scholarly journals Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

2021 ◽  
Vol 6 (12) ◽  
pp. e006788
Author(s):  
Edwin Charles Ernest ◽  
Augustino Hellar ◽  
John Varallo ◽  
Leopold Tibyehabwa ◽  
Margaret Mary Bertram ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Safety ◽  
Safe Surgery ◽  
Low Middle Income Countries ◽  
Utilisation Rate ◽  
Surgical Teams ◽  
The Impact

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

scholarly journals Prevalence and correlates of adherence to movement guidelines among urban and rural children in Mozambique: a cross-sectional study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Taru Manyanga ◽  
Joel D. Barnes ◽  
Jean-Philippe Chaput ◽  
Peter T. Katzmarzyk ◽  
Antonio Prista ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sleep Duration ◽  
Screen Time ◽  
Cross Sectional Study ◽  
Rural Children ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Abstract Background Insufficient physical activity, short sleep duration, and excessive recreational screen time are increasing globally. Currently, there are little to no data describing prevalences and correlates of movement behaviours among children in low-middle-income countries. The few available reports do not include both urban and rural respondents, despite the large proportion of rural populations in low-middle-income countries. We compared the prevalence of meeting 24-h movement guidelines and examined correlates of meeting the guidelines in a sample of urban and rural Mozambican schoolchildren. Methods This is cross-sectional study of 9–11 year-old children (n = 683) recruited from 10 urban and 7 rural schools in Mozambique. Moderate- to vigorous-intensity physical activity (MVPA) and sleep duration were measured by waist-worn Actigraph GT3X+ accelerometers. Accelerometers were worn 24 h/day for up to 8 days. Recreational screen time was self-reported. Potential correlates of meeting 24-h movement guidelines were directly measured or obtained from validated items of context-adapted questionnaires. Multilevel multivariable logit models were used to determine the correlates of movement behaviours. Meeting 24-h movement guidelines was defined as ≥60 min/day of MVPA, ≤2 h/day of recreational screen time, and between 9 and 11 h/night of sleep. Results More rural (17.7%) than urban (3.6%) children met all three 24-h movement guidelines. Mean MVPA was lower (82.9 ± 29.5 min/day) among urban than rural children (96.7 ± 31.8 min/day). Rural children had longer sleep duration (8.9 ± 0.7 h/night) and shorter recreational screen time (2.7 ± 1.9 h/day) than their urban counterparts (8.7 ± 0.9 h/night and 5.0 ± 2.3 h/day respectively). Parental education (OR: 0.37; CI: 0.16–0.87), school location (OR: 0.21; CI: 0.09–0.52), and outdoor time (OR: 0.67; CI: 0.53–0.85) were significant correlates of meeting all three 24-h movement guidelines. Conclusions Prevalence and correlates of meeting movement guidelines differed between urban and rural schoolchildren in Mozambique. On average, both groups had higher daily MVPA minutes, shorter sleep duration, and higher recreational screen time than the 24-h movement guidelines recommend. These findings (e.g., higher than recommended mean daily MVPA minutes) differ from those from high-income countries and highlight the need to sample from both urban and rural areas.

scholarly journals Survey of the pattern of antibiotic dispensing in private pharmacies in Nepal

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032422 ◽  
Author(s):  
Anant Nepal ◽  
Delia Hendrie ◽  
Suzanne Robinson ◽  
Linda A Selvey
Keyword(s):  
Respiratory Infections ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Study Data ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Middle Income ◽  
Frequency Distributions ◽  
Low Middle Income Countries

ObjectivesPrivate pharmacies are widely established in most low/middle-income countries (LMICs) including Nepal, and are often considered as a patient’s first point of contact for seeking healthcare. The aim of this study was to investigate the pattern of antibiotic dispensing in private pharmacies through exit interviews with patients to review their medication information.Design and settingCross-sectional study. Data collection was carried out in 60 days at 33 randomly selected private pharmacies in the Rupandehi district of Nepal.ParticipantsPatients attending private pharmacies (n=1537).Main outcome measureThe pattern of antibiotic prescribing and dispensing was investigated using WHO’s core prescribing indicator, ‘the percentage of patients prescribed an antibiotic’. Frequency distributions were presented based on patients’ characteristics, sources of antibiotic, registration status of pharmacies and education of the pharmacist or drug retailer, and disease or condition. χ2tests and regression analysis were applied to explore factors associated with the pattern of antibiotic dispensing.ResultsOf patients attending private pharmacies, the proportion receiving at least one antibiotic (38.4%) was above the WHO recommended value (20.0%–26.8%). The most commonly dispensed antibiotics were cefixime (16.9%) and the third-generation cephalosporins (38.0%) class. High dispensing rates of antibiotics for selected conditions (eg, respiratory infections, diarrhoeal cases) appeared contrary to international recommendations. The percentage of antibiotic dispensed was highest for patients who obtained their medicines from unlicensed pharmacies (59.1%). Young people were more likely to receive antibiotics than other age groups.ConclusionsThe antibiotic dispensing pattern from private pharmacies in Nepal was high compared with WHO guidelines, suggesting initiatives to reduce inappropriate use of antibiotics should be implemented. The findings of this study may be generalisable to other LMICs in order to assist in developing policies and guidelines to promote more appropriate dispensing and prescribing practices of antibiotics and limit the spread of antibiotic resistance.

