1
|
Frost A, Collins A, Chung EO, Escobar Carias MS, Hagaman A, Gupta S, Bibi A, Sikander S, Maselko J. Trauma exposure among young children in rural Pakistan: Associations with gender, mental health, and cognitive skills. BMC Psychol 2024; 12:454. [PMID: 39183356 PMCID: PMC11346172 DOI: 10.1186/s40359-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The burden of childhood trauma (violence, injury/illness, loss) in low-resource settings is high, although the effect of trauma on children's mental and cognitive health is under-researched. Child gender may moderate the association between trauma and outcomes; boys are more likely to experience trauma, but girls are more likely to show distress following trauma. METHODS We draw on data from the Bachpan cohort (n = 888), a sample of mother-child dyads in rural Pakistan, to investigate these associations among 6-year-old children in a South Asian, low-resource setting. Mothers reported on children's lifetime exposure to 15 possible traumas and their current mental health. In addition, children were assessed for their verbal skills, working memory, and inhibitory control. We estimated trauma prevalence and used generalized estimating equations to test the association between number of traumatic events and child mental health and cognitive skills in the overall sample and by gender. RESULTS 90.5% of children experienced at least one trauma. The most common traumas were death of a loved one (47%) and hearing about war/terrorism on the TV/radio (48%). On average, boys experienced more traumas (M = 3.00) than girls (M = 2.67). Specifically, boys were more likely than girls to experience an injury or hospitalization (30% vs. 21%, p < .05) and to hear about war/terrorism on the TV/radio (52% vs. 43%, p < .05). Trauma was associated with increased mental health difficulties and increased anxiety scores. There was little evidence that trauma exposure was associated with child cognitive skills. The strength of association between trauma and outcomes was similar for boys and girls. CONCLUSIONS Findings show that childhood trauma exposure is common in this setting and associated with worse mental health problems among young boys and girls. Results suggest that trauma-informed interventions are important for supporting child mental health in South Asia.
Collapse
Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill, USA.
| | - Amanda Collins
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | | | | | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sugandh Gupta
- Department of Anthropology, University of North Carolina, Chapel Hill, USA
| | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Siham Sikander
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| |
Collapse
|
2
|
Stephens CQ, Butler MW, Samad L, Seyi-Olajide JO, Evans FM, Gathuya Z, McLeod E. Children's surgery and the emergency, critical, and operative care resolution: immediate actions to eliminate disparities in surgical anesthesia and perioperative care for all children. Pediatr Surg Int 2024; 40:213. [PMID: 39088047 DOI: 10.1007/s00383-024-05748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
Abstract
1.7 billion children lack access to surgical care worldwide. The emergency, critical, and operative care (ECO) resolution represents a call to action to reinvigorate the efforts to address these disparities. We review the ECO resolution and highlight the avenues that may be utilized in advocating for children's surgical care.
Collapse
Affiliation(s)
- Caroline Q Stephens
- Center for Health Equity in Surgery and Anesthesia, Global Initiative for Children's Surgery, University of California-San Francisco, 513 Parnassus Ave, S-321, San Francisco, CA, 94143, USA.
| | - Marilyn W Butler
- Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Lubna Samad
- Global Surgery Programs, IRD Global, Singapore, Singapore
- Global Surgery Programs, IRD Pakistan, Karachi, Pakistan
| | - Justina O Seyi-Olajide
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Faye M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Elizabeth McLeod
- Department of Pediatric Surgery, Monash Children's Hospital, Melbourne, Australia
| |
Collapse
|
3
|
Stephens CQ, Butler MW, Samad L, Seyi-Olajide JO, Evans FM, Gathuya Z, McLeod E. Children's surgery and the emergency, critical, and operative care resolution: Immediate actions to eliminate disparities in surgery, anesthesia, and perioperative care for all children. Paediatr Anaesth 2024. [PMID: 38853668 DOI: 10.1111/pan.14943] [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: 04/11/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
Around 1.7 billion children lack access to surgical care worldwide. To reinvigorate the efforts to address these disparities and support work to address global challenges in surgery, anesthesia, emergency, and critical care, the World Health Assembly passed World Health Organization Resolution World Health Assembly 76.2: Integrated emergency, critical and operative care for universal health coverage and protection from health emergencies (ECO) in 2023. This resolution highlights the integral role of surgery, anesthesia, and perioperative care in health systems. However, understanding how best to operationalize this resolution is challenging. We review the ECO resolution and highlight points that the pediatric surgical and anesthesia community can leverage to advocate for its recommendations for operative care.
Collapse
Affiliation(s)
- Caroline Q Stephens
- Center for Health Equity in Surgery and Anesthesia, University of California-San Francisco, San Francisco, California, USA
| | - Marilyn W Butler
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Lubna Samad
- Global Surgery Programs, IRD Global, Singapore, Singapore
- Global Surgery Programs, IRD Pakistan, Karachi, Pakistan
| | - Justina O Seyi-Olajide
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elizabeth McLeod
- Department of Pediatric and Neonatal Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Bhatia MB, Keung CH, Hogan J, Chepkemoi E, Li HW, Rutto EJ, Tenge R, Kisorio J, Hunter-Squires JL, Saula PW. Implementation of a pediatric trauma registry at a national referral center in Kenya: Utility and concern for sustainability. Injury 2024; 55:111531. [PMID: 38704346 DOI: 10.1016/j.injury.2024.111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Pediatric trauma disproportionately affects low- and middle-income countries, particularly the pediatric trauma systems, are frequently limited. This study assessed the patterns of pediatric traumatic injuries and treatment at the only free-standing public children's hospital in East Africa as well as the implementation and sustainability of the trauma registry. METHODS A prospective pediatric trauma registry was established at Shoe4Africa Children's Hospital (S4A) in Eldoret, Kenya. All trauma patients over a six-month period were enrolled. Descriptive analyses were completed via SAS 9.4 to uncover patterns of demographics, trauma mechanisms and injuries, as well as outcomes. Implementation was assessed using the RE-AIM framework. RESULTS The 425 patients had a median age of 5.14 years (IQR 2.4, 8.7). Average time to care was 267.5 min (IQR 134.0, 625.0). The most common pediatric trauma mechanisms were falls (32.7 %) and burns (17.7 %), but when stratified by age group, toddlers had a higher risk of sustaining injuries from burns and poisonings. Over half (56.2 %) required an operation during the hospitalization. Overall, implementation of the registry was limited by the clinical burden and inadequate personnel. Sustainability of the registry was limited by finances. CONCLUSIONS This is the first study to describe the trauma epidemiology from a Kenyan public pediatric hospital. Maintenance of the trauma registry failed due to cost. Streamlining global surgery efforts through implementation science may allow easier development of trauma registries to then identify modifiable risk factors to prevent trauma and long-term outcomes to understand associated disability.
