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Biomedical subjects

G Tamburlini

Publications and source records attributed to G Tamburlini.

At least 19 recordsLinked to original sources
PubMed2001

Quality of hospital care for seriously ill children in less-developed countries.

BACKGROUND: Improving the quality of care for sick children referred to hospitals in less-developed countries may lead to better outcomes, including reduced mortality. Data are lacking, however, on the quality of priority screening (triage), emergency care, diagnosis, and inpatient treatment in these hospitals, and on aspects of these potential targets that would benefit most from interventions leading to improved health outcomes. METHODS: We did a qualitative study in 13 district hospitals and eight teaching hospitals in seven less-developed countries. Experienced paediatricians used a structured survey instrument to assess initial triage, emergency and inpatient care, staff knowledge and practices, and hospital support services. FINDINGS: Overall quality of care differed between countries and among hospitals and was generally better in teaching hospitals. 14 of 21 hospitals lacked an adequate system for triage. Initial patient assessment was often inadequate and treatment delayed. Most emergency treatment areas were poorly organised and lacked essential supplies; families were routinely required to buy emergency drugs before they could be given. Adverse factors in case management, including inadequate assessment, inappropriate treatment, and inadequate monitoring occurred in 76% of inpatient children. Most doctors in district hospitals, and nurses and medical assistants in teaching and district hospitals, had inadequate knowledge and reported practice for managing important childhood illnesses. INTERPRETATION: Strengthening care for sick children referred to hospital should focus on achievable objectives with the greatest potential benefit for health outcome. Possible targets for improvement include initial triage, emergency care, assessment, inpatient treatment, and monitoring. Priority targets for individual hospitals may be determined by assessing each hospital.

Adolescent↗
PubMed2001

Development of a child health indicator system in Italy.

BACKGROUND: The need for a uniform, comprehensive and action-oriented child health indicator system is widely recognised. As part of a Ministry of Health project, a working group was established in Italy in order to develop a proposal for a minimum set of health indicators to be adopted at the regional and local health authority levels, where the planning process takes place. METHODS: The indicators proposed cover 17 areas of perinatal, child and adolescent health. The informing principles for the choice were relevance to the main health problems, availability of a reliable data collection system, feasibility of the collection and analysis process at the two health system levels proposed and extent to which the information provides clues for policy options. RESULTS: The main difficulties arise from a lack of uniform systems of classification and data collection for disabilities, as well as adequate tools for assessing quality of care and quality of life. A basic framework for analysis is suggested, including further breakdown of the indicators proposed, such as analysis by birthweight and by cause of neonatal death and by mother's education and father's employment. The information provided by the health indicators put forward needs to be evaluated within the broader scenario of the child's situation so that associated factors may be identified and clues found for intersectoral policies. Two research projects were started to evaluate the feasibility and reliability of data collection and the impact on the planning process at both the regional and local health authority levels. CONCLUSION: A European-wide initiative is proposed to tackle existing methodological problems effectively and develop a common child health indicator system.

Adolescent↗
PubMed1999

Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project.

Simplified guidelines for the emergency care of children have been developed to improve the triage and rapid initiation of appropriate emergency treatments for children presenting to hospitals in developing countries. The guidelines are part of the effort to improve referral level paediatric care within the World Health Organisation/Unicef strategy integrated management of childhood illness (IMCI), based on evidence of significant deficiencies in triage and emergency care. Existing emergency guidelines have been modified according to resource limitations and significant differences in the epidemiology of severe paediatric illness and preventable death in developing countries with raised infant and child mortality rates. In these settings, it is important to address the emergency management of diarrhoea with severe dehydration, severe malaria, severe malnutrition, and severe bacterial pneumonia, and to focus attention on sick infants younger than 2 months of age. The triage assessment relies on a few clinical signs, which can be readily taught so that it can be used by health workers with limited clinical background. The assessment has been designed so that it can be carried out quickly if negative, making it functional for triaging children in queues.

Case Management↗
PubMed1999

Evaluation of guidelines for emergency triage assessment and treatment in developing countries.

AIM: To evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries. METHODS: All infants aged 7 days to 5 years presenting to an accident and emergency department were simultaneously triaged and assessed by a nurse and a senior paediatrician. Nurse ETAT assessment was compared to standard emergency advanced paediatric life support (APLS) assessment by the paediatrician. Sensitivity, specificity, and predictive values were calculated and appropriateness of nurse treatments was evaluated. RESULTS: The ETAT algorithm as used by nurses identified 731/3837 patients (19.05%); 98 patients (2.6%) were classified as needing emergency treatment and 633 (16.5%) as needing priority assessment. Sensitivity was 96.7% with respect to APLS assessment, 91.7% with respect to all patients given priority by the paediatrician, and 85.7% with respect to patients ultimately admitted. Specificity was 90.6%, 91.0%, and 85.2%, respectively. Nurse administered treatment was appropriate in 94/102 (92.2%) emergency conditions. CONCLUSIONS: The ETAT algorithm and treatment instructions, when carried out by nurses after a short specific training period, performed well as a screening tool to identify priority cases and as a treatment guide for emergency conditions.

