Outcome of infants with 10 min Apgar scores of 0–1 in a low-resource setting

2021 ◽  
pp. fetalneonatal-2021-322545
Author(s):  
Thorkild Tylleskär ◽  
Francesco Cavallin ◽  
Susanna Myrnerts Höök ◽  
Nicolas J Pejovic ◽  
Clare Lubulwa ◽  
...  
Keyword(s):  
Delivery Room ◽  
Apgar Scores ◽  
Low Resource Settings ◽  
Low Resource ◽  
High Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Mulago National Referral Hospital ◽  
Term Newborns

BackgroundIn high-resource settings, postponing the interruption of cardiopulmonary resuscitation from 10 to 20 min after birth has been recently suggested, but data from low-resource settings are lacking. We investigated the outcome of newborns with Apgar scores of 0–1 at 10 min of resuscitative efforts in a low-resource setting.MethodsThis observational substudy from the NeoSupra trial included all 49 late preterm/full-term newborns with Apgar scores of 0–1 at 10 min of resuscitation. The study was carried out at Mulago National Referral Hospital (Kampala, Uganda) between May 2018 and August 2019. Outcome measures were mortality and hypoxic-ischaemic encephalopathy in the first week of life. All resuscitations were video recorded and daily reviewed by trial researchers.ResultsMedian duration of resuscitation was 32 min (IQR 17–37). Advanced resuscitation was provided to 21/49 neonates (43%). Overall, 48 neonates (98%) died within 2 days of life (44 in the delivery room, three on the first day and one on the second day) and one survived at 1 week with severe hypoxic-ischaemic encephalopathy.ConclusionOur study adds information from a low-resource setting to the recent evidence from high-resource settings about prolonging the resuscitation in infants with Apgar scores of 0–1 at 10 min. The vast majority died in the delivery room despite prolonged resuscitative efforts. We confirm that duration of resuscitation should be tailored to the setting, while the focus in low-resource settings should be improving the quality of antenatal and immediately after birth care.

scholarly journals Performance of colposcopic scoring by modified International Federation of Cervical Pathology and Colposcopy terminology for diagnosing cervical intraepithelial neoplasia in a low-resource setting

2019 ◽  
Vol 08 (04) ◽  
pp. 218-220 ◽  
Author(s):  
Prabhakaran Nair Rema ◽  
Aleyamma Mathew ◽  
Shaji Thomas
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Scoring Systems ◽  
Intraepithelial Neoplasia ◽  
International Federation ◽  
Screening Tests ◽  
Substantial Agreement ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Abstract Introduction: Colposcopy is a tool to evaluate women with cervical pre-cancer and cancer. To interpret the colposcopic findings, various scoring systems are used but with inter observer variations. To improve the quality of colposcopy, International Federation of Cervical Pathology and Colposcopy (IFCPC) has introduced a colposcopic nomenclature in 2011. Colposcopic scoring helps to select patients who need treatment for cervical intraepithelial neoplasia. Aim of the Study: The study aimed to evaluate the agreement between colposcopic diagnosis with the modified IFCPC terminology and cervical pathology in patients with abnormal screening tests and to assess the utility of this colposcopic scoring system in low resource settings. Methodology: Patients with abnormal screening tests who underwent colposcopic assessment in the department of Gynaecological oncology were included in the study. Colposcopic scoring was done by the modified IFCPC nomenclature. The results were compared with cytology and the final histopathology. Results: 56 patients were included in the study. The colposcopic scoring when compared to histopathology showed agreement in 65.7% which indicated the agreement was substantial and was statistically significant (P = 0.0001). With cytology the colposcopic score showed agreement in 35.6% indicating a fair agreement and this was also statistically significant (P = 0.001). Conclusion: Colposcopic scoring by modified IFCPC 2011 criteria showed substantial agreement with cervical histopathology. Compared to traditional methods, 2011 international terminology of colposcopy could improve colposcopic accuracy.

Context

2020 ◽  
pp. 1-20
Author(s):  
Tom Bashford ◽  
Julian Gore-Booth ◽  
Jo James ◽  
Stephen Pickering ◽  
Becky Paris ◽  
...  
Keyword(s):  
Local Context ◽  
Technical Aspects ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Clinical Background ◽  
Developmental Principles ◽  
The Way

The chapter provides the reader with information on the non-clinical background to working as an anaesthetist in a low-resource setting. It concentrates on important concepts that should inform the way you practise and teach, rather than technical aspects of anaesthesia. Although technical aspects of delivering anaesthesia are usually uppermost in the minds of anaesthetists new to working in low-resource settings, it is often the case that adapting successfully to the local context proves the more challenging aspect. Topics covered include humanitarian and developmental principles, teaching anaesthesia, looking after your own health, being a good visitor, and how to adapt your practice.

scholarly journals Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

2021 ◽  
Vol 6 (6) ◽  
pp. e005190
Author(s):  
Chanel van Zyl ◽  
Marelise Badenhorst ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Content Analysis ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

scholarly journals Outcomes of Treatment With CHOP and EPOCH in Patients With HIV Associated NHL in a Low Resource Setting

2020 ◽  
Author(s):  
Clement Dove Okello ◽  
Abrahams Omoding ◽  
Henry Ddungu ◽  
Yusuf Mulumba ◽  
Jackson Orem
Keyword(s):  
Retrospective Study ◽  
Adverse Events ◽  
Overall Response Rate ◽  
Survival Rates ◽  
Curative Intent ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP=13, 12%; DA-EPOCH=2, 17%), anaemia (CHOP=12, 12%; DA-EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; DA-EPOCH=0), sepsis (CHOP=1), treatment related death (DA-EPOCH=1) and hepatic encephalopathy (CHOP=1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with >50% one year survival.

