Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational study.

BACKGROUND: Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi. METHODOLOGY: This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%. RESULTS: Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means. CONCLUSION: Glycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.

Doctors' experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors' practices at two tertiary hospitals in Malawi.

OBJECTIVE: To explore doctors' experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi. DESIGN: This was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis. SETTING: Two public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021. PARTICIPANTS: Sixteen doctors who were involved in the referral and admission of patients to the ICU. RESULTS: Four themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU. CONCLUSION: Despite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.

Factors associated with in-hospital mortality of patients admitted to an intensive care unit in a tertiary hospital in Malawi.

OBJECTIVE: To determine factors associated with in-hospital death among patients admitted to ICU and to evaluate the predictive values of single severely deranged vital signs and several severity scoring systems. METHODS: A combined retrospective and prospective cohort study of patients admitted to the adult ICU in a tertiary hospital in Malawi was conducted between January 2017 and July 2019. Predefined potential risk factors for in-hospital death were studied with univariable and multivariable logistic regression models, and the performance of severity scores was assessed. RESULTS: The median age of the 822 participants was 31 years (IQR 21-43), and 50% were female. Several factors at admission were associated with in-hospital mortality: the presence of one or more severely deranged vital signs, adjusted odds ratio (aOR) 1.9 (1.4-2.6); treatment with vasopressor aOR 2.3 (1.6-3.4); received cardiopulmonary resuscitation aOR 1.7 (1.2-2.6) and treatment with mechanical ventilation aOR 1.5 (1.1-2.1). Having had surgery had a negative association with in-hospital mortality aOR 0.5 (0.4-0.7). The predictive accuracy of the severity scoring systems had varying sensitivities and specificities, but none were sufficiently accurate to be clinically useful. CONCLUSIONS: In conclusion, the presence of one or more severely deranged vital sign in patients admitted to ICU may be useful as a simple marker of an increased risk of in-hospital death.