Kiwoko Hospital

Neonatal units can be stressful for pre-term infants at a time of rapid brain growth and plasticity, which may contribute to poorer developmental outcomes. Environmental modification to protect against negative sensory experiences and provide positive caregiver stimuli is the standard of care, but little is known about practices in low-income settings. We aimed to determine knowledge and practice relating to developmentally-supportive-care in Uganda. A quantitative survey on knowledge and practice of developmentally-supportive-care was conducted with 135 health workers in four neonatal units. In addition, observations of practices and sound measurements were conducted. Only 36% of respondents reported that stress, and 21% that parental interaction can affect brain development, and knowledge of stress reduction was limited. 84% of respondents reported actions to protect infants from excessive light in their unit, 33% from excessive sound, and 69% from sleep disruption. The main perceived benefit of family involvement in care was to reduce parental stress levels (67%), with infection risk perceived as the main negative (71%). Workers at the largest volume facility had the lowest knowledge and practice, with wide variations across facilities. All units had sound readings over recommended levels. Knowledge and practice of DSC in this setting were low and needs to be improved to ensure that pre-terms in this setting both survive and thrive.

IntroductionOver 60% of premature infants are born in Africa or South Asia. Infants born early, small or who become sick after birth have a higher risk of death, poor growth and developmental impairments. Innovative interventions tailored for low- and middle-income countries are essential to help these newborns survive and develop optimally. This study evaluated the feasibility, acceptability and preliminary effectiveness of Hospital to Home (H2H), a discharge and follow-up programme for small and sick newborns in rural Uganda.MethodsWe compared two cohorts of high-risk hospitalised neonates in Uganda: a historical-comparison cohort receiving standard facility-based care and an intervention cohort that received the H2H programme, a hospital and community spanning package of interventions designed to improve neurodevelopmental outcomes. We compared 6-month corrected neurodevelopmental, growth, nutritional and vaccination outcomes between the cohorts complemented by qualitative interviews of caregivers, community health workers and health facility staff.ResultsWe recruited 191 participants: 91 historical-comparison cohort (born between July and September 2018), and 100 intervention cohort (born July 2019 to February 2020). No statistically significant difference was seen in neurodevelopmental outcomes (adjusted OR 0.68; 95% CI: 0.32 to 1.46). Improved vaccination completion (88.5% intervention vs 76.9% comparison, p=0.041), and exclusive breastfeeding rates (42% vs 6.6%, p<0.001) were seen. Caregivers and healthcare workers reported the intervention to be acceptable and feasible in this rural Ugandan setting.ConclusionThe H2H programme was feasible and acceptable to caregivers and healthcare providers. Improved vaccination and exclusive breastfeeding rates were seen in the intervention group when compared with a historical comparison cohort in this rural Ugandan setting. Further investigation on the short and long-term effectiveness of the H2H programme in a government health services setting is warranted.Trial registration numberISRCTN51636372.

IntroductionA follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim to assess the feasibility, acceptability and early outcomes of a discharge and follow-up programme, called Hospital to Home (H2H), in a neonatal unit in central Uganda.Methods and analysisWe will use a mixed-methods study design comparing a historical cohort and an intervention cohort of newborns and their caregivers admitted to a neonatal unit in Uganda. The study design includes two main components. The first component includes qualitative interviews (n=60 or until reaching saturation) with caregivers, community health workers called Village Health Team (VHT) members and neonatal unit staff. The second component assesses and compares outcomes between a prospective intervention cohort (n=100, born between July 2019 and September 2019) and a historical cohort (n=100, born between July 2018 and September 2018) of infants. The historical cohort will receive standard care while the intervention cohort will receive standard care plus the H2H intervention. The H2H intervention comprises training for healthcare workers on lactation, breast feeding and neurodevelopmentally supportive care, including cue-based feeding, and training to caregivers on recognition of danger signs and care of their high-risk infants. Infants and their families receive home visits until 6 months of age, or longer if necessary, by specially trained VHTs. Quantitative data will be analysed using descriptive statistics and regression analysis. All results will be stratified by cohort group. Qualitative data will be analysed guided by Braun and Clarke’s thematic analysis technique.Ethics and disseminationThis study protocol was approved by the relevant Ugandan ethics committees. All participants will provide written informed consent. We will disseminate through peer-reviewed publications and key stakeholders and public engagement.Trial registration numberISRCTN51636372; Pre-result.

