Tina Slusher - Academia.edu (original) (raw)

Papers by Tina Slusher

Journal of Tropical Pediatrics, May 10, 2013

This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devi... more This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devices on irradiance levels in a cross-section of Nigerian hospitals. A total of 76 phototherapy devices were evaluated in 16 hospitals while adjustments were implemented for a subset of 25 devices for which consent was obtained. The mean irradiance level was 7.6 AE 5.9 mW/cm 2 /nm for all devices prior to adjustments. The average irradiance level improved from 9.0 mW/cm 2 /nm to 27.3 mW/cm 2 /nm for the adjusted group (n ¼ 25) compared with 6.8 AE 5.4 mW/cm 2 /nm for the unadjusted group (n ¼ 51). Simple, inexpensive adjustments to phototherapy devices with sub-optimal irradiance levels can significantly improve their effectiveness to acceptable international standards and should be widely promoted in resource-constrained settings.

Journal of Tropical Pediatrics, Oct 6, 2017

We report a case of a 4-year-old boy from Oyo, Nigeria, presenting with prolonged seizures and co... more We report a case of a 4-year-old boy from Oyo, Nigeria, presenting with prolonged seizures and coma with the subsequent development of oro-lingual-facial dyskinesia with frequent tongue thrusting, dysconjugate gaze and choreoathetoid movements of the limbs because of autoimmune encephalitis consistent with anti-N-methyl-D-aspartate (anti-NMDAR) encephalitis.

Pediatrics, Jun 1, 2014

OBJECTIVES: Evaluate safety and efficacy of filtered-sunlight phototherapy (FS-PT). METHODS: Term... more OBJECTIVES: Evaluate safety and efficacy of filtered-sunlight phototherapy (FS-PT). METHODS: Term/late preterm infants #14 days old with clinically significant jaundice, assessed by total bilirubin (TB) levels, were recruited from a maternity hospital in Lagos, Nigeria. Sunlight was filtered with commercial window-tinting films that remove most UV and significant levels of infrared light and transmit effective levels of therapeutic blue light. After placing infants under an FS-PT canopy, hourly measurements of axillary temperatures, monitoring for sunburn, dehydration, and irradiances of filtered sunlight were performed. Treatment was deemed safe and efficacious if infants were able to stay in FS-PT for $5 hours and rate of rise of TB was ,0.2 mg/dL/h for infants #72 hours of age or TB decreased for infants .72 hours of age. RESULTS: A total of 227 infants received 258 days of FS-PT. No infant developed sunburn or dehydration. On 85 (33%) of 258 treatment days, infants were removed briefly from FS-PT due to minor temperaturerelated adverse events. No infant met study exit criteria. FS-PT was efficacious in 92% (181/197) of evaluable treatment days. Mean 6 SD TB change was-0.06 6 0.19 mg/dL/h. The mean 6 SD (range) irradiance of FS-PT was 38 6 22 (2-115) mW/cm 2 /nm, measured by the BiliBlanket Meter II. CONCLUSIONS: With appropriate monitoring, filtered sunlight is a novel, practical, and inexpensive method of PT that potentially offers safe and efficacious treatment strategy for management of neonatal jaundice in tropical countries where conventional PT treatment is not available.

Journal of Tropical Pediatrics, Jan 10, 2014

Neonatal hyperbilirubinemia continues to be a leading cause of morbidity and mortality in resourc... more Neonatal hyperbilirubinemia continues to be a leading cause of morbidity and mortality in resource-limited countries. The aim of this study was to measure the effectiveness of existing phototherapy units at a local hospital in Cameroon using an irradiance meter. Phototherapy units (n ¼ 4) in one newborn nursery in Cameroon were evaluated. The average irradiance of the functioning units was 2.87 mW/cm 2 /nm, which is substantially below the recommended range of 10-30 mW/cm 2 /nm. With simple improvements, one new prototype unit was developed. Its irradiance was 23.3 mW/cm 2 /nm. We concluded that irradiance of phototherapy units should be measured, as many local nurseries worldwide may not be delivering effective treatment. Simple and costeffective changes to phototherapy units can make a substantial improvement in irradiance.

