Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh

ObjectiveDelays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh.MethodsWe conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically.ResultsWe found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors.ConclusionsThis study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.

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Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.763827 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peter Jirak ◽

Zornitsa Shomanova ◽

Robert Larbig ◽

Daniel Dankl ◽

Nino Frank ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Severe Pneumonia ◽

Thromboembolic Events ◽

Therapeutic Anticoagulation ◽

Tertiary Hospitals ◽

Ventricular Tachycardias ◽

Disease Specific ◽

Rhythm Monitoring

Aims: Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%).Conclusions: Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.

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COVID-19 in-hospital mortality of a secondary care center of Mexico City in a marginated area during the first months of the Mexican epidemic

10.21203/rs.3.rs-384455/v4 ◽

2021 ◽

Author(s):

José Martín Alanís-Naranjo ◽

Víctor Manuel Anguiano-Álvarez ◽

Eduardo Federico Hammeken-Larrondo

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Mexico City ◽

Secondary Care ◽

Care Center ◽

Severe Pneumonia ◽

P Value ◽

Intravenous Antibiotics ◽

Tertiary Hospitals ◽

Hospital Acquired

Abstract Introduction: Low socioeconomic conditions and hospital saturation have been associated with higher mortality rates in hospitalized patients with COVID-19. Mexico City has become the country’s highest death toll. Iztapalapa is the district with the highest population density and marginalization in Mexico City. Most of the information on COVID-19 in-hospital mortality in Mexico comes from intensive care units or tertiary hospitals without considering the level of income. Data regarding hospital mortality in care centers with low availability of intensive care beds has not been explored.Material and methods: A retrospective cohort study in consecutive patients with COVID-19 hospitalized managed outside the intensive care unit in a secondary care center in Mexico City from April 1st, 2020, to May 31st, 2020. Analysis was performed between subgroups with a p-value <0.05 considered statistically significant.Results: A total of 164 patients were recruited; the median age was 52.5 years (IQR 44 - 64.5), 68% were males, 48.7% were obese, and 59.7% had comorbidities. Among those patients, 67% required mechanical ventilation and 32.3% vasopressor support. In this population, 52 recovered (31.7%) and 112 died (68.3%). The main risk factors associated with death were male sex, age > 50 years, diabetes, severe pneumonia on admission, PORT / PSI > 91, SMART-COP > 5, SCAP score > 10, dyspnea on admission, fever during hospitalization [p <0.05] and the administration of intravenous antibiotics [RR 3.45, 95% CI 1.69-7.06, p <0.001].Conclusion: In this study, we found higher in-hospital mortality compared to previous reports. We suggest that the administration of intravenous antibiotics could impact patient survival for the risk of developing hospital-acquired infections.

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HOUT-26. FACTORS ASSOCIATED WITH TREATMENT DELAY IN CENTRAL NERVOUS SYSTEM LYMPHOMA

Neuro-Oncology ◽

10.1093/neuonc/noz175.491 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi117-vi117

Author(s):

Marissa Barbaro ◽

Peter Pan ◽

Sarah Torres ◽

Kiran Thakur ◽

Mary Welch

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Treatment Initiation ◽

Central Nervous System Lymphoma ◽

Initial Presentation ◽

Medical Attention ◽

Single Center ◽

Delayed Treatment ◽

Factors Associated ◽

Multifocal Disease

Abstract OBJECTIVE To identify clinico-radiographic characteristics associated with delayed treatment initiation in central nervous system lymphoma (CNSL). INTRODUCTION Clinical and radiographic characteristics of CNSL are often varied with a broad differential diagnosis, potentially leading to delays in diagnosis and treatment. METHODS A single-center retrospective review of clinico-radiographic data was performed at Columbia University Irving Medical Center in patients with pathologically confirmed CNSL diagnosed from 1/2010–12/2018. Descriptive statistics and univariate logistic regression were used to identify variables associated with delayed treatment. Using visual binning, delayed treatment time was designated as >33 days from first presentation to medical attention to first chemotherapy for CNSL. Variables of interest included demographic data, presenting symptomatology, radiographic characteristics, location of initial presentation, and diagnostic and therapeutic interventions performed before biopsy. RESULTS Seventy patients (36 men (51%); median age at diagnosis 70 years, IQR 14.75 years; median time from first presentation to treatment 21 days, IQR 41.25 days) were included. Presentation with cognitive deficits suggested a strong, but not statistically significant, association with delayed treatment (OR=1.93, p=0.20), whereas presentation with focal neurologic deficits suggested protection against delayed treatment (OR=0.25, p=0.05). Initial presentation to a hospital suggested a strong, but not statistically significant, trend against delayed treatment (OR=0.41, p=0.08). Multifocal disease on neuroimaging (OR=7.18, p=0.001), pre-biopsy cerebrospinal fluid (CSF) sampling (OR=5.18, p=0.002), and pre-biopsy immunomodulatory treatment (including high-dose intravenous corticosteroids) for suspected neuroinflammatory disease (OR=6.33, p=0.03) had statistically significant associations with delayed treatment. Antimicrobial treatment before biopsy for suspected CNS infection suggested a trend toward delayed treatment, but the association was not statistically significant (OR=5.1, p=0.06). CONCLUSIONS Multifocal disease and pre-biopsy CSF sampling and immunomodulatory therapy were associated with delayed treatment initiation for CNSL in our single-center cohort. Recognizing factors associated with delayed treatment may allow physicians to circumvent these factors and permit more rapid diagnosis through tissue sampling.

