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Graham HR, Bagayana SM, Bakare AA, Olayo BO, Peterson SS, Duke T, Falade AG. Improving Hospital Oxygen Systems for COVID-19 in Low-Resource Settings: Lessons From the Field. Glob Health Sci Pract 2020; 8:858-862. [PMID: 33361248 PMCID: PMC7784072 DOI: 10.9745/ghsp-d-20-00224] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023]
Abstract
Oxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access-a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation.
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Affiliation(s)
- Hamish R Graham
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, University College Hospital, Ibadan, Oyo, Nigeria
| | - Sheillah M Bagayana
- FREO2 Uganda, FREO2 Foundation, Kampala, Uganda.,Biomedical consultant, Uganda Ministry of Health, Kampala, Uganda
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Oyo, Nigeria.,Oxygen for Life Initiative, Oyo, Nigeria
| | | | - Stefan S Peterson
- Chief of Health, United Nations Children's Fund, New York, NY, USA.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, Makerere University, Kampala, Uganda
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Melbourne, Australia.,School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Oyo, Nigeria.,Oxygen for Life Initiative, Oyo, Nigeria
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Graham HR, Bagayana SM, Bakare AA, Olayo BO, Peterson SS, Duke T, Falade AG. Improving Hospital Oxygen Systems for COVID-19 in Low-Resource Settings: Lessons From the Field. Glob Health Sci Pract 2020. [PMID: 33361248 DOI: 10.9745/ghsp-d-20-00224.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Oxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access-a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation.
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Affiliation(s)
- Hamish R Graham
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, University College Hospital, Ibadan, Oyo, Nigeria
| | - Sheillah M Bagayana
- FREO2 Uganda, FREO2 Foundation, Kampala, Uganda.,Biomedical consultant, Uganda Ministry of Health, Kampala, Uganda
| | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Oyo, Nigeria.,Oxygen for Life Initiative, Oyo, Nigeria
| | | | - Stefan S Peterson
- Chief of Health, United Nations Children's Fund, New York, NY, USA.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, Makerere University, Kampala, Uganda
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Melbourne, Australia.,School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Oyo, Nigeria.,Oxygen for Life Initiative, Oyo, Nigeria
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Al-Murani F, Aweko J, Nordin I, Delobelle P, Kasujja F, Östenson CG, Peterson SS, Daivadanam M, Alvesson HM. Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm. Glob Health Action 2019; 12:1609313. [PMID: 31116096 PMCID: PMC6537701 DOI: 10.1080/16549716.2019.1609313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders' interactions and engagement in NCDs prevention and management. Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D). Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis. Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner. Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.
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Affiliation(s)
- F Al-Murani
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - J Aweko
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - I Nordin
- b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - P Delobelle
- c School of Public Health , University of the Western Cape , Bellville , South Africa.,d Chronic Disease Initiative for Africa , University of Cape Town , Rondebosch , South Africa
| | - Fx Kasujja
- e Department of Biostatistics and Epidemiology , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda
| | - C-G Östenson
- f Department of Molecular Medicine and Surgery, Diabetes and Endocrinology Unit , Karolinska Institutet , Stockholm , Sweden
| | - S S Peterson
- g Department of Women's and Children's Health , International Maternal and Child Health, Uppsala University , Uppsala , Sweden
| | - M Daivadanam
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - H M Alvesson
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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Peterson SS. UNICEF Rebuttal to Claims Made in "The Tobacco Industry and Children's Rights" Article. Pediatrics 2018; 142:peds.2018-1783A. [PMID: 30266870 DOI: 10.1542/peds.2018-1783a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stefan S Peterson
- Chief of Health Section, Associate Director, Programme Division, UNICEF
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George A, Tetui M, Pariyo GW, Peterson SS. Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda. Glob Health Action 2017; 10:1359924. [PMID: 28876193 PMCID: PMC5786315 DOI: 10.1080/16549716.2017.1359924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan S Peterson
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Health Section, Programme Division, UNICEF NY, New York, NY, USA
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Kozuki N, Guenther T, Vaz L, Moran A, Soofi SB, Kayemba CN, Peterson SS, Bhutta ZA, Khanal S, Tielsch JM, Doherty T, Nsibande D, Lawn JE, Wall S. A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia. BMC Public Health 2015; 15:989. [PMID: 26419934 PMCID: PMC4589085 DOI: 10.1186/s12889-015-2330-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries. METHODS A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children's Saving Newborn Lives project and other relevant research groups. RESULTS Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion. CONCLUSIONS Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences.