Pediatric Hematology and Oncology, Dec 5, 2013

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the w... more Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the world. G6PD deficiency puts children at risk for hyperbilirubinemia and kernicterus during the newborn period and an increased risk of severe hemolysis after exposure to many anti-malarial medications. A laboratory diagnosis of G6PD deficiency is rare in the developing world due to limited resources. We developed a Taqman-based allele specific assay to rapidly determine rates of G6PD deficiency contributing alleles (G202A and A376G) in East Africa. We tested umbilical cord blood from 100 Ugandan newborns and found the overall allele frequency of G202A was 0.13 and A376G was 0.32. The overall incidence of G6PD A-(G202A/A376G) was 6%; all Avariants were males. There was no correlation between G6PD deficiency and umbilical cord blood hemoglobin, white blood count, platelet count, or other hematologic parameters. Allele specific PCR can serve as a rapid method to determine specific G6PD deficiency allele frequencies in a given population and as a diagnostic tool in a hospital setting in which laboratory resources are present.

Journal of Perinatology, Mar 3, 2016

Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange ... more Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many lowand middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical prioritysetting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

Paediatrics and International Child Health, Dec 25, 2019

Frontiers in Pediatrics

Corrigendum: Management challenges in the treatment of severe hyperbilirubinemia in lowand middle... more Corrigendum: Management challenges in the treatment of severe hyperbilirubinemia in lowand middle-income countries: encouraging advancements, remaining gaps, and future opportunities.

Pediatrics

Purpose: Neonatal jaundice is a serious condition that may result in fatal complications if not t... more Purpose: Neonatal jaundice is a serious condition that may result in fatal complications if not treated appropriately and in a timely manner. Prior research studies indicate that there is a high incidence of neonatal jaundice in Iran and that the use of herbal or traditional remedies may lead to a delay in the diagnosis and treatment of neonatal jaundice in Iran. Further, there is a paucity of research on the knowledge and practices of mothers related …

Pediatrics

Purpose: Kernicterus due to severe neonatal hyperbilirubinemia is a leading cause of preventable ... more Purpose: Kernicterus due to severe neonatal hyperbilirubinemia is a leading cause of preventable deaths and disabilities in resource-limited countries due in part to the lack of high-quality, blue-light phototherapy. We have previously shown that filtered-sunlight phototherapy (FSPT) is safe and efficacious in mild-moderate hyperbilirubinemia. Our objective was to compare the safety and efficacy of FSPT with conventional PT (CPT) in moderate-to-severe neonatal hyperbilirubinemia. Methods: We performed a prospective, randomized, controlled, non-inferiority trial to compare safety and efficacy of FSPT vs. CPT in …

Frontiers in Pediatrics

Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neu... more Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.

Journal of Tropical Pediatrics

Background Malaria kills a child in sub-Saharan Africa every 2 min despite widely available inter... more Background Malaria kills a child in sub-Saharan Africa every 2 min despite widely available interventions including intermittent preventive treatment in infants (IPTi). Since 2010, when World Health Organization (WHO) recommended IPTi, no country has implemented it. To our knowledge, no IPTi study has been conducted in Nigeria. Considering severity of malaria in infancy and urgency to improve malaria prevention, we proposed a study to investigate the efficacy of this intervention in reducing malarial morbidity and mortality. Objective(s) The aim of this was to determine the safety and efficacy of SP-IPTi in reducing the prevalence of asymptomatic malaria parasitemia and malarial-associated hospital admissions. Methods We performed a cluster-randomized controlled trial in 1379 infants. SP was administered alongside routine vaccinations in immunization centers randomized to intervention groups. Infants in control groups received only routine vaccines. Malarial ‘morbidity and adverse e...