scholarly journals The Impact of COVID-19 on the Working Equid Community: Responses from 1530 Individuals Accessing NGO Support in 14 Low- and Middle-Income Countries

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1363
Author(s):  
Isabella Wild ◽  
Amy Gedge ◽  
Jessica Burridge ◽  
John Burford
Keyword(s):  
Household Income ◽  
Cross Sectional Study ◽  
Monthly Income ◽  
Cross Sectional ◽  
Daily Lives ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
The Impact

The COVID-19 pandemic was declared on 11 March 2020. The working equid community includes some of the world’s most marginalised people, who rely on animals for their daily lives and livelihoods. A cross-sectional study investigated the effects of COVID-19 on working equid communities, with the intention of developing methods for replication in future unprecedented events. A multi-language survey was developed, involving 38 predominantly closed questions, and carried out face-to-face, over telephone, or online. There were 1530 respondents from a population of individuals who received support from equid welfare projects across 14 low- or middle-income countries projects during November and December 2020. Overall, at the time of survey completion, 57% (875/1522) of respondents reported that their equids were working less, 76% (1130/1478) reported a decreased monthly income from equids, and 78% (1186/1519) reported a reduction in household income compared to pre-pandemic levels. Costs of equid upkeep remained the same for 58% (886/1519) of respondents and 68% (1034/1518) reported no change in the health of their equid. The potential long-term impacts on human and equid welfare due to reported financial insecurities necessitates monitoring. A One Welfare approach, involving collaboration with governments, humanitarian, and animal welfare non-governmental organisations is required to mitigate deep-rooted issues.

scholarly journals Tropheryma whipplei in Immunocompromised Children in Iran: A Preliminary Study

2021 ◽  
Author(s):  
Saeed Shams ◽  
Nilofar Rezaei ◽  
Anna Beltrame ◽  
Lucia Moro ◽  
Chiara Piubelli ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Risk Groups ◽  
Epidemiological Studies ◽  
Cross Sectional Study ◽  
Tropheryma Whipplei ◽  
Lymphocytic Leukemia ◽  
Cross Sectional ◽  
Middle Income ◽  
Non Hodgkin Lymphoma ◽  
Low Middle Income Countries

Background: Tropheryma whipplei is the causative pathogen of Whipple&rsquo;s disease and other acute and chronic manifestations. Children have been identified as reservoirs of this bacterium especially in low-middle income countries. No information is currently available on the dissemination of T. whipplei in Iran. Therefore, the aim of this study was to investigate the presence of T. whipplei in children with immunodeficiency. Methods: This cross-sectional study was performed from July 2018 to February 2019 in Qom province (central Iran). Stool samples were collected from immuno-compromised children. T. whipplei was tested by SYBR Green and Taq-Man Real-time PCR assays. For confirmation, sequencing of the isolated bacteria was done. Results: One hundred and 30 children with a mean age of 56.7 months were enrolled. Acute lymphocytic leukemia was the most reported immunodeficient disease (77%), followed by non-Hodgkin lymphoma and retinoblastoma. The majority of the children were undergoing chemotherapy during the study. Thirteen (10%) children had T. whipplei DNA in the collected stools. Sequencing results confirmed T. whipplei identification in all the cases. Eight out of 70 (11.4%) children under 5 years old resulted positive. Conclusion: This is the first study showing the circulation of T. whipplei among immunocompromised children in Iran. More epidemiological studies are needed to evaluate the prevalence of this pathogen in different risk groups in Iran and to increase the knowledge of its rare clinical manifestations.

scholarly journals Knowledge of Alzheimer’s Disease Among Medical Students of a Medical College

2018 ◽  
Vol 56 (211) ◽  
pp. 666-669 ◽  
Author(s):  
Rachana Sharma ◽  
Subhash Chandra Sharma ◽  
Sudarshan N Pardhan ◽  
Pratikshya Chalise ◽  
Luna Paudel
Keyword(s):  
Medical Students ◽  
Cross Sectional Study ◽  
Health Concern ◽  
First Year ◽  
Cross Sectional ◽  
Middle Income ◽  
Medical College ◽  
Middle Income Countries ◽  
Medical Study ◽  
Low Middle Income Countries