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Serum Micronutrients as related to Childhood Pneumonia Severity and Outcome in a Nigerian Health Facility

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13792 ◽

2021 ◽

Vol 15 (07) ◽

pp. 953-961

Author(s):

Bankole Peter Kuti ◽

Hammed Hassan Adetola ◽

Oyeku Akibu Oyelami

Keyword(s):

Indoor Air Pollution ◽

Health Centre ◽

Severe Pneumonia ◽

Zn Deficiency ◽

Pneumonia Severity ◽

Childhood Pneumonia ◽

Nigerian Children ◽

And Zn Deficiency ◽

Optimal Health ◽

Low Serum

Introduction: Micronutrients are essential minerals and vitamins needed for optimal health. There are however conflicting reports about the roles of micronutrients in severity and outcomes of childhood pneumonia. This study aims to determine the socio-demographic and serum micronutrients – Zinc (Zn), Selenium (Se), Vitamins (Vit) A, C and E status of Nigerian children with or without pneumonia and relate these to pneumonia severity and outcome. Methodology: Children aged two months to 14 years with severe and non-severe pneumonia were recruited with age and sex-matched controls over 12 month period in a Nigerian tertiary health centre. Relevant history and serum micronutrients were compared in the two groups and related to pneumonia severity and length of hospitalisation (LOH). Results: One hundred and forty-four children (72 for each group) were recruited with median (IQR) age 1.6 (0.6 – 4.0) years and fifty-six (38.8%) had severe pneumonia. Pneumonia incidence was associated with undernutrition, inappropriate immunisation and Zn deficiency (p < 0.05). Hypovitaminosis A [60.8(22.2)µg/dl vs. 89.5(34.7)µg/dl; p < 0.001], low serum Zn [71.6(32.5)µg/dl vs. 92.6(24.6)µg/dl; p=0.019] and indoor air pollution (IAP) were associated with pneumonia severity. However, only IAP (OR = 4.529; 95%CI 1.187–17.284; p=0.027) and Zn deficiency (OR=6.144; 95%CI 1.157–32.617; p=0.033) independently predicted severe pneumonia. No significant correlation between serum micronutrients and LOH. Conclusions: Exposure to IAP and low serum micronutrients particularly Zn and Vit A were associated with pneumonia incidence and severity in Nigerian children. Routine micronutrient supplementation may assist to reduce the burden of childhood pneumonia in developing countries.

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Epidemiology and Mortality Predictors for Severe Childhood Pneumonia in ICUs: A Real-World Study in China

10.21203/rs.3.rs-27792/v1 ◽

2020 ◽

Author(s):

lu cao ◽

zhaohua ji ◽

yan zuo ◽

jingwen wang

Keyword(s):