Collapse
Affiliation(s)
- Manisha B Bhatia
- Indiana University Department of Surgery, Indianapolis, IN, USA.
| | | | - Jessica Hogan
- University of Alberta, Department of Surgery, Alberta, Canada
| | | | - Helen W Li
- Washington University Department of Surgery, St. Louis, Missouri, USA
| | | | - Robert Tenge
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | - Joshua Kisorio
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| | | | - Peter W Saula
- Moi University, Department of Anesthesia and Surgery, Eldoret, Kenya
| |
Collapse
|
5
|
Naus A, Carroll M, Gerk A, Mooney DP, Yanchar NL, Ferreira J, Poenaru D, Gripp KE, Ouellet C, Botelho F. Implementation of a Global Pediatric Trauma Course in an Upper Middle-Income Country: A Pilot Study. J Surg Res 2024; 298:355-363. [PMID: 38663262 DOI: 10.1016/j.jss.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/25/2024] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. METHODS A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests. RESULTS Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. CONCLUSIONS Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.
Collapse
Affiliation(s)
- Abbie Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Lahey Hospital and Medical Center, Beth Israel Lahey, Burlington, MA. https://twitter.com/abbieEnaus
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Yale New Haven Hospital, New Haven, CT
| | - Ayla Gerk
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Natalie L Yanchar
- Department of Surgery, Alberta Children's Hospital, Calgary, AB, Canada
| | - Julia Ferreira
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Dan Poenaru
- Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen E Gripp
- Emergency Department, The Children's Hospital of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Ouellet
- Emergency Department, Montreal Children's Hospital, Montreal, QC, Canada
| | - Fabio Botelho
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
6
|
Gyedu A, Issaka A, Appiah AB, Donkor P, Mock C. Care of Injured Children Compared to Adults at District and Regional Hospitals in Ghana and the Impact of a Trauma Intake Form: A Stepped-Wedge Cluster Randomized Trial. J Pediatr Surg 2024; 59:1210-1218. [PMID: 38154994 PMCID: PMC11105994 DOI: 10.1016/j.jpedsurg.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND This study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana. METHODS A stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression. RESULTS Management of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030). CONCLUSIONS While the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries. TYPE OF STUDY Stepped-wedged cluster randomized controlled trial. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Adamu Issaka
- Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Anthony Baffour Appiah
- Ghana Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA
| |
Collapse
|
7
|
Ali AE, Ademuyiwa A, Abib S, Carapinha C, Wahid FN, Rolle U, Lakhoo K. Global Initiative for Children's Surgery (GICS) Pediatric Trauma Care Initiative: A Call for a Comprehensive Approach to a Global Problem. CHILDREN (BASEL, SWITZERLAND) 2024; 11:666. [PMID: 38929245 PMCID: PMC11202123 DOI: 10.3390/children11060666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Trauma is a major problem which has a significant health, social, and economic impact. Particularly, pediatric trauma carries substantial mortality and morbidity. This is a great concern for subspecialized general and pediatric surgeons. Therefore, a global initiative for pediatric trauma care is warranted and should be initiated. AIM The international association "Global Initiative for Children's Surgery" (GICS) would like to propose and organize a children's trauma care (CTC) initiative. This initiative should comprehensively address pediatric trauma management globally, especially in low- and middle-income countries (LMICs). The initiative seeks to achieve a structured cooperation and collaboration with respective sister organizations and local stakeholders. METHODS The initiative will address these relevant aspects: 1. first aid; 2. prehospital primary trauma care; 3. hospital primary trauma care; 4. advanced care (ATLS); 5. diagnostic facilities; 6. operation room (OR) equipment; 7. specialized surgical services; 8. rehabilitation; 9. registry, research, and auditing; 10. specialization in pediatric trauma; 11. capacity and confidence building in pediatric trauma; 12. PREVENTION The GICS CTC provided activities have been recorded and evaluated in a structured manner. This statement paper is based on data of a narrative review as well as expert opinions. RESULTS The Trauma Working Group of GICS provided specialized trauma prevention leaflets available for translation to different languages. A one-day children's primary trauma course has been designed to be delivered at the physical GICS meetings. Exercising advocacy, the group addressed several meetings on prevention of pediatric trauma, which included the 75th United Nations General Assembly (UNGA) (2020), GICS IVth meeting in Johannesburg (2020), Norwich (UK) Joint SPRINT Symposium on Pediatric Surgery for Pediatricians (2021), the second online Pan African Pediatric Surgical Association (PAPSA) meeting (2021), the seventh World Congress of the World Federation of Associations of Pediatric Surgeons (WOFAPS) in Prague (2022), and GICS pediatric trauma webinar (2023). Additionally, the working group participated in the preparations of a pediatric trauma module for the World Health Organization (WHO) and published several related studies. The contents of the selected articles added relevant information to the categories stated above. CONCLUSIONS The CTC initiative of GICS is proposed as a mean to address pediatric trauma comprehensively through a process of collaboration and advocacy with existing organizations to achieve awareness, health education, prevention, health, and training. Further, it will support the provision of suitable facilities to health institutions. The establishment of a specialization in pediatric trauma is encouraged. GICS CTC initiative aims to improve pediatric trauma care in LMICs by developing injury prevention strategies; optimizing the use of locally available resources; obtaining commitment by LMICs governments; improvement in all fields of hospital care; improvements in infrastructure, education and training, and attention to data registry and research.
Collapse
Affiliation(s)
- Abdelbasit E. Ali
- Department of Pediatric Surgery, King Saud Medical City, Imam Abdelaziz bin Mohamed bin Saud Street, Olayshah, Riyadh 12746, Saudi Arabia;
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos Nigeria 102216, Nigeria;
| | - Simone Abib
- Pediatric Surgery, Federal University of São Paulo, São Paulo 04023-062, Brazil;
| | | | - Fazal Nouman Wahid
- Department of Pediatric Surgery, King Saud Medical City, Imam Abdelaziz bin Mohamed bin Saud Street, Olayshah, Riyadh 12746, Saudi Arabia;
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/M, 60590 Frankfurt, Germany;
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Paediatric Surgery, University of Oxford, Oxford University Hospitals, Oxford OX3 9DU, UK;
| |
Collapse
|
8
|
Petitt Z, Trillo Ordonez Y, Agwu C, Ott M, Shakir M, Ayala Mullikin A, Davis J, Khalafallah AM, Tang A, Shalita C, Ssembatya JM, Deng DD, Headley J, Obiga O, Haglund MM, Fuller AT. Exploring the feasibility of pupillometry training and perceptions of potential use for intracranial pressure monitoring in Uganda: A mixed methods study. PLoS One 2024; 19:e0298619. [PMID: 38748676 PMCID: PMC11095748 DOI: 10.1371/journal.pone.0298619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/26/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) accounts for the majority of Uganda's neurosurgical disease burden; however, invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring could change the care of patients in such a setting through quick detection of elevated ICP. PURPOSE Given the novelty of pupillometry in Uganda, this mixed methods study assessed the feasibility of pupillometry for noninvasive ICP monitoring for patients with TBI. METHODS Twenty-two healthcare workers in Kampala, Uganda received education on pupillometry, practiced using the device on healthy volunteers, and completed interviews discussing pupillometry and its implementation. Interviews were assessed with qualitative analysis, while quantitative analysis evaluated learning time, measurement time, and accuracy of measurements by participants compared to a trainer's measurements. RESULTS Most participants (79%) reported a positive perception of pupillometry. Participants described the value of pupillometry in the care of patients during examination, monitoring, and intervention delivery. Commonly discussed concerns included pupillometry's cost, understanding, and maintenance needs. Perceived implementation challenges included device availability and contraindications for use. Participants suggested offering continued education and engaging hospital leadership as implementation strategies. During training, the average learning time was 13.5 minutes (IQR 3.5), and the measurement time was 50.6 seconds (IQR 11.8). Paired t-tests to evaluate accuracy showed no statistically significant difference in comparison measurements. CONCLUSION Pupillometry was considered acceptable for noninvasive ICP monitoring of patients with TBI, and pupillometer use was shown to be feasible during training. However, key concerns would need to be addressed during implementation to aid device utilization.
