scholarly journals Effect of The CRADLE Vital Signs Alert Device Intervention on Referrals for Obstetric Haemorrhage in Low-Middle Income Countries: A Secondary Analysis of A Stepped-Wedge Cluster-Randomised Control Trial

Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Muchabayiwa Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536 223 women attended maternity care facilities. We reviewed a total of 144 cases that were referred, 119 cases 3.84% pre-implementation and 4.48% post-implementation were referred to higher-level facilities. Overall referrals did not significantly reduce (OR 0.89 (0.39- 2.05)) but there was a significant reduction in referrals for bleeding (OR 0.5 (0.39-0.65) following introduction of the device, with homogeneity (I-squared 10.4) between sites. There was no increase in any bleeding-related morbidity.Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of Shock Index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial Registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucie Giblin ◽  
Nicola Vousden ◽  
Hannah Nathan ◽  
Francis Gidiri ◽  
Shivaprasad Goudar ◽  
...  

Abstract Background Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. Methods This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. Results Between April 1 2016 and Nov 30th, 2017 536,223 women attended maternity care facilities. Overall, 3.7% (n = 2784/74,828) of women seen in peripheral maternity facilities were referred to higher level care in the control period compared to 4.4% (n = 3212/73,371) in the intervention period (OR 0.89; 0.39–2.05) (data for nine sites that were able to collect denominator). Of these 0.29% (n = 212) pre-intervention and 0.16% (n = 120) post-intervention were referred to higher-level facilities for maternal haemorrhage. Although overall referrals did not significantly reduce there was a significant reduction in referrals for obstetric haemorrhage (OR 0.56 (0.39–0.65) following introduction of the device with homogeneity (i-squared 26.1) between sites. There was no increase in any bleeding-related morbidity (maternal death or emergency hysterectomy). Conclusions Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of shock index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. Trial registration This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016).


2020 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan

Abstract Background: Malaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods: CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.Results: Five hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.Conclusion: Malaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial Registration: This is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.


2021 ◽  
Author(s):  
Katy Kuhrt ◽  
Paul T Seed ◽  
Andrew H Shennan

Abstract BackgroundMalaria is a significant threat to refugee populations. Bidibidi Refugee Settlement, Northern Uganda hosts 223 000 of Uganda’s 1.4 million refugees, vulnerable to malaria due to crowded conditions and limited access to preventative measures and health care. Early detection and referral of suspected malaria cases is key to reducing associated morbidity and mortality. We therefore aimed to evaluate shock index (heart rate/ systolic blood pressure), calculated by the CRADLE Vital Signs Alert (VSA) device, an easy-to-use blood pressure and heart rate monitor, for detection of malaria as grounds for whether the device could be used for low cost identification and referral of patients by non-medically trained Village Health Team workers (VHTs).Methods CRADLE VSA devices and related training were delivered to all health facilities and VHTs in Bidibidi Refugee Settlement from April to August 2018. CRADLE VSA readings was performed as part of routine patient assessment. CRADLE VSA data (blood pressure, heart rate) and assigned diagnoses were collected from health facility data record books and shock index calculated for each case. Cases were grouped into predefined disease categories, including malaria and severe malaria. A control group consisted of refugees undergoing asymptomatic screening using the CRADLE VSA. Average shock index was calculated for cases and controls and prespecified disease categories, and predictive statistics to evaluate shock index for prediction of malaria and severe malaria.ResultsFive hundred and eighty-seven CRADLE VSA devices were delivered. Malaria accounted for 26% (915/3577) of cases and had the highest shock index compared to other disease categories. Positive likelihood ratios for shock index using a threshold of greater than or equal to 0.9 were 5 and 11 for malaria and severe malaria respectively.ConclusionMalaria accounted for over a quarter of cases. Positive likelihood ratios indicated that patients with shock index greater than or equal to 0.9 were 5 and 11 times more likely to be suffering from malaria and severe malaria respectively, indicating that the CRADLE VSA could be used by non-medically trained VHTs to identify patients likely to have malaria, and those most at risk of severe disease needing urgent referral. Trial RegistrationThis is an observational study and therefore does not have or require a trial registration. Appropriate permissions were granted by UN Refugee Council, Ministry of Health and Office of the Prime Minister.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Hall ◽  
J Kep ◽  
J Brown ◽  
J Pyakalyia ◽  
R King ◽  
...  

Abstract Background The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries. Objectives The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project. Results Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment. Conclusions Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries. Key messages Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared


2018 ◽  
Vol 22 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Thach Duc Tran ◽  
Beverley-Ann Biggs ◽  
Sara Holton ◽  
Hau Thi Minh Nguyen ◽  
Sarah Hanieh ◽  
...  

AbstractObjectiveTo determine the prevalence of co-morbidity of two important global health challenges, anaemia and stunting, among children aged 6–59 months in low- and middle-income countries.DesignSecondary analysis of data from Demographic and Health Surveys (DHS) conducted 2005–2015. Child stunting and anaemia were defined using current WHO classifications. Sociodemographic characteristics of children with anaemia, stunting and co-morbidity of these conditions were compared with those of ‘healthy’ children in the sample (children who were not stunted and not anaemic) using multiple logistic models.SettingLow- and middle-income countries.SubjectsChildren aged 6–59 months.ResultsData from 193 065 children from forty-three countries were included. The pooled proportion of co-morbid anaemia and stunting was 21·5 (95 % CI 21·2, 21·9) %, ranging from the lowest in Albania (2·6 %; 95 % CI 1·8, 3·7 %) to the highest in Yemen (43·3; 95 % CI 40·6, 46·1 %). Compared with the healthy group, children with co-morbidity were more likely to be living in rural areas, have mothers or main carers with lower educational levels and to live in poorer households. Inequality in children who had both anaemia and stunting was apparent in all countries.ConclusionsCo-morbid anaemia and stunting among young children is highly prevalent in low- and middle-income countries, especially among more disadvantaged children. It is suggested that they be considered under a syndemic framework, the Childhood Anaemia and Stunting (CHAS) Syndemic, which acknowledges the interacting nature of these diseases and the social and environmental factors that promote their negative interaction.


2021 ◽  
Author(s):  
Minerva Rivas Velarde ◽  
Caroline Jagoe ◽  
Jess Cuculick

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Pisake Lumbiganon ◽  
Hla Moe ◽  
Siriporn Kamsa-ard ◽  
Siwanon Rattanakanokchai ◽  
Malinee Laopaiboon ◽  
...  

2019 ◽  
Vol 4 (1) ◽  
pp. 625-628
Author(s):  
Nisha Ghimire ◽  
Renu Yadav ◽  
Soumitra Mukhopadhyay

Introduction: Studies have shown different views regarding the effect of music in vitals e.g Heart rate (HR), Blood pressure (BP) and atiention. The effect of preferred music with lyrics in vitals and reaction time in stroop test has not been performed in Nepalese students so, we conducted the study. Objective: To find out the change in HR, BP and reaction time in Stroop test before and after their preferred music with lyrics. Methodology Thirty male medical and paramedical students aged 25.27 ± 2.0 participated in study. The vital signs and reaction time in Stroop test before and after music was taken. Results Paired-t test was used to compare means before and after exposure to music. The means are expressed as Mean ± SD. Heart rate (HR) increased after exposure to music (66.33±9.51 Vs 67.2±8.44) (p<.05). The error in Stroop test was less after music (.66±.49 Vs.63±.66) (p<.05). The reaction time after error correction decreased post exposure to music (24.117±4.61Vs23.29±4.45) (p<.05). Conclusion The heart rate increased after exposure to music. The errors decreased after listening to music which also decreased reaction time.


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