Dataset Information

Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.

ABSTRACT:

Background

Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of this study is to evaluate barriers and facilitators for phototherapy to treat neonatal jaundice at Malawian hospitals.

Methods

We conducted a convergent mixed-method study comprised of a facility assessment and qualitative interviews with healthcare workers and caregivers in southern Malawi. The facility assessment was conducted at three secondary-level hospitals in rural districts. In-depth interviews following a semi-structured topic guide were conducted at a district hospital and a tertiary-level hospital. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia).

Results

The facility assessment found critical gaps in initiating and monitoring phototherapy in all facilities. Based on a total of 31 interviews, participants identified key challenges in diagnosing neonatal jaundice, counselling caregivers, and availability of infrastructure. Participants emphasized the need for transcutaneous bilirubinometers to guide treatment decisions. Caregivers were sometimes fearful of potential harmful effects of phototherapy, which required adequate explanation to mothers and family members in non-medical language. Task shifting and engaging peer support for caregivers with concerns about phototherapy was recommended.

Conclusion

Implementation of a therapeutic intervention is limited if accurate diagnostic tests are unavailable. The scale up of therapeutic interventions, such as phototherapy for neonatal jaundice, requires careful holistic attention to infrastructural needs, supportive services such as laboratory integration as well as trained human resources.

SUBMITTER: Kinshella MW

PROVIDER: S-EPMC9235141 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.

Kinshella Mai-Lei Woo MW Salimu Sangwani S Chiwaya Brandina B Chikoti Felix F Chirambo Lusungu L Mwaungulu Ephrida E Banda Mwai M Hiwa Tamanda T Vidler Marianne M Molyneux Elizabeth M EM Dube Queen Q Mfutso-Bengo Joseph J Goldfarb David M DM Kawaza Kondwani K Nyondo-Mipando Alinane Linda AL

BMC pediatrics 20220627 1

<h4>Background</h4>Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of this study is to evaluate barriers and facilitators for phototherapy to treat neonatal jaundice at Malawian hospitals.<h4>Methods</h4>We condu ...[more]

PMID: 35761203

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Project description:ObjectivesCOVID-19 has strained healthcare systems, requiring the redesign of their structure, human resource management and clinical approach. Countries have adopted implementation strategies and maximise field hospital functionality to address the issue of overflow of patients with COVID-19. This scoping review was based on the main research question, 'What are the implementation strategies, challenges and opportunities in managing the field hospital during the COVID-19 pandemic?', and aimed to consolidate all recent evidence on COVID-19 field hospital implementation approaches, challenges and potentialities.DesignScoping review, following the Arksey and O'Malley's framework, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Data sourcesPubMed, Web of Science and Scopus were searched from 1 January 2020 through 31 December 2021.Eligibility criteriaOriginal articles, reviews, case studies and reports written in English were included. Works without full article and articles that did not answer the research questions were excluded.Data extraction and synthesisData were extracted using a standardised data extraction form in Microsoft Excel. The findings of all included articles were synthesised narratively.ResultsEighty-five records were reviewed and 25 studies were included. For the field hospital implementation strategies, 'surge capacity', namely space, human resource, supply and system, was discussed in addition to the preparation and workflow of other services such as pharmacy, rehabilitation, food and nutrition. The management of COVID-19 field hospitals is challenging with respect to staff and resource shortages, inability to anticipate patient load and poor communication. The opportunities and recommendations for improvement of management were also highlighted.ConclusionsThe compilation of lessons learnt may help improve the future management of field hospitals, administratively and clinically.

Project description:BackgroundThe cost of implementation is typically not accounted for in published economic evaluations, which determine the relative value for money of health innovations and are important for allocating scarce resources. Despite key papers outlining relevant implementation costs, they continue to be under reported in the literature and often not considered in practice. This study sought to understand and outline current practices for capturing the costs associated with implementation efforts, with examples from the digital health setting.MethodsA qualitative study of semi-structured interviews with purposefully sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question.ResultsInterviews were conducted with sixteen participants with specialist expertise in implementation science (n = 8), health economics (n = 6), and/or digital health (n = 8). Five participants were experienced in more than one field. Four key themes were elicited from the data: difficulty identifying and collecting implementation cost data; variation in approaches for collecting implementation cost data; the value of implementation costs; and collaboration enables implementation costing. Broadly, while interviewees recognised implementation costs as important, only some costs were considered in practice likely due to the perceived ill-defined boundaries and inconsistencies in terminology. A variety of methods were used to collect and estimate implementation costs; the most frequent approach was staff time tracking. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was also highlighted.ConclusionsIn current practice, standardised methods are not commonly used for data collection or estimation of implementation costs. Improved data collection through standardised practices may support greater transparency and confidence in implementation cost estimates. Although participants had industry exposure, most were also academic researchers and findings may not be representative of non-academic industry settings.

Project description:BackgroundPhototherapy is a common treatment for neonatal hyperbilirubinemia, however it generates reactive oxygen species and induces apoptosis, potentially influencing blood cells. Assessing changes in hematological parameters is essential to minimize complications and enhance outcomes.ObjectiveThis study assessed hematological parameters changes and associated factors in neonates with hyperbilirubinemia undergoing phototherapy.MethodA cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from May 29 to November 8, 2023. About 246 neonates were selected by convenient sampling. Blood samples were collected before and after phototherapy. Data were entered into Epi-data (4.6.0) and analyzed using SPSS (25.0). The normality of the data was checked by Kolmogorov-Smirnov tests. A paired t-test and Wilcoxon Sign Rank test were used to compare mean differences for normally distributed and skewed data, respectively. Pearson correlation and multiple linear regressions were used to measure the association. A significance level of p < 0.05 was used for statistical significance.ResultAmong neonates, 141 (57.3%) were males, and the median age was 2 days. Phototherapy treatment led to significant increases in WBC and lymphocyte count, 11.02 ± 2.21 to 11.35 ± 2.60, and 3.93 ± 1.19 to 4.16 ± 1.34, respectively. However, hemoglobin and platelet count significantly decreased from 15.05 ± 3.67 to 14.55 ± 2.62, and 243.23 ± 74.78 to 239.32 ± 73.29, respectively. Other blood cell parameters were unaffected. WBC and lymphocytes showed a positive association with preterm neonates and intensive phototherapy, while WBC count showed a negative association with total bilirubin. Hemoglobin counts are positively associated with total bilirubin but negatively associated with neonate age and treatment duration. Platelet count showed negative associations with low-birth-weight neonates, intensive phototherapy, and treatment duration. After treatment, normocytic normochromic cells increased, microcytic hypochromic decreased, and abnormal RBC shapes were reduced.ConclusionPhototherapy significantly affected key hematological parameters, notably WBC, lymphocytes, hemoglobin, and platelet count. Treating neonates with intensive phototherapy affects WBC and platelet counts while undergoing phototherapy for a longer duration affects hemoglobin and platelet counts. Therefore, routine monitoring of these parameters is crucial for neonates undergoing intensive or prolonged phototherapy.

Dataset Information

Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.

Background

Methods

Results

Conclusion

Publications

Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.

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