Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study

Abstract Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers.

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Risk Assessment and Outcome of Venous Thromboembolism in Pediatric Population in an Academic Care Center of a Low-Middle Income Country

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029621995895 ◽

2021 ◽

Vol 27 ◽

pp. 107602962199589

Author(s):

Muhammed Wahhaab Sadiq ◽

Ronika Devi Ukrani ◽

Aiman Arif ◽

Inaara Akbar ◽

Sadaf Altaf ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Pediatric Patients ◽

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Middle Income Country ◽

Income Country ◽

Tertiary Care Center ◽

Middle Income

Venous thromboembolism (VTE) is a recognized complication of hospital stay in young patients in many developed countries, but such an information is largely unavailable from a low middle-income country (LMIC). This study aimed at identifying the frequency, risk factors, treatment options and outcome of deep venous thrombosis/pulmonary embolism (DVT/PE) in pediatric population in a tertiary care center from a LMIC. International classification of disease, ninth revision (ICD-9) was used to identify VTE in patients aged 0-18 years during January 2011 to September 2019. In-house computerized system was used to collect data for demographics, clinical and laboratory details. SPSS version 19 was used to analyzed data. The study was approved by Institutional ethical review committee (3872-Pat-ERC-15). During the study period, 134617 pediatric patients were hospitalized, DVT/PE was observed in 77 unique patients (47 males and 30 females) with a median (IQR) age of 14 (5-16) years equivalent to 5.9 VTE events /10,000 hospital admissions. Malignancy, community acquired infections and autoimmune diseases were the predominant risk factors (75%) in adolescent age-group while surgery for congenital heart anomalies was the primary reason (71%) in infants. Overall, lower extremity thrombosis was the most frequent (51%) followed by pulmonary embolism (25%). and upper extremity thrombosis (24%). Enoxaparin and unfractionated heparin were mainly used to treat VTE and all-cause mortality was 13% in the cohort studied. We observed substantial VTE events in pediatric patients during their hospital stay in a tertiary care center of a low-middle income country.

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Association Between Breastfeeding and Child Overweight in Mexico

Food and Nutrition Bulletin ◽

10.1177/03795721211014778 ◽

2021 ◽

pp. 037957212110147

Author(s):

Ana Paola Campos ◽

Mireya Vilar-Compte ◽

Summer Sherburne Hawkins

Keyword(s):

Risk Factors ◽

Maternal Obesity ◽

Secondary Data ◽

Nutrition Survey ◽

Middle Income ◽

Logistic Regression Models ◽

Middle Income Countries ◽

Child Overweight ◽

The Individual ◽

Adjusted Model

Background: Globally, the prevalence of child overweight has increased over the past few decades. The largest burden of child overweight is identified among upper-middle-income countries, such as Mexico. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child overweight. Objective: To examine the association between breastfeeding and child overweight while sequentially controlling for individual, household, and area factors in Mexican children. Methods: Secondary data analysis using the 2012 Mexican National Health and Nutrition Survey which included risk factors for overweight on 2089 children aged 6 to 35 months and analyzed data to estimate fixed- and mixed-effects logistic regression models. Results: Overall, 9.0% of children were overweight and 71.1% of mothers reported any breastfeeding for ≥6 months. We found no evidence for a protective effect of any breastfeeding for ≥6 months on child overweight when compared to children who were never breastfed in the fully adjusted model and across all models (model 4, adjusted odds ratio [AOR] [95% CI] = 0.76 [0.31-1.86]). We identified risk factors for child overweight at the individual and area levels, with maternal obesity and offspring high birthweight being significant in the fully adjusted model and across all models (model 4, AOR [95% CI] = 2.26 [1.32-3.85] and 2.83 [1.44-5.56], correspondingly). Conclusions: Our results suggest shared obesogenic environment influences from which the overweight-obese maternal-child dyads are emerging in Mexican households. More research is needed to better understand these obesogenic environments grounded on the particular contexts among upper-middle-income countries.

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Infant malnutrition in low- and middle-income countries: assessment and prevalence of small and nutritionally at-risk infants aged under 6 months in 54 Demographic & Health Survey datasets

10.1101/2021.12.23.21268306 ◽

2021 ◽

Author(s):

Marko Kerac ◽

Philip Thomas James ◽

Marie McGrath ◽

Eilise Brennan ◽

Charles Opondo ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Logistic Regression ◽