Collapse
Affiliation(s)
- Zoey Petitt
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
| | - Yesel Trillo Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Chibueze Agwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, IL, United States of America
| | - Maura Ott
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Muhammad Shakir
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Aga Khan University Hospital, Karachi, Pakistan
| | - Alexandria Ayala Mullikin
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Jenna Davis
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Adham M. Khalafallah
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, University of Miami, Miami, FL, United States of America
| | - Alan Tang
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Chidyaonga Shalita
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Joseph Mary Ssembatya
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Division of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Di D. Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
| | - Jennifer Headley
- Duke University Global Health Institute, Durham, NC, United States of America
| | - Oscar Obiga
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Michael M. Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
- Duke University Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America
| |
Collapse
|
9
|
Ali AE, Sharma S, Elebute OA, Ademuyiwa A, Mashavave NZ, Chitnis M, Abib S, Wahid FN. Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries. Semin Pediatr Surg 2023; 32:151356. [PMID: 38041908 DOI: 10.1016/j.sempedsurg.2023.151356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.
Collapse
Affiliation(s)
- Abdelbasit E Ali
- Department of Pediatric Surgery, King Saud Medical City, KSA, Associate Professor of Surgery, Faculty of Medicine, University of Khartoum, Sudan
| | - Shilpa Sharma
- MCh, PhD, ATLS Faculty, ISTPF(UK), FIAPS, MNAMS, FAMS. Professor of Pediatric Surgery, Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Olumide A Elebute
- College of Medicine, University of Lagos and Lagos University Teaching Hospital Idi Araba, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos & Honorary Consultant and Chief Pediatric Surgery Unit, Lagos University Teaching Hospital. Lagos, Nigeria
| | - Noxolo Z Mashavave
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | - Milind Chitnis
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | | | | |
Collapse
|
10
|
Keating EM, Sakita F, Vlasic K, Amiri I, Nkini G, Nkoronko M, Young B, Birchall J, Watt MH, Staton CA, Mmbaga BT. Healthcare provider perspective on barriers and facilitators in the care of pediatric injury patients at a tertiary hospital in Northern Tanzania: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002599. [PMID: 37983210 PMCID: PMC10659160 DOI: 10.1371/journal.pgph.0002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). The recovery of injured children in LMICs is often impeded by barriers in accessing and receiving timely and quality care at healthcare facilities. The purpose of this study was to identify the barriers and the facilitators in pediatric injury care at Kilimanjaro Christian Medical Center (KCMC), a tertiary zonal referral hospital in Northern Tanzania. In this study, focus group discussions (FGDs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the barriers and facilitators in pediatric injury care. Five FGDs were completed from February 2021 to July 2021. Participants (n = 30) were healthcare providers from the emergency department, burn ward, surgical ward, and pediatric ward. De-identified transcripts were analyzed with team-based, applied thematic analysis using qualitative memo writing and consensus discussions. Our study found barriers that impeded pediatric injury care were: lack of pediatric-specific injury training and care guidelines, lack of appropriate pediatric-specific equipment, staffing shortages, lack of specialist care, and complexity of cases due to pre-hospital delays in patients presenting for care due to cultural and financial barriers. Facilitators that improved pediatric injury care were: team cooperation and commitment, strong priority and triage processes, benefits of a tertiary care facility, and flexibility of healthcare providers to provide specialized care if needed. The data highlights barriers and facilitators that could inform interventions to improve the care of pediatric injury patients in Northern Tanzania such as: increasing specialized provider training in pediatric injury management, the development of pediatric injury care guidelines, and improving access to pediatric-specific technologies and equipment.
Collapse
Affiliation(s)
- Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajsa Vlasic
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mugisha Nkoronko
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bryan Young
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Jenna Birchall
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| |
Collapse
|
11
|
Amado V, Moller J, Couto MT, Wallis L, Laflamme L. Effect of the COVID-19 pandemic on emergency department attendances for pediatric injuries in Mozambique's central hospitals: an interrupted time series and a comparison within the restriction periods between 2019 and 2020. Trauma Surg Acute Care Open 2023; 8:e001062. [PMID: 37484836 PMCID: PMC10350904 DOI: 10.1136/tsaco-2022-001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/25/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives Hospital-based studies indicate that restriction measures imposed during the COVID-19 pandemic have affected the number and characteristics of pediatric injuries. However, few studies have been conducted in resource-poor countries. This study aimed to determine whether injury-related emergency department (ED) attendances in Mozambique were affected during the restriction periods in 2020 and how the pattern of injury changed. Methods Mozambique faced two restriction periods in 2020. An interrupted time series was applied to weekly data of pediatric injuries from the ED records of four central hospitals in Mozambique in 2019 and 2020. Weekly numbers of injuries were modeled using a Poisson regression model to estimate the effect of COVID-19 restrictions on trends over calendar time. Then, for each restriction period, differences in injury mechanisms, severity, need for surgery, and intensive care unit (ICU) attendances were compared between 2019 and 2020. Results During the 76 weeks preceding the restrictions, there was a stable trend in ED attendances. The weekly number dropped by 48.7% after implementation of the first restrictions. By the end of 2020, the weekly numbers were back to the levels observed before the restrictions. Road traffic injuries (RTIs) and falls dropped during the first restriction period and RTIs and burns during the second. There was an increase of 80% in ICU attendances in all periods of 2020 at three hospitals during the first and second restriction periods. Conclusion The COVID-19 restrictions yielded a reduction in the weekly number of pediatric injuries seen at Mozambique's central hospitals, above all RTIs and falls. The drop reflects reductions in visits most importantly for RTIs, falls, and burns, but was accompanied by an increase in the proportion of ICU cases. This effect was not maintained when the restrictions were relaxed. Whether this reflects reduced exposure to injury or hesitancy to seek care remains to be determined. Level of evidence Level III, retrospective study with up to two negative criteria.
