Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (>48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.

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Family companions’ involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.30 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 30-30

Author(s):

Sarina Isenberg ◽

Rebecca Aslakson ◽

J Nicholas Dionne-Odom ◽

Thomas J. Smith ◽

Katherine Clegg Smith ◽

...

Keyword(s):

Medical Information ◽

Interaction Analysis ◽

Tertiary Care ◽

Secondary Analysis ◽

Cancer Surgery ◽

Major Surgery ◽

Care Hospital ◽

Patient Centeredness ◽

Logistic Regression Models ◽

Surgeon Satisfaction

30 Background: While research has explored the role of companions (accompanying family members) in medical visits, studies have not examined companions’ involvement in pre-surgical visits. This study explored how companions’ presence impacts communication and satisfaction during pre-surgical visits to discuss major cancer surgery. Methods: Secondary analysis of 61 pre-surgical visit recordings with 8 surgical oncologists at an academic tertiary care hospital. Recordings were analyzed using the Roter Interaction Analysis System, and surgeons and patients completed a post-visit satisfaction questionnaire. Poisson and logistic regression models were used to assess differences in communication and satisfaction when companions were present (n = 46, 75%) and not present (n = 16, 25%). Models were fit using generalized estimating equations to account for nesting of patients within surgeons. Results: Companion communication was largely emotional and facilitative. In unadjusted analyses, companion presence was associated with a 29% increase in surgeon talk in the visit overall (IRR 1.29, p = 0.006), and a 41% increase in the amount of medical information provided (IRR 1.41, p = 0.001). Companion presence was associated with 45% less patient disclosure related to lifestyle/psychosocial topics (IRR 0.55, p = 0.037). In adjusted analyses, companions’ presence was associated with 23% lower levels of patient-centeredness (IRR 0.77, p 0.004). No difference between visits with and without companions in patient nor surgeon satisfaction. Conclusions: Companions’ presence increased the medical focus of the discussion; surgeons conveyed more medical information, and patients disclosed less psychosocial information. Companions might perceive patients as anxious prior to major surgery, compelling companions to advocate for the patient. Companion’s presence might be beneficial; however, this benefit might not be captured by the patient-centeredness ratio. As there was no difference in satisfaction, patient and surgeon satisfaction may not be predicated on patient-centeredness, but on the conveyance of timely, surgery-related information. Clinical trial information: NCT02489799.

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Lessons from the frontlines: a junior doctor’s experience of the first wave of the COVID-19 pandemic in a resource-limited setting

Medical Humanities ◽

10.1136/medhum-2020-012109 ◽

2021 ◽

pp. medhum-2020-012109

Author(s):

Brabaharan Subhani ◽

Dilushi Wijayaratne ◽

Saroj Jayasinghe

Keyword(s):

Structural Changes ◽

Tertiary Care ◽

Medical Officer ◽

Healthcare Services ◽

Care Hospital ◽

Generic Skills ◽

Quality Healthcare ◽

Resource Limited ◽

Uncertain Future ◽

Second Wave

COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.

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Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v5i1.187 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Kirtika Patel ◽

R. Matthew Strother ◽

Francis Ndiangui ◽

David Chumba ◽

William Jacobson ◽

...

Keyword(s):

Cancer Care ◽

Cost Model ◽

Tertiary Care ◽

Care Hospital ◽

Middle Income ◽

Western Kenya ◽

Middle Income Countries ◽

Resource Limited ◽

Limited Setting ◽

Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

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Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

Journal of Medical Microbiology ◽

10.1099/jmm.0.001370 ◽

2021 ◽

Vol 70 (5) ◽

Author(s):

Mragnayani Pandey ◽

Immaculata Xess ◽

Gagandeep Singh ◽

Rakesh Kumar ◽

Manoranjan Mahapatra ◽

...

