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1.
Trop Med Int Health ; 19(4): 417-26, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24495284

RESUMEN

OBJECTIVE: To evaluate the impact of a district hospital intervention focused on enhancing healthcare provider capacity to address leading causes of neonatal death: birth asphyxia, infection and prematurity. METHODS: The neonatal quality improvement initiative was launched at two intervention referral district hospitals in Ghana. Local Health and Demographic Surveillance Systems were enlisted to enhance recording of neonatal and infant deaths in the community and at the facility. After baseline site assessments, a team of local paediatric experts conducted three clinical trainings on-site at each intervention hospital. Assessments were conducted to evaluate participant knowledge before and after participation in training modules. Monthly mentorship visits provided additional training to support the adoption of essential early neonatal care practices. RESULTS: In the first year of implementation, the initiative provided focused clinical training to 278 participants. A comparison of pre- and post-training test results demonstrates significant improvement in provider knowledge (73% vs. 89% correct, P < 0.001), with even greater improvement among trainees receiving recurrent refresher training (86% vs. 94% correct, P < 0.001). Participant feedback following training revealed enthusiasm about the programme and improved confidence. CONCLUSIONS: Locally led initiatives that invest directly in healthcare provider education and health systems strengthening represent a promising avenue for reducing neonatal morbidity and mortality. The NQI initiative demonstrates the positive impact of a district hospital intervention that combines on-site training, mentorship and enhanced demographic surveillance.


Asunto(s)
Práctica Clínica Basada en la Evidencia/educación , Cuidado del Lactante/normas , Mortalidad Infantil , Enfermedades del Recién Nacido/prevención & control , Evaluación de Procesos y Resultados en Atención de Salud , Personal de Hospital/educación , Garantía de la Calidad de Atención de Salud/normas , Causas de Muerte , Práctica Clínica Basada en la Evidencia/normas , Ghana/epidemiología , Hospitales de Distrito/organización & administración , Humanos , Cuidado del Lactante/métodos , Recién Nacido , Enfermedades del Recién Nacido/mortalidad , Enfermedades del Recién Nacido/terapia , Capacitación en Servicio/métodos , Cooperación Internacional , Maryland , Mentores , Vigilancia de la Población/métodos , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud/métodos , Universidades , Recursos Humanos , Organización Mundial de la Salud
2.
Open Forum Infect Dis ; 9(5): ofac102, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35434174

RESUMEN

Background: The World Health Organization (WHO) recommends routine surveillance of pretreatment human immunodeficiency virus (HIV) drug resistance (HIVDR) in children <18 months of age diagnosed with HIV through early infant diagnosis (EID). In 2016, 262 children <18 months of age were diagnosed with HIV in Namibia through EID. Levels of HIVDR in this population are unknown. Methods: In 2016, Namibia surveyed pretreatment HIVDR among children aged <18 months following WHO guidance. Reverse transcriptase, protease, and integrase regions of HIV-1 were genotyped from remnant dried blood spot specimens from all infants diagnosed with HIV in Namibia in 2016. HIVDR was predicted using the Stanford HIVdb algorithm. Results: Of 262 specimens genotyped, 198 HIV-1 protease and reverse transcriptase sequences and 118 HIV-1 integrase sequences were successfully amplified and analyzed. The prevalence of efavirenz/nevirapine (EFV/NVP), abacavir (ABC), zidovudine, lamivudine/emtricitabine (3TC/FTC), and tenofovir (TDF) resistance was 62.6%, 17.7%, 5.6%, 15.7%, and 10.1%, respectively. No integrase inhibitor resistance was detected. Conclusions: The high level of EFV/NVP resistance is unsurprising; however, levels of ABC and TDF resistance are among the highest observed to date in infants in sub-Saharan Africa. The absence of resistance to dolutegravir (DTG) is reassuring but underscores the need to further study the impact of ABC and 3TC/FTC resistance on pediatric protease inhibitor- and DTG-based regimens and accelerate access to other antiretroviral drugs. Results underscore the need for antiretroviral therapy optimization and prompt management of high viral loads in infants and pregnant and breastfeeding women.

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