Real World ◽

Age Groups ◽

Severe Pneumonia ◽

Hospital Death ◽

Observation Study ◽

Childhood Pneumonia ◽

Prophylactic Measures ◽

Sedative Hypnotics ◽

Independent Risk Factors ◽

Mortality Predictors

Abstract Background To identify the epidemiology and mortality predictors for severe childhood pneumonia and evaluate the influence of medications on clinical outcome in the real world.Methods We performed a retrospective observation study among children with severe pneumonia aged ≤ 5 years of age, separately comparing the detailed information between the in-hospital death cases and the survival cases in two different age groups. Multivariate regression model was used to figure out mortality predictors.Results 945 children were recruited, including 604 infants and 341 young children. Overall 88 deaths occurred (9.3%). There was low adherence to guidelines in antimicrobials and carbapenems were widely served as initial empiric regimens, but the efficacy was not superior to the guidelines recommended. In multivariate analyses, very severe pneumonia (OR: 3.55; 95% CI: 1.39–9.09), lower birth weight (OR: 3.92; 95% CI: 1.50-10.23), severe underweight (OR: 4.72; 95% CI: 1.92–11.62), mechanical ventilation (OR: 5.06; 95% CI: 1.97–12.95;OR: 14.43; 95% CI 3.31–62.96),comorbidity including anemia (OR: 5.61; 95% CI: 2.36–13.35), neonatal asphyxia (OR: 6.03; 95% CI: 1.57–23.12), gastrointestinal hemorrhage (OR: 3.73; 95% CI: 1.21–11.48) and sedative-hypnotics ( OR: 4.32; 95% CI: 1.76–10.61; OR: 4.13; 95% CI༚1.50-11.38) were independent risk factors for death, whereas a lower mortality was present in infants with probiotics (OR: 0.24; 95% CI: 0.10–0.54).Conclusions Severe pneumonia remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidity and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of the mortality predictors and establish prophylactic measures to reduce the mortality.

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Application of Long Endurance UAS for Top-Down Methane Emission Measurements of Oil and Gas Facilities in an Offshore Environment

10.2118/205467-ms ◽

2021 ◽

Author(s):

Charles Alexander Tavner ◽

Daniel Francis Touzel ◽

Brendan James Smith

Keyword(s):

Oil And Gas ◽

Methane Emissions ◽

Unmanned Aircraft ◽

Measurement Technology ◽

Top Down ◽

Long Distance ◽

Novel Approach ◽

Net Zero ◽

Facility Level ◽

Individual Asset

Abstract Oil & gas (O&G) operators are increasingly focused on decarbonization and reaching net-zero carbon emissions. The O&G industry seeks to minimise methane emissions. Verification of estimated emissions using top down measurement methods represents a critical component of this effort. A novel approach to operationalizing top-down emissions surveys was developed and demonstrated, leveraging expertise in unmanned vehicle application, innovative methane emissions measurement technology, and an O&G industry collaborator. The inspection technique utilizes a fixed-wing unmanned aircraft to perform a remote offshore asset inspection while safely launching and recovering onshore. This method enables the collection of many tens of thousands individual point methane concentration measurements and affords the ability to resolve facility-level methane emissions and in conjunction with appropriate environmental conditions information, derive an accurate emission rate for an individual asset, while accounting for background fluctuation and potential upwind sources.The unmanned aircraft does not require any crew or equipment to be taken offshore or make modifications to the asset, thus allowing inspections to be performed with minimum impact to facility operations. This work overcame significant regulatory hurdles to fly long distance unmanned aircraft in congested airspace, developed detailed operational procedures and demonstrated the safety of the technique to both the O&G and aviation community, and the effectiveness of the measurement technology. The work demonstrated the suitability of the technique for operationalisation for routine measurement programmes.

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Socioeconomic status and fertility in rural Bangladesh

Journal of Biosocial Science ◽

10.1017/s0021932000015480 ◽

1985 ◽

Vol 17 (1) ◽

pp. 81-89 ◽

Cited By ~ 34

Author(s):

K. Shaikh ◽

S. Becker

Keyword(s):

Diarrhoeal Disease ◽

Demographic Surveillance System ◽

Occupational Groups ◽

Rural Bangladesh ◽

Disease Research ◽

Registration Data ◽

Fertility Differentials ◽

Education Of Women ◽

Lower Fertility ◽

Household Heads

SummaryUsing a unique set of birth registration data from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, for the period 1974–77, and socioeconomic information collected in the 1974 census, fertility was studied in relation to occupation, size of dwelling, number of cows and number of boats owned. The total fertility rate was found to vary between 6 and 6·5 except in the famine year of 1975. There was no consistent relationship between fertility and education of women. Fertility differentials by occupation showed that the household heads who were farm labourers had relatively lower fertility compared to other occupational groups, except for the year 1977 where the families of service holders were found to have relatively lower fertility. There was a consistent direct relationship between the dwelling size and fertility for each of the years.

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Mothers’ Perception and Healthcare Seeking Behavior of Pneumonia Children in Rural Bangladesh

ISRN Family Medicine ◽

10.1155/2014/690315 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Farzana Ferdous ◽

Fahmida Dil Farzana ◽

Shahnawaz Ahmed ◽

Sumon Kumar Das ◽

Mohammad Abdul Malek ◽

...

Keyword(s):

Cold Water ◽

Group Discussion ◽

Signs And Symptoms ◽

Healthcare Facility ◽

Dust Particles ◽

Childhood Pneumonia ◽

Healthcare Seeking ◽

Rural Bangladesh ◽

Seeking Behavior ◽

Healthcare Seeking Behavior

We describe mothers’ perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers’ perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers (n=24) could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia.

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