scholarly journals Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya

2020 ◽  
Author(s):  
Winstone Mokaya Nyandiko ◽  
Paul Kiptoon ◽  
Florence Ajaya Lubuya
Keyword(s):  
World Health Organisation ◽  
Referral Hospital ◽  
World Health ◽  
Categorical Variables ◽  
Systematic Sampling ◽  
Continuous Variables ◽  
Local Data ◽  
Thermal Care ◽  
Care Guidelines ◽  
Neonatal Hypothermia

ABSTRACTBackgroundNeonatal hypothermia is a great concern with near epidemic levels globally. The prevalence in Kenya is as high as 87%. Local data on the associated factors including adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited.ObjectiveTo determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH).MethodsThis descriptive cross-sectional study was carried out among neonates admitted at the MTRH newborn unit. Systematic sampling was used to recruit 372 eligible participants. Axillary thermometry, interview of respective mothers and observation of thermal care practices was done. Means and medians described continuous variables while frequencies with corresponding percentages summarized categorical variables. Associations between various variables and neonatal hypothermia were computed using the Pearson chi-square test. Relative Risks and Odds Ratios were assessed between predictor and outcome variables. Independence among significant variables was determined through the logistic regression model at 5% prediction level.ResultsAmong the 372 participants, 64.5% (n=240) were born at MTRH, 47.6% (177) were preterm while 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (n= 274) while 13% (49) died on day one of admission. Only 7.8 % (29) newborns accessed optimal thermal care. Prematurity (RR=1.62, 95% CI: 1.43-1.84), day one mortality (RR=17.7, 95% CI: 2.40, 122.71) and adherence to the warm chain (p<0.001) was significantly associated with admission hypothermia. Inappropriate thermal resuscitation appliance (RR=1.50, 95% CI: 1.34-1.67) inappropriate clothing (RR = 1.78, 95% CI: 1.54 - 2.05) and late breastfeeding (RR = 2.01, 95% CI: 1.39-2.89) significantly increased the risk of hypothermia. Non hypothermic newborns had twenty-fold increased odds of survival (AOR=20.91, 95% CI: 2.15-153.62).ConclusionThree out four neonates at the MTRH newborn unit had hypothermia at admission. Hypothermia was significantly associated with prematurity, adherence to warm chain and day one mortality. There was notably low adherence to the warm chain.RecommendationStrategies to optimize adherence to the warm chain at MTRH with emphasis on 1thermal care of the preterm neonate should be instituted.

scholarly journals Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248838
Author(s):  
Winstone Mokaya Nyandiko ◽  
Paul Kiptoon ◽  
Florence Ajaya Lubuya
Keyword(s):  
World Health Organisation ◽  
Referral Hospital ◽  
World Health ◽  
Preterm Neonates ◽  
Local Data ◽  
Thermal Care ◽  
Increased Risk ◽  
Care Guidelines ◽  
Prospective Study Design ◽  
Neonatal Hypothermia

Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson’s chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15–153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.

scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Hengameh Abdi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
World Health ◽  
Incident Diabetes ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Diabetes Status ◽  
Adjusted Model

Abstract Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

scholarly journals Association between Intimate Partner Violence with Quality of Life

2021 ◽  
Author(s):  
NV Roopesh Gopal ◽  
SV Sathish Kumar ◽  
Kiran S Bhat
Keyword(s):  
Quality Of Life ◽  
Intimate Partner Violence ◽  
Partner Violence ◽  
Intimate Partner ◽  
World Health ◽  
Categorical Variables ◽  
Early Interventions ◽  
Continuous Variables ◽  
Cross Sectional

