81 research outputs found
Exposure to household air pollution from solid cookfuels and childhood stunting: a population-based, cross-sectional study of half a million children in low- and middle-income countries
BACKGROUND: Household air pollution from the incomplete combustion of solid cookfuels in low- and middle-income countries (LMICs) has been largely ignored as a potentially important correlate of stunting. Our objective was to examine the association between solid cookfuel use and stunting in children aged <5 y. METHODS: We used data from 59 LMICs' population-based cross-sectional demographic and health surveys; 557 098 children aged <5 y were included in our analytical sample. Multilevel logistic regression was used to examine the association between exposure to solid cookfuel use and childhood stunting, adjusting for child sex, age, maternal education and number of children living in the household. We explored the association across key subgroups. RESULTS: Solid cookfuel use was associated with child stunting (adjusted OR 1.58, 95% CI 1.55 to 1.61). Children living in households using solid cookfuels were more likely to be stunted if they lived in rural areas, the poorest households, had a mother who smoked tobacco or were from the Americas. CONCLUSIONS: Focused strategies to reduce solid cookfuel exposure might contribute to reductions in childhood stunting in LMICs. Trial evidence to assess the effect of reducing solid cookfuel exposure on childhood stunting is urgently needed
Thermoregulatory effects of swaddling in Mongolia: A randomised controlled study
Objective To investigate thermal balance of infants in a Mongolian winter, and compare the effects of traditional swaddling with an infant sleeping-bag in apartments or traditional tents (Gers).Design A substudy within a randomised controlled trial.Setting Community in Ulaanbaatar, Mongolia.Subjects A stratified randomly selected sample of 40 swaddled and 40 non-swaddled infants recruited within 48â
h of birth.Intervention Sleeping-bags and baby outfits of total thermal resistance equivalent to that of swaddled babies.Outcome measure Digital recordings of infantsâ core, peripheral, environmental and microenvironmental temperatures at 30-s intervals over 24â
h at ages 1 month and 3â
months.Results In Gers, indoor temperatures varied greatly ( 25°C), but remained between 20°C and 22°C, in apartments. Despite this, heavy wrapping, bed sharing and partial head covering, infant core and peripheral temperatures were similar and no infants showed evidence of significant heat or cold stress whether they were swaddled or in sleeping-bags. At 3â
months, infants in sleeping-bags showed the âmatureâ diurnal pattern of a fall in core temperature after sleep onset, accompanied by a rise in peripheral temperature, with a reverse pattern later in the night, just before awakening. This pattern was not related to room temperature, and was absent in the swaddled infants, suggesting that the mature diurnal pattern may develop later in them.Conclusions No evidence of cold stress was found. Swaddling had no identifiable thermal advantages over sleeping-bags during the coldest times, and in centrally heated apartments could contribute to the risk of overheating during the daytime.Trial registration number ISRTN01992617
Medical device procurement in low- and middle-income settings: protocol for a systematic review
Background: Medical device procurement processes for low- and middle-income countries (LMICs) are a poorly
understood and researched topic. To support LMIC policy formulation in this area, international public health
organizations and research institutions issue a large body of predominantly grey literature including guidelines,
manuals and recommendations. We propose to undertake a systematic review to identify and explore the medical
device procurement methodologies suggested within this and further literature. Procurement facilitators and
barriers will be identified, and methodologies for medical device prioritization under resource constraints will be
discussed.
Methods/design: Searches of both bibliographic and grey literature will be conducted to identify documents relating
to the procurement of medical devices in LMICs. Data will be extracted according to protocol on a number of
pre-specified issues and variables. First, data relating to the specific settings described within the literature will be noted.
Second, information relating to medical device procurement methodologies will be extracted, including prioritization
of procurement under resource constraints, the use of evidence (e.g. cost-effectiveness evaluations, burden of
disease data) as well as stakeholders participating in procurement processes. Information relating to prioritization
methodologies will be extracted in the form of quotes or keywords, and analysis will include qualitative
meta-summary. Narrative synthesis will be employed to analyse data otherwise extracted. The PRISMA guidelines
for reporting will be followed.
Discussion: The current review will identify recommended medical device procurement methodologies for
LMICs. Prioritization methods for medical device acquisition will be explored. Relevant stakeholders, facilitators
and barriers will be discussed. The review is aimed at both LMIC decision makers and the international research
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Ranking hospitals based on preventable hospital death rates:a systematic review with implications for both direct measurement and indirect measurement through standardized mortality rates
Objectives
There is interest in monitoring avoidable or preventable deaths measured directly or indirectly through standardized mortality rates (SMRs). We reviewed studies that use implicit case note reviews to estimate the range of preventable death rates observed, the measurement characteristics of those estimates, and the measurement procedures used to generate them. We comment on the implications for monitoring SMRs and illustrate a way to calculate the number of reviews needed to establish a reliable estimate of preventability of one death or the hospital preventable death rate.
Design
Systematic review of the literature supplemented by re-analysis of authors previously published and un-published data and measurement design calculations.
Data source
Searches in PubMed, MEDLINE (OvidSP) and Web of Knowledge in June 2012, updated December 2017.
Eligibility criteria
Studies of hospital-wide admissions from general and acute medical wards where preventable deaths rates are provided or can be estimate and which can provide inter- observer variations.
Results
Twenty-four studies were included from 1983-2017. Recent larger studies suggest consistently low rates of preventable deaths (3.0-6.5% since 2012). Reliability of a single review for distinguishing between individual cases with regard to the preventability of death had a Kappa rate of 0.27-0.50 for deaths and 0.24-0.76 for adverse events. A Kappa of 0.35 would require an average of 8-17 reviews of a single case to be precise enough to have confidence about high stakes decisions to change care procedures or impose sanctions within a hospital as a result. No study estimated the variation in preventable deaths across hospitals, although we were able to re-analyse one study to obtain an estimate. Based on this estimate, 200-300 total case-note reviews per hospital could be required to reliably distinguish between hospitals.
The studies display considerable heterogeneity: 13/24 studies defined preventable with a threshold of â„4 in a six-category Likert scale; 11/24 involved a two-stage screening process with nurses at the first stage and physicians at the second. Fifteen studies provided expert clinical review support for reviewer disagreements, advice, or quality control. A âgeneralist/internistâ was the modal physician specialty for reviewers and they received 1-3 days of generic tools orientation and case-note review practice. Methods did not consider the influence of human or environmental factors.
Conclusions
The literature provides limited information about the measurement characteristics of preventable deaths that suggests substantial numbers of reviews may be needed to create reliable estimates of preventable deaths at the individual or hospital level. Any operational program would require population specific estimates of reliability. Preventable death rates are low, which is likely to make it difficult to use SMRs based on all deaths to validly profile hospitals. The literature provides little information to guide improvements in the measurement procedures.
Systematic review registration
The systematic review was conceived prior to PROSPERO, and so has not been registered
Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.
Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36-55%), 24% (95% CI 17-32%), and 1.4% (95% CI 1.2-1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings
Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data
This study was supported by a grant from the National Institute for Health Research (NIHR) under its Health Technology Assessment programme (reference No 13/03/25, to ARM
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