scholarly journals Recording Patient Data in Burn Unit Logbooks in Rwanda: Who and What Are We Missing?

2020 ◽  
Author(s):  
Elizabeth Miranda ◽  
Lotta Velin ◽  
Faustin Ntirenganya ◽  
Robert Riviello ◽  
Francoise Mukagaju ◽  
...  
Keyword(s):  
Missing Data ◽  
University Teaching ◽  
Burn Patients ◽  
Middle Income ◽  
Data Completeness ◽  
Middle Income Countries ◽  
Burn Care ◽  
Burn Unit ◽  
Over Time ◽  
Low And Middle Income

Abstract Systematic data collection in high-income countries has demonstrated a decreasing burn morbidity and mortality, whereas lack of data from low- and middle-income countries hinders a global overview of burn epidemiology. In low- and middle-income countries, dedicated burn registries are few. Instead, burn data are often recorded in logbooks or as one variable in trauma registries, where incomplete or inconsistently recorded information is a known challenge. The University Teaching Hospital of Kigali hosts the only dedicated burn unit in Rwanda and has collected data on patients admitted for acute burn care in logbooks since 2005. This study aimed to assess the data registered between January 2005 and December 2019, to evaluate the extent of missing data, and to identify possible factors associated with “missingness.” All data were analyzed using descriptive statistics, Fisher’s exact test, and Wilcoxon Rank Sum test. In this study, 1093 acute burn patients were included and 64.2% of them had incomplete data. Data completeness improved significantly over time. The most commonly missing variables were whether the patient was referred from another facility and information regarding whether any surgical intervention was performed. Missing data on burn mechanism, burn degree, and surgical treatment were associated with in-hospital mortality. In conclusion, missing data is frequent for acute burn patients in Rwanda, although improvements have been seen over time. As Rwanda and other low- and middle-income countries strive to improve burn care, ensuring data completeness will be essential for the ability to accurately assess the quality of care, and hence improve it.

scholarly journals Feminine Appeals on Cigarette Packs Sold in 14 Countries

2021 ◽  
Vol 66 ◽  
Author(s):  
Lauren Czaplicki ◽  
Kevin Welding ◽  
Joanna E. Cohen ◽  
Katherine Clegg Smith
Keyword(s):  
Substantial Proportion ◽  
Middle Income ◽  
Global Trends ◽  
Plain Packaging ◽  
Middle Income Countries ◽  
Gender Neutral ◽  
Traditional Femininity ◽  
Over Time ◽  
Cigarette Packs ◽  
Low And Middle Income

Objective: Limited research has examined feminine marketing appeals on cigarette packs in low-and middle-income countries (LMICs). We reviewed a systematically collected sample of cigarette packs sold across 14 LMICs in 2013 (Wave 1) and 2015–2017 (Wave 2).Methods: Packs in Wave 1 (n = 3,240) and Wave 2 (n = 2,336) were coded for feminine imagery and descriptors (flowers, fashion, women/girls, color “pink”). We examined trends in feminine appeals over time, including co-occurrence with other pack features (slim or lipstick shape, flavor, reduced harm, and reduced odor claims).Results: The proportion of unique feminine cigarette packs significantly decreased from 8.6% (n = 278) in Wave 1 to 5.9% (n = 137) in Wave 2 (p < 0.001). Among all feminine packs, flower-and fashion-related features were most common; a substantial proportion also used flavor and reduced odor appeals.Conclusion: While there was a notable presence of feminine packs, the decline observed may reflect global trends toward marketing gender-neutral cigarettes to women and a general contempt for using traditional femininity to market products directly to women. Plain packaging standards may reduce the influence of branding on smoking among women.

scholarly journals Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool

2019 ◽  
Vol 12 (5) ◽  
pp. 499-506 ◽  
Author(s):  
Imogen K Thomson ◽  
Katie R Iverson ◽  
Simeon H S Innocent ◽  
Neema Kaseje ◽  
Walter D Johnson
Keyword(s):  
Assessment Tool ◽  
Skin Grafting ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Burn Care ◽  
Contracture Release ◽  
Health Organization ◽  
Traditional Approaches ◽  
Low And Middle Income