Introduction: An intimate relationship is an interpersonal relationship that involves physical or emotional intimacy. Those who are in such a relationship may experience violence from partners which may affect their day-to-day quality of life and thus cause a burden on the family. Aim: To assess the relationship between Intimate Partner Violence (IPV) with Quality of life and to provide early interventions. Materials and Methods: Hospital-based, cross-sectional study was conducted at the Department of Psychiatry, Kodagu Institute of Medical Sciences (KoIMS) teaching hospital Madikeri, Karnataka. The subjects were recruited by purposive sampling method. A total of 5810 consecutive subjects who visited the psychiatry OPD from March 2017 to June 2019 were assessed and among them, 82 subjects both men and women in the age group of 18 to 60 years were recruited. All of them reported IPV on the Hurt, Insulted, Threatened, and Screamed (HITS) scale and were further assessed for Quality of life using the World Health Organisation Quality of Life BREF (WHOQOL-BREF) scale. Descriptive statistics were used for continuous variables. A Nonparametric Chi-square test was applied for categorical variables and Mann-Whitney U scores were used for quality of life variables. The correlation was done using Pearson’s correlation. Results: Mean age was 36.04 in years (SD±11.28) having a mean of 7.5 years of schooling (SD±4.5). The majority belonged to the rural background and lower socioeconomic status. Out of 82 subjects, 21 subjects reported IPV score less than 10 (25.60%) and among the rest of the 61 (74.39%) subjects, 80.32% were females and 19.67% were males who had IPV scores of more than 10. The study subjects reported poor and very poor scores in their overall quality of life and very dissatisfied and dissatisfied in their health domain. IPV also correlated with reduced quality of life, which was statistically significant. Conclusion: People that experience IPV has an overall reduced quality of life. Routine clinical assessment needs to be done to provide early interventions.

scholarly journals Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yibeltal Asmamaw Yitayew ◽  
Endashaw Belayhun Aitaye ◽  
Helina Wondimu Lechissa ◽  
Lubaba Oumer Gebeyehu
Keyword(s):  
Preterm Delivery ◽  
Associated Factors ◽  
The Body ◽  
Referral Hospital ◽  
Night Time ◽  
Thermal Care ◽  
Skin Contact ◽  
Skin To Skin ◽  
Dessie Referral Hospital ◽  
Neonatal Hypothermia

Introduction. Neonatal hypothermia is the reduction in the body temperature of the newborn (less than 36.5°C). It is a global problem in neonates born both at hospitals and homes, but it showed a higher prevalence in developing countries (>90%). Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally. Objective. To assess neonatal hypothermia and associated factors among newborns admitted in the NICU of Dessie Referral Hospital. Methods and Materials. An institution-based cross-sectional study was conducted from March 15 to May 30, 2018. The data was collected from the mother and the chart of the newborn using a semistructured questionnaire. Data were cleaned, coded, and entered in EPI-info version 7.1.2.0 then exported to Statistical Package for Social Sciences (SPSS) version 20 software for analysis. Descriptive statistics were used to summarize the data. Bivariate and multivariate logistic regression and crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p value < 0.05 was used to identify variables that had a significant association with neonatal hypothermia. Result. The proportion of neonatal hypothermia in the study area was 66.8%. Preterm delivery (AOR=2.6, 95% CI: 1.1, 6.2), no skin-to-skin contact within 1 hour of delivery (AOR=3.0, 95% CI: 1.3, 7.8), delivered at night time (AOR=2.0, 95% CI: 1.02, 4.0), and neonates who had resuscitation (AOR=2.9, 95% CI: 1.1, 7.2) showed significant association with neonatal hypothermia. Conclusion. In this study, the proportion of hypothermia was high. Preterm delivery, no skin-to-skin contact within 1 hour, night-time delivery, and having resuscitation were significantly associated with neonatal hypothermia. Therefore, special attention is needed for the thermal care of preterm neonates and neonates delivered at night time. Furthermore, there should be strict adherence to cost-effective thermal care recommendations like warm resuscitation and skin-to-skin contact.

scholarly journals Changes in obesity, sedentary behavior and physical inactivity, between 2010 and 2017, in adolescents

