi's predominantly rural population. These findings highlight the need for long-term investments in health systems strengthening and underscore the importance of understanding capacity in LIC settings to inform these efforts. FUNDING Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Department of Emergency Medicine, Brigham and Women's Hospital.
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Affiliation(s)
- Paul D. Sonenthal
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Corresponding author at: Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115, USA.
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, Malawi
- University of Malawi College of Medicine, Private Bag 360 Blantyre 3, Chichiri, Malawi
| | - Noel Kasomekera
- Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Regan H. Marsh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Emily B. Wroe
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA 02115, USA
| | - Kirstin W. Scott
- University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Alice Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Emilia Connolly
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | | | - Martha Katete
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Grace Banda-Katha
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, Malawi
| | - Joia S. Mukherjee
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
| | - Shada A. Rouhani
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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Abstract
This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.
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Kunnumpurath A. Pwojé Bon Vwazen (The Good Neighbor Project) An initiative to develop a community health worker project as a response to COVID-19 in Haiti. LINACRE QUARTERLY 2021; 89:178-183. [PMID: 35619885 PMCID: PMC9127894 DOI: 10.1177/00243639211040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding the resource limitations in developing countries, a community health worker (CHW) project was developed to help educate, provide materials, and prevent the spread of COVID-19 in Haiti. CHWs have shown to be an evidence-driven alternative in resource-limited settings. Pwojé Bon Vwazen (The Good Neighbor Project) took place from May 2020 to September 2020 in Port-au-Prince, Haiti. Through the project, 9 CHWs were trained. The project had two coordinators in Haiti. The CHWs, over the period of 4 months, were able to reach 1350 individuals and provide them with education regarding spread and prevention of COVID-19 and distribute materials including soap, hand sanitizers, and masks which were sewn in Haiti. Access to affordable health care presents a unique challenge in resource-limited countries. Training of CHWs and implementation of a CHW program can be an alternative in certain situations.
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Park E, Park H, Kang D, Chung CR, Yang JH, Jeon K, Guallar E, Cho J, Suh GY, Cho J. Health disparities of critically ill children according to poverty: the Korean population-based retrospective cohort study. BMC Public Health 2021; 21:1274. [PMID: 34193092 PMCID: PMC8243750 DOI: 10.1186/s12889-021-11324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/18/2021] [Indexed: 01/09/2023] Open
Abstract
Background There is a lack of nationwide studies on critically ill patients’ health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children. Methods We conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures. Results Out of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42). Conclusion Under the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11324-4.
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Affiliation(s)
- Esther Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Laytin AD, Sultan M, Debebe F, Walelign Y, Fisseha G, Gebreyesus A. Critical care capacity in Addis Ababa, Ethiopia: A citywide survey of public hospitals. J Crit Care 2021; 63:1-7. [PMID: 33549908 DOI: 10.1016/j.jcrc.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated critical care capacity in the 15 intensive care units (ICUs) in public hospitals in Addis Ababa, Ethiopia to determine the current state of critical care in the city and inform capacity-building efforts. METHODS We conducted a cross-sectional survey of ICU medical and nursing directors or their delegates using a standardized questionnaire based on World Federation of Society of Intensive and Critical Care Medicine (WFSICCM) criteria. RESULTS ICU size ranged from 3 to 15 beds. All ICUs had capacity for mechanical ventilation and vasopressor support, and 53% had intensivists on staff. Ultrasound was available in 93%, while 40% had capacity for invasive blood pressure monitoring. Identified barriers to care included a lack of essential equipment, supplies, medications and specially trained providers. Respondents considered increasing available beds and coordinating between hospitals crucial for capacity building. CONCLUSIONS There is burgeoning critical care capacity in Addis Ababa, Ethiopia with 103 ICU beds in public hospitals, and the WFSICCM criteria provide a useful framework for evaluating critical care capacity and identifying priorities for capacity building. All ICUs in public hospitals in Addis Ababa were able to provide basic support for patients with life-threatening organ failure but demonstrated marked heterogeneity in critical care capacity.
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Affiliation(s)
- Adam D Laytin
- Department of Anesthesiology and Critical Care Medicine and Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Menbeu Sultan
- Department of Emergency Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Finot Debebe
- Department of Emergency Medicine, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yenegeta Walelign
- Emergency and Critical Care Directorate, Ministry of Health-Ethiopia, Addis Ababa, Ethiopia.
| | - Gete Fisseha
- Emergency and Critical Care Directorate, Ministry of Health-Ethiopia, Addis Ababa, Ethiopia.
| | - Alegnta Gebreyesus
- Emergency and Critical Care Directorate, Ministry of Health-Ethiopia, Addis Ababa, Ethiopia.
