Background Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. Aim This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. Setting Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. Methods A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. Results Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. Conclusions In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.
Background We assessed and summarized the peer-reviewed literature on the state of neonatal oxygen therapy in low and lower-middle income countries. Methods A literature search was performed in 3 online databases (Pub Med, EMBASE, CAB Global Health) and amongst USAID’s Service Provision Assessment (SPA) reports for publications pertaining to neonatal oxygen therapy in low and lower-middle income countries over the past 10 years (2007-2017). Results Our search yielded 474 records, of which 26 were relevant and included in the review. Maintenance and indirect costs associated with the procurement of oxygen may constitute barriers to oxygen supply. The quality of therapy provided to neonates was affected by factors including a lack of necessary equipment at neonatal healthcare facilities and high indirect costs associated with the procurement of oxygen. Pulse oximeters used for monitoring of oxygen therapy were available in healthcare facilities, but there is scant data on the frequency of that monitoring. There are some hospitals that deliver neonatal oxygen therapy without any necessary monitoring equipment. Prevalence of retinopathy of prematurity among neonates with risk factors ranged from 11.9-47.2%, which is notably higher than published rates in neonates of similar gestational age being treated in high-income countries. Conclusion There is a lack of data that provides direct estimates of availability of neonatal oxygen equipment and related clinical applications of oxygen therapy across health systems, particularly around the usage and availability of necessary monitoring equipment. Attention to the maintenance of oxygen and ancillary equipment for neonates and quality improvement initiatives to promote adherence to those guidelines can reduce the morbidity and mortality burden among neonates in low and lower-middle income countries.
Background BackgroundAccording to a recent 2018 survey, the rate of childhood acute malnutrition in Malawi has decreased while the rate of stunting in children under five has remained at 37.4%. Our study assesses the impact of child sex, child age, and household distance from main road access on nutritional status in rural Malawi. Methods MethodsAnthropometric data was collected on a sample of children aged 0-18 years at three sites in rural Malawi. Z-scores were calculated based on normative height-for-weight and height-for-age World Health Organization (WHO) growth curves. Univariate odds ratios and 95% confidence intervals (CIs) were calculated for the association of the assessed risk factors with stunting prevalence. Results Results198 children were assessed [46.4% male (92)]. Children were grouped ages 0-<2 years (19, 10%), 2-<5 years (88, 44%), and 5-≤18 years (91, 46%). 2.5% met criteria for wasting, 8.6% had moderate stunting, 5.1% had severe stunting. Data was collected from 3 villages at <2km (16%), 4-5km (35%) and >10 km (52%). Village distance of ≥10 km from the main road (OR = 2.91, CI = 1.26-6.75) and child age under 2 years (odds ratio, OR = 5.54, 95% CI = 1.61-19.1) were both significantly associated with childhood stunting.
Objectives Both chronic and acute malnutrition in children under 5 remain a persistent problem in low and low-middle income countries. Haiti faces the highest burden of childhood malnutrition in the Western Hemisphere. We attempted to describe the prevalence of malnutrition in children in a farming community in Haiti and record characteristics of the those experiencing the disease. Methods A household survey was conducted within the town of Fontaine in the Nord department of Haiti on all children under the age of 5. A total of 535 children were assessed. Anthropometric data was taken on the children and household information was assessed via a population-based survey. Results Of the children assessed, 28% (149/535) were either chronically or acutely malnourished. Of the children who were malnourished: 36.4% (43/118) had 3 or more bouts of diarrhea in the past 3 months and only 5.3% (7/132) had stopped breastfeeding before 1 year of age. On average, the mothers of these children had completed 6.2 years of formal schooling. A slight majority of mothers, 54.7% (81/148), either “never” or “rarely” were concerned their child was malnourished. Of the households with malnourished children 88.4% (130/147) had reported running out of food in the last month. When asked what caused children in Fontaine to be malnourished, mothers of malnourished children cited a lack of food, 56.2% (82/146), and a lack of access to employment, 25.3% (37/146), most frequently. Conclusions Malnutrition commonly affects children in Fontaine. Efficacious prevention interventions could possibly include decreasing food insecurity, or increasing girls’ education level. Funding Sources None.
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