Paediatrics and International Child Health最新文献

{"title":"Suicide attempt with isoniazid in adolescents receiving tuberculous prophylaxis: three cases.","authors":"Emine Polat,&nbsp;Saliha Senel","doi":"10.1080/20469047.2021.1946651","DOIUrl":"https://doi.org/10.1080/20469047.2021.1946651","url":null,"abstract":"<p><p>An overdose of isoniazid (INH) is potentially fatal and attempts at suicide are very rare in children. Three patients aged 14-17 years who were receiving INH for tuberculosis prophylaxis were admitted to the emergency department with generalised tonic-clonic seizures. There was metabolic acidosis and elevated levels of blood creatine kinase, aminotransferases and lactate dehydrogenase following ingestion of excess INH in attempts at suicide. The presumed total amounts of INH ingested were 3 g (40 mg/kg), 9 g (160 mg/kg) and 6 g (100 mg/kg), respectively. They all improved with general supportive measures including airway protection, gastric lavage, activated charcoal administration, sodium bicarbonate infusion, fluid replacement, seizure control and pyridoxine administration. They were discharged without complications. Attempts to commit suicide by excess intake of INH is rare in children but should be considered in the differential diagnosis of acute intractable seizures and metabolic acidosis refractory to conventional anticonvulsant therapy in adolescents.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"228-230"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1946651","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39155489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Neisseria oralis</i> septicaemia in a newborn: first recorded case.","authors":"Gabriele Baniulyte,&nbsp;Sima Svirpliene,&nbsp;Andrew Eccleston,&nbsp;Sangeetha Arjunan,&nbsp;Martin Connor","doi":"10.1080/20469047.2020.1826780","DOIUrl":"https://doi.org/10.1080/20469047.2020.1826780","url":null,"abstract":"<p><p><i>Neisseria oralis</i> is a bacterium which normally resides within the oral microflora. A female infant was born by emergency caesarean section owing to fetal distress with a gestational age of 38 weeks, a birthweight of 2250 g and a temperature of 36.5°C. The pregnancy had been normal. The delivery was complicated by prolonged rupture of membranes (48 hours) and meconium-stained and foul-smelling liquor. APGAR scores were 1 at 1 min, 9 at 5 min and 9 at 10 min. The infant looked pale and had respiratory distress requiring resuscitation for the first 4 minutes. After a septic screen, she was commenced on benzylpenicillin and gentamicin. On Day 1 of life she was diagnosed with neonatal sepsis, and <i>N. oralis</i> was identified in blood cultures and blood-stained cerebrospinal fluid (CSF). Although <i>N. oralis</i> was cultured from the CSF, it was considered that this was more likely owing to blood contamination of the CSF. In view of the blood and CSF cultures, antibiotics were changed to intravenous cefotaxime. By Day 6 blood infection markers were regarded as normal. Antibiotics were continued for 14 days. Although neonatal sepsis caused by <i>N. oralis</i> has not been reported before, it should be considered to be a pathogen able to cause neonatal sepsis.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"226-227"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2020.1826780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38477931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of single phototherapy with low-cost reflective sheets versus single phototherapy alone in mild-to-moderate unconjugated hyperbilirubinaemia in full-term neonates.","authors":"Amira M Sabry,&nbsp;Mortada H F El-Shabrawi,&nbsp;Abdelrahman A Abdelrazek,&nbsp;Mahmoud F Ali","doi":"10.1080/20469047.2021.1958603","DOIUrl":"https://doi.org/10.1080/20469047.2021.1958603","url":null,"abstract":"<p><strong>Background: </strong>An economical alternative method of increasing the light intensity of phototherapy for neonatal jaundice is the use of reflective sheets placed on the sides of the incubator.</p><p><strong>Aim: </strong>To determine whether reflective sheets in addition to phototherapy increase the reduction of bilirubin levels and the duration of hospital stay.</p><p><strong>Methods: </strong>The study was undertaken in the neonatal intensive care unit of Cairo University Children's Hospital. There were two groups: a study group of 90 full-term neonates with neonatal jaundice who received single phototherapy in incubators covered with white plastic reflective sheets and a control group of 90 full-term neonates with neonatal jaundice who received single phototherapy without the reflective sheets.</p><p><strong>Results: </strong>The mean (SD) rate of bilirubin decline in the first 24 hours of phototherapy was greater in the study group [3.7 (0.86) µmol/L/hr] than in the control group [2.2 (0.14) µmol/L/hr] (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>Use of reflective sheets decreases the total duration of phototherapy and the cost and duration of hospitalisation without any added complications.