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Schultz MJ, Gebremariam TH, Park C, Pisani L, Sivakorn C, Taran S, Papali A. Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:34-47. [PMID: 33534752 PMCID: PMC7957242 DOI: 10.4269/ajtmh.20-0730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
Management of patients with severe or critical COVID-19 is mainly modeled after care of patients with severe pneumonia or acute respiratory distress syndrome from other causes. These models are based on evidence that primarily originates from investigations in high-income countries, but it may be impractical to apply these recommendations to resource-restricted settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for microbiology and laboratory testing, imaging, and the use of diagnostic and prognostic models in patients with severe COVID-19 in LMICs. For diagnostic testing, where reverse transcription-PCR (RT-PCR) testing is available and affordable, we recommend using RT-PCR of the upper or lower respiratory specimens and suggest using lower respiratory samples for patients suspected of having COVID-19 but have negative RT-PCR results for upper respiratory tract samples. We recommend that a positive RT-PCR from any anatomical source be considered confirmatory for SARS-CoV-2 infection, but, because false-negative testing can occur, recommend that a negative RT-PCR does not definitively rule out active infection if the patient has high suspicion for COVID-19. We suggest against using serologic assays for the detection of active or past SARS-CoV-2 infection, until there is better evidence for its usefulness. Where available, we recommend the use of point-of-care antigen-detecting rapid diagnostic testing for SARS-CoV-2 infection as an alternative to RT-PCR, only if strict quality control measures are guaranteed. For laboratory testing, we recommend a baseline white blood cell differential platelet count and hemoglobin, creatinine, and liver function tests and suggest a baseline C-reactive protein, lactate dehydrogenase, troponin, prothrombin time (or other coagulation test), and D-dimer, where such testing capabilities are available. For imaging, where availability of standard thoracic imaging is limited, we suggest using lung ultrasound to identify patients with possible COVID-19, but recommend against its use to exclude COVID-19. We suggest using lung ultrasound in combination with clinical parameters to monitor progress of the disease and responses to therapy in COVID-19 patients. We currently suggest against using diagnostic and prognostic models as these models require extensive laboratory testing and imaging, which often are limited in LMICs.
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Affiliation(s)
- Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Tewodros H. Gebremariam
- Department of Internal Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Casey Park
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Toronto, Canada
| | - Luigi Pisani
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Operational Research Unit, Doctors with Africa – CUAMM, Padova, Italy
- Department of Anesthesia and Intensive Care, Miulli Regional Hospital, Acquaviva delle Fonti, Italy
| | - Chaisith Sivakorn
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shaurya Taran
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Toronto, Canada
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Department of Internal Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Toronto, Canada
- Operational Research Unit, Doctors with Africa – CUAMM, Padova, Italy
- Department of Anesthesia and Intensive Care, Miulli Regional Hospital, Acquaviva delle Fonti, Italy
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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Lucien MAB, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, Cerpa M, Joseph GA, Maki G, Zervos MJ, Dely P, Boncy J, Sati H, Rio AD, Ramon-Pardo P. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. Int J Infect Dis 2021; 104:250-254. [PMID: 33434666 PMCID: PMC7796801 DOI: 10.1016/j.ijid.2020.12.087] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.
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Affiliation(s)
- Mentor Ali Ber Lucien
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.
| | - Michael F Canarie
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul E Kilgore
- Eugene Applebaum School of Pharmacy, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | - Gerard A Joseph
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Gina Maki
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Marcus J Zervos
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Patrick Dely
- Direction d'Épidémiologie, de Laboratoire et de Recherches, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Hatim Sati
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Ana Del Rio
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Pilar Ramon-Pardo
- Pan American Health Organization, AMR Special Program, Washington DC, USA
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Siaw-Frimpong M, Touray S, Sefa N. Capacity of intensive care units in Ghana. J Crit Care 2020; 61:76-81. [PMID: 33099204 PMCID: PMC7560159 DOI: 10.1016/j.jcrc.2020.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 01/09/2023]
Abstract
Purpose To document the equipment, resource and bed capacity of Intensive Care Units (ICUs) in the Republic of Ghana. Materials and methods Cross-sectional observational study of all operating ICUs in Ghana. Sixteen operating ICUs in 9 hospitals were identified and surveyed (13 adult and 3 pediatric ICUs). Results There were a total of 113 adult and 36 pediatric ICU beds for a population of 30 million, (0.5 ICU beds per 100,000 people). The median number of staffed ICU beds and ventilators were 5 (IQR 4–6), and 4 (IQR 3–5) respectively. There were 2 pediatric and 6 adult intensivists practicing in the country. About half of the ICUs (56%) were staffed solely by non-intensivist providers. While there is adequate nursing support and availability of essential critical care medications, the current financing model for critical care delivery creates a significant barrier for most patients. Conclusion Ghana has a significant shortage of critical care beds that are inequitably distributed across the country and a shortfall of intensivists to staff ICUs. A holistic approach that focuses on the key bottlenecks to quality improvement would be required to improve the capacity and quality of critical care delivery. There were a total of 113 adult and 36 pediatric critical care beds for a population of 30 million people in Ghana. In February 2020, Ghana had a total Critical Care bed capacity of 0.5 ICU beds per 100,000 people. There were 16 operational ICUs across 9 institutions, of which 13 were adult and 3 were pediatric ICUs. There were 8 intensivists (5 on loan from the Cuban Government) in the whole country.