Collapse
Affiliation(s)
- Vanda Amado
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, University of Eduardo Mondlane Faculty of Medicine, Maputo, Mozambique
| | - Jette Moller
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Maria Tereza Couto
- Department of Community Health, University of Eduardo Mondlane Faculty of Medicine, Maputo, Mozambique
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| |
Collapse
|
12
|
Amado V, Couto MT, Filipe M, Möller J, Wallis L, Laflamme L. Assessment of critical resource gaps in pediatric injury care in Mozambique's four largest Hospitals. PLoS One 2023; 18:e0286288. [PMID: 37262032 DOI: 10.1371/journal.pone.0286288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/14/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Hospitals from resource-scarce countries encounter significant barriers to the provision of injury care, particularly for children. Shortages in material and human resources are seldom documented, not least in African settings. This study analyzed pediatric injury care resources in Mozambique hospital settings. METHODS We undertook a cross-sectional study, encompassing the country's four largest hospitals. Data was collected in November 2020 at the pediatric emergency units. Assessment of the resources available was made with standardized WHO emergency equipment and medication checklists, and direct observation of premises and procedures. The potential impact of unavailable equipment and medications in pediatric wards was assessed considering the provisions of injury care. RESULTS There were significant amounts of not available equipment and medications in all hospitals (ranging from 20% to 49%) and two central hospitals stood out in that regard. The top categories of not available equipment pertained to diagnosis and monitoring, safety for health care personnel, and airway management. Medications to treat infections and poisonings were those most frequently not available. There were several noteworthy and life-threatening shortcomings in how well the facilities were equipped for treating pediatric patients. The staff regarded lack of equipment and skills as the main obstacles to delivering quality injury care. Further, they prioritized the implementation of trauma courses and the establishment of trauma centers to strengthen pediatric injury care. CONCLUSION The country's four largest hospitals had substantial quality-care threatening shortages due to lack of equipment and medications for pediatric injury care. All four hospitals face issues that put at risk staff safety and impede the implementation of essential care interventions for injured children. Staff wishes for better training, working environments adequately equipped and well-organized. The room for improvement is considerable, the study results may help to set priorities, to benefit better outcomes in child injuries.
Collapse
Affiliation(s)
- Vanda Amado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of the Community Health, Eduardo Mondlane University, Maputo, Mozambique
- Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
| | - Maria Tereza Couto
- Department of the Community Health, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Medical Council Maputo, Maputo, Mozambique
| | - Manuel Filipe
- Department of the Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lee Wallis
- Faculty of Health Sciences, Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa
| |
Collapse
|
13
|
Amato S, Culbreath K, Dunne E, Sarathy A, Siroonian O, Sartorelli K, Roy N, Malhotra A. Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis. J Pediatr Surg 2023; 58:99-105. [PMID: 36328820 DOI: 10.1016/j.jpedsurg.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (US). METHODS A retrospective cohort study was conducted for pediatric patients (age <18 years) in India's Towards Improved Trauma Care Outcomes (TITCO) project database and the US National Trauma Data Bank (NTDB) from 2013 to 2015. Demographic, injury, physiologic, anatomic and outcome data were analyzed. Multivariable regressions were used to determine independent predictors of mortality. RESULTS 126,678 pediatric trauma patients were included (India 3,373; US 123,305). Pediatric patients in India were on average significantly younger, with a higher median injury severity score (ISS), had lower systolic blood pressure, and suffered a higher case fatality rate (13.0% vs. 1.0%). When controlling for demographic, mechanism, physiologic, and anatomic injury characteristics, sustaining an injury in India was the strongest predictor of mortality (OR 22.70, 95% CI 18.70-27.56). On subgroup analysis, the highest relative odds of mortality in India was seen in children with lower injury and physiologic severity. CONCLUSIONS Risk-adjusted pediatric trauma-related mortality is significantly higher in India compared to the US. The comparative odds of mortality are highest among children with lower injury and physiologic severity. This suggests that low-cost targeted interventions focused on standard timely trauma care, protocols, training and early imaging could improve pediatric injury mortality in India. TYPE OF STUDY Retrospective Prognosis Study LEVEL OF EVIDENCE: II.
Collapse
Affiliation(s)
- Stas Amato
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.
| | - Katherine Culbreath
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA; Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Emma Dunne
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Ashwini Sarathy
- University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Olivia Siroonian
- Department of Pharmacology, University of Vermont, Larner College of Medicine, 89 Beaumont Ave, Burlington, VT 05401, USA
| | - Kennith Sartorelli
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Nobhojit Roy
- The George Institute for Global Health, 308, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India; WHO Collaborating Centre for Research in Surgical Care Delivery, Anushakti Nagar, Mumbai, MH 400094, India
| | - Ajai Malhotra
- Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA
| |
Collapse
|
14
|
Rivas JA, Bartoletti J, Benett S, Strong Y, Novotny TE, Schultz ML. Paediatric trauma education in low- and middle-income countries: A systematic literature review. J Glob Health 2022; 12:04078. [PMID: 36580057 PMCID: PMC9801138 DOI: 10.7189/jogh.12.04078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Trauma-specific training improves clinician comfort and reduces patient morbidity and mortality; however, curricular content, especially with regard to paediatric trauma, varies greatly by region and income status. We sought to understand how much paediatric education is included in trauma curricula taught in low- and middle-income countries (LMICs). Methods We conducted a systematic literature review in October 2020 and in July 2022 based on PRISMA guidelines, utilizing seven databases: MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Reviews, Cochrane Trials, and Global Index Medicus. Reports were limited to those from World Bank-designated LMICs. Key information reviewed included use of a trauma curriculum, patient-related outcomes, and provider/participant outcomes. Results The search yielded 2008 reports, with 987 included for initial screening. Thirty-nine of these were selected for review based on inclusion criteria. Sixteen unique trauma curricula used in LMICs were identified, with only two being specific to paediatric trauma. Seven of the adult-focused trauma programmes included sections on paediatric trauma. Curricular content varied significantly in educational topics and skills assessed. Among the 39 included curricula, 33 were evaluated based on provider-based outcomes and six on patient-based outcomes. All provider-based outcome reports showed increased knowledge acquisition and comfort. Four of the five patient-based outcome reports showed reduction in trauma-related morbidity and mortality. Conclusion Trauma curricula in LMICs positively impact provider knowledge and may decrease trauma-related morbidity and mortality; however, there is significant variability in existing trauma curricula regarding to paediatric-specific content. Trauma education in LMICs should expand paediatric-specific education, as this population appears to be underserved by most existing curricula.
Collapse
Affiliation(s)
- Jane A Rivas
- Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Bartoletti
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah Benett
- Department of Pediatrics, John Hopkin’s University, Baltimore, Maryland, USA
| | - Yukino Strong
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas E Novotny
- Department of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
| | - Megan L Schultz
- Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
15
|
Postoiu RL, Onose G. Research on the possibilities of a therapeutic approach through physical interventions with Laser MLS (Multiwave Locked System) in post-combustion pathology (burns and severe burns). BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract:
Introduction. Depending on their severity, most of the burns are "particularly disabling injuries", which is why a constant improvement of current therapeutic interventions is necessary [1]. The patient describes the severe burn as the "ultimate agony" placing an important responsibility on the medical staff to achieve a satisfactory level of recovery and reintegration into society [2]. "Burns negatively influence the main aspects of life", but also the quality of life [3]. Laser therapy has stood out in recent years in stimulating the healing process of burn patients [4]. The role of this study is to highlight the therapeutic effects of the MLS LASER in the case of burns and severe burns.
Methods. We previously carried out a systematic review of the related literature through the method of filtering and selecting profile documentary material, widely used and accepted at the international level: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Thus, we searched, using contextually, combinations/syntaxes of search keywords in the following international databases: Elsevier, PubMed, PMC, PEDro, articles published in English in ISI indexed journals Web of Knowledge/Science, during 01.01.2021-31.12.2021.
