Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts

Dörnemann, Jenny; Boogaard, Wilma van den; Bergh, Rafaël Van den; Takarinda, K. C.; Martinez, Paige; Bekouanebandi, J. G.; Javed, Isma; Ndelema, B.; Lefevre, Annabelle; Khalid, Gul Ghuttai; Zuniga, Isabel

doi:10.5588/pha.16.0127

Cited by 8 publications

(14 citation statements)

References 20 publications

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“…Out of the 283 patients that were randomly selected to form the comparison group, 223 were included in group 3 (non-pregnant). Twenty-six (26) were included in group 2 after record review confirming that they had VL diagnosed within the first two weeks postpartum. Thirty-four (34) records were excluded from analysis: 15 because their files could not be found; 12 because the pregnancy status was unclear/not recorded in the file; and 7 were excluded because after record review it turned out they were lactating women with unknown delivery date.…”

Section: Resultsmentioning

confidence: 99%

“…Data about the condition of the neonate after delivery until discharge were also not available, as the neonates often had their own patient records which we were not able to identify from the archive. Preterm birth is the most important determinant of adverse infant outcomes in terms of survival and quality of life globally, and adverse outcomes are significant especially in low resource settings [25,26].…”

Section: Obstetric and Perinatal Outcomesmentioning

confidence: 99%

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Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan

et al. 2020

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Introduction Visceral leishmaniasis (VL) is endemic in South Sudan, where outbreaks occur frequently. Because of changes in the immune system during pregnancy, pregnant women are considered particularly vulnerable for developing complications of VL disease, including opportunistic infections. There is limited evidence available about clinical aspects and treatment outcomes of VL in pregnancy. We describe characteristics, maternal and pregnancy outcomes from a cohort of pregnant women with VL. Methods We conducted a retrospective analysis using routine programme data from a MSF health facility in Lankien, Jonglei State, South Sudan, between Oct 2014 and April 2018. Records were extracted of women diagnosed with VL while pregnant, and those symptomatic during pregnancy but diagnosed during the first two weeks postpartum. Records were matched with a random sample of non-pregnant women of reproductive age (15-45 years) with VL from the same period. Results We included 113 women with VL in pregnancy, and 223 non-pregnant women with VL. Women with VL in pregnancy presented with more severe anaemia, were more likely to need blood transfusion (OR 9.3; 95%CI 2.5-34.2) and were more often prescribed antibiotics (OR 6.0; 95%CI 3.4-10.6), as compared to non-pregnant women with VL. Adverse pregnancy outcomes, including miscarriage and premature delivery, were reported in 20% (16/ 81) where VL was diagnosed in pregnancy, and 50% 13/26) where VL was diagnosed postpartum. Postpartum haemorrhage was common. Pregnant women were more likely to require extension of treatment to achieve cure (OR 10.0; 95%CI 4.8-20.9), as compared to non-pregnant women with VL. Nevertheless, overall initial cure rates were high (96.5%) and mortality was low (1.8%) in this cohort of pregnant women with VL.

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Section: Resultsmentioning

confidence: 99%

Section: Obstetric and Perinatal Outcomesmentioning

confidence: 99%

Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan

et al. 2020

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“…This is comparable to published data from other neonatal units in areas with limited resources as reported by Mèdecins Sans Frontières (MSF) and Dörnemann et al . [ 11 ]. They found a mortality rate of 17% when looking at eight of their specialised neonatal care units.…”

Section: Discussionmentioning

confidence: 99%

Neonatal morbidity and mortality in Hargeisa, Somaliland: an observational, hospital based study

et al. 2020

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Introduction Hargeisa Group Hospital, Somaliland, opened a neonatal unit in 2013. We aimed to study causes of admission, risk factors for neonatal death and post-discharge care to address modifiable factors. Methods we analysed hospital records from June-October 2013 (n=164). In addition, we reached primary caregivers of 94 patients for further information after discharge. Results of the 164 patients, 65% were male, 31% weighed <2500 grams, 16% were premature, 43% were exposed to meconium and 29% had premature rupture of membranes (PROM). Twenty-seven percent were admitted after caesarean section and 36% had been bag-mask ventilated. The most common diagnoses for admission were asphyxia (34%), respiratory distress (27%), sepsis (16%) and prematurity (15%). The mortality before discharge was 15%, 23/1430 (1.6%) of live-born at the hospital. Half of the admitted preterm babies died (RR for death for preterm vs term born 4.6, 95% CI 2.3-9.0) as well as 28% of the patients with birth weight <2500 grams (RR 2.1, 95% CI 1.0-4.2). The mortality rate with or without PROM was 29% vs 15% (RR 2.0, 95% CI 1.0-3.9). At 28 days of age, 34% of the patients were exclusively breastfed and 44% had not yet been vaccinated. Diarrhoea, vomiting and/or respiratory distress after discharge were reported for 44%. Conclusion prematurity and low birth weight were important risk factors for neonatal death in this cohort, contributing to the high mortality rate. Low numbers of exclusively breastfed and vaccinated infants are also issues of concern to be targeted in the peri- and postnatal care.

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“…Within the health-care facility, particular clinical challenges stand in the way of meeting such an acute need. [1][2][3][4]6 One such challenge is that limitations or absence of advanced services-such as diagnostic and monitoring capacity, non-invasive or mechanical ventilation, enteral nutrition, or central vascular accessrender responders heavily reliant on clinical acumen to diagnose and treat the critically ill. Another challenge is that antibiotic use in these circumstances is empirical, all the while involving decreasingly effective drugs. 7 In terms of the responders themselves, most healthcare workers are generalists, often without training in paediatric critical care or even in paediatrics.…”

Section: Delivering Paediatric Critical Care In Humanitarian Settingsmentioning

confidence: 99%

Delivering paediatric critical care in humanitarian settings

Umphrey¹,

Brown²,

Hiffler

et al. 2018

The Lancet Child & Adolescent Health

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Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts

Cited by 8 publications

References 20 publications

Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan

Outcomes of visceral leishmaniasis in pregnancy: A retrospective cohort study from South Sudan

Neonatal morbidity and mortality in Hargeisa, Somaliland: an observational, hospital based study

Delivering paediatric critical care in humanitarian settings

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