<b>Abbreviations:</b> AAP: American Academy of Pediatrics; HIDS: high-intensity double-surface; LMIC: low- and middle-income countries; MCTP: mirror-covered tunnel phototherapy; NICU: neonatal intensive care unit; TSB: total serum bilirubin.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"206-210"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39393215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic thrombosis in a neonate with COVID-19-related fetal inflammatory response syndrome requiring amputation of the leg: a case report.","authors":"Priyanka S Amonkar,&nbsp;Jeetendra B Gavhane,&nbsp;Suhas N Kharche,&nbsp;Sameer S Kadam,&nbsp;Dattatray B Bhusare","doi":"10.1080/20469047.2021.1968596","DOIUrl":"https://doi.org/10.1080/20469047.2021.1968596","url":null,"abstract":"<p><p>Neonatal infection with SARS-CoV-2 is considered to have no major complications. A neonate with lower limb gangrene owing to spontaneous aortic thrombosis in the setting of a fetal inflammatory response syndrome (FIRS) post-intrauterine COVID-19 infection is presented. A healthy full-term newborn discharged from hospital on Day 3 developed irritability and progressive blackish discoloration of the toes of the right lower limb on Day 6 of life. Doppler imaging revealed acute thrombosis of the abdominal aorta with a critically ischaemic right lower limb. On Day 11 of life, SARS-CoV-2 RT-PCR was negative but total antibodies (IgG and IgM) were positive in both mother and neonate. The neonate showed raised inflammatory markers including CRP, ESR, interleukin-6, procalcitonin, ferritin and LDH along with elevated N-terminal pro-brain natriuretic peptide and D-dimer. In the absence of clinical signs of sepsis, FIRS was diagnosed. The neonate was treated with corticosteroids, heparin infusion and recombinant tissue plasminogen activator, and required surgical embolectomy followed by right limb amputation. By Day 31 of life, inflammatory markers showed serial return to normal and the neonate was discharged on oral steroids and aspirin. Intrauterine SARS-CoV-2 infection may trigger a systemic inflammatory response in some fetuses which is similar to post-COVID-19 multisystem inflammatory syndrome in children (MIS-C). Development of lower limb gangrene is a unique COVID-19-related neonatal complication and is attributed to thrombo-inflammation.<b>ABBREVIATIONS</b>CRP: C-reactive protein; FIRS: fetal inflammatory response syndrome; MIS-C: multisystem inflammatory syndrome in children; NT-proBNP: N-terminal pro-brain natriuretic peptide; RT-PCR: real-time polymerase chain reaction.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"211-216"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39389102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and predictive risk factors for ophthalmological complications in children with nephrotic syndrome receiving long-term oral corticosteroids: a cohort study.","authors":"Raja Hariharan,&nbsp;Sriram Krishnamurthy,&nbsp;Subashini Kaliaperumal,&nbsp;Pediredla Karunakar,&nbsp;Bobbity Deepthi","doi":"10.1080/20469047.2021.1983315","DOIUrl":"https://doi.org/10.1080/20469047.2021.1983315","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data from India on ophthalmological complications in children on long-term oral corticosteroids for idiopathic nephrotic syndrome.</p><p><strong>Methods: </strong>All children aged 4-18 years with idiopathic nephrotic syndrome who had received long-term oral steroids for >6 months  and who attended the paediatric nephrology clinic between January 2019 and January 2021 were included. The majority of them (95/110) were being followed up in the paediatric nephrology clinic which was functioning from 2010.   The children were screened for ophthalmological complications at 6-month intervals.</p><p><strong>Results: </strong>Overall, 110 children with nephrotic syndrome  were enrolled. Their median (IQR) age was 9.4 (7.0-12.8) years, and the median (range) duration of follow-up following onset of nephrotic syndrome was 5 years (1.0-16). The incidence of cataract was 18.1% (20 of 110 cases).  Visual acuity was impaired in seven (35%) of the children with cataract.  Children with cataract were younger as compared to those without cataract [Median (IQR) age at onset of nephrotic syndrome [2.5 (2.0-4.0) yrs <i>vs</i> 4 (2.1-6.0) yrs] (<i>p</i>=0.03)]. Children with cataract also had higher cumulative dose of prednisolone intake (mg/m²) [28,669 (21,329-33,500) <i>vs</i> 14,995 (10,492-19,687)] (<i>p</i><0.01)] and greater cumulative duration of prednisolone intake [4.3 (3.1-5.2) <i>vs</i> 2.25 (1.3-3.7) yrs] (<i>p</i><0.01). The incidence of raised IOP was 9.1% (10 of 110 cases).</p><p><strong>Conclusions: </strong>The incidence of cataract and raised IOP was high. The risk factors for the development of cataract were age at onset of nephrotic syndrome, cumulative dose and cumulative duration of steroid intake.