Results and discussion. Seven of the selected articles have been included in our systematic literature review. The evolution of burn injuries materialized through improvements, will hopefully be achievable, both through direct observation and through the favorable dynamic progress of the scores of the quantification scales used: (VSS – Vancouver Scar Scale, VAS – Visual Analogue Scale, 5-D ITCH Scale, according to the model of the American Spinal Injury Association Impairment Scale – AIS - for sensitivity disorders, 3-step scale, ROM – Range of motion, MMT – Manual Muscle Test Scale, The Barthel Index, FIM – Functional Independence Measure scale, ADL, Timed up and go test, Walk Speed, Berg Balance Scale, Six-Minutes Walk Test). If it will be possible, sufficiently sustained medium/long-term follow-up of the cases included in our doctoral research will also be measured by the frequency of readmissions.
Conclusions. Through this research, which is part of the doctoral study, we hope to be able to deepen aspects related to both the still existing limits and the identifiable possibilities for optimizing the conceptual and practical approach to patients with such pathologies.
Keywords: Burns, MLS LASER, Burn wound, Burn Rehabilitation, Multiwave Locked System.
Collapse
Affiliation(s)
- Ruxandra Luciana Postoiu
- Faculty of Medicine – „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2. Neuromuscular Clinic Division – Teaching Emergency Hospital „Bagdasar-Arseni”, Bucha-rest, Romania
| | - Gelu Onose
- Faculty of Medicine – „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2. Neuromuscular Clinic Division – Teaching Emergency Hospital „Bagdasar-Arseni”, Bucha-rest, Romania
| |
Collapse
|
16
|
Dinh T, Khairallah T, Nguyen C, Deshpande G, Krzyzaniak S, Barton G, Bohrensen S, Vu MT, Holterman A. PASS-A course in Pediatric Acute Surgical Support to build pediatric surgical emergencies capacity in developing countries. J Pediatr Surg 2022; 57:1018-1025. [PMID: 35396086 DOI: 10.1016/j.jpedsurg.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The burden of pediatric trauma and emergency, including pediatric surgical emergencies in low middle income countries (LMIC) is high. The goal of Pediatric Acute Surgical Support (PASS) course is to prepare caregivers in LMIC for the acute management of life-threatening pediatric surgical emergencies. We aim to show the feasibility of its initial deployment. METHODS PASS was developed in 2016 with LMIC faculty from a teaching children hospital CH. The course contents consisted of a mix of didactic materials for serious general neonatal and pediatric surgery modified PALS/ATLS, in-person multidisciplinary team-based skill stations, interactive clinical scenarios and simulated trauma cases. The course was subsequently revised and delivered to 92 learners in four classes of 2.5-days sessions at two CHs between 2017 and 2019. Learners' demographics, written exams, team-based case performance, and post-course survey data were prospectively collected and retrospectively analyzed. RESULTS Physician (60%) and nurse learners (40%) from pediatric critical care (36%), surgery (23%), emergency medicine (20%) and anesthesiology (9%) had 3.6 +/- 3.6 years of clinical practice; pre- and post-course written exam score of 55.4+/-15.5% vs 71.6+/-12.8%, team-based trauma scenario management 22.6 ± 7.8% vs 54.7 ± 16.6% and team-based dynamic scores 17+/- 10% vs 53.3+/- 15.5%, respectively (p<0.0001). Self-reported satisfaction scores were ≥ 95% for course method, level of difficulty, clinical applicability, and quality of instructors. CONCLUSION PASS is well-received by LMIC learners, with short-term improvement in knowledge-, team-based management of acute pediatric surgery emergencies; and has the potential to be a model of horizontal capacity building for pediatric surgery in LMIC. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Thanh Dinh
- Children's Hospital, Ho Chi Minh City, Viet Nam
| | - Toufic Khairallah
- Deshpande. U of Illinois College of Medicine at Peoria, Critical Care Medicineb, Krzyzaniak- U of IL college of Medicine at Peoria, Emergency Medicine
| | - Chau Nguyen
- Children's Hospital, Ho Chi Minh City, Viet Nam
| | - Girish Deshpande
- Deshpande. U of Illinois College of Medicine at Peoria, Critical Care Medicineb, Krzyzaniak- U of IL college of Medicine at Peoria, Emergency Medicine
| | - Sara Krzyzaniak
- Deshpande. U of Illinois College of Medicine at Peoria, Critical Care Medicineb, Krzyzaniak- U of IL college of Medicine at Peoria, Emergency Medicine
| | - Ginger Barton
- Deshpande. U of Illinois College of Medicine at Peoria, Critical Care Medicineb, Krzyzaniak- U of IL college of Medicine at Peoria, Emergency Medicine
| | - Sintje Bohrensen
- Holterman: U of Illinois College of Medicine at Chicago, Surgery and Pediatrics
| | - Megan T Vu
- Baylor College of Medicine Department of Surgery, Houston, TX, USA
| | - Aixuan Holterman
- Deshpande. U of Illinois College of Medicine at Peoria, Critical Care Medicineb, Krzyzaniak- U of IL college of Medicine at Peoria, Emergency Medicine.
| |
Collapse
|
17
|
Barcenas LK, Appenteng R, Sakita F, O’Leary P, Rice H, Mmbaga BT, Vissoci JRN, Staton CA. The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania. PLoS One 2022; 17:e0273991. [PMID: 36197935 PMCID: PMC9534435 DOI: 10.1371/journal.pone.0273991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background Over 95% of childhood injury deaths occur in low- and middle-income countries (LMICs). Patients with severe traumatic brain injury (TBI) have twice the likelihood of dying in LMICs than in high-income countries (HICs). In Africa, TBI estimates are projected to increase to upwards of 14 million new cases in 2050; however, these estimates are based on sparse data, which underscores the need for robust injury surveillance systems. We aim to describe the clinical factors associated with morbidity and mortality in pediatric TBI at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania to guide future prevention efforts. Methods We conducted a secondary analysis of a TBI registry of all pediatric (0–18 years of age) TBI patients presenting to the KCMC emergency department (ED) between May 2013 and April 2014. The variables included demographics, acute treatment and diagnostics, Glasgow Coma Scores (GCSs, severe 3–8, moderate 9–13, and mild 14–15), morbidity at discharge as measured by the Glasgow Outcome Scale (GOS, worse functional status 1–3, better functional status 4–6), and mortality status at discharge. The analysis included descriptive statistics, bivariable analysis and multivariable logistic regression to report the predictors of mortality and morbidity. The variables used in the multivariable logistic regression were selected according to their clinical validity in predicting outcomes. Results Of the total 419 pediatric TBI patients, 286 (69.3%) were male with an average age of 10.12 years (SD = 5.7). Road traffic injury (RTI) accounted for most TBIs (269, 64.4%), followed by falls (82, 19.62%). Of the 23 patients (5.58%) who had alcohol-involved injuries, most were male (3.6:1). Severe TBI occurred in 54 (13.0%) patients. In total, 90 (24.9%) patients underwent TBI surgery. Of the 21 (5.8%) patients who died, 11 (55.0%) had severe TBI, 6 (30.0%) had moderate TBI (GCS 9–13) and 3 (15.0%) presented with mild TBI (GCS>13). The variables most strongly associated with worse functional status included having severe TBI (OR = 9.45) and waiting on the surgery floor before being moved to the intensive care unit (ICU) (OR = 14.37). Conclusions Most pediatric TBI patients were males who suffered RTIs or falls. Even among children under 18 years of age, alcohol was consumed by at least 5% of patients who suffered injuries, and more commonly among boys. Patients becoming unstable and having to be transferred from the surgery floor to the ICU could reflect poor risk identification in the ED or progression of injury severity. The next steps include designing interventions to reduce RTI, mitigate irresponsible alcohol use, and improve risk identification and stratification in the ED.
