Aims Globally, an estimated 0.8 million children under five die of diarrhoea annually. Clear, evidence-based clinical management protocols exist, but their successful implementation in resource-limited clinical settings remains challenging. This clinical audit aimed to evaluate the impact of a simple, novel integrated care pathway (ICP) on standards of assessment and management of children with acute diarrhoea in a rural hospial in Bangladesh, and to assess any cost implication for the family. The ICP includes a simple checklist of clinical symptoms and signs which allow the severity of dehydration to be accurately assessed, and integrates this with the relevant treatment algorithm.The impact of the new ICP was measured against the 4 endpoints listed in the results section. Methods Retrospective case notes study of admitted children (1 month to 12 years) with acute diarrhoea in 2012. Patient management was evaluated against hospital guidelines. As the ICP was implemented at the end of May 2012, the patients were split into two cohorts: A (pre-ICP) and B (post-ICP). 183 patients were included in total. Conclusion The implementation of the ICP in this clinical setting improved the quality of acute diarrhoea management.Rates of incorrect dehydration assessment fell by 25%, rates of evidence-based rehydration increased by 48% and rates of unnecessary IV fluid administration decreased by 33%. In addition, there was a 72% reduction in cost of fluids for the family. Aims Severe Acute Malnutrition (SAM) underlies some 500,000 young child deaths per year. For the first time, new (December 2013) World Health Organisation Guidelines recognise SAM in infants <6 months (u6m). Research in this group is however lacking: WHO assessed the quality of current evidence as 'VERY LOW' according to the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation).In this study we aimed to address a key question highlighted by WHO: how best to identify high risk infants u6m. We did this by:-Comparing prevalence of infant SAM as defined by current weight-for-length (WFL)-based definitions with proposed new definitions based on mid-upper-arm circumference (MUAC).-Identifying risk factors for use in future clinical assessment tools. Methods A cross sectional prevalence survey conducted in two referral hospitals and three community health centres in Malawi. All infants u6m excluding twins attending for either medical attention or routine immunizations were measured and asked about potential malnutrition risk factors.Results From October 2013-January 2014 we measured 6,787 infants u6m. After data cleaning, we analysed a total of 5,717 infants u6m: 582 from hospitals; 5,135 from health centres.Defined by WFL <À3 z-scores, 1.6% (90) infants had SAM. Defined by MUAC <110mm, 3.9% (214) had SAM. By MUAC <115mm, an additional 3.5% (188) had SAM. However defined, prevalence was higher in the hospitals than in health centres (3.5% vs 1.4% by WFL; 4.5% vs 3.4% by MUAC).There were no male/female sex differences. Infants with low...
Background: Childhood pneumonia continues to be a disease that causes severe morbidity and mortality among children mainly in SouthEast Asia and Africa though it is not so in the developed world. Pneumonia accounts for 16% of all deaths of children under 5 years old in the world, killing nearly one million children in 2015. In Sri Lanka, there were 21,000 reported cases of pneumonia in 2006, 40% were in the age group of less than 4 years. Methods: This was a retrospective study done on the children aged 1 month to 14 years who were admitted to the Professorial Paediatric unit of Teaching Hospital, Peradeniya between 1st of March 2016 and 30th of July 2017 fulfilling diagnostic criteria for community-acquired pneumonia. Data including diagnosis, clinical details, management details and other relevant data were collected from patient records by using a data collection sheet. Results: In this study, 48% of 127 patients admitted with community-acquired pneumonia had bronchopneumonia. About 2/3 of the patients neededa secondline of intravenous antibiotics while 51/ 127 needed care in the high dependency unit with supplemental oxygen. No mortality was observed in the group. Conclusions: Community-acquired paediatric pneumonia has a significant associated morbidity but not mortality in the studied population. The need for the second-line treatment with intravenous antibiotics in a significant proportion of patients may indicate a high degree of antibiotic resistance. Introduction of national antibiotic policy will help the cause.
Introduction: Protein energy malnutrition continues to be a serious health concern in Sri Lanka and the country's estate sector is worst affected. Understanding the local patterns of food consumption will be beneficial before planning programmes of nutritional intervention.
Objectives: To determine the prevalence of childhood overweight, obesity and metabolic abnormalities among children aged 12-15 years within the schools in Kandy Municipality area, Sri Lanka.
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