Algorithms↗
PubMed1998

Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants. International Network on Kangaroo Mother Care.

Good quality care of low birthweight infants could reduce neonatal mortality in low-income countries, but the technologies used in rich countries are inappropriate. Kangaroo Mother Care does not need expensive and sophisticated equipment, and for its simplicity it can be applied almost everywhere, including peripheral maternity units of very low-income countries. Kangaroo Mother Care (KMC) can also contribute to the humanization of neonatal care and to better bonding between mother and baby in both poor and rich countries. A group of health professionals with experience in KMC met in a workshop to discuss its effectiveness, safety, applicability and acceptability in different settings: from first and second level maternity units in settings with very limited resources, to second and third level units in settings with limited resources, to second and third level maternity and neonatal care units in settings with ample resources and infant mortality rates <15/1000. The paper summarizes the recommendations of this group of health professionals for the implementation of KMC in these various settings, together with suggested research priorities.

Developing Countries↗
PubMed1998

Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings.

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000-1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11,788 vs US$ 29,888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000-1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low-income countries KMC may represent an appropriate use of scarce resources.

Breast Feeding↗
PubMed1998

Success and constraints in the implementation of WHO guidelines for the management of diarrhoea in Albania.

BACKGROUND: The aim of this study is to evaluate the advantages as well as the difficulties resulting from the introduction of WHO guidelines for the treatment of acute diarrhoea in Albania. METHODS: The study was carried out at the Department of Paediatrics, Tirana, Albania. To evaluate the changes in case fatality and duration of hospital stay the clinical course of 226 children admitted for acute diarrhoea during a 1-month period was compared with the course of 235 children admitted for an equivalent period, prior to the introduction of World Health Organisation (WHO) guidelines. A detailed prospective study of 43 children admitted for acute diarrhoea with moderate (28 cases) or severe (15 cases) dehydration, managed according to WHO guidelines, was also carried out to identify problems arising from the new approach. RESULTS: The case fatality ratio was lower (0.44% versus 1.27%) and the mean duration of hospital stay shorter (4.8 versus 5.5 days) after the introduction of WHO guidelines. In 35% (10/28) of cases with moderate dehydration, the oral rehydration therapy failed to improve the hydration status, leading to the need of i.v. treatment. Failures in the Oral Rehydration Solution (ORS) group were always due to the insufficient intake of fluids, in the majority of cases because mothers were not administering it properly. CONCLUSIONS: The introduction of WHO Guidelines for diarrhoea case-management was beneficial. To obtain better compliance in giving ORS to moderately dehydrated children, appropriate training of nursing staff, together with better communication and support to mothers admitted with their child are necessary.

Acute Disease↗
PubMed1997

Thermal control of the newborn: knowledge and practice of health professional in seven countries.

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.

Body Temperature Regulation↗
PubMed1996

Dexamethasone adjunctive therapy for bacterial meningitis in children: a retrospective study in Brazil.

The clinical records of 87 children with bacterial meningitis treated with antibiotics (group 1) and of 92 treated with antibiotics plus dexamethasone (group 2), admitted to the Instituto Materno Infantil de Pernambuco, Recife, Brazil over 2 consecutive years (1991 and 1992), were analysed. There were no significant differences between treatment groups regarding characteristics on admission except that group 1 were younger. The overall case fatality rate was 19%, with 14% in group 2 and 24% in group 1 (p = 0.09). Rate of discharge without sequelae was 70% in the steroid-treated children and 56% in children treated with antibiotics alone (p = 0.07). Among children aged 6-59 months, those treated with dexamethasone compared with those treated with antibiotics alone had a better case fatality rate (11% vs 25%; p = 0.05) and a better rate of discharge without sequelae (73% vs 52%; p = 0.02). Among the cases with a CSF culture positive for Haemophilus influenzae, 77% were discharged without sequelae in group 2 compared with 51% in group 1 (p = 0.03). The addition of dexamethasone to standard antibiotic treatment improves the outcome of children between 6 and 59 months of age admitted to hospital with a diagnosis of bacterial meningitis.

Adolescent↗