BMJ Case Reports, 2021

This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a hist... more This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.

Pediatric Critical Care Medicine, 2021

The American Journal of Tropical Medicine and Hygiene, 2019

Residency programs are increasingly responding to the growing demand for global health (GH) educa... more Residency programs are increasingly responding to the growing demand for global health (GH) education by forming dedicated GH tracks. These tracks incorporate a targeted curriculum, support best practices surrounding GH electives such as predeparture preparation and post-return debriefing, and encourage meaningful engagement with international and domestic partners. The University of Minnesota's pediatric residency has had a formal GH track since 2005, and although they have shared several curricular components in the literature, they have yet to provide a comprehensive summary of their GH track. In this article, the authors provide a thorough description of their evolving GH track model, highlighting outcomes and sharing free resources, with the goal of providing a concise, replicable GH track framework for educators seeking to provide more formal GH education within residency programs.

Global Pediatric Health, 2019

Paediatrics and International Child Health, 2018

Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low-and ... more Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low-and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP setups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate-severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (P < 0.0001) improvement in their TAL score, respiratory rate and O 2 sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials. Abbreviations: ACU, acute care unit; bCPAP, bubble continuous positive airway pressure; BUBBLES, bCPAP used beyond babies in low economic settings; cmH 2 O, cm of water; CPAP, continuous positive airway pressure; LMIC, low-and middle-income countries; OR, odds ratio; O 2 sat, oxygen saturation; RR, respiratory rate; SD, standard deviation; SEAL-bCPAP, simplified earplug adapted low-cost bCPAP; TAL score, modified TAL clinical score

Journal of Tropical Pediatrics, 2019

Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determ... more Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occup...

Journal of Tropical Pediatrics, May 10, 2013

This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devi... more This study investigated the effectiveness of simple-to-implement adjustments of phototherapy devices on irradiance levels in a cross-section of Nigerian hospitals. A total of 76 phototherapy devices were evaluated in 16 hospitals while adjustments were implemented for a subset of 25 devices for which consent was obtained. The mean irradiance level was 7.6 AE 5.9 mW/cm 2 /nm for all devices prior to adjustments. The average irradiance level improved from 9.0 mW/cm 2 /nm to 27.3 mW/cm 2 /nm for the adjusted group (n ¼ 25) compared with 6.8 AE 5.4 mW/cm 2 /nm for the unadjusted group (n ¼ 51). Simple, inexpensive adjustments to phototherapy devices with sub-optimal irradiance levels can significantly improve their effectiveness to acceptable international standards and should be widely promoted in resource-constrained settings.

Journal of Tropical Pediatrics, Oct 6, 2017

We report a case of a 4-year-old boy from Oyo, Nigeria, presenting with prolonged seizures and co... more We report a case of a 4-year-old boy from Oyo, Nigeria, presenting with prolonged seizures and coma with the subsequent development of oro-lingual-facial dyskinesia with frequent tongue thrusting, dysconjugate gaze and choreoathetoid movements of the limbs because of autoimmune encephalitis consistent with anti-N-methyl-D-aspartate (anti-NMDAR) encephalitis.