Keyword(s):

Antifungal Susceptibility ◽

Tertiary Care ◽

Care Hospital ◽

Direct Microscopy ◽

Specific Pcr ◽

Resource Limited ◽

Valuable Adjunct ◽

Panfungal Pcr ◽

A Prospective Study

Introduction. Invasive mucormycosis (IM) is a life-threatening infection caused by fungi belonging to the order Mucorales. Histopathology, culture and radiology are the mainstay of diagnosis but lack sensitivity, leading to a delay in timely diagnosis and intervention. Recently, PCR-based approaches have been shown to be a promising method in diagnosing IM. Hypothesis/Gap Statement. Molecular-based approaches may be a valuable adjunct to standard conventional methods for diagnosing IM, especially among culture negatives and patients on antifungal therapy. Aim. In the present study we aimed to evaluate the clinical utility of panfungal and Mucorales-specific PCR for diagnosing IM from various clinical specimens. Methodology. This was a prospective study in which 239 clinically suspected cases of IM attending our tertiary care hospital from August 2015 to March 2018 were enrolled. All the cases were defined as ‘proven’, ‘probable’ or ‘possible’ based on EORTC/MSGERC guidelines. In addition to conventional diagnostics (KOH-calcofluor stain and culture), panfungal and Mucorales-specific PCR assays were also performed. The amplified products were sequenced for species identification. In vitro antifungal susceptibility was performed on all the culture-positive isolates. Results. Among 239 clinically suspected cases of IM, only 140 cases were diagnosed by the demonstration of aseptate ribbon-like hyphae on direct microscopy. Culture was positive in 35.7 % (54/140) of direct microscopy-positive samples. Among the proven cases (n=11), the sensitivity for both Mucorales-specific nested PCR and panfungal PCR was 100 %, but specificity was 91.9 and 73.7% respectively. In probable cases (n=129), the sensitivity of both the PCRs was 98.5 % and specificity for panfungal PCR was 73.7 and 91.9 % for Mucorales-specific PCR. Conclusion. Pan fungal PCR in combination with Mucorales-specific PCR, followed by sequencing, may play a significant role in IM diagnosis especially among those negative for both direct microscopy and culture.

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A current analysis of caregivers’ approaches to fever and antipyretic usage

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3904 ◽

2014 ◽

Vol 8 (03) ◽

pp. 365-371 ◽

Cited By ~ 16

Author(s):

Meltem Polat ◽

Soner Kara ◽

Hasan Tezer ◽

Anıl Tapısız ◽

Okşan Derinöz ◽

...

Keyword(s):

Temperature Measurement ◽

Parental Education ◽

Tertiary Care ◽

Measurement Methods ◽

Medical Attention ◽

Urban Region ◽

Care Hospital ◽

Convenience Sample ◽

Attitudes And Practices ◽

Children's Caregivers

Introduction: The aim of this survey was to investigate the current knowledge, attitudes, and practices of febrile children’s caregivers about fever, antipyretic usage, and temperature measurement methods in a tertiary care hospital. Methodology: A 41-item questionnaire was administered to a convenience sample of febrile children’s caregivers in face-to-face interviews by two research assistants from January 2012 through June 2012 in an urban region of Turkey. Results: A total of 1,032 caregivers completed the interview. Approximately one-third of caregivers considered a temperature of less than 37.8°C (100°F) to be a fever, and 13% of all respondents would give antipyretics for a body temperature ≤ 37.8°C. Furthermore, 76% of parents would wake their children from sleep to administer antipyretics. Although a high proportion (89.5%) of respondents believed that fever had harmful effects, 10.5% considered fever to be beneficial. Alternating use of acetaminophen and ibuprofen (44%) and giving antipyretics routinely (71%) before and after immunizations were common parental practices and generally advised by pediatricians. Parents with higher levels of education were more likely to consider fever to be beneficial and to treat fever with antipyretics, and less likely to seek medical attention for mild fever. Most caregivers stated that they were unsure about the right site (90%) and thermometer type (95%) for temperature measurement. Conclusions: Persistent fever anxiety and excessive antipyretic usage may be heightened by the lack of knowledge regarding accurate temperature measurement methods with digital thermometers in our population. Parental education may positively affect the approach to fever and antipyretic usage.

