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Mwale D, Manda-Taylor L, Langton J, Likumbo A, van Hensbroek MB, Calis J, Janssens W, Pell C. The role of healthcare providers and caregivers in monitoring critically ill children: a qualitative study in a tertiary hospital, southern Malawi. BMC Health Serv Res 2024; 24:595. [PMID: 38714998 PMCID: PMC11077805 DOI: 10.1186/s12913-024-11050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Critically ill children require close monitoring to facilitate timely interventions throughout their hospitalisation. In low- and middle-income countries with a high disease burden, scarce paediatric critical care resources complicates effective monitoring. This study describes the monitoring practices for critically ill children in a paediatric high-dependency unit (HDU) in Malawi and examines factors affecting this vital process. METHODS A formative qualitative study based on 21 in-depth interviews of healthcare providers (n = 12) and caregivers of critically ill children (n = 9) in the HDU along with structured observations of the monitoring process. Interviews were transcribed and translated for thematic content analysis. RESULTS The monitoring of critically ill children admitted to the HDU was intermittent, using devices and through clinical observations. Healthcare providers prioritised the most critically ill children for more frequent monitoring. The ward layout, power outages, lack of human resources and limited familiarity with available monitoring devices, affected monitoring. Caregivers, who were present throughout admission, were involved informally in monitoring and flagging possible deterioration of their child to the healthcare staff. CONCLUSION Barriers to the monitoring of critically ill children in the HDU were related to ward layout and infrastructure, availability of accurate monitoring devices and limited human resources. Potential interventions include training healthcare providers to prioritise the most critically ill children, allocate and effectively employ available devices, and supporting caregivers to play a more formal role in escalation.
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Affiliation(s)
- Daniel Mwale
- Kamuzu University of Health Sciences, Blantyre, Malawi.
- Training Research Unit of Excellence, Blantyre, Malawi.
| | - Lucinda Manda-Taylor
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Training Research Unit of Excellence, Blantyre, Malawi
| | | | - Alice Likumbo
- Training Research Unit of Excellence, Blantyre, Malawi
| | - Michael Boele van Hensbroek
- Department of Paediatric Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Meibergdreef, NL, the Netherlands
| | - Job Calis
- Department of Paediatric Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Meibergdreef, NL, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciencies, Blantyre, Malawi
| | - Wendy Janssens
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Global Health Amsterdam, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Edridge AWD, Abd-Elfarag G, Deijs M, Broeks MH, Cristella C, Sie B, Vaz FM, Jans JJM, Calis J, Verhoef H, Demir A, Poppert S, Nickel B, van Dam A, Sebit B, Titulaer MJ, Verweij JJ, de Jong MD, van Gool T, Faragher B, Verhoeven-Duif NM, Elledge SJ, van der Hoek L, Boele van Hensbroek M. Parasitic, bacterial, viral, immune-mediated, metabolic and nutritional factors associated with nodding syndrome. Brain Commun 2023; 5:fcad223. [PMID: 37731906 PMCID: PMC10507744 DOI: 10.1093/braincomms/fcad223] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/25/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Nodding syndrome is a neglected, disabling and potentially fatal epileptic disorder of unknown aetiology affecting thousands of individuals mostly confined to Eastern sub-Saharan Africa. Previous studies have identified multiple associations-including Onchocerca volvulus, antileiomodin-1 antibodies, vitamin B6 deficiency and measles virus infection-yet, none is proven causal. We conducted a case-control study of children with early-stage nodding syndrome (symptom onset <1 year). Cases and controls were identified through a household survey in the Greater Mundri area in South Sudan. A wide range of parasitic, bacterial, viral, immune-mediated, metabolic and nutritional risk factors was investigated using conventional and state-of-the-art untargeted assays. Associations were examined by multiple logistic regression analysis, and a hypothetical causal model was constructed using structural equation modelling. Of 607 children with nodding syndrome, 72 with early-stage disease were included as cases and matched to 65 household- and 44 community controls. Mansonella perstans infection (odds ratio 7.04, 95% confidence interval 2.28-21.7), Necator americanus infection (odds ratio 2.33, 95% confidence interval 1.02-5.3), higher antimalarial seroreactivity (odds ratio 1.75, 95% confidence interval 1.20-2.57), higher vitamin E concentration (odds ratio 1.53 per standard deviation increase, 95% confidence interval 1.07-2.19) and lower vitamin B12 concentration (odds ratio 0.56 per standard deviation increase, 95% confidence interval 0.36-0.87) were associated with higher odds of nodding syndrome. In a structural equation model, we hypothesized that Mansonella perstans infection, higher vitamin E concentration and fewer viral exposures increased the risk of nodding syndrome while lower vitamin B12 concentration, Necator americanus and malaria infections resulted from having nodding syndrome. We found no evidence that Onchocerca volvulus, antileiomodin-1 antibodies, vitamin B6 and other factors were associated with nodding syndrome. Our results argue against several previous causal hypotheses including Onchocerca volvulus. Instead, nodding syndrome may be caused by a complex interplay between multiple pathogens and nutrient levels. Further studies need to confirm these associations and determine the direction of effect.
