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Quality of pediatric anesthesia: A cross-sectional study of a university hospital in a low-income country.

ABSTRACT: To evaluate the quality of pediatric anesthesia in a university hospital in Dar es Salaam, Tanzania.A cross-sectional study conducted using a new tool that was developed from the literature and WHO recommendations including 28 parameters as standards for pediatric anesthesia. These 28 parameters consisted of 17 structure parameters of the equipment and medicines that should be present in theatre before any surgery starts, and 11 process parameters of actions taken by staff. Adverse events occurring during the anesthesia were recorded.30 patients were included, aged between 1.5 months to 5 years with a mean of 2.4 years. 26 of the patients underwent elective surgery and 4 patients emergency surgery. Nine parameters were always present and one parameter (bag and mask) was not available for any of the patients. The structure index ranged from 71% to 94% with a mean of 84%. The process index had a mean score of 71% with a range from 50% to 90%: lower than the structure index (p<0.001). With the structure and process index combined the average score was 79% with a low of 67% and high of 89%. 70 adverse events were observed with a range from 0 to 7 adverse events per patient. The most common adverse event was hypoxia at extubation in 20 (69%) patients. Nine patients had an episode of severe hypoxia at extubation.Pediatric anesthesia in low resource settings suffers from deficiencies in the structures and processes of providing good quality care. Improvement efforts may be best focused on improving the consistency and quality of the process of care and a reduction in adverse events rather than the structures available. Use of the assessment tool developed for this research could be useful for systematic quality-improvement efforts and to assess the needs in different settings.

SUBMITTER: Andersson O

PROVIDER: S-EPMC5890975 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Quality of pediatric anesthesia: A cross-sectional study of a university hospital in a low-income country.

Andersson Oskar O Radell Peter P Ringo Victor V Mulungu Moses M Baker Tim T

PloS one 20180409 4

<h4>Objective</h4>To evaluate the quality of pediatric anesthesia in a university hospital in Dar es Salaam, Tanzania.<h4>Method</h4>A cross-sectional study conducted using a new tool that was developed from the literature and WHO recommendations including 28 parameters as standards for pediatric anesthesia. These 28 parameters consisted of 17 structure parameters of the equipment and medicines that should be present in theatre before any surgery starts, and 11 process parameters of actions take ...[more]

PMID: 29630656

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Project description:The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa.A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561).Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country.We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.

Project description:BackgroundChronic patients persistently seek for health information on the internet for medication information seeking, nutrition, disease management, information regarding disease preventive actions and so on. Consumers ability to search, find, appraise and use health information from the internet is known as eHealth literacy skill. eHealth literacy is a congregate set of six basic skills (traditional literacy, health literacy, information literacy, scientific literacy, media literacy and computer literacy). The aim of this study was to assess eHealth literacy level and associated factors among internet user chronic patients in North-west Ethiopia.MethodsInstitutional based cross-sectional study design was conducted. Stratified sampling technique was used to select 423 study participants among chronic patients. The eHealth literacy scale (eHEALS) was used for data collection. The eHEALS is a validated eight-item Likert scaled questionnaire used to asses self-reported capability of eHealth consumers to find, appraise, and use health related information from the internet to solve health problems. Statistical Package for Social science version 20 was used for data entry and further analysis. Multivariable logistic regression was used to examine the association between the eHealth literacy skill and associated factors. Significance was obtained at 95% CI and p < 0.05.ResultIn total, 423 study subjects were approached and included in the study from February to May, 2019. The response rate to the survey was 95.3%. The majority of respondents 268 (66.3%) were males and mean age was 35.58 ± 14.8 years. The multivariable logistic regression model indicated that participants with higher education (at least having the diploma) are more likely to possess high eHealth literacy skill with Adjusted Odds Ratio (AOR): 3.48, 95% CI (1.54, 7.87). similarly, being government employee AOR: 1.71, 95% CI (1.11, 2.68), being urban resident AOR: 1.37, 95% CI (0.54, 3.49), perceived good health status AOR: 3.97, 95% CI (1.38, 11.38), having higher income AOR: 4.44, 95% CI (1.32, 14.86), Daily internet use AOR: 2.96, 95% CI (1.08, 6.76), having good knowledge about the availability and importance of online resources AOR: 3.12, 95% CI (1.61, 5.3), having positive attitude toward online resources AOR: 2.94, 95% CI (1.07, 3.52) and higher level of computer literacy AOR: 3.81, 95% CI (2.19, 6.61) were the predictors positively associated with higher eHealth literacy level.ConclusionBesides the mounting indication of efficacy, the present data confirm that internet use and eHealth literacy level of chronic patients in this setting is relatively low which clearly implicate that there is a need to fill the skill gap in eHealth literacy among chronic patients which might help them in finding and evaluating relevant online sources for their health-related decisions.