1989 ◽  
Vol 32 ◽  
Author(s):  
Marcelo Barros Vasconcellos ◽  
◽  
Isabela Matta ◽  
Danilo Dias Santana ◽  
Gloria Valeria da Veija ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Sedentary Behavior ◽  
Body Mass ◽  
Video Game ◽  
Physical Inactivity ◽  
World Health ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Prevalence Of Obesity

The study investigated changes in the prevalence of obesity, sedentary behavior (SB) and physical inactivity (PI) in adolescents. Two cross-sectional studies were analyzed, 2010 and 2017, with probabilistic samples from students (328 and 366, respectively) in 12 municipal schools in Niterói, RJ. Obesity was classified based on body mass index (BMI = weight / height2) Z score values ≥ +2, according to the World Health Organization criteria. The weight classification was made with body mass index (BMI = weight/height2), the SB for those with some screen behavior (television, video game) for ≥ 2 hours/day and IF those who performed <300 min / week moderate to intense physical activity. The comparison between the studies was based on the chi-square test (categorical variables) and Student's t test (continuous variables). The prevalence of obesity increased in boys (6.2% to 15.6% p <0.001) and decreased in girls (8.4% to 6.9% p = 0.035). The frequency of SB decreased from (90.7% to 67.7% p <0.001) in boys and from (90.3 to 52.8% p <0.001) in girls and the PI did not change in boys and increased in girls (84.6% to 89.9% p <0.001). The changes observed were sex-dependent, with boys more vulnerable to increased obesity, girls more PI and both sexes less SB in the investigated period.

scholarly journals Anomalous Concentration of Uranium in Groundwater in Parts of Salem District, Central Tamil Nadu, India

2020 ◽  
Keyword(s):  
Shear Zone ◽  
Tamil Nadu ◽  
Uranium Concentration ◽  
World Health Organisation ◽  
Uranium Content ◽  
Vital Role ◽  
World Health ◽  
Systematic Sampling ◽  
Hand Pump ◽  
Salem District

Anomalous concentration of Uranium in groundwater has been identified around Virakkal, Veerapanpalayam, Pakkanadu, Erithottam, Kammampatti, Kumarappalyam, Idappadiand Moolakkadu areas in parts of Salem district, Tamil Nadu. In this study, an area of 970 sq. km from Mettur in the north to Kumarapalayam in the south parallel to the Koratti shear zone has been examined for uranium content in groundwater. Systematic sampling of groundwater (n=78) from bore well, open well and hand pump have been collected. The samples were analysed for uranium concentration using LED Fluorimeter. Analysis resulted higher concentration of uranium along the southern extension of Koratti Shear Zone where the emplacement of younger granites, syenite and carbonatites has been reported. These lithounits might have played a vital role in the contribution of uranium to the groundwater. Based on the result, two areas have been identified such as North Block and South Block for detailed investigation.58 systematic samples from North block and 52 samples from South block have been collected and analysed. Uranium values assayed in these areas are many times higher than the prescribed limit of World Health organisation and Atomic Energy Regulatory Board of 30ppb and 60ppb respectively. In northern block, among 58 samples 18 samples were assayed higher than 30ppb in which the samples from Veerappanpalayam assayed upto 545.81 ppb. Apart from Veerappanpalayam, many areas such as Mosakumarapalayam (273.90), Arasiramani (250.49ppb), Vellarivalli (131.32ppb), Kodarapalayam (106.52ppb), Savuthanur (174.79ppb), Veerapanpalayam-2 (373.43ppb) and Kotamppalayam (100ppb) were assayed more than 100ppb. Similarly, in the southern block, 52 samples were assayed in which 15 samples were higher than the prescribed limit in which Kuppampatti analyzed 402.29ppb, Virakkal and Thannikuttampatti assayed more than 100ppb. Among the total samples (n=188), 28% of samples were falling under non-potable category. The Present study has spatially brought to light significant areas where groundwater enriched by uranium concentration. It is also provided indirect evidences for uranium exploration in the study area.