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Affiliation(s)
- Arthur W D Edridge
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Gasim Abd-Elfarag
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Neurology & Psychiatry, College of Medicine, University of Juba, P.O. Box 82, Juba, South Sudan
| | - Martin Deijs
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Melissa H Broeks
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Cosimo Cristella
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brandon Sie
- Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Frédéric M Vaz
- Department of Clinical Chemistry, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Judith J M Jans
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Job Calis
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, P.O. Box 95, Blantyre, Malawi
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University, 6701 AR Wageningen, The Netherlands
| | - Ayse Demir
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, 3813 TZ Amersfoort, The Netherlands
| | - Sven Poppert
- Diagnostic Centre, Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland
- University of Basel, 4056 Basel, Switzerland
| | - Beatrice Nickel
- Diagnostic Centre, Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland
- University of Basel, 4056 Basel, Switzerland
| | - Alje van Dam
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Boy Sebit
- Department of Neurology & Psychiatry, College of Medicine, University of Juba, P.O. Box 82, Juba, South Sudan
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Jaco J Verweij
- Microvida Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tom van Gool
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nanda M Verhoeven-Duif
- Department of Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Stephen J Elledge
- Division of Genetics, Brigham and Women’s Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA
| | - Lia van der Hoek
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Michael Boele van Hensbroek
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Prins W, Stamatelou E, Dellimore K, Likumbo A, Kafulafula E, Langton J, Njirammadzi J, Mwenisungo J, Msukwa T, Calis J, van Sloun R, Bierling B. A U - Net Deep Learning Model for Infant Heart Rate Estimation from Ballistography . Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1919-1922. [PMID: 36086528 DOI: 10.1109/embc48229.2022.9871797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ballistography(BSG) is a non-intrusive and low- cost alternative to electrocardiography (ECG) for heart rate (HR) monitoring in infants. Due to the inter-patient variance and susceptibility to noise, heartbeat detection in the BSG waveform remains a challenge. The aim of this study was to estimate HR from a bed-based pressure mat BSG signal using a deep learning approach. We trained a U-Net deep neural network through supervised learning by deriving ground truth as the location of the heartbeats from simultaneously recorded ECG signals after peak matching. For improved generalization, we modified an existing U - Net to include an IC-layer. A predictive performance of 80% was achieved using the U-Net without the IC-layer. The inclusion of the IC-layer, while improving the generalization ability of the model to detect heartbeats, did not improve the HR estimation performance.
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Nkosi-Gondwe T, Calis J, Boele van Hensbroek M, Bates I, Blomberg B, Phiri KS. A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi. PLoS One 2021; 16:e0246267. [PMID: 33529189 PMCID: PMC7853449 DOI: 10.1371/journal.pone.0246267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. METHODS This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. RESULTS Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8). CONCLUSION Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.
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Affiliation(s)
- Thandile Nkosi-Gondwe
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- * E-mail:
| | - Job Calis
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Liverpool–Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
- Emma Children’s Hospital, The Global Child Health Group, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Boele van Hensbroek
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Liverpool–Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
- Emma Children’s Hospital, The Global Child Health Group, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Björn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kamija S. Phiri
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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