Background Bubble continuous positive airway pressure (bCPAP) is a simple and effective treatment for neonates with respiratory distress syndrome (RDS), a condition that kills and disables many of the 15 million preterm and low birth-weight neonates born worldwide annually. Commercialized CPAP devices are often too expensive for low- and middle-income country (LMIC) settings and while lower cost devices exist, they still cost in excess of $800. In these settings, providers improvise bCPAP devices using components available to save lives, but little is known about their construction, quality, and safety. In September 2015, a 3-day symposium was …

Reducing child mortality is a WHO Millennium Development Goal. Child mortality rate in Uganda in 2009 was 128. In a rural hospital observations on the paediatric ward were being performed infrequently. Introduction of regular observation. Hourly, two hourly or 4 hourly observation on sick children. Training of nurses I interpretation of observations. The number of admissions, discharges and deaths was calculated during two six month periods and mortality rates calculated. Mortality decreased from 6.9% (34 deaths from 496 admissions) to 4% (27 deaths from 706 admissions). This is statistically significant (p-value 0.023). The demographics, cause of death and length of stay remained similar in both groups. The simple intervention of regular nursing observation in children with associated training of nurses has resulted in a statistically significant reduction in child mortality rates in a rural hospital in Uganda.

Backgrounds: Vulnerable plaques typically contain large lipid cores accompanied by expansive vascular remodeling and spotty calcification. While non-occlusive plaque rupture has been proposed as a mechanism for sudden disease progression, the natural history of atheroma progression in patients with vulnerable plaques have not been well characterized. Methods: 3460 patients with angiographic coronary artery disease underwent serial intravascular ultrasound imaging to monitor atheroma progression in 7 clinical trials of anti-atherosclerotic therapies. Patients with (n=1063) and without (n=2397) focal vulnerable plaques, defined as the combination of percent atheroma volume (PAV) &gt;40%, expansive vascular remodeling and spotty calcification, were compared with regard to clinical characteristics and the rate of atheroma progression. Results: Patients with vulnerable plaques were less likely to be female (24 v. 31%, p&lt;0.001) and more likely to have hypertension (82 v. 78%, p=0.01) and diabetes (38 v. 30%, p&lt;0.001). Vulnerable plaque patients harbored more extensive atherosclerotic disease at baseline, with a greater PAV (42.5±7.4 v. 36.9±9.2%, p&lt;0.001) and total atheroma volume (TAV, 207.6±82.7 v. 184.6±82.7 mm3, p&lt;0.001). On serial evaluation, less progression of PAV (0.25±0.28 v. 0.46±0.27%, p=0.08) and TAV (-4.6±2.2 v. -3.0±2.2mm3, p=0.03) was observed in vulnerable plaque patients. Use of statins and optimal control of risk factors including LDL-C and HDL-C levels were associated with the slowest disease progression in patients with vulnerable plaques (Figure). Conclusions: While focal vulnerable plaques are associated with more extensive atherosclerotic burden, these patients demonstrate the greatest benefit of risk factor interventions. These findings suggest that while vulnerable lesions have the propensity to promote ischemic syndromes, they present a modifiable substrate that is sensitive to intensive use of medical therapies.

EDITOR—Minerva reports that a Jehovah's Witness survived emergency surgery for a leaking abdominal aneurysm despite having a postoperative haemoglobin concentration of only 30 g/l; he spent 14 weeks in hospital.1 Those of us who work in rural Africa can only …