Data Quality ◽

Regression Models ◽

Middle Income ◽

Logistic Regression Models ◽

Middle Income Countries ◽

Low Weight ◽

Weight For Age

Background There is increasing global focus on malnutrition in infants aged under 6 months (u6m) but evidence on how best to identify and manage at-risk individuals is sparse. Our objectives were to: explore data quality of commonly used anthropometric indicators; describe prevalence and disease burden of infant u6m malnutrition; compare wasting and underweight as measures of malnutrition by determining the strength and consistency of associations with biologically plausible risk factors. Methods We performed a cross-sectional secondary analysis of Demographic and Health Survey (DHS) datasets, focussing on infants u6m. We calculated underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age), and concurrent wasting and stunting. We explored data quality by recording extreme (flagged, as per standard criteria) or missing values. We calculated the population-weighted prevalence of each type of malnutrition and extrapolated the burden to all low- and middle- income countries (LMICs). We explored associations between infant, maternal and household risk factors with underweight and wasting using logistic regression models. Results We analysed 54 DHS surveys. Data quality in terms of refusals and missingness was similar for both weight and length. There were more extreme (flagged) values for length-based measures (6.1% flagged for weight-for-length, 4.8% for length-for-age) than for weight-for-age (1.0% flagged). Overall, 20.1% of infants (95% CI: 19.5, 20.7) were underweight, 21.3% (95% CI: 20.7, 22.3) were wasted, 17.6% (95% CI: 17.0, 18.2) were stunted, and 2.0% (95% CI: 1.8, 2.2) were concurrently wasted and stunted. This corresponds to an estimated burden in LMICs of 23.8m underweight infants, 24.5m wasted infants, 21.5m stunted infants and 2.2m concurrently wasted and stunted. Logistic regression models showed that numerous risk factors were associated with wasting and underweight. Effect sizes of risk factors tended to be stronger and more consistently associated with underweight compared to wasting. Conclusion Malnutrition in infants u6m is a major problem in LMICs. This is true whether assessed by underweight, wasting or stunting. Our data build on other evidence suggesting that underweight may be a better anthropometric case definition than wasting: data quality is better when length is not involved; biologically plausible risk factors are better reflected by an infant being underweight. Future research, ideally from intervention trials, should further explore how best to identify malnourished (small and nutritionally at-risk) infants u6m. For now, treatment programmes should note that many factors might underlie problems in this age group: services should thus consider how to address maternal health and wider social circumstances as well as caring for infants themselves.

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Abstract 16749: Prevalence, Predictors, and Prognostic Implications of Left Ventricular Systolic Dysfunction Among Patients With STEMI in India: The Prospective NORIN-STEMI Registry

Circulation ◽

10.1161/circ.142.suppl_3.16749 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ambarish Pandey ◽

Shreya Rao ◽

Girish MP ◽

Puneet Gupta ◽

Sameer Arora ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Tertiary Care ◽

Anterior Wall ◽

Left Ventricular ◽

Middle Income ◽

Logistic Regression Models ◽

Low Middle Income Countries ◽

Prognostic Implications

Introduction: Left ventricular (LV) systolic dysfunction (LVSD) and HF are important complications of ST-elevation myocardial infarction (STEMI). The prevalence and prognostic implications of LVSD in patients with STEMI in low/middle-income countries such as India are not well established. Methods: The present analysis was performed using data from the ongoing , prospective NORIN-STEMI registry of patients presenting with STEMI to 2 tertiary care medical centers in New Delhi, India from January to November 2019. LV ejection fraction (EF) was assessed at STEMI presentation using transthoracic echocardiography. Covariate-adjusted logistic regression models were constructed to evaluate the association of LVSD (mild: EF = 40-50%; moderate/severe: EF<40%; ref: EF>50%) with risk of in-hospital and 30-day mortality. Results: Among 3,635 patients with STEMI (age: 55[45-62], 33%≤50 years, 16% women), 1,489 (41%) had mild and 1,675 (46%) had moderate/severe LVSD on presentation. Patients with greater LVSD more commonly presented with anterior wall STEMI and had more frequent involvement of the left anterior descending artery as the culprit vessel. Among those with no, mild or moderate/severe LVSD, PCI was performed in 70% and 62% of patients, respectively. Hypertension, prior myocardial infarction, physical inactivity, greater time since symptom onset, and lower literacy levels were each independently associated with higher likelihood of LVSD. In adjusted analysis, LVSD was significantly associated with higher likelihood of in-hospital but not 30-day mortality ( See Table ). Conclusion: Among patients presenting to tertiary care centers in India with STEMI, LVSD is common, with 87% demonstrating LVEF<50%. LVSD was significantly associated with higher risk of in-hospital and 30-day mortality. Future studies are needed to determine if quality improvement efforts to standardize pathways for primary PCI may lessen occurrence of LVSD.

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A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

Burns & Trauma ◽

10.1186/s41038-017-0095-7 ◽

2017 ◽

Vol 5 ◽

Cited By ~ 3

Author(s):

Amol Dhopte ◽

Rahul Bamal ◽

Vinay Kumar Tiwari

Keyword(s):

Risk Factors ◽

Nuclear Family ◽

Tertiary Care ◽

Total Body Surface Area ◽

Female Gender ◽

Inhalation Injury ◽

Female Ratio ◽

Burn Center ◽

Risk Of Mortality ◽

Pediatric Burns

Abstract Background None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. Methods A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. Results A total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. Conclusion TBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.

