scholarly journals Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: a prospective cohort study.

2021 ◽  
Author(s):  
Hamish R Graham ◽  
Yewande Kamuntu ◽  
Jasmine Miller ◽  
Anna Barrett ◽  
Blasio Kunihira ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Pulse Oximetry ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
World Health ◽  
Blood Oxygen ◽  
Severe Hypoxaemia ◽  
Care Facilities

Introduction Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing risk of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. Methods Prospective cohort study in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors assessed blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults, and followed up children aged under 15 years with SpO2<93% to determine subsequent care and outcome. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe/moderate hypoxaemia (SpO2 90-93%) by age/sex/complaint. Results Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. Conclusion Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials.

scholarly journals Supplemental oxygen in Queen Elizabeth Central Hospital Malawi: a prospective cohort study of patients admitted to medical wards

2021 ◽  
Vol 6 ◽  
pp. 29
Author(s):  
Helen Thomson ◽  
Maness Mlaviwa ◽  
Jamie Rylance ◽  
Hannah Jones ◽  
Ammoah Reuben ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Chest Radiograph ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Medical Wards

Background: Oxygen is designated an essential drug by the World Health Organisation, and reduces mortality in hypoxic patients. In low-resource settings the provision of oxygen seldom meets its demand. This study explores predictors and observed time-course of hypoxaemia in order to help inform needs assessments for oxygen in hospitals in low- and middle-income countries. Methods: A prospective cohort study of adults with hypoxaemia admitted to medical wards of a teaching hospital in Malawi between February and March 2020. Vital signs and oxygen therapy were recorded daily. We analysed outcomes (death, discharge from hospital or ongoing inpatient care at 14 days after admission) using Kaplan-Meier and Cox regression time-to-event analysis. Results: 33 patients were recruited with median age 45 years (IQR 33-61). 13 (39%) were female. Median pre-treatment oxygen saturations were 84% (IQR 76-87%). Oxygen delivery devices were often shared with other patients (n=10, 33%) and the flow rate was often unknown (n=14, 47%), mostly because of broken equipment (n=8, 57%). Median duration of oxygen therapy was 3 days (IQR 1-7). Death occurred in 16 (49%). Hazard ratios for short oxygen therapy were reduced in patients who had a chest radiograph performed (HR 0.08, 95% CI 0.02–0.30), in ex-smokers (HR 0.01, 95% CI 0.00-0.22) and in never smokers (HR 0.03, 95% CI 0.00 – 0.78). Conclusions: Delivering oxygen therapy in lower-middle income countries is challenging; broken equipment and shared delivery devices prevented titration of flow rates. Patients were relatively young and at a high risk of death. Patients with a chest radiograph received oxygen for longer than those without. This hypothesis generating study can be used to build a more comprehensive understanding of oxygen supply need at the hospital level.

scholarly journals Supplemental oxygen in Queen Elizabeth Central Hospital Malawi: a prospective cohort study of patients admitted to medical wards

2021 ◽  
Vol 6 ◽  
pp. 29
Author(s):  
Helen Thomson ◽  
Maness Mlaviwa ◽  
Jamie Rylance ◽  
Hannah Jones ◽  
Ammoah Reuben ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Chest Radiograph ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Medical Wards

Background: Oxygen is designated an essential drug by the World Health Organisation, and reduces mortality in hypoxic patients. In low-resource settings the provision of oxygen seldom meets its demand. This study describes the predictors and observed time-course of hypoxaemia in order to inform needs assessments for oxygen in hospitals in low and middle income countries. Methods: A prospective cohort study of adults with hypoxaemia admitted to medical wards of a teaching hospital in Malawi between January and March 2020. Vital signs and oxygen therapy were recorded daily. We analysed outcomes (death, discharge from hospital or ongoing inpatient care at 14 days after admission) using Kaplan-Meier and Cox regression time-to-event analysis. Results: 33 patients were recruited with median age 45 years (IQR 33-61), and 13 (39%) female. Median pre-treatment oxygen saturations were 84% (IQR 76-87%). Oxygen delivery devices were often shared with other patients (n=10, 33%) and the flow rate was often unknown (n=14, 47%), mostly because of broken equipment (n=8, 57%). Median duration of oxygen therapy was 3 days (IQR 1-7). Death occurred in 16 (49%). Hazard ratios for short oxygen therapy were reduced in patients who had a chest radiograph performed (HR 0.08, 95% CI 0.02–0.30), in ex-smokers (HR 0.01, 95% CI 0.00-0.22) and in never smokers (HR 0.03, 95% CI 0.00 – 0.78). Conclusions: Delivering oxygen therapy in lower-middle income countries is challenging; broken equipment and shared delivery devices prevented titration of flow rates. Patients were relatively young and at a high risk of death. Patients with a chest radiograph received oxygen for longer than those without. Knowledge of oxygen therapy durations will allow careful assessment of the oxygen supply need at the hospital level.

scholarly journals Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients

2013 ◽  
Vol 150 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Sebastian Köhler ◽  
Frans Verhey ◽  
Siegfried Weyerer ◽  
Birgitt Wiese ◽  
Kathrin Heser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Old Age ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fatal Stroke ◽  
All Cause Mortality ◽  
Primary Care Patients

scholarly journals Incidence of Neuralgic Amyotrophy (Parsonage Turner Syndrome) in a Primary Care Setting - A Prospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. e0128361 ◽  
Author(s):  
Nens van Alfen ◽  
Jeroen J. J. van Eijk ◽  
Tessa Ennik ◽  
Sean O. Flynn ◽  
Inge E. G. Nobacht ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Turner Syndrome ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Setting ◽  
Primary Care Setting ◽  
Neuralgic Amyotrophy

scholarly journals Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e682-e693 ◽  
Author(s):  
Niamh M Redmond ◽  
Sophie Turnbull ◽  
Beth Stuart ◽  
Hannah V Thornton ◽  
Hannah Christensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Respiratory Symptoms ◽  
Linear Models ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Antibiotic Prescribing ◽  
Acute Cough

BackgroundClinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.AimTo estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.Design and settingSecondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.MethodBaseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.ResultsSixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).ConclusionMost children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

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