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Affiliation(s)
- Moses Siaw-Frimpong
- Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sunkaru Touray
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nana Sefa
- Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
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Shamasunder S, Holmes SM, Goronga T, Carrasco H, Katz E, Frankfurter R, Keshavjee S. COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment. Glob Public Health 2020; 15:1083-1089. [PMID: 32352911 DOI: 10.1080/17441692.2020.1760915] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic demonstrates the critical need to reimagine and repair the broken systems of global health. Specifically, the pandemic demonstrates the hollowness of the global health rhetoric of equity, the weaknesses of a health security-driven global health agenda, and the negative health impacts of power differentials not only globally, but also regionally and locally. This article analyses the effects of these inequities and calls on governments, multilateral agencies, universities, and NGOs to engage in true collaboration and partnership in this historic moment. Before this pandemic spreads further - including in the Global South - with potentially extreme impact, we must work together to rectify the field and practice of global health.
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Affiliation(s)
- Sriram Shamasunder
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Seth M Holmes
- Division of Society and Environment and Medical Anthropology, University of California Berkeley, Berkeley, CA, USA.,Berkeley Center for Social Medicine, University of California Berkeley, Berkeley, CA, USA
| | - Tinashe Goronga
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium.,University of Zimbabwe, Harare, Zimbabwe
| | - Hector Carrasco
- T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, México City, MX, USA.,Global Health Initiative, Tecnológico de Monterrey, Monterrey, Mexico
| | - Elyse Katz
- UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Raphael Frankfurter
- UCSF-UC Berkeley Medical Scientist Training Program, School of Medicine, Joint Program in Medical Anthropology, University of California San Francisco, San Francisco, CA, USA
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine and Department of Medicine, Harvard Medical School, Boston, MA, USA
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22
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Hashimoto K, Adrien L, Rajkumar S. Moving Towards Universal Health Coverage in Haiti. Health Syst Reform 2020; 6:e1719339. [PMID: 32101069 DOI: 10.1080/23288604.2020.1719339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Haiti announced in 2018 its aim to achieve universal health coverage. In this paper, we discuss what this objective means for the country and what next steps should be taken. To contextualize the notion, we framed Haiti en route to the 2030 goal and analyzed qualitatively the status quo in terms of geographic, financial, and service access. For each dimension, we focused on the context, the government's policies and political agendas, their implementation progress, and key influential factors. Our analysis found little progress and numerous challenges. Geographic access was limited due principally to the insufficient number of facilities, difficulties in reaching health facilities, and local customs. Financial coverage was low because of the government's insufficient budgets, inefficient budget allocation, and ineffective management. Service access also had room for significant improvement for a lack of basic infrastructure and resources, gaps between the essential service package guidelines, health professionals' skills, and the needs, as well as deficiencies in people-centered care. These factors affected not only health service coverage but also its quality. We found that the root causes of these issues were composed of unstable financing mechanisms, opportunistic resource allocation, and ineffective management control systems. We suggest that to overcome these issues and achieve universal health coverage with decent service quality, Haiti's health system needs to be reformed by implementing strategic financing, decentralized management systems, and community engagement in primary health care.
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Affiliation(s)
- Ken Hashimoto
- Independent Global Health Consultant (Former Advisor of Japan International Cooperation Agency for the Ministry of Health in Haiti), Kakogawa, Japan
| | - Lauré Adrien
- Direction Générale, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Sunil Rajkumar
- Health, Nutrition & Population, World Bank, Washington, DC, USA
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