Predictors of Complication Following Cleft Lip and Palate Surgery in a Low-Resource Setting: A Prospective Outcomes Study in Nicaragua

Background Higher rates of postoperative complication following cleft lip or palate repair have been documented in low resource settings, but their causes remain unclear. This study sought to delineate patient, surgeon, and care environment factors in cleft complications in a low-income country. Design Prospective outcomes study. Setting Comprehensive Cleft Care Center. Patients Candidate patients presenting for cleft lip or palate repair or revision. Interventions Patient anthropometric, nutritional, environmental and peri- and post-operative care factors were collected. Post-operative evaluation occurred at standard 1-week and 2-month postoperative intervals. Main Outcome Measures Complication was defined as fistula, dehiscence and/or infection. Results Among 408 patients enrolled, 380 (93%) underwent surgery, of which 208 (55%) underwent lip repair (124) or revision (84), and 178 (47%) underwent palate repair (96) or revision (82). 322 (85%) were evaluated 1 week and 166 (44%) 2 months postoperatively. 50(16%) complications were identified, including: 25(8%) fistulas, 24(7%) dehiscences, 17(5%) infections. Mid-upper arm circumference (MUAC) ≤12.5 cm was associated with dehiscence after primary lip repair (OR = 28, p = 0.02). Leukocytosis ≥11,500 on pre-operative evaluation was associated with dehiscence (OR = 2.51, p = 0.04) or palate revision fistula (OR = 64, p < 0.001). Surgeons who performed fewer previous-year palate repairs had higher likelihood of palate complications, (OR = 3.03, p = 0.01) although there was no difference in complication rate with years of surgeon experience or duration of surgery. Conclusions Multiple patient, surgeon, and perioperative factors are associated with higher rates of complication in a low-resource setting, and are potentially modifiable to reduce complications following cleft surgery.

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Challenges of establishing a Community Advisory Board (CAB) in a low-income, low-resource setting: experiences from Bagamoyo, Tanzania

Health Research Policy and Systems ◽

10.1186/1478-4505-7-16 ◽

2009 ◽

Vol 7 (1) ◽

Cited By ~ 23

Author(s):

Kafuruki Shubis ◽

Omar Juma ◽

Rahiya Sharifu ◽

Brandt Burgess ◽

Salim Abdulla

Keyword(s):

Low Income ◽

Advisory Board ◽

Community Advisory Board ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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National Egyptian Model of Breast Cancer Care Project As a Model for Low Resource–Setting Countries to Improve Outcomes From Early Screening Early Treatment

Journal of Global Oncology ◽

10.1200/jgo.18.79101 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 124s-124s

Author(s):

I. Sallam ◽

G. Amira ◽

A. Youssri

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Low Income ◽

Screening Program ◽

High Rate ◽

Standards Of Care ◽

Cancer Center ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

Background: 40% of Egyptians has access to public health system, 60% served by NGOs and private centers. The problem is the late presentation and inadequate access to services due to lack of a structured screening program and awareness. Aim: To present a model of breast cancer (BC) care in low resource setting (LRS) and to assess risk factors for BC in Egypt the high BC incidence country based on registry estimates stating that about 22000 new BC cases will be diagnosed by 2020. Strategy: In Giza region there used to be no mammographic (MMG) reference service. Women with breast symptoms were referred to the NCI, where they were offered the services (diagnosis, treatment). With very long waiting times. Women aged 20 years or older visiting one of the 5 participating centers were evaluated in a cross-sectional study, which included: (1) Data entry form questionnaire of risk factors for breast cancer - including family history of cancer - and presence of breast symptoms, and (2) Breast examination by a trained professional (nurse or medical doctor). All patients with breast complaints or an abnormal physical exam were referred to NCI, MISR Cancer Center, Kasr El Aini, Agouza and Bahia Hospital for further evaluation. Women 40-69 years of age were invited to participate in the screening both actively (digital invitations, Facebook groups, brochures distributed in governmental buildings and WhatsApp groups) and passively (women that attended for any reason to other hospitals in the region are called and delivered brochures and vouchers to join the project). The screening program is based on annual MMG in women between the ages of 40 and 69 years, which are always preceded by physical examination performed by a breast surgeon or a trained nurse. Program: Close control of the frequency of visits using a simple computer program with patient listing and reminder. The close contact and continuous feedback that helped adherence to the screening program. The proposal of the project includes the performance of all clinical, imaging and pathology exams, as well as clinical visits and surgical treatment, in the same center in the shortest time and the highest standards of care. The health care approach is multidisciplinary, including nurses, breast surgeons and a nutritionist. Outcomes: High rate of compliance is the main strength of project, achieved by patient education about the importance of the screening, intense contact with the primary trained staff, with provision of lists of patients who should come next visits. Free transportation for women with very low income is arranged. Every 3-4 months, we established jointly a charity workshops and projects of handmade cloths and bags for BCPs and encouraged social clubs and societies to adopt parties and to host educational BC advocacy campaigns. What was learned: A simple project is successful and its cost-effectiveness is balanced in Egypt as a developing country where the mortality associated with this disease is very high.

