The Effect of Ethnicity on Extremity Fracture Analgesia in Native American Patients at a Regional Children\u27s Hospital

Objectives: To determine whether pediatric Native American patients with long bone fractures are as likely to receive adequate analgesia as non-Native Americans with similar fractures at a regional academic hospital in the Southwest. Patients and Methods: Charts of 61 Native Americans and 121 non-Native American patients ages 2 months to 15 years discharged from the pediatric emergency department (PED) or the pediatric urgent care (PUC) with long-bone fractures between June 2005 and May 2007 were reviewed. Insurance status, either Indian Health Service or exempt Medicaid, indicated Native American ethnicity. Potential confounders: age, language, gender, need for fracture reduction, previous analgesia, fracture location, and site of treatment were abstracted. Age, language, gender, pain score, and duration of analgesia at discharge were analyzed. Dose adequacy (mg/kg) and the likelihoods of receiving any analgesia or narcotic analgesia were calculated. Univariate analysis was performed to assess potential confounding variables on the likelihood of receiving analgesia; multivariate analysis was performed to control for variables shown to have an effect. Results: Neither demographic data nor pain scores differed significantly between the two groups. 61% of Native Americans and 65% of non-Native Americans received analgesia (p=0.53). Native Americans were as likely to receive narcotic analgesia (p=0.24) and to receive an adequate dose as non-Native Americans (p=0.24). Age, language, and gender correlated with the likelihood of receiving analgesia. Pain score did not correlate (p=0.09). Conclusions: Native American ethnicity did not affect quality of analgesia care in this multi-ethnic hospital

Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited