scholarly journals The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa

2018 ◽  
Vol 18 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Martin Otyek Opio ◽  
Teopista Namujwiga ◽  
Imaculate Nakitende ◽  
John Kellett ◽  
Mikkel Brabrand
Keyword(s):  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Sub Saharan Africa ◽  
Medical Patients ◽  
Upper Arm ◽  
Arm Circumference ◽  
Resource Poor ◽  
Sub Saharan ◽  
Mid Upper Arm Circumference

scholarly journals Presenting symptoms, diagnoses and in-hospital mortality in a low resource hospital environment

QJM ◽  
2020 ◽  
Author(s):  
L Wasingya-Kasereka ◽  
I Nakitende ◽  
J Nabiryo ◽  
T Namujwiga ◽  
J Kellett
Keyword(s):  
Hospital Mortality ◽  
Vital Signs ◽  
Sub Saharan Africa ◽  
Hospital Environment ◽  
Medical Patients ◽  
Low Resource ◽  
Presenting Symptoms ◽  
Arm Circumference ◽  
Sub Saharan ◽  
Mid Upper Arm Circumference

Summary Background The relationship between symptoms, signs and discharge diagnoses with in-hospital mortality is poorly defined in low-resource settings. Aim To explore the prevalence of presenting symptoms, signs and discharge diagnoses of medical patients admitted to a low-resource sub-Saharan hospital and their association with in-hospital mortality. Methods In this prospective observational study, the presenting symptoms and signs of all medical patients admitted to a low-resource hospital in sub-Saharan Africa, their discharge diagnoses and in-hospital mortality were recorded. Results Pain, gastro-intestinal complaints and feverishness were the commonest presenting symptoms, but none were associated with in-hospital mortality. Only headache was associated with decreased mortality, and no symptom was associated with increased in-hospital mortality. Malaria was the commonest diagnosis. Vital signs, mobility, mental alertness and mid-upper arm circumference (MUAC) had the strongest association with in-hospital mortality. Tuberculosis and cancer were the only diagnoses associated with in-hospital mortality after adjustment for these signs. Conclusion Vital signs, mobility, mental alertness and MUAC had the strongest association with in-hospital mortality. All these signs can easily be determined at the bedside at no additional cost and, after adjustment for them by logistic regression the only diagnoses that remain statistically associated with in-hospital mortality are tuberculosis and cancer.

scholarly journals Respiratory rates observed over 15 and 30 s compared with rates measured over 60 s: practice-based evidence from an observational study of acutely ill adult medical patients during hospital admission

QJM ◽  
2019 ◽  
Vol 112 (7) ◽  
pp. 513-517 ◽  
Author(s):  
M Rimbi ◽  
D Dunsmuir ◽  
J M Ansermino ◽  
I Nakitende ◽  
T Namujwiga ◽  
...  
Keyword(s):  
Observational Study ◽  
Respiratory Rate ◽  
Sub Saharan Africa ◽  
Early Warning Score ◽  
Medical Patients ◽  
Rate Measurement ◽  
Limits Of Agreement ◽  
Resource Poor ◽  
Sub Saharan ◽  
Single Center Observational Study

AbstractBackgroundRespiratory rate is often measured over a period shorter than 1 min and then multiplied to produce a rate per minute. There are few reports of the performance of such estimates compared with rates measured over a full minute.AimCompare performance of respiratory rates calculated from 15 and 30 s of observations with measurements over 1 min.DesignA prospective single center observational studyMethodsThe respiratory rates calculated from observations for 15 and 30 s were compared with simultaneous respiratory rates measured for a full minute on acutely ill medical patients during their admission to a resource poor hospital in sub-Saharan Africa using a novel respiratory rate tap counting software app.ResultsThere were 770 respiratory rates recorded on 321 patients while they were in the hospital. The bias (limits of agreement) between the rate derived from 15 s of observations and the full minute was −1.22 breaths per minute (bpm) (−7.16 to 4.72 bpm), and between the rate derived from 30 s and the full minute was −0.46 bpm (–3.89 to 2.97 bpm). Rates observed over 1 min that scored 3 National Early Warning Score points were not identified by half the rates derived from 15 s and a quarter of the rates derived from 30 s.ConclusionPractice-based evidence shows that abnormal respiratory rates are more reliably detected with measurements made over a full minute, and respiratory rate measurement ‘short-cuts’ often fail to identify sick patients.

Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees

2021 ◽  
pp. 1-24
Author(s):  
David CE Philpott ◽  
Valérie Belchior-Bellino ◽  
Mija Ververs
Keyword(s):  
Characteristic Curve ◽  
International Committee ◽  
Red Cross ◽  
African Countries ◽  
Upper Arm ◽  
Arm Circumference ◽  
Group A ◽  
Sub Saharan ◽  
Sensitivity Specificity ◽  
Mid Upper Arm Circumference

Abstract Objective: Body mass index (BMI) is a time-intensive measurement to assess nutritional status. Mid-upper arm circumference (MUAC) has been studied as a proxy for BMI in adults, but there is no consensus on its optimal use. Design: We calculated sensitivity, specificity, and area under receiver operating characteristic curve (AUROCC) of MUAC for BMI <18.5, <17, and <16 kg/m2. We designed a system using two MUAC cutoffs, with a healthy (non-thin) “green” group, a “yellow” group requiring BMI measurement, and a “red” group who could proceed directly to treatment for thinness. Setting: We retrospectively analyzed monitoring data collected by the International Committee of the Red Cross in places of detention. Participants: 11,917 male detainees in eight African countries. Results: MUAC had excellent discriminatory ability with AUROCC: 0.87, 0.90, and 0.92 for BMI<18.5, BMI<17, and BMI<16 kg/m2, respectively. An upper cutoff of MUAC 25.5 cm to exclude healthy detainees would result in 64% fewer detainees requiring BMI screening and had sensitivity 77% (95%CI 69.4,84.7) and specificity 79.6 (95%CI: 72.6,86.5) for BMI<18.5 kg/m2. A lower cutoff of MUAC<21.0 cm had sensitivity 25.4% (95%CI: 11.7,39.1) and specificity 99.0% (97.9,100.0) for BMI<16 kg/m2. An additional 50kg weight requirement improved specificity to 99.6% (95%CI: 99.0,100.0%) with similar sensitivity. Conclusions: A MUAC cutoff of 25.5 cm, above which detainees are classified as healthy and below receive further screening would result in significant time savings. A cutoff of <21.0 cm and weight <50 kg can identify some detainees with BMI <16 kg/m2 who require immediate treatment.

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