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Gebre M, Uddin MF, Duke T, Haile K, Faruk MT, Kamal M, Kabir MF, Genetu A, Kebede RA, Demtse A, Weldetsadik AY, Demisse AG, Haile BW, Abdissa A, Elfu T, Tesfaye B, Balcha TT, Shemeles M, Ahmed T, Clemens JD, Chisti MJ. Perception and experience of clinicians and caregivers in treating childhood severe pneumonia and hypoxemia using bubble continuous positive airway pressure in Ethiopian tertiary and general hospitals. PLoS One 2022; 17:e0275952. [PMID: 36315509 PMCID: PMC9621408 DOI: 10.1371/journal.pone.0275952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In low and middle-income countries (LMICs), severe pneumonia with hypoxemia is the leading cause of child deaths, even with the provision of WHO-recommended antibiotic therapy, oxygen therapy and other supportive care. Previous studies found positive outcomes from the use of bubble continuous positive airway pressure (bCPAP) for treating these children compared to the standard oxygen therapy. Due to lack of data on the perceptions and experiences of hospital health care workers and caregivers of children on the feasibility and acceptability of bCPAP in treating children with severe pneumonia and hypoxemia in real-life settings, we examined these issues in tertiary and general hospitals in Ethiopia. METHODS As part of a three-stages clinical trial, this qualitative study was conducted in two tertiary (stage I) and two general (stage II) hospitals from September 2019 to July 2020. During stages I and II, we have consecutively enrolled children with severe pneumonia and hypoxemia and put them on bCPAP to examine its feasibility and acceptability by clinicians and parents. A total of 89 children were enrolled (49 from two tertiary and 40 from two general hospitals). Then qualitative data were collected through 75 repeated in-depth interviews by social-science experts with purposively selected 30 hospital health workers and 15 parents of 12 children who received bCPAP oxygen therapy in the hospitals. Interview data were supplemented by 6 observations in the hospitals. Data were analyzed using a thematic approach. RESULTS Identified structural and functional challenges for the introduction of bCPAP in treating childhood severe pneumonia and hypoxemia in the study hospitals include: inadequate number of pulse oximeters; unavailability of nasal prongs with age-specific size; inadequate and non-functioning oxygen flow meters, concentrator, and cylinders; disruption in power-supply; and inadequate number of staff. The opportunities in introducing bCPAP oxygen therapy included the availability of a dedicated corner for the study patients situated in front of nurse's station, required medicines and satisfactory level of clinicians' knowledge and skills for treating severe pneumonia patients. Additionally, the identified operational challenges were occasional lack of bubbling in the water-filled plastic bottle, lack of stand for holding the water-filled plastic bottle, and delayed shifting of oxygen source from an oxygen concentrator to a cylinder, particularly during electricity disruption. Participants (clinicians and parents) expressed their satisfaction as bCPAP oxygen therapy was found to be simple to handle, children had ease of breathing and recovered fast without major ill effects. CONCLUSION Our study identified some important structural, functional, and operational challenges that need to be addressed before implementation of bCPAP oxygen therapy especially in frontline general hospitals with limited resources. In spite of these observed challenges, the clinicians and caregivers were highly satisfied with the overall performance of bCPAP oxygen therapy.
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Affiliation(s)
- Meseret Gebre
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Md. Fakhar Uddin
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Trevor Duke
- Centre for International Child Health, Royal Children’s Hospital, The University of Melbourne, Melbourne, Australia
| | - Kassa Haile
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Md. Tanveer Faruk
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Mehnaz Kamal
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Md. Farhad Kabir
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Abebe Genetu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Asrat Demtse
- Centre for International Child Health, Royal Children’s Hospital, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | - Teferi Elfu
- Butajira General Hospital, Addis Ababa, Ethiopia
| | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - John D. Clemens
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
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Kim JM, Park JH, Kim HS, Lee JW, Lim HS, Choi WA, Kang SW. Epidemiology and diagnostic process of amyotrophic lateral sclerosis as distinct from myelopathy: 5-year cohort study of whole-population in South Korea. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:547-554. [PMID: 30421999 DOI: 10.1080/21678421.2018.1491600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the incidence, prevalence, and demographic factors of all amyotrophic lateral sclerosis (ALS) patients diagnosed in South Korea from 2011 to 2015, and to analyze cases misdiagnosed as myelopathy. METHODS The whole population registered under the Korean National Health Insurance Service (KNHIS) was applied. All 4551 patients who were registered as having ALS code from 2011 to 2015 were included. For all ALS patients, the incidence, prevalence, and demographic factors were assessed. Trends of diagnosis for myelopathy, and surgery prior to confirmation of ALS diagnosis were identified. RESULTS When the whole 48,135,715 KNHIS population enrolled in 2015, the incidence of ALS in 2015 was estimated to be 1.68 per 100,000 person-years, and the prevalence was 6.49 per 100,000 persons. Life expectancy of ALS can be calculated as 3.9 years after the diagnosis, and the mean age of diagnosis was 59.5 ± 13.1. A total of 1902 patients diagnosed with myelopathy before a diagnosis of ALS accounted for 0.13% of all myelopathy patients, and 41.8% of all ALS patients. It took an average of 471.7 d to confirm a diagnosis of ALS after the myelopathy diagnosis. Among the patients finally diagnosed with ALS, more patients underwent surgery for myelopathy (n = 263, 13.8%) than among patients who were diagnosed with myelopathy alone, and underwent surgery (n = 141,148, 9.8%). CONCLUSIONS This whole-population nationwide demographic study confirmed the data from previous studies. Clinicians should consider the possibility of ALS when making a myelopathy diagnosis, especially if the symptoms are sufficiently severe to require surgery.
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Affiliation(s)
- Jong Moon Kim
- a Department of Rehabilitation Medicine , CHA Bundang Medical Center, CHA University , Gyeonggi-do , Republic of Korea
| | - Jung Hyun Park
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Hyung Seop Kim
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Jang Woo Lee
- c Departments of Physical Medicine and Rehabilitation , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea and
| | - Hyun Sun Lim
- d Research and Analysis Team , National Health Insurance Service Ilsan Hospital , Gyeonggi-do , Republic of Korea
| | - Won Ah Choi
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
| | - Seong-Woong Kang
- b Department of Rehabilitation Medicine , Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine , Gangnam-gu, Seoul , Korea
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