Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed

Ensino da reanimação neonatal para parteiras tradicionais - do aprendizado à prática nas Regiões Norte e Nordeste do Brasil

No Brasil, a maioria dos partos é hospitalar, mas nas zonas rurais, ribeirinhas e de difícil acesso ocorrem partos domiciliares e são as parteiras tradicionais que prestam assistência à mulher e ao recém-nascido.Descrever quem são as parteiras tradicionais das regiões norte e nordeste do Brasil, quais suas percepções sobre asfixia e reanimação neonatal e quais são suas práticas no parto domiciliar. Estudo observacional de corte transversal, com entrevista das parteiras antes do treinamento em reanimação neonatal, durante o ano de 2012. Foram incluídas 155 parteiras não indígenas, do Amazonas, Amapá, Sergipe, Paraíba e Pernambuco. Variáveis independentes: idade, escolaridade e experiência prévia. Desfecho: respostas às questões da entrevista. Para os dados categorizados foram calculadas as frequências absolutas e relativas. As parteiras são mulheres maduras, com baixa escolaridade e pouca experiência. Identificam o risco de asfixia no neonato que não chora ou chora pouco. Não ligam o cordão umbilical até a saída da placenta, enxugam o recém-nascido com panos secos e aquecidos, aspiram boca e narina do bebê com a própria boca e para estimular a respiração sacodem e sopram sua boca e nariz. Se o neonato não chora ou não melhora pedem ajuda e encaminham para o hospital. A maioria das parteiras acompanha o bebê no transporte. As parteiras sabem pouco sobre reanimação neonatal, atuam de forma precária, mas realizam os passos iniciais da reanimação. Capacitações periódicas para parteiras podem melhorar o atendimento ao nascimento no domicílioIn Brazil, most births occur in hospitals, but in rural, riparian and remote areas, home births happen frequently, and traditional birth attendants (TBAs or midwives) assist the women and their newborns. Describe the traditional TBAs in North and Northeast regions of Brazil, including their perceptions on neonatal asphyxia and resuscitation and their practices regarding home birth. An observational cross-sectional study which interviewed TBAs before a neonatal resuscitation training conducted during the year 2012. We included 155 non-indigenous midwives from Amazonas, Amapá, Sergipe, Pernambuco and Paraíba. Independent variables: age, education and prior experience. Endpoint: answers given during the interview. For categorical data we calculated absolute and relative frequencies. These midwives are middle-aged women with low education and little experience. The risk of birth asphyxia is detected when the newborn does not cry or shows a weak cry after delivery. These TBAs do not cut the umbilical cord until the delivery of the placenta. Common practices are wiping the baby with dry and warm cloths, aspiring the newborn mouth and nostril with their own mouth and stimulating breathing shaking the baby and blowing air into the newborn’s nose and mouth. When the infant does not cry or does not show any improvement, these women ask for help to send the baby to a hospital. Most midwives accompany the newborn baby to the hospital. Brazilian midwives know little about neonatal resuscitation, their work happen in a precarious way, but they do perform the initial steps of resuscitation. Regular training for midwives might improve their service during home birth

La práctica en el cuidado de los recién nacidos sanos en Brasil

O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available

La práctica en el cuidado de los recién nacidos sanos en Brasil

O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available