SummaryWe examined the haemodynamic effects of colloid preload, and phenylephrine and ephedrine administered for spinal hypotension, during caesarean section in 42 women with severe early onset pre-eclampsia. Twenty patients with predelivery spinal hypotension were randomly allocated to receive an initial dose of either 50 lg phenylephrine or 7.5 mg ephedrine; the primary outcome was percentage change in cardiac index. After a 300-ml colloid preload, mean (SD) cardiac index increased from 4.9 (1.1) to 5.6 (1.2) l.min À1 .m À2 (p < 0.01), resulting from an increase in both heart rate, from 81.3 (17.2) to 86.3 (16.5) beats.min À1 (p = 0.2), and stroke volume, from 111.8 (19.0) to 119.8 (17.9) ml (p = 0.049).Fourteen (33%) and 23 (54.8%) patients exhibited a stroke volume response > 10% and > 5%, respectively; a significant negative correlation was found between heart rate and stroke volume changes. Spinal hypotension in 20 patients was associated with an increase from baseline in cardiac index of 0.6 l.min À1 .m À2 (mean difference 11.5%; p < 0.0001). After a median [range] dose of 50 lg phenylephrine or 15 [7.5-37.5] mg ephedrine, the percentage change in cardiac index during the measurement period of 150 s was greater, and negative, in patients receiving phenylephrine vs. ephedrine, at À12.0 (7.3)% vs. 2.6 (6.0)%, respectively (p = 0.0001). The percentage change in heart rate after vasopressor was higher in patients receiving phenylephrine, at À9.1 (3.4)% vs. 5.3 (12.6)% (p = 0.0027), as was the change in systemic vascular resistance, at 22.3 (7.5) vs. À1.9 (10.5)% (p < 0.0001). Phenylephrine effectively reverses spinal anaesthesiainduced haemodynamic changes in severe pre-eclampsia, if left ventricular systolic function is preserved.
BackgroundValidating a questionnaire/instrument (whether developed or adapted) before proceeding to the field for data collection is important. This article presents the modification of an Irish questionnaire for a Nigerian setting. The validation process and reliability testing of this questionnaire (which was used in assessing previous breastfeeding practices and breastfeeding intentions of pregnant women in English and Hausa languages) were also presented.MethodFive experts in the field of breastfeeding and infant feeding voluntarily and independently evaluated the instrument. The experts evaluated the various items of the questionnaire based on relevance, clarity, simplicity and ambiguity on a Likert scale of 4. The analysis was performed to determine the content validity index (CVI).Two language experts performed the translation and back-translation. Ten pregnant women completed questionnaires which were evaluated for internal consistency. Two other pregnant women completed the questionnaire twice at an interval of two weeks to test the reliability. SPSS version 21 was used to calculate the coefficient of reliability.ResultsThe content validity index was high (0.94 for relevance, clarity and ambiguity and 0.96 for simplicity). The analysis suggested that four of the seventy one items should be removed.Cronbach’s Alpha was 0.81, while the reliability coefficient was 0.76. The emerged validated questionnaire was translated from English to Hausa, then, back-translated into English and compared for accuracy.ConclusionThe final instrument is reliable and valid for data collection on breastfeeding in Nigeria among English and Hausa speakers. Therefore, the instrument is recommended for use in assessing breastfeeding intention and practices in Nigeria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1366-9) contains supplementary material, which is available to authorized users.
Sub-Saharan Africa, has the highest child mortality rate in the world (World Health Organization [WHO], 2016). However, there is a paucity of current systematic reviews on the impact of essential newborn care interventions in Africa. Therefore, the aim of this systematic review was to summarize evidence about the impact of essential newborn care interventions in Africa. Numerous databases were searched to retrieve articles that reported interventions in newborn care in Africa. The search was limited to the English language and to articles published between 2007 and 2017. Nine articles were selected for inclusion in this systematic review. Overall, these papers demonstrated an increase in performance of health workers (between 8 and 400%) following a test of knowledge, while health workers practical performance increased by 34%. Moreover, neonatal mortality was reduced by 45%, while perinatal mortality was reduced by 30%. Training healthcare workers is one of the most effective ways of improving newborn care and neonatal survival in Africa. However, there is a need for additional evidence to support this, because none of the reviewed studies assessed the impact of training by examining variables such as trainees' satisfaction with training, the knowledge and skills developed, and the health outcomes achieved.
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