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Affiliation(s)
- Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. W5019, Baltimore, MD, 21205, USA.
| | - Tanya Guenther
- Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA.
| | - Lara Vaz
- Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA.
| | - Allisyn Moran
- Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA.
| | | | | | - Stefan S Peterson
- Makerere University College of Health Sciences School of Public Health, Kampala, Uganda. .,International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan. .,Center for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G A04, Canada.
| | - Sudhir Khanal
- Morang Innovative Neonatal Intervention/John Snow Inc. Research and Training Institute, Kathmandu, Nepal.
| | - James M Tielsch
- Department of Global Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave., NW, Suite 400, Washington, DC, 20052, USA.
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow, Cape Town, South Africa. .,School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa.
| | - Duduzile Nsibande
- Health Systems Research Unit, South African Medical Research Council, 491 Ridge Road, Durban, South Africa.
| | - Joy E Lawn
- Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA. .,Maternal Reproductive and Child Health (MARCH) Center, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Research and Evidence Division, UK AID, 22 Whitehall, London, SW1A 2EG, UK.
| | - Stephen Wall
- Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA.
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Waiswa P, Peterson SS, Namazzi G, Ekirapa EK, Naikoba S, Byaruhanga R, Kiguli J, Kallander K, Tagoola A, Nakakeeto M, Pariyo G. The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial. Trials 2012; 13:213. [PMID: 23153395 PMCID: PMC3599589 DOI: 10.1186/1745-6215-13-213] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 09/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. METHODS/DESIGN Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas.The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during pregnancy and the neonatal period. Both areas benefit from a standardized strengthening of facility care for mothers and neonates. DISCUSSION UNEST is designed to directly feed into the operationalization of maternal and newborn care in the national VHT strategy, thereby helping to inform scale-up in rural Uganda. The study is registered as a randomized controlled trial, number ISRCTN50321130.
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Affiliation(s)
- Peter Waiswa
- Makerere University School of Public Health, College of Health Sciences, Mulago Hill, Kampala, Uganda.
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Goldman E, McDonald JS, Peterson SS, Stock MC, Betts R, Frolicher D. Transtracheal ventilation with oscillatory pressure for complete upper airway obstruction. J Trauma 1988; 28:611-4. [PMID: 3285015 DOI: 10.1097/00005373-198805000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Another study documented that percutaneous transtracheal ventilation with a special 3.5-mm I.D. cannula was possible in experimental complete upper airway obstruction (CAO) using Ambu-assisted ventilation. The effects of ventilation during CAO by occlusion of the endotracheal tube was evaluated by use of a portable oscillatory pressure device (POPD) attached to a 10-g (I.D. 2.4 mm) angiocath catheter inserted through the tracheal wall. Eight pigs were anesthetized and ventilated with the POPD for 15 minutes after CAO with a mean peak airway pressure of 14 cm H2O and continuous positive airway pressure of 5-7 cm H2O, tidal volume below 100 ml, and a rate below 0.5 Hz. A Venturi delivered an FIO2 of 0.68-0.92. All eight showed markedly stable blood gases and cardiovascular parameters (heart rate and systemic and pulmonary arterial pressures). A similar trend was obtained in a separate group of four pigs ventilated with an Ambu bag for 30 minutes; however, the PO2 was lower. In the control group, asphyxia after CAO produced cardiorespiratory failure in every animal in less than 6 minutes. Low-frequency ventilation with a POPD for CAO ensures adequate gas exchange using a standard transtracheal catheter of only 2.4 mm I.D.
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Affiliation(s)
- E Goldman
- Department of Anesthesiology, Ohio State University College of Medicine, Columbus 43210
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Carver DD, Peterson SS. Brain abscess of odontogenic origin: report of a case. J Houston Dist Dent Soc 1988:24. [PMID: 3216113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
We evaluated the effects of two classes of phenols on performance of penultimate instar southern armyworms, Spodoptera eridania. One class consisted of phenols containing a catechol (ortho-dihydroxybenzene) moiety and included chlorogenic acid, quercetin, rutin, and rhamnetin. A second group consisted of the phenolic glycoside salicin and its derivatives salicortin and tremulacin. The compounds were painted onto lima bean (Phaseolus lunatus) leaves and fed to larvae for the duration of the fifth instar. Chlorogenic acid and rhamnetin had no deleterious effects; rutin and quercetin caused some mortality and rutin reduced growth rates by decreasing consumption and digestion efficiency. Results showed that ortho-dihydroxybenzene groups may be necessary, but are not sufficient for biological activity. Salicin did not affect larvae; salicortin and tremulacin reduced growth rates primarily by decreasing consumption. These two compounds also caused degenerative lesions in midgut tissues. The presence of a benzoyl ester group in tremulacin accentuates its toxicity, relative to that of salicortin.
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Affiliation(s)
- R L Lindroth
- Department of Entomology, 237 Russell Laboratories, 1630 Linden Drive, 53706, Madison, WI, USA
| | - S S Peterson
- Department of Entomology, 237 Russell Laboratories, 1630 Linden Drive, 53706, Madison, WI, USA
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