Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

Bataar, Otgon; Lundeg, Ganbold; Tsenddorj, Ganbat; Jochberger, Stefan; Grander, Wilhelm; Baelani, Inipavudu; Wilson, Iain; Baker, Tim; Dünser, Martin W.

doi:10.2471/blt.10.077073

Cited by 52 publications

(56 citation statements)

References 23 publications

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“…The experience of the authors is, however, that similar findings can be seen in many other hospitals in Tanzania. Recent studies in related disciplines have shown findings consistent with our results in the Gambia [30], Zambia [31], Mongolia [32] and in sub-Saharan Africa [33]. A further limitation is the lack of some data due to unavailability of information when the hospital visits were conducted.…”

Section: Discussionsupporting

confidence: 79%

Emergency and critical care services in Tanzania: a survey of ten hospitals

Baker

Lugazia

Eriksen

et al. 2013

BMC Health Serv Res

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123

162

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BackgroundWhile there is a need for good quality care for patients with serious reversible disease in all countries in the world, Emergency and Critical Care tends to be one of the weakest parts of health systems in low-income countries. We assessed the structure and availability of resources for Emergency and Critical Care in Tanzania in order to identify the priorities for improving care in this neglected specialty.MethodsTen hospitals in four regions of Tanzania were assessed using a structured data collection tool. Quality was evaluated with standards developed from the literature and expert opinion.ResultsImportant deficits were identified in infrastructure, routines and training. Only 30% of the hospitals had an emergency room for adult and paediatric patients. None of the seven district and regional hospitals had a triage area or intensive care unit for adults. Only 40% of the hospitals had formal systems for adult triage and in less than one third were critically ill patients seen by clinicians more than once daily. In 80% of the hospitals there were no staff trained in adult triage or critical care. In contrast, a majority of equipment and drugs necessary for emergency and critical care were available in the hospitals (median 90% and 100% respectively. The referral/private hospitals tended to have a greater overall availability of resources (median 89.7%) than district/regional hospitals (median 70.6).ConclusionsMany of the structures necessary for Emergency and Critical Care are lacking in hospitals in Tanzania. Particular weaknesses are infrastructure, routines and training, whereas the availability of drugs and equipment is generally good. Policies to improve hospital systems for the care of emergency and critically ill patients should be prioritised.

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Section: Discussionsupporting

confidence: 79%

Emergency and critical care services in Tanzania: a survey of ten hospitals

Baker

Lugazia

Eriksen

et al. 2013

BMC Health Serv Res

Self Cite

123

162

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“…This suggests that, even in a resource-limited setting, implementation of an infection treatment bundle is feasible without provision of extra material resources [16][17][18]. This interpretation is consistent with the results of previous surveys indicating that material resources required to implement the infection treatment bundle (as used in this trial) were widely available even in resource-limited healthcare facilities in middle-and low-income countries [16][17][18].…”

Section: Discussionsupporting

confidence: 86%

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda

et al. 2018

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Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections.Design: Single-center, prospective, before-and-after feasibility trial.Setting: Emergency department of a sub-Saharan African district hospital. Patients:Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions:The trial had three phases (each of 4 months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and main results:Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 h after hospital admission; and at discharge. A total of 1594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001).No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (pre-intervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 h (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed.

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“…Mongolia is a relatively small country in North-East Asia locked for the most part between China in the south and Russia in the north with a population of approximately 2.8 million (Bataar et al, 2010; Ider et al, 2010). The capital city of Ulaanbaatar is home to roughly half of the country’s population.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance and molecular epidemiology ofStaphylococcus aureusfrom Ulaanbaatar, Mongolia

Nair

Hanson

Kondratowicz

et al. 2013

PeerJ

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This study aimed to characterize Staphylococcus aureus (S. aureus) strains isolated from human infections in Mongolia. Infection samples were collected at two time periods (2007–08 and 2011) by the National Center for Communicable Diseases (NCCD) in Ulaanbaatar, Mongolia. S. aureus isolates were characterized using polymerase chain reaction (PCR) for mecA, PVL, and sasX genes and tested for agr functionality. All isolates were also spa typed. A subset of isolates selected by frequency of spa types was subjected to antimicrobial susceptibility testing and multilocus sequence typing. Among 251 S. aureus isolates, genotyping demonstrated methicillin resistance in 8.8% of isolates (22/251). Approximately 28% of the tested S. aureus isolates were observed to be multidrug resistant (MDR). Sequence type (ST) 154 (spa t667) was observed to be a strain with high virulence potential, as all isolates for this spa type were positive for PVL, had a functional agr system and 78% were MDR. S. aureus isolates of ST239 (spa t037) were observed to cause infections and roughly 60% had functional agr system with a greater proportion being MDR. Additionally, new multilocus sequence types and new spa types were identified, warranting continued surveillance for S. aureus in this region.

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Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia

Cited by 52 publications

References 23 publications

Emergency and critical care services in Tanzania: a survey of ten hospitals

Emergency and critical care services in Tanzania: a survey of ten hospitals

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda

Antimicrobial resistance and molecular epidemiology ofStaphylococcus aureusfrom Ulaanbaatar, Mongolia

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