scholarly journals Clinical and Laboratory Features of COVID-19 in Ulin Referral Hospital of South Kalimantan: Predictors of Clinical Outcome

2021 ◽  
Vol 11 (3) ◽  
pp. 299-307
Author(s):  
Hariyati Hariyati ◽  
◽  
Mohamad Isa ◽  
Ali Assagaf ◽  
Ira Nurrasyidah ◽  
...  
Keyword(s):  
Risk Factor ◽  
Virus Disease ◽  
Demographic Data ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Referral Hospital ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Laboratory Features ◽  
D Dimer

Corona Virus Disease (COVID-19) is becoming a global pandemic. Indonesia, especially South Kalimantan had recorded increasing cases with a high fatality rate of 3.7%. Information about factors related to outcomes based on clinical and laboratory features in Indonesia is still limited. Identification of the risk is crucial to determine optimal management and reducing mortality. This retrospective study enrolled 455 adults COVID-19 patients, and data were extracted from medical records of Ulin General Hospital Banjarmasin. The latter is COVID-19 referral hospital in South Kalimantan between March-November 2020. Demographic data, comorbidities, and laboratory were all collected. Data were compared between survivors and non-survivors. Fisher’s exact test and chi-square were used to compare categorical variables. The Mann_Whitney U test was used to compare continuous variables. Analysis was continued by multivariate logistic regression then receiver operating characteristic (ROC) curve to determine cut-off value. The multivariate analysis showed that number of comorbidities [odds ratio (OR) 1,339 (95% confidence interval (CI): 1,064-1,685, P = 0,013) was a significant risk factor to the outcome. In laboratory, lactate dehydrogenase (LDH) [OR: 1.001, 95% CI: 1,000-1.002, P = 0.001], Ferritin (OR 1.000, CI: 1,000-1.001, P = 0.013), APTT (OR: 1.045, CI: 1.010-1.082, P = 0.012), and D-dimer (OR: 1.188, CI: 1.064 - 1.327, P = 0.002) were significant predictor factors but only LDH, ferritin, and D- dimer were obtained good AUC 0.731, 0.715, and 0.705, respectively. The cut of the value of LDH was 656.5 U/L, ferritin was 672.18 ng/ml, and D-dimer was 2.28 mg/L. Sensitivity and specificity were 66.7% and 68,0% for LDH, 83,2% and 56,3% for ferritin, and 62,8 and 70,8% for D-dimer. From this research, we revealed that the number of comorbidities was a risk factor for death. Elevated LDH, ferritin, and D-dimer could be good predictive factors for poor outcomes, thereby considering the accelerating management of COVID-19 patients

Analysis of contrast-enhanced ultrasound features of hepatocellular adenoma according to different pathological molecular classifications

2020 ◽  
Vol 76 (3) ◽  
pp. 391-403 ◽  
Author(s):  
Kailing Chen ◽  
Yi Dong ◽  
Weibin Zhang ◽  
Hong Han ◽  
Feng Mao ◽  
...  
Keyword(s):  
Late Phase ◽  
Hepatocellular Adenoma ◽  
World Health ◽  
Categorical Variables ◽  
Arterial Phase ◽  
Histopathological Diagnosis ◽  
Imaging Features ◽  
Continuous Variables ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