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Frequency of Anxiety and Its Risk Factors Among Working & Non-Working Women of Peshawar

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.4-2.16 ◽

2018 ◽

Vol 4 (2) ◽

pp. 4-7

Author(s):

Nighat Musa ◽

Yasir Mehmood ◽

Asghar Khan

Keyword(s):

Risk Factors ◽

Household Income ◽

Family System ◽

Nuclear Family ◽

Working Women ◽

Income Group ◽

Age Group ◽

Middle Income ◽

Middle Income Group ◽

Manifest Anxiety

OBJECTIVE: to determine the frequency of anxiety & its risk factors among working and non-working women. METHODOLOGY: Study design was descriptive observational. The study duration was seven months (June – December 2016). It was a community based study.Sample size for this study was calculated on 52% prevalence of anxiety Pakistan. A total of 400 women were selected (200 working and 200 non-working women). A semi structured questionnaire was used along with Taylor manifest anxiety scale as study tool. Data was presented in the form of tables and graphs. RESULTS:The frequency of anxiety was 58%. Anxiety was more among working women than non-working women. Most of the women were literate 65.5%. Majority of the women having anxiety were living in nuclear family. The age group most effected was between 21-35 years (67%), 58% were married, single were 34% and 8% were either divorced or widow. Approximately 58% of women with anxiety had less than 2 children and 42% were having more than 2 children. Approximately 88% women with anxiety belonged from low and middle income group having less than 20,000/-PKR and 20,001-50,000/-PKR household income respectively. Only 12% belonged from high group having more than 50,001/- PKR.Conclusions: Anxiety is more common among working women. Married women living in nuclear family system, being single, young age group between 21-35 years, less than 2 children and low household income were the key risk factors.

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Predisposing and precipitating risk factors for delirium in palliative care patients

Palliative & Supportive Care ◽

10.1017/s1478951519000919 ◽

2019 ◽

Vol 18 (4) ◽

pp. 437-446 ◽

Cited By ~ 1

Author(s):

Annina Seiler ◽

Maria Schubert ◽

Caroline Hertler ◽

Markus Schettle ◽

David Blum ◽

...

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Care Center ◽

Tertiary Care ◽

Symptom Burden ◽

Terminal Phase ◽

Precipitating Factors ◽

Logistic Regression Models ◽

Observational Cohort ◽

Care Requirements

AbstractObjectiveDelirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse.MethodIn this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients.ResultsThe prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069–0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918–37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251–3.841; p < 0.01), frailty (OR 15.28; CI 5.885–39.665; p < 0.001), hearing (OR 3.52; CI 1.721–7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765–5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033–12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062–43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102–12.149; p < 0.05).Significance of resultsOur study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.

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An observational study from a new tertiary care hospital in North Odisha: clinical and etiological profile of acute ischemic stroke patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20194227 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1605

Author(s):

Bibhu P. Behera ◽

Partha S. Mohanty

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Observational Study ◽

Acute Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Tertiary Care ◽

Care Hospital ◽

Stroke Patients ◽

Middle Income ◽

Stroke Subtypes

Background: Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability. According to WHO estimation, by 2050 nearly 80% of stroke cases may occur in low and middle-income countries like China and India. It is critical that we understand the etiology causing the stroke so that appropriate treatment can be initiated in a timely fashion. Furthermore, understanding the risk factors associated with stroke is important before primary and secondary preventive measures can be prescribed to the patient.Methods: This observational study was carried out amongst 481 acute ischemic stroke patients that fulfils the inclusion and exclusion criteria and admitted in medicine ward of Pandit Raghunath Murmu Medical College and Hospital, Baripada, Dist. Mayurbhanj, Odisha, India from June 2018 to January 2019. Results: In our study, 481(60.43%) patients had ischemic stroke and 315 (39.57%) patients had hemorrhagic stroke. The incidence of stroke is maximum in 51-70 years of age group which comprises of 59.46% of total patients. The average age + SD were 61.4±13.1 in our study. The most common risk factor was hypertension with 69.85% followed by dyslipidemia 51.77%. Most common clinical presentation was hemiplegia (72.35%) followed by speech involvement (59.46%). Most common site of infarct was parietal (22.25%), followed by periventricular (12.68%).Conclusions: Most of the patients had ischemic stroke as compared to hemorrhagic stroke. It was more common in males. The study contributes to understanding of demographic characteristics, risk factors, and stroke subtypes in acute ischemic stroke. The importance of various risk factors among ischemic stroke subtypes should be stressed for prompt preventive strategies and treatment.

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