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"199-205"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39571232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, risk factors and outcome of Mycoplasma pneumoniae infection among children in Uganda: a prospective study.","authors":"Rebecca Nantanda,&nbsp;Freddie Bwanga,&nbsp;Irene Najjingo,&nbsp;Grace Ndeezi,&nbsp;James K Tumwine","doi":"10.1080/20469047.2021.1980698","DOIUrl":"https://doi.org/10.1080/20469047.2021.1980698","url":null,"abstract":"<p><strong>Background: </strong>: Atypical bacteria cause 10-40% of all childhood pneumonia.. Data on the burden of atypical pneumonia in sub-Saharan Africa are limited.</p><p><strong>Aim: </strong>: To determine the prevalence, associated factors, and outcome of <i>Mycoplasma pneumoniae</i> infection in children with respiratory symptoms at Mulago National Referral Hospital, Kampala.</p><p><strong>Methods: </strong>: Children aged 2 months to 12 years with cough and/or difficult breathing and fast breathing were recruited. A clinical history and physical examination were undertaken. Blood samples for <i>Mycoplasma pneumoniae</i> IgM antibodies were taken at enrolment and Day 21 and induced sputum for DNA-PCR. Admitted participants were followed for a maximum of 7 days or until discharge or death, whichever came first.</p><p><strong>Results: </strong>: A total of 385 children were enrolled, and, of these, 368 (95.6%) were <5 years. Overall, 60/385 (15.6%) participants tested positive for <i>M. pneumoniae</i> IgM and/or DNA-PCR. Of these, 56/60 (93.3%) were <5 years of age. Wheezing was present in 21/60 (35.0%) of the children with atypical pneumonia and in 128/325 (39.4%) with typical pneumonia. The factors associated with <i>M. pneumonia</i> were female sex (AOR 1.94, 95% CI 1.22-3.08, <i>p</i> < 0.001), age ≥12 months (AOR 2.73, 95% CI 1.53-4.87, <i>p</i> = 0.01) and a history of prematurity (AOR 2.07, 95% CI 1.23-3.49, <i>p</i> = 0.01). Mortality was 17/352 (4.8%) and, of these, 4/17 (23.5%) had <i>M. pneumonia</i>.</p><p><strong>Conclusion: </strong>: <i>M. pneumonia</i> is common in young children , especially females above 2 years and those with history of prematurity. It presents with severe symptoms. The results of the study highlight the importance of considering atypical bacteria in under-5s with the symptoms of pneumonia.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"188-198"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791631/pdf/nihms-1741896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39596458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodevelopmental outcome in neonates with hypoxic-ischaemic encephalopathy managed with therapeutic hypothermia in a tertiary-level public hospital outside an intensive care unit setting.","authors":"S Mbatha,&nbsp;F L Nakwa,&nbsp;K Thandrayen,&nbsp;S Velaphi","doi":"10.1080/20469047.2021.1967625","DOIUrl":"https://doi.org/10.1080/20469047.2021.1967625","url":null,"abstract":"<p><strong>Background: </strong>Management of hypoxic-ischaemic encephalopathy (HIE) by therapeutic hypothermia (TH) is a major challenge in low- and middle-income countries (LMIC) because of the limited resources. Clinicians in LMIC offer this intervention outside neonatal intensive care units (NICU). The effect of this practice on neurodevelopmental outcome is not well known.</p><p><strong>Aim: </strong>To determine neurodevelopmental outcome in neonates with HIE managed with TH outside NICU settings.</p><p><strong>Methods: </strong>: This was a retrospective descriptive study of neonates with HIE managed with TH and followed up for neurodevelopmental assessment at 12 and 18-24 months postnatal age. Patients were reviewed over a 24-month period. Outcome at 12 and 18-24 months was compared.</p><p><strong>Results: </strong>Of 178 neonates with HIE attending the clinic, there was information on TH for 155 (87.1%), 113 of whom (72.9%) received TH. HIE was moderate in 88% and severe in 10%. Twenty-seven (23.9%) and 16 (14.1%) were assessed at one time-point at 12 or 18-24 months, respectively, 40 (35.3%) at both time-points, and 30 (26.6%) were not assessed. At 18-24 months, 32% had moderate-to-severe disability compared with 6% at 12 months, with the sensitivity and specificity of assessment at 12 months being 50% and 100%, respectively. The disability attrition rate at 18-24 months was 50%.</p><p><strong>Conclusions: </strong>The relatively low prevalence of disability (32%) at 18-24 months suggests that use of TH in a Level 2 nursery is feasible and possibly beneficial. More studies are needed to confirm these findings.</p><p><strong>Abbreviations: </strong>aEEG: amplitude electroencephalogram; CP: cerebral palsy; GMDS: Griffiths mental developmental scales; GQ: general quotient; HIC: high-income countries; HIE: hypoxic-ischaemic encephalopathy; LMIC: low- and middle-income countries; LTFU: loss to follow-up; NICU: neonatal intensive care unit; TH: therapeutic hypothermia; TOBY: total body hypothermia.