Introduction:Dementia is a public health concern as the prevalence is increasing worldwide with significant increase being in low-middle income countries. However these countries appear to be less prepared in handling this rise in terms of diagnosis and management. Methods: This cross-sectional study was conducted in Kathmandu medical College, from June 2017 to July 2017. Purposive sampling was done and the medical students who were in their first and final year of study were included in the study after obtaining an informed consent. Results: Total 185 students were included in the study, 80 (43.24%) from first year and 105 (56.75%) from final year of medical study. The mean score of knowledge among the students was 17.44± 2.46; 15.32± 1.22 among first year and 19.06± 1.87 among the final year students. Majority of the students said they have heard about dementia however, only 3 (3.75%) of first year and 43 (41.9%) from final year students have either attended a class or CME on dementia Conclusion:The knowledge about dementia was found to be average among medical students but better among final year medical students in comparison to first year. The knowledge was found to be better statistically among those who had either attended a class or CME on dementia or had exposure through different medias. Keywords:alzheimer`s disease; dementia; knowledge; medical students.

scholarly journals Evaluation of a multidisciplinary global health online course in Mexico

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Héctor Carrasco ◽  
Patricia Fuentes ◽  
Itzel Eguiluz ◽  
Cesar Lucio-Ramírez ◽  
Sandra Cárdenas ◽  
...  
Keyword(s):  
Global Health ◽  
Health Systems ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Exact Test ◽  
Health Course ◽  
Development Goals ◽  
Strongly Agree ◽  
The Impact

Abstract Background Global Health Education (GHE) focuses on training proactive global citizens to tackle health challenges in an increasingly interconnected and interdependent world. Studies show that health professionals in training have reported that GHE has improved their teamwork, responsiveness to contextual factors that impact health, and understanding of health systems; however, there is little research on the impact of GHE courses in undergraduate settings, especially in low and middle-income countries (LMICs). Methods Our study analyzes a multidisciplinary online global health course at Tecnologico de Monterrey, México. We conducted a cross-sectional study with pre- and post-design. Students who took the multidisciplinary course of Global Health for Leaders in the Fall of 2019 (n = 153) and Spring of 2020 (n = 348) were selected for this study. Using a five-point Likert scale (strongly agree to strongly disagree), the survey assessed seven competencies as well as questions about course expectations, takeaways, and recommendations to improve the course. We performed descriptive statistical analyses comparing the combined pre-tests (from Fall and Spring cohorts) to the combined post-tests. Fisher’s exact test was used to compare the samples. Results Of the 501 pre-course surveys administered, 456 responses were completed in the pre-course and 435 in the post-course (91% overall response rate). Only 8.7% of the respondents in the pre-course survey strongly agreed that they could describe fundamental aspects of global health such as the Millennium Development Goals or Sustainable Development Goals, in contrast to a 56% of the students who strongly agreed in the post-course survey (p < 0.001). Similar differences were captured in understanding the global burden of disease, social determinants of health, the effects of globalization in health, health systems’ goals and functions, and human rights. 38% felt that the course helped them develop a more empathetic perception of the suffering of others experiencing global health-related issues. Conclusion In this study, we have presented our experience in teaching an online global health course for multidisciplinary undergraduates in a LMIC. The competencies reported by our students indicate that the course prepared them to confront complex global health issues.

scholarly journals Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5724 ◽  
Author(s):  
Ainslie Lavers ◽  
Wai Siong Yip ◽  
Bruce Sunderland ◽  
Richard Parsons ◽  
Sarah Mackenzie ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Breast Surgery ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Drug Dosage ◽  
Cross Sectional Study ◽  
Infection Prevalence ◽  
Cross Sectional ◽  
The Impact

Background Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Method A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017. Results Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306). Conclusion These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p =  < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies.

