scholarly journals Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

2021 ◽  
Vol 6 (5) ◽  
pp. e004475
Author(s):  
Grace Irimu ◽  
Jalemba Aluvaala ◽  
Lucas Malla ◽  
Sylvia Omoke ◽  
Morris Ogero ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Income ◽  
Universal Access ◽  
Low Cost ◽  
Newborn Care ◽  
Routine Data ◽  
Public Hospitals ◽  
Childhood Mortality ◽  
Age Group ◽  
Common Diagnosis

BackgroundMost of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.MethodsContinuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.FindingsDuring the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.InterpretationThe high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight.

scholarly journals Fe0/H2O Filtration Systems for Decentralized Safe Drinking Water: Where to from Here?

Water ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 429 ◽  
Author(s):  
Charles Nanseu-Njiki ◽  
Willis Gwenzi ◽  
Martin Pengou ◽  
Mohammad Rahman ◽  
Chicgoua Noubactep
Keyword(s):  
Drinking Water ◽  
Low Income ◽  
Universal Access ◽  
Low Cost ◽  
Low Income Countries ◽  
Future Research ◽  
Systematic Research ◽  
Safe Drinking Water ◽  
Iron Corrosion ◽  
Small Communities

Inadequate access to safe drinking water is one of the most pervasive problems currently afflicting the developing world. Scientists and engineers are called to present affordable but efficient solutions, particularly applicable to small communities. Filtration systems based on metallic iron (Fe0) are discussed in the literature as one such viable solution, whether as a stand-alone system or as a complement to slow sand filters (SSFs). Fe0 filters can also be improved by incorporating biochar to form Fe0-biochar filtration systems with potentially higher contaminant removal efficiencies than those based on Fe0 or biochar alone. These three low-cost and chemical-free systems (Fe0, biochar, SSFs) have the potential to provide universal access to safe drinking water. However, a well-structured systematic research is needed to design robust and efficient water treatment systems based on these affordable filter materials. This communication highlights the technology being developed to use Fe0-based systems for decentralized safe drinking water provision. Future research directions for the design of the next generation Fe0-based systems are highlighted. It is shown that Fe0 enhances the efficiency of SSFs, while biochar has the potential to alleviate the loss of porosity and uncertainties arising from the non-linear kinetics of iron corrosion. Fe0-based systems are an affordable and applicable technology for small communities in low-income countries, which could contribute to attaining self-reliance in clean water supply and universal public health.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

scholarly journals Maternal, social and health factors influencing admission of newborns to the special newborn care unit at Kakinada, India

2020 ◽  
Vol 7 (4) ◽  
pp. 1504
Author(s):  
Suhasini Vasireddy ◽  
G. Krishna Babu ◽  
Jhansi Nadipena ◽  
Thej Kiran Reddy Dalli ◽  
Krishna Kishore Aligina ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Income ◽  
Statistical Significance ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Low Literacy ◽  
Maternal Risk ◽  
Substantial Progress ◽  
The Mean ◽  
Antenatal Visits

Background: Substantial progress has been made in reducing under five mortality, infant mortality in the last two decades. We need to focus our attention in reducing neonatal mortality.Methods: Setting and design was observational study in SNCU of Government General Hospital, Kakinada. Data collected using semi-structured questionnaire and Hospital Records of mother and newborn. Analysis was done using MS EXCEL2007 and SPSS 20 software. Sample size and time period was a convenient sample of 300 mothers were interviewed from Jan- June, 2018.Results: The mean age of the mothers in the study is 23.39±3.195 years and age at marriage is 19.12±2.29 years. 79% of study population belong to lower social classes. Maternal risk factors-35.6 % are pre-obese or obese and 9.3% underweight, 11.3% had <4 antenatal visits, 87.33% (262) had anemia, 18.33% (55) had PIH. The mean birth weight of newborns was 2601±0.93 grams. 58.3% are preterm and 38.3% (115) low birth weight. 46.33% (139) of newborn admissions were due to birth asphyxia, 27.33% (82) jaundice 9.66% (29) convulsions, 6.66% (20) congenital anomalies, 4% (12) sepsis.Conclusions: Low income, low literacy and less no of antenatal visits showed an association with maternal anemia and LBW (statistically not significant). Upon regression analysis age of mother and gestational period were the only factors with statistical significance.