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Prevalence and Specificity of RBC Alloantibodies in Indian Patients Attending a Tertiary Care Hospital

Advances in Hematology ◽

10.1155/2014/749218 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Shamsuz Zaman ◽

Rahul Chaurasia ◽

Kabita Chatterjee ◽

Rakesh Mohan Thapliyal

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Patient Population ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

North India ◽

Care Hospital ◽

Antibody Screening ◽

Resource Limited ◽

Transfusion Requirements

Background.Red blood cell (RBC) alloimmunization results from genetic disparity of RBC antigens between donor and recipients. Data about alloimmunization rate in general patient population is scarce especially from resource limited countries. We undertook this study to determine prevalence and specificity of RBC alloantibodies in patients admitted in various clinical specialties at a tertiary care hospital in North India.Methods.Antibody screening was carried out in 11,235 patients on automated QWALYS 3 platform (Diagast, Loos, France). Antibody identification was carried out with an 11-cell identification panel (ID-Diapanel, Diamed GmbH, Switzerland).Results.The overall incidence of RBC alloimmunization in transfused patients was 1.4% (157/11235), with anti-E being the most common specificity (36.3%), followed by anti-D (16%), anti-c (6.4%), anti-c + E (6.4%), anti-C + D (5.1%), and anti-K (4.5%). The highest incidence of alloimmunization was observed in hematology/oncology patients (1.9%), whereas in other specialties the range was 0.7–1%.Conclusion.As alloimmunization complicates the transfusion outcomes, authors recommend pretransfusion antibody screening and issue of Rh and Kell matched blood to patients who warrant high transfusion requirements in future.

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Common orthopedic problems in the neonate: a comparative study of 2 periods at a tertiary-care hospital

Asian Biomedicine ◽

10.1515/abm-2019-0047 ◽

2019 ◽

Vol 13 (3) ◽

pp. 101-105

Author(s):

Anongnart Sirisabya ◽

Tanteera Tooptakong ◽

Noppachart Limpaphayom

Keyword(s):

Parental Education ◽

Tertiary Care ◽

Newborn Infants ◽

International Classification Of Diseases ◽

Published Data ◽

Care Hospital ◽

Average Birth Weight ◽

Live Births ◽

Starting Point ◽

Siriraj Hospital

Abstract Background In 1975, King Chulalongkorn Memorial Hospital (KCMH) in Bangkok, Thailand, published data on common orthopedic problems in neonates. Objectives To determine the more recent incidence of these conditions and to compare the results with those reported 40 years ago by KCMH. The data were also compared with a recent report from Siriraj Hospital. Methods We reviewed medical records of newborn infants from 2012 to 2016, all of whom were born in KCMH with deformities of upper and lower extremities or other birth-related injuries. The cases were grouped according to International Classification of Diseases, 10th edition. The incidence of common neonatal orthopedic problems was calculated as cases per 1,000 live births and compared, using a chi-squared test, with the earlier data from KCMH and with the data recently reported by Siriraj hospital. Results Of the 24,825 live births, 54% were male and 46% were female. The average birth weight was 3,052.2 ± 516.1 g (range, 535–5,320 g) for infants. The most common deformity was postural clubfoot, followed by calcaneovalgus and hip dysplasia, with incidences of 1.37, 0.93 and 0.52 per 1,000 live births, respectively. The incidence of calcaneovalgus, metatarsus adductus, and clubfoot was lower than in the 1975 study and in the report from Siriraj. In all 3 studies, the incidence of birth-related injury was similar and clavicular fracture was the most common, with a rate of 1.3/1,000 live births. Conclusion The incidence of common neonatal orthopedic problems varies among institutions. Birth-related injury is a major challenge. The results may be utilized as updated data and as a starting point for parental education.

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Etiologies of Neonatal Mortality in a Tertiary Care Hospital in a Resource-Limited Setting

Open Journal of Pediatrics ◽

10.4236/ojped.2021.112026 ◽

2021 ◽

Vol 11 (02) ◽

pp. 268-280

Author(s):

Calixte Ida Penda ◽

Ritha Mbono Betoko ◽

Danielle Kedy Koum ◽

Essome Henri ◽

Patricia Epée Eboumbou ◽

...

