scholarly journals Chest radiography in children aged 2–59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Tisungane Mvalo ◽  
Eric D. McCollum ◽  
Elizabeth Fitzgerald ◽  
Portia Kamthunzi ◽  
Robert H. Schmicker ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Chest Radiography ◽  
Secondary Analysis ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
World Health ◽  
Middle Income ◽  
Radiographic Findings ◽  
Link Type ◽  
Significant Pathology

Abstract Background Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes. Methods When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes. Results Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was “other infiltrates only” in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was “primary endpoint pneumonia”(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58). Conclusions In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with “primary endpoint pneumonia” was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs. Trial registration ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov (NCT02760420, NCT02678195, and NCT02960919, respectively).

scholarly journals Training physicians in India to interpret pediatric chest radiographs according to World Health Organization research methodology

2021 ◽  
Author(s):  
Eric D. McCollum ◽  
Melissa M. Higdon ◽  
Nicholas S. S. Fancourt ◽  
Jack Sternal ◽  
William Checkley ◽  
...  
Keyword(s):  
World Health Organization ◽  
Primary Endpoint ◽  
Low Income ◽  
Chest Radiography ◽  
Epidemiological Studies ◽  
Chest Radiographs ◽  
World Health ◽  
Average Score ◽  
Pediatric Chest ◽  
Health Organization

Abstract Background Chest radiography is the standard for diagnosing pediatric lower respiratory infections in low-income and middle-income countries. A method for interpreting pediatric chest radiographs for research endpoints was recently updated by the World Health Organization (WHO) Chest Radiography in Epidemiological Studies project. Research in India required training local physicians to interpret chest radiographs following the WHO method. Objective To describe the methodology for training Indian physicians and evaluate the training’s effectiveness. Materials and methods Twenty-nine physicians (15 radiologists and 14 pediatricians) from India were trained by two WHO Chest Radiography in Epidemiological Studies members over 3 days in May 2019. Training materials were adapted from WHO Chest Radiography in Epidemiological Studies resources. Participants followed WHO methodology to interpret 60 unique chest radiographs before and after the training. Participants needed to correctly classify ≥80% of radiographs for primary endpoint pneumonia on the post-training test to be certified to interpret research images. We analyzed participant performance on both examinations. Results Twenty-six of 29 participants (89.7%) completed both examinations. The average score increased by 9.6% (95% confidence interval [CI] 5.0–14.1%) between examinations (P<0.001). Participants correctly classifying ≥80% of images for primary endpoint pneumonia increased from 69.2% (18/26) on the pretraining to 92.3% (24/26) on the post-training examination (P=0.003). The mean scores of radiologists and pediatricians on the post-training examination were not statistically different (P=0.43). Conclusion Our results demonstrate this training approach using revised WHO definitions and tools was successful, and that non-radiologists can learn to apply these methods as effectively as radiologists. Such capacity strengthening is important for enabling research to support national policy decision-making in these settings. We recommend future research incorporating WHO chest radiograph methodology to consider modelling trainings after this approach.

scholarly journals 2621. Influence of HIV Exposure Status on Carriage Rates and Density of Streptococcus Pneumoniae and Pneumocystis Jirovecii in Zambian Children

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S912-S913
Author(s):  
ingrid Y Camelo ◽  
Christopher Gill ◽  
Donald M Thea ◽  
John Weinstein
Keyword(s):  
Streptococcus Pneumoniae ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Severe Pneumonia ◽  
Infected Group ◽  
Pneumocystis Jirovecii ◽  
World Health ◽  
Mortality And Morbidity ◽  
Hiv Exposure ◽  
Hiv Exposed

Abstract Background Low rates of mother to child HIV transmission in Zambia, translates into a high number of children who are HIV exposed but uninfected (HEU) who have increased mortality and morbidity when compared with children HIV unexposed and uninfected (HUU). We performed a secondary analysis on The Pneumonia Etiology Research in Child Health (PERCH), a case–control study focused on identifying the etiologies of pediatric pneumonia including two pathogens, Streptococcus pneumoniae and Pneumocystis jirovecii in Zambian children to evaluate if HIV exposure status influences carriage rates and density for these pathogens. Methods Children ages 1–59 months were enrolled as cases if they met the World Health Organization (WHO) definition of severe or very severe pneumonia. Controls did not have a diagnosis of pneumonia and were matched by age and HIV status to cases. Each case and control had a nasopharyngeal (NP) swab and an oropharyngeal (OP) swab specimen. A multiplex real-time polymerase chain reaction (PCR) assay was used to test the NP/OP specimens for S. pneumoniae and P. jirovecii. A density of log10 copies/mL in microbiology confirmed cases compared with controls was used to define positive infection with S. pneumoniae and P. jirovecii. Results The highest S. pneumoniae carrier rates were seen in HIV unexposed controls and the lowest carrier rates seen in HIV-infected controls. HIV-infected children who were S. pneumoniae carriers and were classified as controls had the highest S. pneumoniae density of all groups. Overall, the HIV-infected group had the highest S. pneumoniae density rates. There was minimal variation in the S. pneumoniae density of those in the HIV exposed and HIV unexposed. P. jirovecii was present only in 31% of HIV-infected cases and 7% of the same group controls. HIV exposed cases had half the carrier rates of their counterparts in the HIV-infected group, but the P. jirovecii carriage rates were the same as the carriage rates in HIV-infected controls. The P. jirovecii carriage density in HIV-infected and HIV-exposed cases was similar. Conclusion HIV exposure status in children can be a predictor factor in S. pneumoniae and P. jirovecii carriage and density. The results of our analysis could potentially explain the high rates of pneumonia in children exposed to HIV but uninfected. Our findings open the door to more in-depth studies about the immunological status in children exposed to HIV but uninfected. Disclosures All authors: No reported disclosures.