scholarly journals The Raspberry Pi as a Computer Substitute at Elementary Schools in Developing Countries: A Pilot Experiment in Ecuador

2018 ◽  
Vol 210 ◽  
pp. 04023 ◽  
Author(s):  
Alfredo Nuñez-Unda ◽  
Angelo Vera ◽  
Lidice Haz ◽  
Viviana Pinos ◽  
Roberto Zurita ◽  
...  
Keyword(s):  
Developing Countries ◽  
Low Income ◽  
Universal Access ◽  
Low Cost ◽  
Developed Countries ◽  
Raspberry Pi ◽  
Pilot Experiment ◽  
Countries In Transition ◽  
The Government ◽  
Technology And Communication

One of the main challenges of developing countries is to shorten the digital divide that exists with developed countries and countries in transition. The government of Ecuador through its National Plan for Technologies and Telecommunications (Plan Nacional de Telecomunicaciones y Tecnologías), has as a goal to give universal access to Technologies of Information and Communication (TICs) to its entire citizens. One of its projects is to assure connectivity and infrastructure in schools. This paper proposes a low-cost open source solution to improve the access to information technology and communication through computers to children of schools in low income areas. The proposed alternative was set out to using the Raspberry Pi 3 s a substitute of standard computer. Its performance and capabilities were put to test comparing them to standard PC main functions. the pilot experiment was implemented at the "Ciudad de Ariel" elementary school, located on Durán, Ecuador.

scholarly journals Early growth and markers of cardiovascular risk in Keralan children in the Integrated Child Development Scheme

2009 ◽  
Vol 13 (7) ◽  
pp. 1042-1048 ◽  
Author(s):  
Nick Brown ◽  
Chaniyil Krishnan Sasidharan ◽  
David Fisher
Keyword(s):  
Birth Weight ◽  
Child Development ◽  
Universal Access ◽  
Low Cost ◽  
Fat Distribution ◽  
Postnatal Growth ◽  
Maternal Child Health ◽  
Childhood Growth ◽  
Development Scheme ◽  
Early Markers

AbstractObjectiveLow birth weight is associated with increased lifelong morbidity. Kerala has a renowned, low-cost, maternal–child health system in which is couched universal access to the Integrated Child Development Scheme (ICDS), central to which is community-based maternal–infant nutritional supplementation. We assessed whether children in this environment showed enhanced birth weight and postnatal growth and whether the evolution of early markers of CVD was attenuated in comparison to contemporaries from other states.DesignA part retrospective, part prospective cohort study in which children (n 286) born in 1998–2000 in Calicut were identified from Anganwadi records. They were traced at 6 years and underwent full anthropometry and blood pressure measurements at 6 and 8 years.ResultsMean birth weight (2·86 (sd 0·40) kg) was greater than in Indian contemporaries but consistently <−1sd below the National Center for Health Statistics reference median throughout childhood. Birth weight significantly predicted body mass (BMI) at 8 years. Lower birth weight was strongly predictive of a higher waist:hip ratio (WHR) indicative of adverse central (coelomic) fat distribution (P < 0·01). Faster weight gain in infancy was weakly predictive of a lower WHR (P = 0·59), but faster late childhood growth at 6–8 years was non-significantly predictive of adverse WHR.ConclusionsAt 8 years of age, children in Calicut participating in the ICDS have greater birth weight and relative attenuation of the evolution of early CVD markers compared with children in apparently comparable states. The relative contributions of the ICDS and other factors inherent to Kerala cannot be inferred from the present study.