Pediatrics, Jun 1, 2014

OBJECTIVES: Evaluate safety and efficacy of filtered-sunlight phototherapy (FS-PT). METHODS: Term... more OBJECTIVES: Evaluate safety and efficacy of filtered-sunlight phototherapy (FS-PT). METHODS: Term/late preterm infants #14 days old with clinically significant jaundice, assessed by total bilirubin (TB) levels, were recruited from a maternity hospital in Lagos, Nigeria. Sunlight was filtered with commercial window-tinting films that remove most UV and significant levels of infrared light and transmit effective levels of therapeutic blue light. After placing infants under an FS-PT canopy, hourly measurements of axillary temperatures, monitoring for sunburn, dehydration, and irradiances of filtered sunlight were performed. Treatment was deemed safe and efficacious if infants were able to stay in FS-PT for $5 hours and rate of rise of TB was ,0.2 mg/dL/h for infants #72 hours of age or TB decreased for infants .72 hours of age. RESULTS: A total of 227 infants received 258 days of FS-PT. No infant developed sunburn or dehydration. On 85 (33%) of 258 treatment days, infants were removed briefly from FS-PT due to minor temperaturerelated adverse events. No infant met study exit criteria. FS-PT was efficacious in 92% (181/197) of evaluable treatment days. Mean 6 SD TB change was-0.06 6 0.19 mg/dL/h. The mean 6 SD (range) irradiance of FS-PT was 38 6 22 (2-115) mW/cm 2 /nm, measured by the BiliBlanket Meter II. CONCLUSIONS: With appropriate monitoring, filtered sunlight is a novel, practical, and inexpensive method of PT that potentially offers safe and efficacious treatment strategy for management of neonatal jaundice in tropical countries where conventional PT treatment is not available.

Journal of Tropical Pediatrics, Jan 10, 2014

Neonatal hyperbilirubinemia continues to be a leading cause of morbidity and mortality in resourc... more Neonatal hyperbilirubinemia continues to be a leading cause of morbidity and mortality in resource-limited countries. The aim of this study was to measure the effectiveness of existing phototherapy units at a local hospital in Cameroon using an irradiance meter. Phototherapy units (n ¼ 4) in one newborn nursery in Cameroon were evaluated. The average irradiance of the functioning units was 2.87 mW/cm 2 /nm, which is substantially below the recommended range of 10-30 mW/cm 2 /nm. With simple improvements, one new prototype unit was developed. Its irradiance was 23.3 mW/cm 2 /nm. We concluded that irradiance of phototherapy units should be measured, as many local nurseries worldwide may not be delivering effective treatment. Simple and costeffective changes to phototherapy units can make a substantial improvement in irradiance.

Pediatric Hematology and Oncology, Dec 5, 2013

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the w... more Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked disorder in the world. G6PD deficiency puts children at risk for hyperbilirubinemia and kernicterus during the newborn period and an increased risk of severe hemolysis after exposure to many anti-malarial medications. A laboratory diagnosis of G6PD deficiency is rare in the developing world due to limited resources. We developed a Taqman-based allele specific assay to rapidly determine rates of G6PD deficiency contributing alleles (G202A and A376G) in East Africa. We tested umbilical cord blood from 100 Ugandan newborns and found the overall allele frequency of G202A was 0.13 and A376G was 0.32. The overall incidence of G6PD A-(G202A/A376G) was 6%; all Avariants were males. There was no correlation between G6PD deficiency and umbilical cord blood hemoglobin, white blood count, platelet count, or other hematologic parameters. Allele specific PCR can serve as a rapid method to determine specific G6PD deficiency allele frequencies in a given population and as a diagnostic tool in a hospital setting in which laboratory resources are present.

Journal of Perinatology, Mar 3, 2016

Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange ... more Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many lowand middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical prioritysetting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

Paediatrics and International Child Health, Dec 25, 2019

Frontiers in Pediatrics

Corrigendum: Management challenges in the treatment of severe hyperbilirubinemia in lowand middle... more Corrigendum: Management challenges in the treatment of severe hyperbilirubinemia in lowand middle-income countries: encouraging advancements, remaining gaps, and future opportunities.

