To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).
Systematic review and ...meta-analysis.
Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.
Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.
Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.
Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.
The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.
To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries.
Systematic review and meta-analysis.
Observational studies reporting ...on risk factors for death from ALRI in children below five years in low- and middle income countries.
Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014.
Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.
Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61), chronic underlying diseases (4.76, 3.27‒6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death.
Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.
This study aimed to explore the association between maternal satisfaction and other indicators of quality of care (QoC) at childbirth, as defined by WHO standards.
Cross-sectional study.
Referral ...hospital in Northeast Italy.
1244 consecutive mothers giving birth in the hospital participated in a survey.
Univariate analyses were performed to evaluate the association between maternal satisfaction and 61 variables, including measures of 'provision of care', 'experience of care', 'availability of resources' and other maternal characteristics. Exploratory factor analysis was performed to create groups of correlated variables, which were used in multivariate analysis.
Overall, 509 (40.9%) of women were >35 years of age, about half (52.7%) were highly educated, most (95.2%) were married/living with partner and employed (79.3%) and about half (52.9%) were primiparous. Overall, 189 (15.2%) were not born in Italy and 111 (8.9%) did not have Italian citizenship. Most women (84.2%) were highly satisfied (score ≥7/10) with the care received. Among the 61 variables explored, 46 (75.4%) were significantly associated with women's satisfaction, 33 with higher satisfaction and 13 with lower satisfaction. Multivariate analysis largely confirmed univariate findings, with six out of eight groups of correlated variables being statistically significantly associated with women's satisfaction. Factors most strongly associated with women's satisfaction were 'effective communication, involvement, listening to women's needs, respectful and timely care' (OR 16.84, 95% CI 9.90 to 28.61, p<0.001) and 'physical structure' (OR 6.51, 95% CI 4.08 to 10.40, p<0.001). Additionally, 'victim of abuse, discrimination, aggressiveness' was inversely associated with the wish to return to the facility or to recommend it to a friend (OR 0.35, 95% CI 0.17 to 0.70, p<0.003).
This study suggested that many variables are strongly associated with women's satisfaction with care during childbirth and support the use of multiple measures to monitor the QoC at childbirth.
AIM:To review pediatric cases of orofacial granulomatosis(OFG),report disease characteristics,and explore the association between OFG and Crohn’s disease.METHODS:We conducted a systematic review ...according to the PRISMA guidelines.We searched Medline,LILACS,Virtual Health Library,and Web of Knowledge in September 2013 for cases of OFG in the pediatric age range(<18 years),with no language limitations.All relevant articles were accessed in full text.The manual search included references of retrieved articles.We extracted data on patients’characteristics,disease characteristics,association with other diseases,and treatment.We analyzed the data and reported the results in tables and text.RESULTS:We retrieved 173 reports of OFG in children.Mean age at onset was 11.1±3.8 years(range:2.0-18years).Prevalence in males was significant higher than in females(P<0.001),with a male:female ratio of 2:1.Gastrointestinal signs or symptoms were present in 26.0%of children at the time of OFG diagnosis.Overall,70/173(40.4%)children received a concomitant diagnosis of Crohn’s disease.In about half(51.4%)of the cases the onset of OFG anticipated the diagnosis of Crohn’s disease,with a mean time between the two diagnoses of 13.1±11.6 mo(range:3-36 mo).Overall,21/173(12.1%)of the children with OFG had perianal disease,while 11/173(6.4%)had a family history of Crohn’s disease.Both perianal disease and a family history of Crohn’s disease were significantly associated with a higher risk of Crohn’s disease diagnosis in children with OFGrelative risk(RR)=3.10,95%confidence interval(CI):2.46-3.90;RR=2.74,95%CI:2.24-3.36,P<0.0001 for both).Treatment of OFG included steroids(70.8%of children)and other immunosuppressive drugs(42.7%),such as azathioprine,thalidomide and infliximab.CONCLUSION:High prevalence of Crohn’s disease in children with OFG suggests that OFG may be a subtype of Crohn’s disease.
Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by ...28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.
Conclusion
:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs.
What is Known:
• There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases.
What is New:
•
Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease.
• However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM).
CENTRAL, MEDLINE, ...EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched. Experts were contacted. Conference proceedings and reference lists were manually searched. All study types, except single case reports, were included.
Two randomized controlled trials (RCTs), one before-and-after study and two retrospective reports on clinical efficacy and safety were retrieved, together with 18 pharmacokinetic studies. Trial quality was generally poor and results could not be pooled due to heterogeneity. Oral amoxicillin for 5 days was as effective as intramuscular ceftriaxone for 2 days (1 RCT). For uncomplicated SAM, amoxicillin showed no benefit over placebo (1 retrospective study). The introduction of a standardized regimen using ampicillin and gentamicin significantly reduced mortality in hospitalized children (odds ratio, OR: 4.0; 95% confidence interval, CI: 1.7-9.8; 1 before-and-after study). Oral chloramphenicol was as effective as trimethoprim-sulfamethoxazole in children with pneumonia (1 RCT). Pharmacokinetic data suggest that normal doses of penicillins, cotrimoxazole and gentamicin are safe in malnourished children, while the dose or frequency of chloramphenicol requires adjustment. Existing evidence is not strong enough to further clarify recommendations for antibiotic treatment in children with SAM.
Large RCTs are needed to define optimal antibiotic treatment in children with SAM with and without complications. Further research into gentamicin and chloramphenicol toxicity and into the pharmacokinetics of ceftriaxone and ciprofloxacin is also required.
A recent systematic review identified very few studies on women's views on how to improve the quality of maternal and newborn care (QMNC). This study aimed at exploring the suggestions provided by ...women, after hospital delivery in Italy, on how to improve the QMNC.
A questionnaire, containing open questions to capture suggestions on how to improve QMNC, was used to collect suggestions of mothers who gave birth a tertiary care referral hospital in Northeast Italy, between December 2016 and September 2018. Two authors independently used thematic analysis to analyse women's comments, using the WHO Standards for improving the QMNC as framework for the analysis.
Overall 392 mothers provided a total of 966 comments on how to improve the QMNC. Overall 45 (11.5%) women made suggestions pertinent to "provision of care", 222 (56.6%) to the "experience of care", 217 (55.4%) to "physical or to human resources". The top five suggestions were: 1) increase presence of a companion during the whole hospitalization (28.3% of women); 2) improve bathrooms and showers (18.4%); 3) improve effective communication from staff (14.0%); 4) improve staff professionalism, empathy, and kindness (13.5%); 5) increase support and information on how to provide care to the newborn (11.2%). Overall, 158 (16.4%) suggestions could not be classified in any WHO Standards, and among these most (72.1%) were related to physical structures, such as: decrease the number of patients per room; create areas for visitors; avoid case mixing in the same room; reduce rooming-in/better support the mother. Overall 62 (15.8%) women expressed appreciations.
Collecting the women's views on how to improve the QMNC after hospital delivery highlighted critical inputs on aspects of care that should be improved in the opinion of service-users. More investments should be made for establishing routine systems for monitoring patients experience of care. Data collected should be used to improve QMNC. WHO Standards may be further optimized by adding items emerging as relevant for women in high-income countries.
Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to ...evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.
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