Keyword(s):

Neonatal Mortality ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Resource Limited Setting ◽

Care Hospital ◽

Resource Limited ◽

Limited Setting

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Leaving Against Medical Advice From In-patients Departments Rate, Reasons and Predicting Risk Factors for Re-visiting Hospital Retrospective Cohort From a Tertiary Care Hospital

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.26 ◽

2019 ◽

Vol 8 (8) ◽

pp. 474-479 ◽

Cited By ~ 1

Author(s):

Obada Hasan ◽

Muhammad Adeel Samad ◽

Hamza Khan ◽

Maryam Sarfraz ◽

Shahryar Noordin ◽

...

Keyword(s):

Retrospective Cohort ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Medical Advice ◽

Outcome Variable ◽

Care Hospital ◽

Forward Selection ◽

Against Medical Advice ◽

Logistic Regression Models ◽

Hospital Patients

Background: Approximately 1% to 2% of hospitalized patients get discharged or leave from the hospital against medical advice and up to 26% in some centers. They have higher readmission rate and risk of complications than patients who receive complete care. In this study we aimed to determine the rate of leave against medical advice (LAMA) and reasons for the same across different in-patient departments of a tertiary care hospital. Methods: Retrospective cohort study on patients admitted in all departments at our institute over a 1-year period. All patients who were admitted to an in-patient ward at the hospital and who left against medical advice by submitting a duly filled LAMA form were included. Univariate and multivariate logistic regression models with forward selection methods were employed. Revisit to hospital within 30 days; to clinic or emergency department was outcome variable for regression. Results: From June 2015 to May 2016 there were 429 LAMA patients, accounting for 0.7% of total admissions. Females were 223 (52%) compared to males 206 (48%). Finances were quoted as the most common reason for LAMA by 174 (41%) patients followed by domestic problems 78 (18%). Internal medicine was the service with the highest number of LAMA patients ie, 153 (36%) followed by Pediatric medicine with 73 (17%). Of the 429 patients, 147 (34%) patients revisited the hospital within 30 days. Sixty-one percent of these ‘bounced-back’ LAMA patients had worsening or persistence of same problem, or new problem/s had developed. In unadjusted bivariate logistic model, patients who were advised for follow-up during discharge against medical advice were four times more likely to revisit the hospital. Patients who were married had an increased odd of revisiting the hospital. Conclusion: Financial reasons are the most common stated reasons to LAMA. Patients who LAMA are at a high risk of clinical worsening and ‘bouncing back.’ This is the first study from our region on in-patient LAMA rates, to our knowledge. The results can be used for planning measures to reduce LAMA rates and its consequences.

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Clinicoepidemiological Profile of Childhood Poisoning in the Pediatric Unit of a Tertiary Care Hospital in North India

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v29i630094 ◽

2019 ◽

pp. 1-8

Author(s):

Rahid Rasool Malla ◽

Khalid Kawoosa ◽

Meryem Juwhyreeyeh ◽

Riyaz Ahmed Malik ◽

Asif Ahmed ◽

...

Keyword(s):

Parental Education ◽

Pediatric Population ◽

Tertiary Care ◽

Age Groups ◽

Gastric Lavage ◽

North India ◽

Care Hospital ◽

Age Group ◽

College Hospital ◽

Childhood Poisoning

Background: This study was conducted to find out the pattern of poisoning cases among the pediatric population in Srinagar and its Northwestern suburbs and compare it with what occurs elsewhere in India. Thereby we aimed to provide practical knowledge in dealing with these pediatric patients. Methods: The hospital records of children between the ages of 0-19 years admitted to the pediatric emergency ward of SKIMS Medical College Hospital Srinagar with poisoning from July 2016 to June 2018 were evaluated. Results: A total of 154 cases of poisoning were admitted in the study period, of which 89(57%) were males and 69(43%) were females. In the 0-12 year age group the poisonings were mostly in boys (68.26%) and were accidental whereas in the 13-19 year age group poisonings were mostly in girls (64%) and due to suicidal attempts. Organophoshorus poisoning was the most commonly ingested poison across all age groups (44.8%) followed by rodenticides (16.23%), kerosene (13.63%) and medications (11.68%). Interventions mostly commonly done were gastric lavage, induced vomiting. Mortaliy was seen in 2 cases over 2 years (1.29%). Conclusion: Knowledge on epidemiological and clinical features of poisoning in children according to age groups, establishing safety standards for sale and storage of harmful chemicals, and parental education can help to decrease the burden of childhood poisoning.

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