scholarly journals Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future

2021 ◽  
Vol 18 (13) ◽  
pp. 7065
Author(s):  
Anne M. White ◽  
Dominic Mutai ◽  
David Cheruiyot ◽  
Amy R. L. Rule ◽  
Joel E. Mortensen ◽  
...  
Keyword(s):  
Gold Standard ◽  
Best Practice ◽  
Neonatal Resuscitation ◽  
Clean Water ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
Resource Limited ◽  
High Level ◽  
Ongoing Concern

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

scholarly journals Factors Related to Maternal Adverse Outcomes in Pregnant Women with Cardiac Disease in Low-resource Settings

2020 ◽  
Vol 15 ◽  
Author(s):  
Philippe Amubuomombe Poli ◽  
Elkanah Omenge Orang’o ◽  
Ann Mwangi ◽  
Felix Ayub Barasa
Keyword(s):  
Pregnant Women ◽  
Cardiac Disease ◽  
Premature Death ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
Resource Limited ◽  
Maternal And Neonatal Outcomes

Background: Cardiac disease is an important life-threatening complication during pregnancy. It is frequently seen in pregnant women living in resource-limited areas and often results in premature death. Aim: The aim of this hospital-based longitudinal study was to identify factors related to adverse maternal and neonatal outcomes in pregnant women with cardiac disease in low-resource settings. Methods: The study enrolled 91 pregnant women with congenital or acquired cardiac disease over a period of 2 years in Kenya. Results: Maternal and early neonatal deaths occurred in 12.2% and 12.6% of cases, respectively. The risk of adverse outcomes was significantly increased in those with pulmonary oedema (OR 11, 95% CI [2.3–52]; p=0.002) and arrhythmias (OR 16.9, 95% CI [2.5–113]; p=0.004). Limited access to care was significantly associated with adverse maternal outcomes (p≤0.001). Conclusion: Many factors contribute to adverse maternal and neonatal outcomes in pregnant women with cardiac disease. Access to comprehensive specialised care may help reduce cardiac-related complications during pregnancy.

scholarly journals Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

2009 ◽  
Vol 107 (Supplement) ◽  
pp. S47-S64 ◽  
Author(s):  
Stephen N. Wall ◽  
Anne CC Lee ◽  
Susan Niermeyer ◽  
Mike English ◽  
William J. Keenan ◽  
...  
Keyword(s):  
Scale Up ◽  
Neonatal Resuscitation ◽  
Low Resource Settings ◽  
Low Resource

Challenges in implementing best practice DVI guidelines in low resource settings: lessons learnt from the Meethotamulla garbage dump mass disaster

2018 ◽  
Vol 15 (1) ◽  
pp. 125-130
Author(s):  
Sameera A. Gunawardena ◽  
Ravindra Samaranayake ◽  
Vianney Dias ◽  
Selliah Pranavan ◽  
Asela Mendis ◽  
...  
Keyword(s):  
Best Practice ◽  
Mass Disaster ◽  
Garbage Dump ◽  
Low Resource Settings ◽  
Low Resource ◽  
Lessons Learnt

scholarly journals Recommendations for participatory design in low-resource settings

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Lucia CORSINI ◽  
Clara B. ARANDA-JAN ◽  
Henderson Cassi ◽  
James MOULTRIE
Keyword(s):  
Participatory Design ◽  
Best Practice ◽  
Biometric Identification ◽  
Development Projects ◽  
Community Based ◽  
Low Resource Settings ◽  
Low Resource ◽  
Collaborative Community ◽  
Global North ◽  
The Uk

Participatory design is a widely recognised approach in Design for Development projects. It supports collaborative, community-based practices and it empowers users to take ownership. Despite the importance of participatory design in solving global challenges, the majority of research has focused its application in the Global North. Recently, some studies have explored participatory design methods in more low-resource settings. Still there is a gap between the existence of these methods, and designers being able to use them successfully because of the complex realities they face in low-resource settings. Existing knowledge is fragmented and there is a lack of best practice guidance for practitioners using participatory design in low-resource settings. We address this problem by reporting the experiences of Simprints, a technology company based in the UK, providing biometric identification solutions in the Global South. Our study reveals key recommendations for participatory design in low-resource settings, providing useful insights for practitioners and design researchers.

scholarly journals Performance of a Nonelectric Infant Warmer in Rwandan Health Centers

2019 ◽  
Vol 6 ◽  
pp. 2333794X1988482 ◽  
Author(s):  
Leana May ◽  
Alphonse Nshimyiryo ◽  
Marthe Kubwimana ◽  
Evrard Nahimana ◽  
Natalie Schoen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mixed Methods ◽  
Temperature Rise ◽  
Adverse Reactions ◽  
Health Centers ◽  
Resource Limited Settings ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Limited ◽  
Neonatal Hypothermia