Tropical Medicine for Anaesthetists

2020 ◽  
pp. 297-318
Author(s):  
Victoria Howell
Keyword(s):  
Clinical Features ◽  
Tropical Medicine ◽  
Tropical Diseases ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Significant Burden

Many tropical diseases will be unfamiliar to anaesthetists from high-resource settings but are common in low- and middle-income countries. They lead to a significant burden of morbidity and mortality, and some knowledge of the commonly presenting ones and how they might impact on conduct of anaesthesia is essential to anaesthetists practising in these settings. The chapter covers the essentials of several tropical diseases including malaria, tuberculosis, cholera, and typhoid. The chapter outlines for each disease the aetiology, pathophysiology, clinical features, diagnosis, management, and anaesthetic implications. Diseases that are also found in high-resource settings, such as diarrhoea and HIV, are also covered on the basis that they are much more likely to be encountered in a low-resource setting.

scholarly journals “There is no time for knowing each other”: Quality of care during childbirth in a low resource setting

Midwifery ◽  
2019 ◽  
Vol 75 ◽  
pp. 33-40 ◽  
Author(s):  
Florence Mgawadere ◽  
Helen Smith ◽  
Atnafu Asfaw ◽  
Jaki Lambert ◽  
Nynke van den Broek
Keyword(s):  
Quality Of Care ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Typhoidal Salmonella human challenge studies: ethical and practical challenges and considerations for low-resource settings

Trials ◽  
2019 ◽  
Vol 20 (S2) ◽  
Author(s):  
Meriel Raymond ◽  
Malick M. Gibani ◽  
Nicholas P. J. Day ◽  
Phaik Yeong Cheah
Keyword(s):  
Careful Consideration ◽  
Human Infection ◽  
Genetic Profile ◽  
Close Monitoring ◽  
Low Resource Settings ◽  
Low Resource ◽  
Endemic Setting ◽  
High Resource ◽  
Resource Setting ◽  
The Individual

AbstractTyphoidal Salmonella is a major global problem affecting more than 12 million people annually. Controlled human infection models (CHIMs) in high-resource settings have had an important role in accelerating the development of conjugate vaccines against Salmonella Typhi.The typhoidal Salmonella model has an established safety profile in over 2000 volunteers in high-income settings, and trial protocols, with modification, could be readily transferred to new study sites. To date, a typhoidal Salmonella CHIM has not been conducted in a low-resource setting, although it is being considered.Our article describes the challenges posed by a typhoidal Salmonella CHIM in the high-resource setting of Oxford and explores considerations for an endemic setting.Development of CHIMs in endemic settings is scientifically justifiable as it remains unclear whether findings from challenge studies performed in high-resource non-endemic settings can be extrapolated to endemic settings, where the burden of invasive Salmonella is highest. Volunteers are likely to differ across a range of important variables such as previous Salmonella exposure, diet, intestinal microbiota, and genetic profile. CHIMs in endemic settings arguably are ethically justifiable as affected communities are more likely to gain benefit from the study. Local training and research capacity may be bolstered.Safety was of primary importance in the Oxford model. Risk of harm to the individual was mitigated by careful inclusion and exclusion criteria; close monitoring with online diary and daily visits; 24/7 on-call staffing; and access to appropriate hospital facilities with capacity for in-patient admission. Risk of harm to the community was mitigated by exclusion of participants with contact with vulnerable persons; stringent hygiene and sanitation precautions; and demonstration of clearance of Salmonella infection from stool following antibiotic treatment.Safety measures should be more stringent in settings where health systems, transport networks, and sanitation are less robust.We compare the following issues between high- and low-resource settings: scientific justification, risk of harm to the individual and community, benefits to the individual and community, participant understanding, compensation, and regulatory requirements.We conclude that, with careful consideration of country-specific ethical and practical issues, a typhoidal Salmonella CHIM in an endemic setting is possible.

scholarly journals Comparison Of Treatment Outcomes Between Epoch And Chop Regimens In Patients With Hiv Associated Nhl In A Low Resource Setting

2020 ◽  
Author(s):  
Clement Dove Okello ◽  
Abrahams Omoding ◽  
Henry Ddungu ◽  
Yusuf Mulumba ◽  
Jackson Orem
Keyword(s):  
Retrospective Study ◽  
Adverse Events ◽  
Overall Response Rate ◽  
Survival Rates ◽  
Curative Intent ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with EPOCH and CHOP regimens at the Uganda Cancer Institute.Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done.Results: One hundred eight patients treated with CHOP and 12 patients treated with EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with EPOCH. The observed survival rates differences were not statistically different between the two groups; hazard ratio, 0.43 (95% CI, 0.10 - 1.78; p=0.24). Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the EPOCH group; these were neutropenia (CHOP=13, 12%; EPOCH=2, 17%), anaemia (CHOP=12, 12%; EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; EPOCH=0), sepsis (CHOP=1), treatment related death (EPOCH=1) and hepatic encephalopathy (CHOP=1).Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional EPOCH is feasible in low resource settings and associated with >50% one year survival.

scholarly journals Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

2022 ◽  
Vol 3 (1) ◽  
pp. 1-4
Author(s):  
Subhashchandra Daga
Keyword(s):  
Nursing Staff ◽  
Health Workers ◽  
Newborn Care ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
General Duty ◽  
Care Services ◽  
Resource Setting ◽  
Low Resource Setting

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

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