‘Top-down’ planning for scalable sustainable sanitation in high-density low-income urban areas: is it more appropriate than ‘bottom-up’ planning?

2018 ◽  
Vol 8 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Duncan Mara
Keyword(s):  
Developing Countries ◽  
Low Income ◽  
Urban Areas ◽  
Universal Access ◽  
Low Cost ◽  
High Density ◽  
Top Down ◽  
Bottom Up ◽  
The Sustainable Development ◽  
Sanitation Systems

Abstract We argue that, if the sanitation target of the Sustainable Development Goals (universal access to ‘safely-managed’ sanitation by 2030) is to have any chance of success, then a community-sensitive top-down planning approach has to be adopted for sanitation provision in high-density low-income urban areas in developing countries, as ‘bottom-up’ planning is much more time-consuming and not yet successfully proven at scale. In high-density low-income urban areas, there is only a limited choice for safely-managed sanitation: (i) simplified/condominial sewerage (which becomes cheaper than on-site sanitation systems at the relatively low population densities of 160–200 people per ha), (ii) low-cost combined sewerage (if it is cheaper than separate simplified sewerage and stormwater drainage), (iii) community-managed sanitation blocks, and (iv) container-based sanitation (the last two of which are suitable, especially in slums, when neither simplified sewerage nor low-cost combined sewerage is affordable or technically feasible). These four sustainable sanitation options are as scalable in developing countries as conventional sewerage has been in industrialized countries.

scholarly journals Use and Quality of Cesarean Delivery in a Low and Middle Income Setting: National Results from Two Emergency Obstetric and Newborn Care Assessments

2020 ◽  
Author(s):  
Misrak Getnet Beyene ◽  
Theodros Getachew Zemedu ◽  
Azmach Hadush Gebregiorgis ◽  
Ana Lorena Ruano ◽  
Patricia E Bailey
Keyword(s):  
Cesarean Delivery ◽  
Low Income ◽  
Unmet Need ◽  
Newborn Care ◽  
Public Hospitals ◽  
Middle Income ◽  
For Profit ◽  
Robson Classification ◽  
Hospital Readiness

Abstract Background: Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in CD rates and the capacity of the Ethiopian health system to deliver quality CD services, highlighting the role of the management sector.Methods: We compare results from two national cross-sectional emergency obstetric and newborn care assessments using descriptive statistics. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 CD case reviews in 2008 and 568 in 2016. Our primary outcome measures include population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management; and the relative size of Robson classification groupsResults: The national population-based rate increased (< 1% to 2.7%) as did all regional rates. Rates ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in the private for-profit sector in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and for-profit hospitals. Only half of the women whose cases were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9% to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, a third of case reviews from the public sector were among low-risk nulliparous women (Robson group 1).Conclusions: Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.

Treadle pump: A low cost irrigation option for marginal farmers

2018 ◽  
Vol 5 (03) ◽  
Author(s):  
ATIQUR RAHMAN ◽  
ASHUTOSH UPADHYAYA ◽  
BP BHATT
Keyword(s):  
Low Cost ◽  
Water Productivity ◽  
High Water ◽  
Water Saving ◽  
Age Group ◽  
Male And Female ◽  
Human Power ◽  
Dry Spells ◽  
Supplementary Irrigation ◽  
Land Holdings

The population of marginal farmers in India is bound to increase due to continued division of farm holdings. Characteristically, marginal farmers are having more family labours but the production and productivity of their land holdings is low. The foremost reason behind this is the erratic rainfall and lack of assure supplementary irrigation during long dry spells. This paper presents the scope and applicability of a diaphragm based treadle pump in Bihar where groundwater is abundant and available at shallow depths round the year. Therefore, this pump could be very useful for marginal farmers in improving production and productivity of their tiny piece of land, as it uses human power and can be operated by male and female of age group 32- 45 years and lifts water from a depth ranging from 0- 30 feet. The water saving technologies such as bucket kit drum kit etc. could be used with this pump to irrigate the crops with high water productivity.

