General Electric Foundation.

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Notes on contributorsBernard Olayo is a public health specialist and an entrepreneur from Kenya. He is the founder of the Center for Public Health and Development, a non-profit which has designed and developed two successful social enterprises -MediQuip Global (biomedical equipment repair and maintenance solutions) and Hewa Tele (a public-private venture delivering affordable oxygen in remote areas). He has over 14 years of experience managing complex public health programs in resource-limited settings in 15 countries across the globe. He is also a technical team member on several World Bank projects, primarily as a technical advisor to a number of ministries of health. Caroline Kendi Kirigia is a public health practitioner with training as a clinical officer, in project management, and a Masters in public health. Her 13 years of work experience ranges from HIV and TB prevention, care and treatment and team leadership with the University of California San Francisco and the Kenya Medical Research Institute's FACES programme to supporting the development of continuous quality improvement systems with HealthStrat and the Center for Public Health and Development in Kenya where she currently works in programmes. Her current work covers her interest areas of mental health, maternal health, newborn and child health. Jacquie Narotso Oliwa is a paediatrician, clinical epidemiologist, lecturer and a research fellow working on improving case detection of TB in children. She has 10 years of experience in medical education as a trainer for Paediatric TB, paediatric HIV Comprehensive Care Course; Paediatric TB; Paediatric Life support courses. She teaches child health and research methods at the University of Nairobi and has worked in health systems research collaborating with the Kenyan Ministry of Health and government hospitals in various quality improvement projects, pragmatic clinical observational studies trials and conducting systematic reviews. Odero Nicholas Agai is a Consultant Paediatrician and Child Health Specialist with 10 years hands-on experience both in the public and private sectors. He is also affiliated to The Centre for Public Health and Development, Kenya where he is a consultant and is actively involved in training of health care workers on innovative technology that are designed to reduce neonatal and childhood morbidity and mortality.

A randomized controlled trial recently demonstrated that continuous positive airway pressure (CPAP) effectively decreases respiratory rate in children presenting to Ghanaian district hospitals with respiratory distress. A follow-up study 16 months later evaluated the extent to which the skills and equipment necessary for CPAP use have been maintained. Seven of eight CPAP machines were functional, but five of eight oxygen concentrators and three of four electric generators were non-functional. Nurses trained by US study personnel (first-generation) and nurses trained by Ghanaian nurses after the study (second-generation) were evaluated on CPAP knowledge and skills. Twenty-eight nurses participated in the study, 9 first-generation and 19 second-generation. First-generation trainees scored significantly higher than second-generation trainees on both skills and knowledge assessments (p = 0.003). Appropriate technical support and training must be ensured to address equipment maintenance. Protocolization of the training program, in conjunction with skills and knowledge assessment, may improve acquisition and retention among second- and future-generation trainees.

Influenza D viruses (IDV) are known to co-circulate with viral and bacterial pathogens in cattle and other ruminants. Currently, there is limited knowledge regarding host responses to IDV infection and whether IDV infection affects host susceptibility to secondary bacterial infections. To begin to address this gap in knowledge, the current study utilized a combination of in vivo and in vitro approaches to evaluate host cellular responses against primary IDV infection and secondary bacterial infection with Staphylococcus aureus (S. aureus). Primary IDV infection in mice did not result in clinical signs of disease and it did not enhance the susceptibility to secondary S. aureus infection. Rather, IDV infection appeared to protect mice from the usual clinical features of secondary bacterial infection, as demonstrated by improved weight loss, survival, and recovery when compared to S. aureus infection alone. We found a notable increase in IFN-β expression following IDV infection while utilizing human alveolar epithelial A549 cells to analyze early anti-viral responses to IDV infection. These results demonstrate for the first time that IDV infection does not increase the susceptibility to secondary bacterial infection with S. aureus, with evidence that anti-viral immune responses during IDV infection might protect the host against these potentially deadly outcomes.

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The role of human rhinovirus/enterovirus (HRV/HEV) in severe lower respiratory tract infections remains unclear. We characterized the respiratory status of children admitted to a large academic pediatric intensive care unit (PICU) who tested positive for only HRV/HEV. One hundred and fifty-five children met inclusion criteria with 62% requiring positive pressure respiratory support of 5 cm of water pressure or more within the first 24 hours of admission. Among them, 34% had SaO2 to FiO2 ratios of 264 or less with 22 patients (14%) meeting criteria for pediatric acute respiratory distress syndrome. HRV/HEV is associated with significant respiratory disease in children admitted to the PICU.

We describe a pragmatic training-of-trainers program for the use of continuous positive airway pressure (CPAP) for neonatal and pediatric patients. The program is designed for medical professionals working in low- and middle-income countries and involves 2 days of in-class training followed by 1 day of in-service training. The program was created after training in Cambodia, Ghana, Honduras, Kenya and Rwanda and addresses the issues of resource availability, cultural context and local buy-in and partnership in low- and middle-income countries. We hope others will use the training program to increase knowledge and use of CPAP with the ultimate goal of improving neonatal and pediatric survival globally.