Abstract Background Burns are a leading cause of global disease burden, with children in low- and middle-income countries (LMICs) disproportionately affected. Effective management improves outcomes; however, the availability of necessary resources in LMICs remains unclear. We evaluated surgical centres in LMICs using the WHO Surgical Assessment Tool (SAT) to identify opportunities to optimize paediatric burn care. Methods We reviewed WHO SAT database entries for 2010–2015. A total of 1121 facilities from 57 countries met the inclusion criteria: facilities with surgical capacity in LMICs operating on children. Human resources, equipment and infrastructure relevant to paediatric burn care were analysed by WHO Regional and World Bank Income Classifications and facility type. Results Facilities had an average of 147 beds and performed 485 paediatric operations annually. Discrepancies existed between procedures performed and resource availability; 86% of facilities performed acute burn care, but only 37% could consistently provide intravenous fluids. Many, particularly tertiary, centres performed contracture release and skin grafting (41%) and amputation (50%). Conclusions LMICs have limited resources to provide paediatric burn care but widely perform many interventions necessary to address the burden of burns. The SAT may not capture innovative and traditional approaches to burn care. There remains an opportunity to improve paediatric burn care globally.

scholarly journals Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

Burns ◽  
2021 ◽  
Author(s):  
Maria Holden ◽  
Edna Ogada ◽  
Caitlin Hebron ◽  
Patricia Price ◽  
Tom Potokar
Keyword(s):  
Quality Improvement ◽  
Middle Income ◽  
Middle Income Countries ◽  
Burn Care ◽  
Low And Middle Income

scholarly journals SWPER Global: A survey-based women’s empowerment index expanded from Africa to all low- and middle-income countries

2020 ◽  
Author(s):  
Fernanda Ewerling ◽  
Anita Raj ◽  
Cesar G. Victora ◽  
Franciele Hellwig ◽  
Carolina V. N. Coll ◽  
...  
Keyword(s):  
Decision Making ◽  
Women's Empowerment ◽  
Women’S Empowerment ◽  
List Type ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
World Regions ◽  
Over Time ◽  
Low And Middle Income

AbstractIntroductionIn 2017, a survey-based women’s empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. External validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception. To determine its value for global monitoring, we explored the applicability of the SWPER in national health surveys from low- and middle-income countries (LMICs) in other world regions.MethodsWe used data from the latest Demographic and Health Survey for 62 LMICs since 2000. 14 pre-selected questions (items) were considered during the validation process. Content adaptations included the exclusion of women’s working status and recategorization of the decision-making related items. We compared the loading patterns obtained from principal components analysis performed for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII) for external validation.ResultsConsistency regarding item loadings for the three SWPER empowerment domains was observed for most countries. Correlations between the scores generated for each country and global score obtained from the combined data were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.72 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.81, 0.67, and 0.44, respectively, with GII.ConclusionThe indicator we propose, named SWPER Global, is a suitable common measure of women’s empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women’s empowerment that allows for tracking of progress over time and across countries at the individual and country levels.SummaryWhat is already known?Although survey-based women’s empowerment indicators have been used in the literature, until 2017 there was no indicator proposed for use in a large set of countries that would be comparable between and within countries.In 2017, we proposed the Survey-based Women’s emPowERment indicator (SWPER, pronounced as “super”), to be used in African countries, that encompasses three wellrecognized domains of women’s empowerment (attitude to violence, social independenceand decision making).The external validity and predictive value of the SWPER has been demonstrated in terms of coverage of maternal and child interventions and use of modern contraception.Validation of the index was restricted to African countries, and a common measure to allow comparisons across low and middle-income countries (LMICs) from all world regions was still lacking.What are the new findings?We show that the SWPER Global may serve as a valid common measure of women’s empowerment among LMICs, as consistent patterns were obtained for most countries and world regions.The SWPER Global index addresses the need for a single cross-cultural standardized survey-based indicator of women’s empowerment in the context of LMICs that enables comparability between countries and over time and subgroup analyses, extending previously proposed indicators such as the Gender Development Index which is limited to the country-levelWhat do the new findings imply?The SWPER Global index enables the study of how women’s empowerment is linked to developmental and health outcomes, allowing for broad comparisons across countries and world regions.As a comprehensive cross-cultural standard tool, it also contributes to the monitoring and accountability of country progress over time in advancing gender equality and women’s empowerment.The new tool may help target and prioritize policy and advocacy efforts toward SDG 5 (achieve gender equality and empower all women and girls) at the regional and country levels.