Implementation of the surgical safety checklist in hospitals of Iran; operating room personnel’s attitude, awareness and acceptance

2018 ◽  
Vol 31 (6) ◽  
pp. 609-618
Author(s):  
Mobin Sokhanvar ◽  
Edris Kakemam ◽  
Narges Goodarzi
Keyword(s):  
Operating Room ◽  
Cross Sectional Study ◽  
Study Data ◽  
Operating Room Personnel ◽  
Cross Sectional ◽  
Content Type ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Validated Questionnaire ◽  
The Impact

Purpose The WHO Surgical Safety Checklist (SSC) has improved patient safety effectively. Despite the known benefits of applying the checklist before surgery, its implementation is less than universal in practice. The purpose of this paper is to determine the operating room personnel’s attitude, their awareness and knowledge of the SSC, and to evaluate staff acceptance of the SSC (including personal beliefs). Design/methodology/approach This cross-sectional study was conducted in eight tertiary general hospitals in Tehran, Iran. Some 145 operating room personnel (surgeons, anaesthetists and nurses) were selected for the study. Data collection was carried out via a validated questionnaire in three parts which included socio-demographic, attitude, awareness and acceptance. Data were then analysed using the Kruskal–Wallis and χ2 statistical test. Findings Out of the 145 participants in the study, 92 per cent were aware of the existence of the SSC and 73.9 per cent of them were aware of the objectives of SSC. Overall, the attitude to SSC was positive. The attitude of surgeons was positive towards the impact of the SSC on safety and teamwork. Surgeons were significantly more sensitive to the barriers of SSC application compared to nurses and anaesthetists (p=0.046). Among the three groups, nurses had the highest level of support for SSC (p=0.001). Practical implications Despite high acceptance of the checklist among staff, there is still a gap in knowledge about when exactly the checklist should be used. Therefore, involvement of all surgical team members to complete the checklist process, support of senior managers, on-going education and training and consideration of the barriers to its implementation are all key areas that need to be taken into account. Originality/value This is the first research to examine the operating room personnel’s attitude, awareness and acceptance about SSC in Iranian hospitals. The outcomes of this study provide documentation and possible justification for effective establishment of SSC in Iran and other countries.

scholarly journals Antenatal drug consumption: the burden of self-medication in a developing world setting

2016 ◽  
Vol 47 (3) ◽  
pp. 193-197 ◽  
Author(s):  
Abiodun Idowu Adanikin ◽  
Jacob Olumuyiwa Awoleke
Keyword(s):  
Scale Up ◽  
Cross Sectional Study ◽  
Risk Category ◽  
Self Medication ◽  
Cross Sectional ◽  
Over The Counter ◽  
Middle Income ◽  
Fetal Wellbeing ◽  
Level Of Significance ◽  
The Impact

This institutional-based cross-sectional study examines the burden of self-medication during pregnancy in a middle-income country setting and the impact on fetal wellbeing. Using a blend of open-ended and indication-oriented questionnaires, 346 pregnant women at term were interviewed about their pregnancy complaints and drug intake. Inferential statistical data analysis was employed with level of significance (α) set at 0.05. Excluding routine supplements and vaccinations, 251 (72.5%) women used medicines, of whom 79 (31.5%) had self-medicated. Consuming drugs without prescription was associated with increased US Food & Drug Administration (FDA) risk category (χ2 = 8.375; P = 0.015). There is therefore a need to scale up efforts towards educating women about the dangers of self-medication, while also introducing effective restrictive policies on over-the-counter drug sales.

scholarly journals Medical costs and out-of-pocket expenditures associated with multimorbidity in China: quantile regression analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e004042
Author(s):  
Yang Zhao ◽  
Rifat Atun ◽  
Kanya Anindya ◽  
Barbara McPake ◽  
Tiara Marthias ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Medical Cost ◽  
Low Income ◽  
Medical Costs ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Nationally Representative ◽  
The Cost ◽  
The Impact

ObjectiveMultimorbidity is a growing challenge in low-income and middle-income countries. This study investigates the effects of multimorbidity on annual medical costs and the out-of-pocket expenditures (OOPEs) along the cost distribution.MethodsData from the nationally representative China Health and Retirement Longitudinal Study (CHARLS 2015), including 10 592 participants aged ≥45 years and 15 physical and mental chronic diseases, were used for this nationally representative cross-sectional study. Quantile multivariable regressions were employed to understand variations in the association of chronic disease multimorbidity with medical cost and OOPE.ResultsOverall, 69.5% of middle-aged and elderly Chinese had multimorbidity in 2015. Increased number of chronic diseases was significantly associated with greater health expenditures across every cost quantile groups. The effect of chronic diseases on total medical cost was found to be larger among the upper tail than those in the lower tail of the cost distributions (coefficients 12, 95% CI 6 to 17 for 10th percentile; coefficients 296, 95% CI 71 to 522 for 90th percentile). Annual OOPE also increased with chronic diseases from the 10th percentile to the 90th percentile. Multimorbidity had larger effects on OOPE and was more pronounced at the upper tail of the health expenditure distribution (regression coefficients of 8 and 84 at the 10th percentile and 75th percentile, respectively).ConclusionMultimorbidity is associated with escalating healthcare costs in China. Further research is required to understand the impact of multimorbidity across different population groups.

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