Conference Material > Slide Presentation
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Rcembdt4Bk
Conference Material > Abstract
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/utH6tREN
INTRODUCTION
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.
Conference Material > Abstract
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/2fBEz60O
BACKGROUND AND OBJECTIVES
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Since 2015, MSF OCBA has supported Abs General Hospital (AGH) with an 88-bed capacity neonatal ward. In the recent years, annual admissions in the service escalated to an average of 3000 but with persistently high inpatient neonatal mortality rates, usually above 20%. Main causes of mortality in 2022 were prematurity (45%), perinatal asphyxia (21%) and sepsis (20%). To tackle this problem we performed an initial mortality analysis and used it to develop a workplan, which was then implemented during March – April 2023. The plan focused on improving compliance with zero-separation practices and adherence to neonatal care protocols and on reducing nosocomial infection. Specific activities, among many, included ensuring enough space for mothers to stay with their newborns in the ward and implementing a breastfeeding group with weekly meetings. Here we present our assessment of whether and how these measures may have affected neonatal mortality.
METHODS
Inpatient mortality rates of pre- and post-implementation period were compared from aggregated monthly data in MSF ́s Health Management Information System (HMIS). We conducted analysis stratified by year and by predefined periods – pre-implementation periods: January to August 22 and September 22 to February 23 (reference period) and post- implementation period: May to December 23. Mortality rate ratios (MRR) were calculated using negative binomial regression adjusted for month of admission.
RESULTS
1050 neonatal deaths and 5733 exits were included in the analysis period. Our data showed a 24% decrease in overall neonatal mortality (MRR = 0.76, 95%CI 0.60-0.95, p=0.02) during the post-implementation period compared to the reference period, with the reduction affecting all three main causes of mortality equally (prematurity accounted for 46% of all deaths post-implementation, sepsis 21%, and perinatal asphyxia 20%). A significant decrease in mortality (26%) was seen in 2023 when compared to 2022 (MRR = 0.74, 95%CI 0.65-0.85, p<0.05).
CONCLUSIONS
Neonatal mortality is usually an important challenge in MSF settings. Here we describe some low-cost strategies that have likely contributed to reducing inpatient mortality. A comprehensive approach to neonatal care with involvement of locally-hired staff seems essential for good outcomes and continuity. This experience provides valuable insights for healthcare professionals working in similar settings.
Conference Material > Slide Presentation
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024; DOI:10.57740/rqziQFZGbh
Conference Material > Video
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 4 May 2024
English
Français
Conference Material > Poster
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/ahq9-t438
Conference Material > Poster
Sheikh Mohamed A, Ilyas A, Abbas A, Avochi S, Kihara M, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/fDNraEM
Conference Material > Video
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 3 May 2024
Conference Material > Poster
Valori AV, Gonzalez J, Alvarez S
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/JAhFctX
Conference Material > Video
Sheikh Mohamed A, Ilyas A, Abbas A, Avochi S, Kihara M, et al.
MSF Paediatric Days 2024. 3 May 2024