Collapse
Affiliation(s)
| | | | | | - Paige O’Leary
- Duke Global Health Institute, Durham, NC, United States of America
| | - Henry Rice
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, United States of America
- Vanderbilt University, Nashville, TN, United States of America
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Catherine A. Staton
- Duke Global Health Institute, Durham, NC, United States of America
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- * E-mail:
| |
Collapse
|
18
|
Affiliation(s)
- Megan Chiu
- Department of Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106
| | - Laura Goodman
- Children's Hospital of Orange County, 505 S. Main St, Orange, CA 92868
| | | | - Michael Dingeldein
- UH Rainbow Babies & Children's Hospital, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106.
| |
Collapse
|
19
|
Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
Collapse
|
20
|
Thakur (Rai) N, Jaiswal V, Singh A, Kumar N, Misra M, Tiwari S, Misra S, Shukla DK, Dheer Y. Epidemiology and pattern of injury of pediatric trauma patients in level l trauma centre of Northern India. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Uttar Pradesh ranks first in India as far as trauma deaths are concerned with 40% of victims under 18 years of age. In spite of such high mortality and morbidity no national portal for trauma registry data exists. This study was conducted to evaluate the profile of injured pediatric patients, to provide baseline knowledge for further research, management and development of pediatric injury prevention programmes. Methods A retrospective observational study was conducted in the only Level 1Trauma Centre of the most populous state of India. Children aged less than 18 years of age admitted to the trauma centre were analysed for mechanism, type and severity of injury, the mode of management and outcome. Result In a 2 year period 916 children were admitted and their data analysed. Most were boys (73%) and the most common age group was 12–18 years. Half of injuries were caused by road traffic accidents, and blunt injuries were commonest. Blunt abdominal trauma then head injury were the commonest areas injured; 20% of children had life-threatening injuries. Nearly half (47%) had moderate to severe trauma according to the Pediatric Trauma Score. 507 patients (55.4%) were managed conservatively and 409 children (44.6%) required surgery; 657 (71%) were successfully discharged and 39 children (4.25%) unfortunately died. Conclusion This study identifies the need for dedicated trauma registries, training of trauma team according to standard operating procedures, the development of paramedical teams for in-the-field management of patients and development of injury prevention programmes according to both age and gender.
Collapse
Affiliation(s)
- Neha Thakur (Rai)
- Department of Pediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vaibhav Jaiswal
- Department of Trauma Surgery, King George Medical University, Lucknow, India
| | - Anita Singh
- Department of Trauma Surgery, King George Medical University, Lucknow, India
| | - Narendra Kumar
- Department of Trauma Surgery, King George Medical University, Lucknow, India
| | - Maitreyi Misra
- Department of General Surgery, Intern TSMisra Medical College, Lucknow, India
| | - Sandeep Tiwari
- Department of Trauma Surgery, King George Medical University, Lucknow, India
| | - Samir Misra
- Department of Trauma Surgery, King George Medical University, Lucknow, India
| | - Devesh Kumar Shukla
- Department of Pediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Yadvendra Dheer
- Department of Pediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
21
|
Dagnaw Y, Fenta B, Yetwale A, Biyazin T, Sayih A, Dessalegn N, Adugnaw E, Ali F, Tesfa Y. Mechanisms, Pattern and Outcome of Pediatrics Trauma At Agaro General Hospital, Southwest Ethiopia, 2021. Health Serv Res Manag Epidemiol 2022; 9:23333928221101975. [PMID: 35633833 PMCID: PMC9130848 DOI: 10.1177/23333928221101975] [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: 03/05/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Over 80% of trauma related deaths in children occur in low income and middle-income countries including Ethiopia. Trauma affects several aspects of child life and is still a major concern. Despite the Ethiopian federal ministry of health (FMoH) conducting away different trials, there was an increased burden and high projection of pediatric trauma. In Ethiopia, There is insufficient evidence about the mechanisms, patterns and outcomes of pediatric trauma including this study area, Therefore this study aimed to assess the mechanisms, patterns, and outcomes of pediatric trauma in Agaro General Hospital, Southwest Ethiopia, 2021. Methods and Materials This cross-sectional study was study conducted on randomly selected 405pediatric patients who visited the Agaro General Hospital between 1/1/2018 and 30/8/2021. Data were extracted from each medical chart using a structured checklist. Data were entered into Epi-data 4.4.2.1for cleaning and analyzed using SPSS version 24. Tables, charts, and text are used to report the results. Results A total of 405 patients were included in the study. This study revealed that majority 271 (66.9%) of injured children were males. Most 188 (46.4%) of the traumas were occurred on the street. Fall down injury were the most common 151(37.3%) cause of trauma, followed by road traffic accidents 98 (24.2%). Trauma caused by falls accounted for 43.7% and 34.4% % of all traumas in the 5–12 year and the <5 year age groups respectively. Most 126 (31.1%) of the subjects were exposed to head and face trauma. Majority 256 (63.2%) of children were discharged with improvement, while12 (3.0%) of them have died. Conclusions Pediatric trauma remains a major public health concern. Most of trauma occurred among boys and falldown injury was the most frequent trauma, and the majority of the subjects were exposed to head and face trauma. Therefore, children should receive safety precautions, more supervision, and identification of specific risk factors for these injuries, and should be prohibited from risky practices by concerned bodies including families and traffic officers.