Burn Care in Low- and Middle-Income Countries

2017 ◽  
Vol 44 (3) ◽  
pp. 479-483 ◽  
Author(s):  
Anthony G. Charles ◽  
Jared Gallaher ◽  
Bruce A. Cairns
Keyword(s):  
Middle Income ◽  
Middle Income Countries ◽  
Burn Care ◽  
Low And Middle Income

scholarly journals Accounting for country- and time-specific values in the economic evaluation of health-related projects relevant to low- and middle-income countries

2021 ◽  
Author(s):  
James Lomas ◽  
Karl Claxton ◽  
Jessica Ochalek
Keyword(s):  
Economic Evaluation ◽  
Marginal Cost ◽  
Healthcare Sector ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Related ◽  
Evaluation Parameters ◽  
Over Time ◽  
Value Of Health ◽  
Low And Middle Income

Abstract Economic evaluation of health-related projects requires principles and methods to address the various trade-offs that need to be made between costs and benefits, across sectors and social objectives, and over time. Existing guidelines for economic evaluation in low- and middle-income countries embed implicit assumptions about expected changes in the marginal cost per unit of health produced by the healthcare sector, the consumption value of health and the appropriate discount rates for health and consumption. Separating these evaluation parameters out requires estimates for each country over time, which have hitherto been unavailable. We present a conceptual economic evaluation framework that aims to clarify the distinct roles of these different evaluation parameters in evaluating a health-related project. Estimates for each are obtained for each country and in each time period, based on available empirical evidence. Where existing estimates are not available, for future values of the marginal cost per unit of health produced by the healthcare sector, new estimates are obtained following a practical method for obtaining projected values. The framework is applied to a simple, hypothetical, illustrative example, and the results from our preferred approach are compared against those obtained from other approaches informed by the assumptions implicit within existing guidelines. This exposes the consequences of applying such assumptions, which are not supported by available evidence, in terms of potentially sub-optimal decisions. In general, we find that applying existing guidelines as done in conventional practice likely underestimates the value of health-related projects on account of not allowing for expected growth in the marginal cost per unit of health produced by the healthcare sector.

scholarly journals Lives turned upside down in COVID-19 times: exploring disabled people's experiences in 5 low-and-middle income countries using narrative interviews

2021 ◽  
Vol 41 (3) ◽  
Author(s):  
Mary Wickenden ◽  
Jackie Shaw ◽  
Stephen Thompson ◽  
Brigitte Rohwerder
Keyword(s):  
Narrative Interviews ◽  
Disabled People ◽  
Middle Income ◽  
Middle Income Countries ◽  
Over Time ◽  
Low And Middle Income

This article explores COVID-19 related experiences of disabled people in Bangladesh, Kenya, Nigeria, Nepal and Uganda. Narrative interviews generated storied responses, focussing on respondents' priorities, which enabled us to hear what was most significant for them and their families. 143 interviews were conducted online or by phone by 7 local researchers (3 disabled), with appropriate inclusive support. Nearly everyone was interviewed twice to capture the progression of impacts over time. The data was analysed thematically through a virtual participatory approach.An overarching 'subjective' theme of feelings experienced by the participants was labelled 'destabilisation, disorientation and uncertainty'. We also identified 'concrete' or material impacts. People experienced various dilemmas such as choosing between securing food and keeping safe, and tensions between receiving support and feeling increased vulnerability or dependence, with interplay between the emotions of fear, loss and hope. We found both the concept of liminality and grief models productive in understanding the progression of participants' experiences. Disabled people reported the same feelings, difficulties and impacts as others, reported in other literature, but often their pre-existing disadvantages have been exacerbated by the pandemic, including poverty, gender and impairment related stresses and discrimination, inaccessible services or relief, and exclusion from government initiatives.