scholarly journals Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Grace K. Ryan ◽  
Andreas Bauer ◽  
Tarik Endale ◽  
Onaiza Qureshi ◽  
Asmae Doukani ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Evidence Synthesis ◽  
World Health ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Link Type ◽  
Humanitarian Crises ◽  
Low And Middle Income

Abstract Background Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. Methods Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov. We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. Results We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. Conclusion Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. Trial registration PROSPERO registration number: CRD42017058287.

scholarly journals Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Meiron Hassen ◽  
Alemayehu Toma ◽  
Mulugeta Tesfay ◽  
Eyoel Degafu ◽  
Solomon Bekele ◽  
...  
Keyword(s):  
Linear Regression ◽  
Hospital Stay ◽  
Chest Radiography ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Severe Community Acquired Pneumonia ◽  
Level Of Agreement ◽  
Radiologic Evidence

Objectives. This study was designed to assess the role of chest radiography for the diagnosis of pneumonia and assess the association of clinical characteristics with radiologic findings and predictors of hospitalization among children with severe community acquired pneumonia. Methods. A prospective study was conducted on 122 children between ages of 3 month and 14 years admitted to pediatric emergency unit with diagnosis of severe pneumonia from September 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). Level of agreement between radiologists was assessed using Cohen’s kappa coefficient. Clinical and laboratory parameters which could explain the variability in the duration of hospital stay were assessed using a linear regression mode. Independent predictors were assessed using multiple linear regression. Results. The median age of the cohort was 10.0 months (interquartile range (IQR): 6.75–24.0); 76 (62.3%) were male. Nearly half, 63 (51.6%) did not have radiologic evidence of pneumonia. There was low level of agreement between R1 and R2 in reporting consolidation (kappa=0.435, p-value≤0.001), haziness (kappa=0.375, p-value≤0.001), and infiltration (kappa=0.267, p-value=0.008). Children with higher recorded temperature were more likely to have radiologic abnormalities suggesting pneumonia (p-value=0.033). The median duration of hospitalization was 3 days (IQR: 1-4 days); 118 (96.7%) were discharged with improvement. Height-for-age z-score (Coef.=0.203, R2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. Conclusion. Radiologic evidence of pneumonia was absent in half of the children with severe pneumonia. There was low agreement between senior radiologists in reporting chest radiographic findings, potentially necessitating harmonization activities to uniformly implement the WHO guidelines in reading chest radiographs.

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

DIAGNOSTICS OF THE CURRENT STATE OF HEALTHCARE IN RUSSIA

2020 ◽  
Vol 15 (5) ◽  
pp. 35-55
Author(s):  
N.P. STARYKH ◽  
◽  
A.V. EGOROVA ◽  
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Statistical Data ◽  
Secondary Analysis ◽  
World Health ◽  
Healthy Life Expectancy ◽  
Federal State ◽  
Sociological Research ◽  
Healthy Life ◽  
Current State

The purpose of the article is to analyze the current state of healthcare in Russia. Scientific novelty of the study: the authors suggest that the efficiency of the health care system depends on the state of such indicators of public health as life expectancy and healthy life expectancy. Life expectancy is an integrated demographic indicator that characterizes the number of years that a person would live on average, provided that the age-specific mortality rate of a generation would be at the level for which the indicator was calculated throughout life. The indicator ‘healthy life expectancy’ is formed by subtracting the number of years of unhealthy life (due to chronic diseases, disabilities, mental and behavioral disorders, etc.) from the life expectancy indicator. Results: the article presents an analysis of the current state of Russian healthcare based on statistical data provided by the Federal State Statistics Service, the World Health Organization, and world rankings. Attention is focused on the perceptions of Russians about the quality of medical services and Russian healthcare. Conclusions about the current state of health care in Russia are formulated by the authors, based on a secondary analysis of statistical data, as well as data from sociological research presented by leading Russian sociological centers.

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

2021 ◽  
pp. 101053952110260
Author(s):  
Mairead Connolly ◽  
Laura Phung ◽  
Elise Farrington ◽  
Michelle J. L. Scoullar ◽  
Alyce N. Wilson ◽  
...  
Keyword(s):  
Preterm Birth ◽  
National Level ◽  
Health Indicators ◽  
Western Pacific ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Definition Of ◽  
Health Organization ◽  
The Impact

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

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