OBJECTIVE: To explore the specific contrast-enhanced ultrasound (CEUS) features of hepatocellular adenomas (HCA) according to their pathological molecular classifications. METHODS & MATERIALS: In this retrospective study, fifty-three histopathologically proved HCA lesions (mean size, 39.7±24.9 mm) were included. Final histopathological diagnosis of HCA lesions were identified by surgical resection (n = 51) or biopsy (n = 2) specimens. CEUS imaging features were compared among four subgroups according to World Health Organization (WHO) 2019 pathological molecular classifications standards. Analysis of variance (ANOVA) were used for statistical analysis of continuous variables. Fisher’s exact test were used for categorical variables. The sensitivity (SE), specificity (SP), and accuracy of CEUS feature in diagnosis of each HCA subtype were calculated and compared. RESULTS: Final histopathological diagnosis included HNF-1α inactivated HCAs (H-HCA, n = 12), β-catenin activated HCAs (B-HCA, n = 8), inflammatory HCAs (I-HCA, n = 31), and unclassified HCAs (U-HCA, n = 2). During arterial phase of CEUS, all HCAs were hyper-enhanced, 66.6% (8/12) of H-HCAs and 50% (4/8) of B-HCAs displayed complete hyperenhancement, whereas 58.0% (18/31) of I-HCAs showed centripetal filling hyperenhancement pattern (P = 0.016). Hyper-enhanced subcapsular arteries could be detected in 64.5% (20/31) I-HCAs during early arterial phase. During portal venous and late phase, sustained hyper- or iso-enhancement were observed in 91.7% (11/12) of H-HCAs, while most of I-HCAs (61.3%, 19/31) and B-HCAs (7/8, 87.5%) were hypo-enhanced (P = 0.000). Central unenhanced areas were most commonly observed in I-HCAs (29.0%, 9/31) (P = 0.034). CONCLUSION: Depending on its unique imaging features including enhancement filling pattern, hyper-enhanced subcapsular artery and presence of washout, CEUS might provide helpful diagnostic information for preoperative prediction of various HCA molecular subtypes.

scholarly journals How closely is COVID-19 related to HCoV, SARS, and MERS? : Clinical comparison of coronavirus infections and identification of risk factors influencing the COVID-19 severity using common data model (CDM)

2020 ◽  
Author(s):  
Yeon Hee Kim ◽  
YeHee Ko ◽  
Soo Young Kim ◽  
Kwangsoo Kim
Keyword(s):  
Risk Factors ◽  
Data Model ◽  
Gastrointestinal Disease ◽  
Statistical Significance ◽  
World Health ◽  
Categorical Variables ◽  
Common Data Model ◽  
Continuous Variables ◽  
The Common ◽  
Post Hoc

AbstractSouth Korea was one of the epicenters for both the 2015 Middle East Respiratory Syndrome (MERS) and 2019 COVID-19 outbreaks. However, there has been a lack of published literature, especially using the EMR records, that provides a comparative summary of the prognostic factors present in the coronavirus-derived diseases. Therefore, in this study, we aimed to compare and evaluate the distinct clinical traits between the infected patients of different coronaviruses, including the lesser pathogenic HCoV strains, SARS-CoV, MERS-CoV, and SARS-CoV-2. We aimed to observe the extent of resemblance within the clinical features between the different coronavirus disease groups and to identify unique factors by disease severity that may influence the prognosis of COVID-19 patients. Here, we utilize the common data model (CDM), which is the database that houses EMR records transformed into the common format to be used by multiple institutions. For the comparative analyses between the different disease groups as well as the mild and non-mild COVID-19 patients, we used independent t-test, Scheffe post-hoc test, and Games-howell post-hoc test for continuous variables, and chi-square test and Fisher’s exact test for categorical variables. From the analyses, we selected variables that showed p-values less than 0.05 to predict COVID-19 severity by a nominal logistic regression with adjustments to age and gender. The results showed diabetes, cardiovascular and cerebrovascular diseases, cancer, pulmonary disease, gastrointestinal disease, and renal disease in all patient groups. The proportions of cancer patients were the highest compared to other comorbidities in every comparative analysis, with no statistical significance. Additionally, we observed high degree of clinical similarity between COVID-19 and SARS patients within more than 50% of the selected clinical variables in the analyses, with no statistical significance between the two groups. Our research effectively utilized the integrated CDM to reflect real-world health challenges in the context of coronavirus. We expect the results from our study to provide clinical insights that can serve as predictor of risk factors for the future coronavirus-derived outbreak as well as the prospective guidelines for the clinical treatments.

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