Issues of geriatric otolaryngologic emergency have not been widely applied despite increase in geriatric population. (Preprint)

2019 ◽  
Author(s):  
Waheed Atilade Adegbiji ◽  
Shuaib Kayode Aremu ◽  
AbdulAkeem Adebayo Aluko
Keyword(s):  
Foreign Body ◽  
Head And Neck ◽  
Clinical Features ◽  
University Teaching ◽  
Age Group ◽  
Geriatric Population ◽  
Female Ratio ◽  
Common Diagnosis ◽  
Foreign Body Impaction ◽  
Nose And Throat

BACKGROUND Issues of geriatric otolaryngologic emergency have not been widely applied despite increase in geriatric population. OBJECTIVE This study aimed at determining prevalence, sociodemographic features, aetiology, clinical features, Complications and sources ofreferral of geriatric otorhinolaryngological, head and neck emergency in our center. METHODS This was a prospective hospital based study of geriatric otorhinolaryngology emergency in the Ear, Nose and Throat Department of Ekiti State University Teaching Hospital. The study was carried out between October 2016 and September 2018. Data were obtained by using pretested interviewers questionnaire.All data were collated and analyzed using SPSS version 18.0. The data were expressed by frequency table, percentage, bar charts and pie charts. RESULTS Geriatric otorhinolaryngology, head and neck emergency accounted for 5.3%. Major prevalence age group was 43.9% in the age group (60-64). There were 38.6% males with male to female ratio of 1:1.5. The main aetiology of geriatric otorhinolaryngology emergency was 29.5% trauma/road traffic accident/foreign body impaction and 25.8% tumour. Main anatomical distribution of geriatric otorhinolaryngology emergency were 38.6% throat diseases and 31.1% ear diseases. The most frequent clinical features were pain in 27.3%, hearing loss in 21.2%, tinnitus in 15.9%, bleeding in 14.4%, difficulty breathing in 12.9% and discharge in 11.4%. Common diagnosis in this study were 15.9% sinonasal tumour, 14.4% upper aerodigestive foreign body impaction, 10.6% earwax impaction and 19.8% otitis externa. Acute presentation (<13 weeks) occurred in 1 week in 74.2% and 2-13 weeks In 19.7%. Commonest time of presentation was daytime in 65.9%. Major sources of referral were 43.2% general practitioner and 31.1% casualty officers. Presentation of geriatric otorhinolaryngology emergency were mainly ear, nose and throat clinic in 59.8% with accident and emergency in 28.8%. Commonest associated comorbid illnesses among the geriatric patients were 18.2% hypertension, 14.4% arthritis and 9.8% diabetes mellitus. CONCLUSIONS Geriatric otorhinolaryngological emergency are common pathology with associated with comorbid illnesses. Detailed clinical assessment are mandatory for effective management outcome.

scholarly journals Clinical Profile of Acute Poisoning in Children at a Teaching Hospital in Lalitpur

2014 ◽  
Vol 34 (2) ◽  
pp. 100-103 ◽  
Author(s):  
Ajaya Kumar Dhakal ◽  
D Shrestha ◽  
A Shakya ◽  
SC Shah ◽  
H Shakya
Keyword(s):  
Teaching Hospital ◽  
Hospital Admissions ◽  
Acute Poisoning ◽  
Childhood Mortality ◽  
Age Group ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
History Of ◽  
The Common ◽  
Poisoning In Children

Introduction: Acute poisonings are one of the common cause of emergency visits and hospital admissions and is potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the common age group in which the incidence of poisoning was high.Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from 2009 July to 2014 January.Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1days and mean age of poisoning was 7.8 years with a male(54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours.Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. Young children were most vulnerable for acute poisoning.DOI: http://dx.doi.org/10.3126/jnps.v34i2.10139J Nepal Paediatr Soc 2014;34(2):100-103 

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