Conference Material > Poster
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 2024 May 3; 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. 2024 May 3; DOI:10.57740/fDNraEM
Conference Material > Poster
Owona Ndouguessa Atangana FX, Mounkaila SA, Boss B, Yonli Yakelendji B, Amadou S, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/5xya-2a63
Français
Conference Material > Slide Presentation
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/Rcembdt4Bk
Conference Material > Poster
Valori AV, Gonzalez J, Alvarez S
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/JAhFctX
Conference Material > Abstract
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 2024 May 4; 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
Ilyas A, Valori AV, Tamannai M, Aderie EM, Isak YA, et al.
MSF Paediatric Days 2022. 2022 December 1; DOI:10.57740/521y-tt84
Conference Material > Poster
Cuenca P, Skidmore J, Adwok E, Dau S, Nggilari J, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/AN1pSCil
Conference Material > Abstract
Ibrahim AI, Valori AV, Aderie EM
MSF Paediatric Days 2022. 2022 November 26; DOI:10.57740/v0ej-8d09
INTRODUCTION
Immunobullous disorders include several uncommon skin disorders rarely seen in infants. They typically present with bullae, erosions and surrounding erythema, although many variants and clinical presentations exist. We report the case of an infant with extended skin lesions who was diagnosed clinically and successfully treated after remote support from a dermatologist.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-month-old boy arrived at our hospital with his mother presenting with diffuse, irregular skin erosions on the face, chest, shoulder and scalp. The condition started when the infant was 40 days old with flaccid, clear blisters on his left cheek. These ruptured to produce itchy, irregular-shaped erosions with thick crusts, and pustules at the edges. The lesions extended to the present locations including mucous membranes of the mouth and conjunctiva. There was no history of maternal skin disease or pregnancy complications. He was delivered at home and was previously healthy. Family history revealed that two older siblings had exhibited similar symptoms at 2 months, and 40 days old, and died at 8 and 4 months old respectively. The case was discussed remotely with a dermatologist using telemedicine, and the diagnosis of immunobullous disorder was made on clinical suspicion. In addition to IV cloxacillin and nutritional support, oral prednisone 2mg/kg and wound care were started. After 14 days he improved clinically, and the lesions started to heal.
DISCUSSION
We report a case of an infant with a clinical diagnosis of immunobullous disorder, successfully treated with oral corticosteroids. Differential diagnosis of skin disorders in settings without laboratory capacity for histopathology is challenging, but subspecialist support via telemedicine allowed the team to start empiric treatment resulting in clinical improvement and discharge of a complicated case. Remote health advice platforms are important tools to improve quality of care for patients in low resource settings.
Immunobullous disorders include several uncommon skin disorders rarely seen in infants. They typically present with bullae, erosions and surrounding erythema, although many variants and clinical presentations exist. We report the case of an infant with extended skin lesions who was diagnosed clinically and successfully treated after remote support from a dermatologist.
CASE DESCRIPTION (Download PDF for photos accompanying this description)
A 4-month-old boy arrived at our hospital with his mother presenting with diffuse, irregular skin erosions on the face, chest, shoulder and scalp. The condition started when the infant was 40 days old with flaccid, clear blisters on his left cheek. These ruptured to produce itchy, irregular-shaped erosions with thick crusts, and pustules at the edges. The lesions extended to the present locations including mucous membranes of the mouth and conjunctiva. There was no history of maternal skin disease or pregnancy complications. He was delivered at home and was previously healthy. Family history revealed that two older siblings had exhibited similar symptoms at 2 months, and 40 days old, and died at 8 and 4 months old respectively. The case was discussed remotely with a dermatologist using telemedicine, and the diagnosis of immunobullous disorder was made on clinical suspicion. In addition to IV cloxacillin and nutritional support, oral prednisone 2mg/kg and wound care were started. After 14 days he improved clinically, and the lesions started to heal.
DISCUSSION
We report a case of an infant with a clinical diagnosis of immunobullous disorder, successfully treated with oral corticosteroids. Differential diagnosis of skin disorders in settings without laboratory capacity for histopathology is challenging, but subspecialist support via telemedicine allowed the team to start empiric treatment resulting in clinical improvement and discharge of a complicated case. Remote health advice platforms are important tools to improve quality of care for patients in low resource settings.
Conference Material > Slide Presentation
Gonzalez Arias M, Buero MM, Salem Z, Yang SL, Valori AV
MSF Paediatric Days 2024. 2024 May 4; DOI:10.57740/rqziQFZGbh