24 research outputs found

    A care bundle including antenatal corticosteroids reduces preterm infant mortality in Tanzania a low resource country

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    Background Preterm neonatal mortality (NM) has remained high and unchanged for many years in Tanzania, a resource-limited country. Major causes of mortality include birth asphyxia, respiratory insufficiency and infections. Antenatal corticosteroids (ACS) have been shown to significantly reduce mortality in developed countries. There is inconsistent use of ACS in Tanzania. Objective To determine whether implementation of a care bundle that includes ACS, maternal antibiotics (MA), neonatal antibiotics (NA) and avoidance of moderate hypothermia (temperature \u3c 36°C) targeting infants of estimated gestational age (EGA) 28 to 34 6/7 weeks would reduce NM (\u3c 7 days) by 35%. Methods A Pre (September 2014 to May 2015) and Post (June 2015 to June 2017) Implementation strategy was used and introduced at three University-affiliated and one District Hospital. Dexamethasone, as the ACS, was added to the national formulary in May 2015, facilitating its free use down to the district level. Findings NM was reduced 26% from 166 to 122/1000 livebirths (P = 0.005) and fresh stillbirths (FSB) 33% from 162/1000 to 111/1000 (p = 0.0002) Pre versus Post Implementation. Medications including combinations increased significantly at all sites (p\u3c0.0001). By logistic regression, combinations of ACS, maternal and NA (odds ratio (OR) 0.33), ACS and NA (OR 0.30) versus no treatment were significantly associated with reduced NM. NM significantly decreased per 250g birthweight increase (OR 0.59), and per one week increase in EGA (OR 0.87). Moderate hypothermia declined pre versus post implementation (p Interpretation A low-cost care bundle, ~$6 per patient, was associated with a significant reduction in NM and FSB rates. The former presumably by reducing respiratory morbidity with ACS and minimizing infections with antibiotics. If these findings can be replicated in other resource-limited settings, the potential for further reduction ofenormou

    Total direct costs and cost factors of HBB training at HLH.

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    a<p>Travel expenses include transport,accommodation and per diems.</p>b<p>Administration includes as well refreshments during the course.</p>c<p>Courses took place during normal working hours and no extra staff was hired during the courses.</p><p>MHSW = Tanzanian Ministry of Health and Social Welfare; HLH = Haydom Lutheran Hospital; LDHF = Low-dose-high-frequency.</p

    Costs per life saved, life year gained and DALY averted.

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    <p>DALYs [r, K, β] = Disability adjusted life years [discounting rate, age weighting constant K, age weighting constant β].</p

    Comparison of the 12-months observation period before and after full HBB implementation.

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    <p>*Pearson Chi-Square analysis, 2-sided.</p><p>ENM = Early neonatal mortality; BMV = Bag mask ventilation.</p

    Illustration of the 4-stage implementation model and categories for discussion during the 1<sup>st</sup> and 2<sup>nd</sup> Utstein-rotation related to the “Utstein Formula for Survival” (adapted from Søreide et al [26] with permission).

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    <p>Illustration of the 4-stage implementation model and categories for discussion during the 1<sup>st</sup> and 2<sup>nd</sup> Utstein-rotation related to the “Utstein Formula for Survival” (adapted from Søreide et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178073#pone.0178073.ref026" target="_blank">26</a>] with permission).</p

    The “Utstein Formula for Survival” with different implementation scenarios (adapted from Søreide et al [26] with permission).

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    <p>The “Utstein Formula for Survival” with different implementation scenarios (adapted from Søreide et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178073#pone.0178073.ref026" target="_blank">26</a>] with permission).</p

    Tanzania: Champions of LDHF in-situ training (adapted from Perlman et al [29] with permission).

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    <p>Tanzania: Champions of LDHF in-situ training (adapted from Perlman et al [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178073#pone.0178073.ref029" target="_blank">29</a>] with permission).</p
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