Background. Neonatal hypothermia remains a challenge in resource-limited settings. Methods. We conducted a prospective mixed-methods cohort study in rural Rwandan health centers to assess the performance of an infant warmer we designed for low-resource settings. All hypothermic infants were eligible for enrollment. Outcomes. Safety: incidence of adverse reactions. Effectiveness: attainment of euthermia, rate of temperature rise. Feasibility: correct use of warmer, signs of wear. Interviews of caregivers and nurses. Findings. Of 102 encounters, there were no adverse reactions. Of 80 encounters for hypothermia when infants on warmer for ≥1 hour, 79 achieved euthermia; 73 in ≤2 hours. Of the 80 encounters, 64 had temperature rise ≥0.5°C/h. Of the 102 encounters, there were no instances of the warmer being prepared, used, or cleaned incorrectly. Five out of the 12 warmers exhibited wear. Interview participants were predominantly positive; some found time for readiness of warmer challenging. Interpretation. The warmer performed well. It is appropriate to study in larger scale.

scholarly journals Potential solutions for screening, triage, and severity scoring of suspected COVID-19 positive patients in low-resource settings: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046130
Author(s):  
Sarah Hirner ◽  
Jennifer Lee Pigoga ◽  
Antoinette Vanessa Naidoo ◽  
Emilie J Calvello Hynes ◽  
Yasein O Omer ◽  
...  
Keyword(s):  
Scoping Review ◽  
Low Income ◽  
The United States ◽  
Validation Data ◽  
Middle Income ◽  
Severity Scoring ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Limited ◽  
Scoring Tools

ObjectivesPurposefully designed and validated screening, triage, and severity scoring tools are needed to reduce mortality of COVID-19 in low-resource settings (LRS). This review aimed to identify currently proposed and/or implemented methods of screening, triaging, and severity scoring of patients with suspected COVID-19 on initial presentation to the healthcare system and to evaluate the utility of these tools in LRS.DesignA scoping review was conducted to identify studies describing acute screening, triage, and severity scoring of patients with suspected COVID-19 published between 12 December 2019 and 1 April 2021. Extracted information included clinical features, use of laboratory and imaging studies, and relevant tool validation data.ParticipantThe initial search strategy yielded 15 232 articles; 124 met inclusion criteria.ResultsMost studies were from China (n=41, 33.1%) or the United States (n=23, 18.5%). In total, 57 screening, 23 triage, and 54 severity scoring tools were described. A total of 51 tools−31 screening, 5 triage, and 15 severity scoring—were identified as feasible for use in LRS. A total of 37 studies provided validation data: 4 prospective and 33 retrospective, with none from low-income and lower middle-income countries.ConclusionsThis study identified a number of screening, triage, and severity scoring tools implemented and proposed for patients with suspected COVID-19. No tools were specifically designed and validated in LRS. Tools specific to resource limited contexts is crucial to reducing mortality in the current pandemic.

scholarly journals Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Shannon Findlay ◽  
Morgan Swanson ◽  
Christian Junker ◽  
Mitchell Kinkor ◽  
Karisa K. Harland ◽  
...  
Keyword(s):  
Community Health ◽  
Neonatal Mortality ◽  
Health Workers ◽  
Neonatal Resuscitation ◽  
Neonatal Health ◽  
Low Resource Settings ◽  
Low Resource ◽  
Helping Babies Breathe ◽  
Community Health Initiative

Abstract Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health.

scholarly journals Equitable data sharing: challenges and suggestions for ways forward

2019 ◽  
Vol 4 ◽  
pp. 172 ◽  
Author(s):  
Karen I. Barnes ◽  
Julio Arturo Canario ◽  
Sunil S. Vernekar ◽  
Shivaprasad S. Goudar ◽  
Roberto Espinal ◽  
...  
Keyword(s):  
Case Studies ◽  
Data Sharing ◽  
Health Research ◽  
Data Science ◽  
Sensitive Data ◽  
Secondary Users ◽  
Low Resource Settings ◽  
Low Resource ◽  
Resource Limited ◽  
Antimalarial Resistance

Data sharing is increasingly mandated by health research funders and publishers. In the context of data collected in low-resource settings, concerns have been raised regarding inequitable opportunities to engage in secondary use of data between researchers in well-resourced and resource-limited settings. In this context, we present three case studies and their issues related to equity: the multicountry Antenatal Corticosteroid Trial, health research in the Dominican Repulic and the WorldWide Antimalarial Resistance Network. These case studies were discussed at the 2018 Global Forum for Bioethics in Research in South Africa, focussing on the theme “The ethics of data sharing and biobanking in health research”. The case studies provide concrete examples of real challenges such as lack of prior consent for data sharing, potential for misinterpretation of data by secondary users and limited capacity of researchers in low-resource settings to conduct secondary analyses. We conclude by suggesting ways forward. We stress the importance of capacity building and investments in data management and data science skills, and in data sharing platforms supporting poverty-related disease research. In addition, we recommend that there should be incentives to promote data sharing and that research groups and institutions establish their own data sharing policies  tailored to their context, data and community while persuing harmonization with existing policies as much as possible. We also think that international guidelines on authorship criteria should be revisited. For new studies, researchers should obtain consent for sharing of participants’ data with secondary users. Lastly we recommend that community and stakeholder engagement be conducted to improve the consent process and identify what might be sensitive data to mitigate any potential harms to data subjects and their communities.

scholarly journals Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

2022 ◽  
Vol 3 (1) ◽  
pp. 1-4
Author(s):  
Subhashchandra Daga
Keyword(s):  
Nursing Staff ◽  
Health Workers ◽  
Newborn Care ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
General Duty ◽  
Care Services ◽  
Resource Setting ◽  
Low Resource Setting

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

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