Collapse
Affiliation(s)
- Yalemtsehay Dagnaw
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Belete Fenta
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Aynalem Yetwale
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Tsegaw Biyazin
- School of Midwifery, Jimma University, Jimma, Oromia Regional State, Ethiopia
| | - Alemayehu Sayih
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Nigatu Dessalegn
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Emebet Adugnaw
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Fatuma Ali
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| | - Yitbarek Tesfa
- Department of Nursing, Mizan Tepi University, Mizan Teferi, South West Region, Ethiopia
| |
Collapse
|
22
|
Teaching Trauma in Resource-Limited Settings: A Scoping Review of Pediatric Trauma Courses. World J Surg 2022; 46:1209-1219. [PMID: 35066628 DOI: 10.1007/s00268-021-06419-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Injury remains an important cause of death and disability globally, with 95% of all childhood injury deaths occurring in low- and lower-middle-income countries (LMICs). Pediatric trauma training, tailored to the resources in LMICs, represents an opportunity to improve such outcomes. We explored the nature of course offerings in pediatric trauma in resource-limited settings. METHODS Seven databases were interrogated up to June 12, 2020, to retrieve articles examining pediatric trauma training in LMICs, as defined by the World Bank, without language restrictions. Independent authors reviewed and selected abstracts based on set criteria. Data from included studies was extracted and analyzed. An adapted Critical Appraisal Skills Programme checklist designed for cohort studies was used to assess the risk of bias. RESULTS After screening 3960 articles for eligibility, 16 were included for final analysis. Course delivery methods included didactic modules, simulations, clinical mentorship, small group discussion, audits, assessments, and feedback. Knowledge acquisition was primarily assessed through pre/post-tests, clinical skills assessments, and self-assessment questionnaires. Twelve studies detailed course content, nine of which were based on the WHO Emergency Triage, Assessment and Treatment model, which is not specific to trauma. The other three studies involved locally developed pediatric trauma-focused training courses, including airway management, head trauma and cervical spine management, thoracic and abdominal trauma, orthopedic trauma, burn and wound management, and shock. CONCLUSION Despite being essential to decreasing pediatric trauma morbidity and mortality worldwide, educational programs in pediatric trauma are not a widespread reality in low-and-middle-income countries. The development of accessible and efficient pediatric trauma education programs is critical for improving pediatric trauma quality of care.
Collapse
|
23
|
Myers JG, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Mutiso V, Thompson P, Aluisio AR, Maingi A, Dunlop SJ, Martin IBK. Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya. Pediatr Emerg Care 2022; 38:e378-e384. [PMID: 34986590 DOI: 10.1097/pec.0000000000002294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population. METHODS Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups. RESULTS Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves. CONCLUSIONS Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.
Collapse
Affiliation(s)
- Justin G Myers
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Uzoma A Nwakibu
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Ali Akida Wangara
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Alice Maingi
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine at the Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
24
|
Raees M, Hooli S, von Saint André-von Arnim AO, Laeke T, Otupiri E, Fabio A, Rudd KE, Kumar R, Wilson PT, Aklilu AT, Tuyisenge L, Wang C, Tasker RC, Angus DC, Kochanek PM, Fink EL, Bacha T. An exploratory assessment of the management of pediatric traumatic brain injury in three centers in Africa. Front Pediatr 2022; 10:936150. [PMID: 36061402 PMCID: PMC9428450 DOI: 10.3389/fped.2022.936150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). Hospital care practices of pediatric TBI patients in LMICs are unknown. Our objective was to report on hospital management and outcomes of children with TBI in three centers in LMICs. METHODS We completed a secondary analysis of a prospective observational study in children (<18 years) over a 4-week period. Outcome was determined by Pediatric Cerebral Performance Category (PCPC) score; an unfavorable score was defined as PCPC > 2 or an increase of two points from baseline. Data were compared using Chi-square and Wilcoxon rank sum tests. RESULTS Fifty-six children presented with TBI (age 0-17 y), most commonly due to falls (43%, n = 24). Emergency department Glasgow Coma Scale scores were ≤ 8 in 21% (n = 12). Head computed tomography was performed in 79% (n = 44) of patients. Forty (71%) children were admitted to the hospital, 25 (63%) of whom were treated for suspected intracranial hypertension. Intracranial pressure monitoring was unavailable. Five (9%, n = 5) children died and 10 (28%, n = 36) inpatient survivors had a newly diagnosed unfavorable outcome on discharge. CONCLUSION Inpatient management and monitoring capability of pediatric TBI patients in 3 LMIC-based tertiary hospitals was varied. Results support the need for prospective studies to inform development of evidence-based TBI management guidelines tailored to the unique needs and resources in LMICs.
Collapse
Affiliation(s)
- Madiha Raees
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Shubhada Hooli
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Amélie O von Saint André-von Arnim
- Division of Pediatric Critical Care, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Tsegazeab Laeke
- Division of Neurosurgery, Department of Surgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,National Institute for Health Care and Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Easmon Otupiri
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kristina E Rudd
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (CRISMA), University of Pittsburgh, Pittsburgh, PA, United States
| | - Rashmi Kumar
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Patrick T Wilson
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - Abenezer Tirsit Aklilu
- Division of Neurosurgery, Department of Surgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,National Institute for Health Care and Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Lisine Tuyisenge
- Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Chunyan Wang
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert C Tasker
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (CRISMA), University of Pittsburgh, Pittsburgh, PA, United States
| | - Patrick M Kochanek
- Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tigist Bacha
- Department of Pediatrics and Child Health, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
25
|
Magnus D, Bhatta S, Mytton J, Joshi E, Bhatta S, Manandhar S, Joshi S. Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance. Arch Dis Child 2021; 106:1050-1055. [PMID: 34462264 PMCID: PMC8543225 DOI: 10.1136/archdischild-2020-321198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.
Collapse
Affiliation(s)
- Dan Magnus
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | - Sumiksha Bhatta
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | | | - Sunil Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| |
Collapse
|
26
|
Rattan A, Joshi MK, Mishra B, Kumar S, Sagar S, Gupta A. Profile of Injuries in Children: Report From a Level I Trauma Center. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
27
|
Mulima G, Purcell LN, Maine R, Bjornstad EC, Charles A. Epidemiology of prehospital trauma deaths in Malawi: A retrospective cohort study. Afr J Emerg Med 2021; 11:258-262. [PMID: 33859929 PMCID: PMC8027520 DOI: 10.1016/j.afjem.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/25/2021] [Accepted: 03/13/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Trauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi. Methods We retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID. Results We reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult (n = 1337/1528, 88.4%) and children (n = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH. Conclusion Efforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.
Collapse
|
28
|
Inclusion of Children's Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children's Surgery. Pediatr Surg Int 2021; 37:529-537. [PMID: 33399928 DOI: 10.1007/s00383-020-04813-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
About 1.7 billion children and adolescents, mostly in low- and middle-income countries (LMICs) lack access to surgical care. While some of these countries have developed surgical plans and others are in the process of developing theirs, children's surgery has not received the much-needed specific emphasis and focus in these plans. With the significant burden of children's surgical conditions especially in low- and middle-income countries, universal health coverage and the United Nations' (UN) Sustainable Development Goals (SDG) will not be achieved without deliberate efforts to scale up access to children's surgical care. Inclusion of children's surgery in National Surgical Obstetric and Anaesthesia Plans (NSOAPs) can be done using the Global Initiative for Children's Surgery (GICS)-modified Children's Surgical Assessment Tool (CSAT) tool for baseline assessment and the Optimal Resources for Children Surgical Care (OReCS) as a foundational tool for implementation.
