Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Evidence-Based Clinical Decision: Key to Improved Patients Care

The practice of medicine had metamorphosed from magical and magical-religious acts of the prehistoric era to empirical-rational decisions of the Egyptian civilization, to modern day evidence-based medicine. Evidence-based medicine requires that clinical decisions and health policies on the prevention, diagnosis and treatment and disease be based on principle and methods scientifically proven to be effective and beneficial. It aims at optimizing clinical and cost effectiveness of an intervention, patients and care provider satisfaction and feasibility. Evidence for clinical decision may be derived form systematic reviews of randomized or quasi-randomized controlled trials, or meta-analysis. Despite effort by World Health Organization, the Cochrane Collaboration and Evidence-based journals to publish systematic reviews and other evidence of best practice, access to these materials remain limited to mostly developed countries. There is need to adopt measures to further facilitate dissemination of current information of effective health to care providers and policymakers in resource-poor countries. This review is aimed at re-enforcing the need for applying best-evidence into clinical practice NQJHM Vol. 13 (3-4) 2003: pp. 43-4

Telemedicine: Definition, Benefits and Limitation

Advances in information and telecommunication technology have brought about new opportunities and capabilities to the delivery of health care services, but these are not without limitations and threats. Telemedicine encompasses my medical activity involving an element of distance and telecommunication in doctor-patients interaction. it may serve as a valuable tool for providing much needed medical services to underserved rural areas in resource poor countries. It allows better utilization of scare medical personnel and resources and promise to enhance continued medical education of young doctors, nurses and other health care practitioners in rural areas, both in training and in established practices. A practical, cheap, “store and forward, electronic mail-based communication may be used to send patients data with image file attachments for expert consultation any where in the world. Issues of major concern in telemedicine are related to security and confidentially of patient data. The cost of establishing telemedicine in resource poor countries must be balanced against need for drugs, medical equipment central control. There is need for national and international central control bodies to license and supervise telemedicine practices. This paper reviews aspects of telemedicine including its clinical applications, cost effectiveness and limitations. NQJHM Vol. 13 (3-4) 2003: pp. 58-6

Medical Informatics in Clinical Practice: An Overview.

Health and patients care is data intensive and involves a wide spectrum of information and often may involve input from other clinical departments and ancillary of clinical support department. For efficient care patients data should be integrated and accessible throughout clinics and hospital. Clinical departmental computer systems can enhance the collection,. Distribution and interpretation of patients data. Providing a high-quality service to patients involves having the right information at the right place and at the right time. Computer technology and networking have revolutionized access and transmission of medical knowledge. Medical informatics involves the use of computer system-analytic tools to support patients of public health care and this forms the basis of hospital information systems. Although the subject of medical informatics has been popularized over two decades in many countries including South African, it remains a largely unexplored subject in the Nigerian medical community. Knowledge and practice and application of computer technology in both private and public Nigeria educational and health institutions are largely rudimentary of non-existent. Yet, health information systems hold tremendous benefits for improving the quality of care including effective utilization of scare human resources. This review article is providing and overview on medical informatics and to stimulate interest in computer support in health care in our locality. NQJHM Vol. 13 (3-4) 2003: pp. 16-1

Oral Health Knowledge, Attitudes and Practices of Parents of Children With Congenital Heart Disease

INTRODUCTION: Caring for chronically ill child could be a great challenge, more so in a depressed economy like in Nigeria. The added burden of dental care appears to be the least among the worries of the parents and guardians of such children. Their oral care is therefore often neglected. This paper aims to obtain baseline data on the current level of knowledge, attitudes and practices of the parents and caregivers of children with congenital heart disease since their own practices will impact on the way they take care of these children. MATERIALS AND METHODS: Examiner administered questionnaires were used to obtain information relating to the oral health, knowledge, attitude and practices of parents/ caregivers of children with congenital heart defects attending the Paediatric Cardiology Clinic of the Lagos University Teaching Hospital from March to July 2003. The children were also examined. A total of 41 children were seen. RESULTS: 76.3% of the parents had never visited a dentist. More mothers were aware of the need for antibiotic prophylaxis before some dental treatments (p=0.049). 82.9% of the parents did not know that bleeding gums could pose a serious health risk to their children. 90.2% are unaware that some dental treatment can complicate their children's heart condition. Though 92.7% of parents were aware of the benefits of tooth brushing; only 36.6% ensured regular brushing for their children. CONCLUSION: There is urgent need for oral health education for the parents/ caregivers of children with congenital heart defects to forestall a situation where they would endanger their children/ wards life through ignorance. There is also a need for interdisciplinary management of these children by the cardiologists and the dentists to ensure these children get the much needed comprehensive care that is important to their wellbeing. Keywords: Congenital heart disease, Oral health knowledge, Oral health practices.NQJHM Vol. 15 (1) 2005: pp. 34-3

Nasopharyngeal pneumococcal carriage in Nigeria: A two-site, population-based survey

Changes in nasopharyngeal (NP) carriage of vaccine-type (VT) Streptococcus pneumoniae can be used to assess the effectiveness of a pneumococcal conjugate vaccine (PCV10). We conducted a baseline carriage survey in rural (Kumbotso, Kano) and urban (Pakoto, Ogun) Nigeria. In this cross-sectional study, we obtained data on demography, clinical history, risk factors, and took NP swabs for pneumococcal culture. We calculated crude and age-standardised carriage prevalence and used log-binomial regression to assess risk factors for carriage. Among children aged &lt;5 years, 92% (95% CI: 88-95%) and 78% (73-82%), respectively, carried any pneumococcus and 48% and 50%, respectively, carried PCV10 serotypes. In Kumbotso, carriage prevalence was &gt;40% across all ages. The age-standardized prevalence of pneumococcal carriage was 66% in Kumbotso and 40% in Pakoto. The most commonly identified serotypes were 19 F, 6 A and 23 F. Risk factors for carriage were young age, recent rhinorrhoea, cohabitation with ≥2 children aged &lt;5 years, and sharing a bed with ≥2 persons. Pneumococcal carriage prevalence is high in this Nigerian population. Persisting prevalence of VT-carriage in older children and adults suggests that PCV10 introduction in children will not eliminate transmission of vaccine serotypes rapidly. High vaccine coverage will therefore be required to ensure full protection of children

Career Intentions of Medical Students Trained in Six Sub-Saharan African Countries

Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected] vir Onderrig en Leer (SOL