Tropical medicine & international health : TM & IH
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Trop. Med. Int. Health · Aug 2013
An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality.
In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. ⋯ This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays.
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Trop. Med. Int. Health · Jul 2013
Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children.
We aimed to improve paediatric inpatient surveillance at a busy referral hospital in Malawi with two new programmes: (i) the provision of vital sign equipment and implementation of an inpatient triage programme (ITAT) that includes a simplified paediatric severity-of-illness score, and (ii) task shifting ITAT to a new cadre of healthcare workers called 'vital sign assistants' (VSAs). ⋯ ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task shifting ITAT to VSAs may improve outcomes in paediatric hospitals in the developing world.
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Trop. Med. Int. Health · Jul 2013
Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries.
To develop a new paediatric illness severity score, called inpatient triage, assessment and treatment (ITAT), for resource-limited settings to identify hospitalised patients at highest risk of death and facilitate urgent clinical re-evaluation. ⋯ We developed an inpatient triage tool (ITAT) appropriate for resource-constrained hospitals that identifies high-risk children after hospital admission. Further research is needed to study how best to operationalise ITAT in developing countries.
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Trop. Med. Int. Health · May 2013
Multicenter StudyScreening of patients with tuberculosis for diabetes mellitus in India.
To assess feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) within the routine healthcare setting across the country at: eight tertiary care hospitals and more than 60 peripheral health institutions in eight tuberculosis units. ⋯ This pilot project shows that it is important and feasible to screen patients with TB for DM in the routine setting, resulting in earlier identification of DM in some patients and opportunities for better management of comorbidity. A policy decision has since been made by the National TB Control Programme of India to implement this intervention countrywide.
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Trop. Med. Int. Health · May 2013
Screening of patients with diabetes mellitus for tuberculosis in India.
To assess the feasibility, results and challenges of screening patients with diabetes mellitus (DM) for tuberculosis (TB) within the healthcare setting of six DM clinics in tertiary hospitals across India. ⋯ In India, it is feasible to screen patients with DM for TB resulting in high rates of TB detection. More attention to detail, human resource requirements and electronic medical records are needed to improve performance.