Collapse
|
29
|
Henry JA. Decentralization and Regionalization of Surgical Care as a Critical Scale-up Strategy in Low- and Middle-Income Countries Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries". Int J Health Policy Manag 2021; 10:211-214. [PMID: 32610784 PMCID: PMC8167267 DOI: 10.34172/ijhpm.2020.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/17/2020] [Indexed: 12/30/2022] Open
Abstract
As global attention to improve the quality, safety and access to surgical care in low- and middle-income countries (LMICs) increases, the need for evidence-based strategies to reliably scale-up the quality and quantity of surgical services becomes ever more pertinent. Iversen et al discuss the optimal distribution of surgical services, whether through decentralization or regionalization, and propose a strategy that utilizes the dimensions of acuity, complexity and prevalence of surgical conditions to inform national priorities. Proposed expansion of this strategy to encompass levels of scale-up prioritization is discussed in this commentary. The decentralization of emergency obstetric services in LMICs shows promising results and should be further explored. The dearth of evidence of regionalization in LMICs, on the other hand, limits extrapolation of lessons learned. Nevertheless, principles from the successful regionalization of certain services such as trauma care in high-income countries (HICs) can be adapted to LMIC settings and can provide the backbone for innovation in service delivery and safety.
Collapse
Affiliation(s)
- Jaymie A Henry
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Wasserman I, Peters AW, Roa L, Amanullah F, Samad L. Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:183-189. [PMID: 32606090 PMCID: PMC7326524 DOI: 10.9745/ghsp-d-20-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/19/2020] [Indexed: 01/17/2023]
Abstract
Children’s health care providers and children’s surgery providers can partner to improve children’s health by developing the surgical workforce, focusing on “best buy” surgeries, integrating children’s surgery into national plans, streamlining data collection and research, and leveraging financing.
Collapse
Affiliation(s)
- Isaac Wasserman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
| | | | - Lubna Samad
- Center for Essential Surgical and Acute Care, Indus Health Network, Karachi, Pakistan
| |
Collapse
|
32
|
Manyumwa P, Chimhundu-Sithole T, Marange-Chikuni D, Evans FM. Adaptations in pediatric anesthesia care and airway management in the resource-poor setting. Paediatr Anaesth 2020; 30:241-247. [PMID: 31910309 DOI: 10.1111/pan.13824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non-physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low-resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.
Collapse
Affiliation(s)
| | - Tsitsi Chimhundu-Sithole
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Danai Marange-Chikuni
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
33
|
Kisa P, Grabski DF, Ozgediz D, Ajiko M, Aspide R, Baird R, Barker G, Birabwa-Male D, Blair G, Cameron B, Cheung M, Cigliano B, Cunningham D, D'Agostino S, Duffy D, Evans F, Fitzgerald TN, Galiwango G, Gerolmini D, Gerolmini M, Kakembo N, Kambugu JB, Lakhoo K, Langer M, Muhumuza MF, Muzira A, Nabukenya MT, Naik-Mathuria B, Nakku D, Nankunda J, Ogwang M, Okello I, Penny N, Reimer E, Sabatini C, Sekabira J, Situma M, Ssenyonga P, Tumukunde J, Villalona G. Unifying Children's Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda. World J Surg 2019; 43:1435-1449. [PMID: 30617561 DOI: 10.1007/s00268-018-04905-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a significant unmet need for children's surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders' meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. METHODS The stakeholders' meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and short-term objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. RESULTS The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. CONCLUSION Collaborations between disciplines, both within LMICs and with international partners, are required to advance children's surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children's surgical capacity. Such a process may prove useful in other LMICs with a wide range of children's surgery stakeholders.
Collapse
Affiliation(s)
- Phyllis Kisa
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, USA
| | - Doruk Ozgediz
- Department of Surgery, Yale University School of Medicine, New Haven, USA.
| | | | | | - Robert Baird
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Gillian Barker
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Doreen Birabwa-Male
- Mulago National Referral Hospital, Uganda Ministry of Health, Kampala, Uganda
| | - Geoffrey Blair
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Brian Cameron
- Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Canada
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, USA
| | | | | | | | - Damian Duffy
- Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Faye Evans
- Department of Anesthesiology, Harvard Medical School, Boston, USA
| | | | | | | | | | - Nasser Kakembo
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | | | - Kokila Lakhoo
- Department of Paediatric Surgery, Oxford University, Oxford, UK
| | - Monica Langer
- Department of Surgery, Northwestern University School of Medicine, Chicago, USA
| | | | - Arlene Muzira
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Mary T Nabukenya
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | | | - Doreen Nakku
- Department of Surgery, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | | | - Innocent Okello
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Norgrove Penny
- Department of Orthopedics, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Eleanor Reimer
- Department of Anesthesiology, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Coleen Sabatini
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, USA
| | - John Sekabira
- Department of Surgery, Makerere University School of Medicine, Kampala, Uganda
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | | | - Janat Tumukunde
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Gustavo Villalona
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, USA
| |
Collapse
|
34
|
Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo. Anesthesiol Res Pract 2019; 2019:4038319. [PMID: 31467523 PMCID: PMC6701323 DOI: 10.1155/2019/4038319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. Patients and Methods This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients' records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). Results We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated (p < 0.05) with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS < 6 (64%), and ISS > 20 (48.9%). Conclusion pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS < 6, and ISS > 20.
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery. RECENT FINDINGS Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions. Surgery has continued to be identified as a cost-effective intervention in LMICs. There have also been substantial advances in research and advocacy for a number of childhood surgical conditions. SUMMARY Substantial global disparities persist in the care of childhood surgical conditions. Recent work has provided greater visibility to the challenges and solutions for children's surgery in LMICs. Capacity-building and scale up of children's surgical care, more robust implementation research and ongoing advocacy are needed to increase access to children's surgical care worldwide.
Collapse
|
36
|
Suriyawongpaisal P, Atiksawedparit P, Srithamrongsawad S, Thongtan T. Assessment of nationwide emergency systems in Thailand, a middle-income country setting with UHC. Int J Health Plann Manage 2019; 34:e1346-e1355. [PMID: 30945365 DOI: 10.1002/hpm.2783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Evidence has been limited regarding broader emergency systems assessment in low- and middle-income countries. The aim of the present study was to provide the empirical evidence of Thai emergency department (ED) workforce vis-à-vis workload on a national scale, the availability of services for selected high-priority health burdens, and the governance obstacles in addressing the workforce management. METHOD One hundred thirty public Thai EDs that provide 24-hour emergency medical care were identified across Thailand as meeting the inclusion criteria. The mailed questionnaires were administered to collect data related to the objectives of the research study. RESULT Responses were received from 91 of 130 (70%) hospitals. The median number of patients visiting hospital EDs was 51 221 per year with 32.8% considered nonurgent (ESI levels 4-5). University hospital EDs were staffed with a higher number of ER professionals than EDs of service-based secondary care and tertiary care hospitals under Ministry of Public Health (MOPH). Almost all hospitals expressed concerns about the deficiency of doctors and nurses especially emergency physician (EP) and emergency nurses. The percentage of hospitals reporting the availability of coronary artery catheterization (34%) and thrombolytic infusion for acute thrombotic stroke (24%) was limited. The governance obstacles to manage emergency systems were considered. CONCLUSION ED staffing seems to positively correlate with workloads except university hospitals, in our study, which may suggest the influence of teaching status on the allocation of the human resource. Among the governance obstacles in ED management, a better response to nonurgent patients requires flexibility for hospitals to set financial disincentives or mobilization and management of human resources.
Collapse
Affiliation(s)
- Paibul Suriyawongpaisal
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsakorn Atiksawedparit
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Samrit Srithamrongsawad
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanita Thongtan
- Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| |
Collapse
|