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Surgical Outreach in a Tertiary Healthcare Facility: A Prototype for Mass Hernia Repair among Children in Low Resource Setting

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.195 ◽

2020 ◽

Vol 4 (1) ◽

pp. 47-54

Author(s):

UU Nnadozie ◽

CC Maduba ◽

EM Anekwu ◽

CC Anikwe ◽

AA Obasi ◽

...

Keyword(s):

Hernia Repair ◽

Tertiary Hospital ◽

Left Groin ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Tertiary Center ◽

Duration Of Surgery ◽

Resource Poor ◽

Groin Hernias

Hernias are common in children and account for most of the surgical operations performed by the Paediatric surgeons. They often present late in resource-poor countries for a variety of reasons. In these settings, surgical outreaches reduce the burden of hernias. We aim to determine the effectiveness of a tertiary hospital-based surgical outreach for hernia repair in children in a low-resource-setting. We did a prospective study conducted during a surgical outreach carried out over seven days at a tertiary center in Southeast Nigeria. Recruited subjects were physically examined to establish a diagnosis and screened for fitness before surgeries were performed. Data were collected using a structured proforma to information from the patient's case-notes. Data analysis was done using the statistical package for social sciences (SPSS) version 25. There were 77 children with 80 hernia surgeries, 71 (92.2%) males, and 6 (7.8%) females (ratio of 12:1) were involved. The majority (66.2%) were aged 2-12years and were mainly rural dwellers. Right groin hernias were present in 54.5% and 40.3% had left groin hernias. Herniotomy was the main procedure offered (93.5%). The complication rate was 9.1%. Senior registrars in surgery (Senior trainee surgeons) participated in most of the operations. The mean duration of surgery was 34.9 + 17.6 minutes. Surgical outreach in tertiary hospital for hernias in children in resource-poor settings offers the opportunity for mass repairs with good outcomes. It provides a hands-on opportunity for trainee surgeons to improve their mastery of hernia surgery.

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Management of prolonged first stage of labour in a low-resource setting: lessons learnt from rural Malawi

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03856-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wouter Bakker ◽

Elisabeth van Dorp ◽

Misheck Kazembe ◽

Alfred Nkotola ◽

Jos van Roosmalen ◽

...

Keyword(s):

Caesarean Section ◽

Low Income ◽

Medical Records ◽

Low Income Countries ◽

Evidence Based ◽

Low Resource ◽

Mission Hospital ◽

Resource Setting ◽

Low Resource Setting ◽

Oxytocin Augmentation

Abstract Background Caesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi. Methods Retrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation. Results Out of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication ‘prolonged first stage of labour’. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour. Conclusion The diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused.

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Challenges to Bringing Personalized Medicine to a Low-Resource Setting in Peru

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041470 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1470

Author(s):

Nelly Solis ◽

Elizabeth Zavaleta ◽

Patrik Wernhoff ◽

Constantino Dominguez-Barrera ◽

Mev Dominguez-Valentin

Keyword(s):

Low Income ◽

Age Of Onset ◽

Genomic Research ◽

Mortality And Morbidity ◽

Screening Programs ◽

Low Resource ◽

Effective Interventions ◽

Resource Limited ◽

Resource Setting ◽

Low Resource Setting

We provide an overview of the challenges that low-resource setting cities are facing, including a lack of global implementation of cancer screening programs, accurate data and statistics that may aid the health authorities and guide future public health activities, as well as reorient strategies, interventions and budgets to promote lifestyles that help prevent disease. Current cancer care does not fully reflect ethnic, cultural, environmental and resource differences. Herein, we described a snapshot of the cancer mortality and morbidity from a hospital that cares a rural and low-income population from Peru, called Chimbote (316,966 inhabitants) and showed the limitation of access to oncological care and genetic services. The city is located in the region of Ancash, which is a department of Northern Peru. Of note, we identified a greater proportion of cancer cases than previously described, with a young age of onset and differential profile of the most frequent cancers. With the emergence of increasingly effective interventions, it becomes paramount that populations living in resource-limited settings have access to cancer services and participate in genetics and genomic research.

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Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽

10.2337/db18-93-lb ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 93-LB

Author(s):

EDDY JEAN BAPTISTE ◽

PHILIPPE LARCO ◽

MARIE-NANCY CHARLES LARCO ◽

JULIA E. VON OETTINGEN ◽

EDDLYS DUBOIS ◽

...

Keyword(s):

Dose Adjustment ◽

Insulin Dose ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Quality indicators and post operative outcome of ERCP performed in a low resource setting ; can quality indicators from developed settings be applied?

10.26226/morressier.59a6b34bd462b80290b557f5 ◽

2017 ◽

Author(s):

Supun Kulatunge

Keyword(s):

Quality Indicators ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Operative Outcome

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Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

BMJ Case Reports ◽

10.1136/bcr-2020-239250 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239250

Author(s):

Vijay Anand Ismavel ◽

Moloti Kichu ◽

David Paul Hechhula ◽

Rebecca Yanadi

Keyword(s):

Plastic Material ◽

Successful Outcome ◽

Paraduodenal Hernia ◽

Transparent Plastic ◽

Low Resource ◽

Entire Small Bowel ◽

Resource Setting ◽

Low Resource Setting ◽

Right Paraduodenal Hernia ◽

Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

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