scholarly journals Inequalities in Delayed Initiation of Breastfeeding: Evidence from Health Surveys in 58 Low- and Middle-Income Countries (2012-2017)

2021 ◽  
Author(s):  
Shahreen Raihana ◽  
Michael J Dibley ◽  
Sabrina Sharmin Priyanka ◽  
Ashraful Alam ◽  
Tanvir M Huda
Keyword(s):  
Wealth Quintile ◽  
Sociodemographic Factors ◽  
Sub Saharan Africa ◽  
Breastfeeding Initiation ◽  
Global Pattern ◽  
Middle Income ◽  
Ample Evidence ◽  
Middle Income Countries ◽  
Over Time ◽  
Low And Middle Income

Abstract Background: Delay in breastfeeding initiation beyond 1 hour of birth increases the risk of neonatal deaths and illnesses. Despite ample evidence highlighting its importance, wealth-related inequalities exist in delayed breastfeeding initiation rates in many low- and middle-income countries (LMICs). Our goal was to examine the magnitude and trend of socio-economic inequalities in delayed breastfeeding initiation rates in LMICs.Methods: We used data from 58 low- and middle-income countries from their most recent Demographic and Health Survey and Multiple Indicator Cluster Survey to present delayed breastfeeding initiation rates across wealth quintile and area of residence. To assess the wealth-related inequalities in delayed breastfeeding initiation rates, we calculated two indicators- the difference, in percentage points, between the rates recorded for the poorest and wealthiest quintiles and the ratio of the same two values. To present the change over time, we calculated- the annual absolute change and annual absolute excess change. Results: Within countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest quintile (median 47.4%) and lower in the poorest quintile (median 42.6%). In 37 study countries, the prevalence of delayed breastfeeding initiation was higher among the wealthiest than among the poorest. The highest prevalence of delayed breastfeeding initiation was in South Asia, and the largest levels of pro-rich inequality were in Latin America and Caribbean. Pro-poor inequality was more common in Sub-Saharan Africa. Delayed breastfeeding initiation rates decreased faster in the poorest quintile (median -1.3 percent-points per year) compared to the wealthiest quintile (median -0.8 percent-points per year), indicating an increase in pro-poor inequality over time.Conclusions: There is no distinguishable global pattern for wealth-related inequality in the prevalence of delayed breastfeeding initiation. The prevailing inequality may be due to a combination of sociodemographic factors and is largely preventable by incorporating adequate infrastructure towards creating a pro-breastfeeding environment.

scholarly journals Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Shelley L. Wall ◽  
Nikki L. Allorto ◽  
Verusia Chetty
Keyword(s):  
Resource Limited Setting ◽  
Burn Injuries ◽  
Expert Consensus ◽  
Burn Patients ◽  
Middle Income ◽  
Burn Care ◽  
Modified Delphi ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Despite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts in the management of burn injuries from low- and middle-income settings across Africa.Methods: A two-round Delphi survey was conducted to achieve consensus on an analgesia protocol for paediatric burn patients for a resource-limited setting. The Delphi panel consisted of nine experts with experience in management of burn injuries in low-income settings.Results: Consensus was determined by an a priori threshold of 80% of agreement for a drug to be included in the analgesia protocol. There was a largely overarching agreement with regard to the background analgesia protocol and strong agreement regarding the use of an initial dose of ketamine and midazolam for procedural sedation.Conclusion: A modified Delphi method was used to obtain expert consensus for a recently adopted analgesia protocol for burn-injured children in a resource-limited setting, with experts in the management of burn injuries in low- and middle-income settings. The expert consensus leads to the rigour and robustness of the protocol. Delphi methods are exceptionally valuable in healthcare research and the aim of such studies is to find converging expert opinions.

Sign in / Sign up

Export Citation Format

Share Document