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 3","pages":"171-176"},"PeriodicalIF":1.8,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39410975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal dialysis in children with sepsis-associated AKI (SA-AKI): an experience in a low- to middle-income country.","authors":"Apurva Tomar,&nbsp;Virendra Kumar,&nbsp;Abhijeet Saha","doi":"10.1080/20469047.2021.1874201","DOIUrl":"https://doi.org/10.1080/20469047.2021.1874201","url":null,"abstract":"<p><p><b>Background</b>: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.<b>Aim</b>: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.<b>Methods</b>: Early PD (<i>n</i> = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (<i>n</i> = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.<b>Results</b>: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (<i>p</i> < 0.001). The duration of PD was less if it was commenced early (<i>p</i> < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (<i>p</i> < 0.001).<b>Conclusions</b>: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.<b>Abbreviations</b> : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"137-144"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1874201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38826874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of adverse birth outcomes among HIV-infected and HIV-uninfected women delivering in high and low risk settings in the era of universal ART in Malawi: a registry study.","authors":"Rachel Chamanga,&nbsp;Chaplain Katumbi,&nbsp;Luis Gadama,&nbsp;Rachel Kawalazira,&nbsp;Dingase Dula,&nbsp;Bonus Makanani,&nbsp;Sufia Dadabhai,&nbsp;Taha E Taha","doi":"10.1080/20469047.2021.1874200","DOIUrl":"https://doi.org/10.1080/20469047.2021.1874200","url":null,"abstract":"<p><p><b>Background</b>: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.<b>Aim</b>: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infected women receiving lifelong ART and HIV-uninfected women giving birth in low- and high-risk settings in Malawi.<b>Methods</b>: This observational, registry study was conducted from January 2016 to August 2017 in one large, tertiary referral hospital and four primary healthcare (PHC) facilities in Blantyre, Malawi. Women who delivered singleton live births or stillbirths of ≥20 weeks gestation were included in the analysis. Descriptive and stratified analyses were conducted using χ² tests and multivariable logistic models to control for maternal age, gravidity and health facility.<b>Results</b>: A total of 14,233 births were included in the analysis (7715 from the tertiary hospital and 6518 from PHC facilities). In the univariable analysis, there were no differences in rates of LBW (6.7% <i>vs</i> 6.4%) and PTB (42.5% <i>vs</i> 42.0%) between HIV-infected and -uninfected women delivering in PHC facilities. However, differences in LBW were significantly higher in HIV-infected women in multivariable analysis (LBW aOR 1.40, 95% CI 1.01-1.95). Rates of LBW and PTB were significantly higher in HIV-infected women than in uninfected women delivering at the tertiary hospital (LBW 17.6% <i>vs</i> 13.2%, aOR 1.53, 95% CI 1.27-1.85; PTB 28.2% <i>vs</i> 24.9%, aOR 1.37, 95% CI 1.17-1.60)<b>Conclusion</b>: Rates of adverse birth outcomes are significantly higher in HIV-infected women than in HIV-uninfected women, and this is more apparent in high-risk hospital settings than in low-risk PHC settings.</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"112-122"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1874200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38815818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight.","authors":"Sarah Unsworth,&nbsp;Hellen C Barsosio,&nbsp;Florence Achieng,&nbsp;Daniel Juma,&nbsp;Linda Tindi,&nbsp;Fred Omiti,&nbsp;Simon Kariuki,&nbsp;Helen M Nabwera","doi":"10.1080/20469047.2021.1881269","DOIUrl":"https://doi.org/10.1080/20469047.2021.1881269","url":null,"abstract":"<p><strong>Background: </strong>Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes.</p><p><strong>Aim: </strong>To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya.</p><p><strong>Methods: </strong>This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data.</p><p><strong>Results: </strong>At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers.</p><p><strong>Conclusion: </strong>Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..</p>","PeriodicalId":19731,"journal":{"name":"Paediatrics and International Child Health","volume":"41 2","pages":"145-153"},"PeriodicalIF":1.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20469047.2021.1881269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25417118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}