Pediatrics

Purpose: Neonatal jaundice is a serious condition that may result in fatal complications if not t... more Purpose: Neonatal jaundice is a serious condition that may result in fatal complications if not treated appropriately and in a timely manner. Prior research studies indicate that there is a high incidence of neonatal jaundice in Iran and that the use of herbal or traditional remedies may lead to a delay in the diagnosis and treatment of neonatal jaundice in Iran. Further, there is a paucity of research on the knowledge and practices of mothers related …

Pediatrics

Purpose: Kernicterus due to severe neonatal hyperbilirubinemia is a leading cause of preventable ... more Purpose: Kernicterus due to severe neonatal hyperbilirubinemia is a leading cause of preventable deaths and disabilities in resource-limited countries due in part to the lack of high-quality, blue-light phototherapy. We have previously shown that filtered-sunlight phototherapy (FSPT) is safe and efficacious in mild-moderate hyperbilirubinemia. Our objective was to compare the safety and efficacy of FSPT with conventional PT (CPT) in moderate-to-severe neonatal hyperbilirubinemia. Methods: We performed a prospective, randomized, controlled, non-inferiority trial to compare safety and efficacy of FSPT vs. CPT in …

Frontiers in Pediatrics

Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neu... more Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.

Journal of Tropical Pediatrics

Background Malaria kills a child in sub-Saharan Africa every 2 min despite widely available inter... more Background Malaria kills a child in sub-Saharan Africa every 2 min despite widely available interventions including intermittent preventive treatment in infants (IPTi). Since 2010, when World Health Organization (WHO) recommended IPTi, no country has implemented it. To our knowledge, no IPTi study has been conducted in Nigeria. Considering severity of malaria in infancy and urgency to improve malaria prevention, we proposed a study to investigate the efficacy of this intervention in reducing malarial morbidity and mortality. Objective(s) The aim of this was to determine the safety and efficacy of SP-IPTi in reducing the prevalence of asymptomatic malaria parasitemia and malarial-associated hospital admissions. Methods We performed a cluster-randomized controlled trial in 1379 infants. SP was administered alongside routine vaccinations in immunization centers randomized to intervention groups. Infants in control groups received only routine vaccines. Malarial ‘morbidity and adverse e...

BMJ Case Reports, 2021

This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a hist... more This report documents a case of sinus bradycardia in a hospitalised 27-month-old girl with a history of moderate persistent asthma, recent suspected viral respiratory infection and suspicion for multisystem inflammatory syndrome in children (MIS-C). This patient developed profound sinus bradycardia during her hospitalisation despite an overall well clinical appearance and good outcome. Reports of bradycardia related to COVID-19 infection are few but growing in number. In this article, we discuss what has been observed in the literature about bradycardia in relation to COVID-19 and MIS-C. We also propose sinus bradycardia as a potential sign of MIS-C with recent respiratory symptoms, which would warrant close follow-up of such patients.

Pediatric Critical Care Medicine, 2021

The American Journal of Tropical Medicine and Hygiene, 2019

Residency programs are increasingly responding to the growing demand for global health (GH) educa... more Residency programs are increasingly responding to the growing demand for global health (GH) education by forming dedicated GH tracks. These tracks incorporate a targeted curriculum, support best practices surrounding GH electives such as predeparture preparation and post-return debriefing, and encourage meaningful engagement with international and domestic partners. The University of Minnesota's pediatric residency has had a formal GH track since 2005, and although they have shared several curricular components in the literature, they have yet to provide a comprehensive summary of their GH track. In this article, the authors provide a thorough description of their evolving GH track model, highlighting outcomes and sharing free resources, with the goal of providing a concise, replicable GH track framework for educators seeking to provide more formal GH education within residency programs.

Global Pediatric Health, 2019

Paediatrics and International Child Health, 2018

Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low-and ... more Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low-and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP setups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate-severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (P < 0.0001) improvement in their TAL score, respiratory rate and O 2 sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials. Abbreviations: ACU, acute care unit; bCPAP, bubble continuous positive airway pressure; BUBBLES, bCPAP used beyond babies in low economic settings; cmH 2 O, cm of water; CPAP, continuous positive airway pressure; LMIC, low-and middle-income countries; OR, odds ratio; O 2 sat, oxygen saturation; RR, respiratory rate; SD, standard deviation; SEAL-bCPAP, simplified earplug adapted low-cost bCPAP; TAL score, modified TAL clinical score

Journal of Tropical Pediatrics, 2019

Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determ... more Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occup...