Project description:BackgroundThe diagnosis of Type 1 diabetes is commonly missed in most health facilities in Nigeria. Adequate knowledge of childhood diabetes is necessary for the recognition and possible intervention for the control of the disease. However, research to assess knowledge deficiencies and their relationship to attitude is lacking in most developing countries including Nigeria. This study intends to survey the beliefs and perceptions of caregivers of children towards diabetes in childhood. It also aims at determining the caregivers' depth of knowledge of diabetes in children, the relationship between knowledge and practices as well as the association between level of education and gender with practices and knowledge. The study outcome will help in the formulation of policy and education of the communities with regards to the preconceived myths and realities of childhood diabetes.MethodsA descriptive study involving 500 respondents, population groups were selected by multi-staged sampling from different areas in Enugu metropolis, south-East of Nigeria. A validated structured interviewer-administered questionnaire was used. Ethical approval was obtained, and only consenting subjects were interviewed. Data was analyzed with Statistical Package for the Social Sciences (SPSS) version 20.ResultAlmost all the respondents (99.8%) had heard of diabetes in adults. However, a lower proportion of respondents 43.2% knew about diabetes in childhood. Only 24.8% had good knowledge of the different aspects of diabetes. Although females were more knowledgeable about the effects of healthy life style modifications on diabetes, there was no gender predisposition in knowledge about diabetes in childhood. A positive association existed between knowledge and education [p < 0.001] concerning childhood diabetes. Irrespective of this association 82.6% of the respondents with good knowledge of the disease still had a poor attitude towards healthy life style practices.ConclusionThis study has shown that beliefs and perceptions of childhood diabetes among the adult caregivers in Enugu, south - East Nigeria is mostly erroneous and their knowledge deficient. Literacy did not improve both knowledge and attitude to healthy lifestyle practices.

Project description:IntroductionGood handover creates a common understanding of responsibility and patients' status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams.MethodologyA descriptive cross-sectional study was conducted at post anesthesia care unit of Dilla University Referral Hospital from October 1 to November 30, 2020. To conduct the study, consecutively selected 208 handovers of patients from operation theatre (OT) to PACU were assessed. A checklist was developed based on a combination of criteria adopted from the Australian Medical Association 2006 and British Doctors Committee 2004. It was pilot tested and changes were made before the actual data collection.ResultOur study found that the postoperative patient handover practice among professionals was poor (below 50%) in the areas of patients' full name, age, medical registration number (MRN), ASA class, allergic history, medical history, baseline vital signs, preoperative diagnosis and surgical procedure performed. Our study also found poor postoperative hand overing regarding the intraoperative blood loss 9.6%, intraoperative clinical incidents 5.3%, recovery condition 7.2%, postoperative analgesia plan 18.8%, and post operative antibiotic plan 8.2%. Whereas, type of anesthesia 81.3%, intraoperative vital signs 80.8%, and intraoperative analgesia used 79.8%, intraoperative fluid management 80.8% were among the indicators with >50% completion rate.Conclusion and recommendationOur study found a poor practice of patient handover regarding sociodemographic and preoperative profile, anesthesia, surgery and other necessary information. We believe standardizing this process and providing training will improve the quality of postoperative handovers and the safety of patients during this critical period.

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Quality of pediatric anesthesia: A cross-sectional study of a university hospital in a low-income country.

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Quality of pediatric anesthesia: A cross-sectional study of a university hospital in a low-income country.

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