Adapting Helping Babies Breathe into a Virtual Curriculum: Methods, Results, and Lessons Learned.

Introduction. The Helping Babies Breathe (HBB) curriculum is an established, effective method to combat neonatal mortality. The COVID-19 pandemic has disrupted in-person HBB training sessions worldwide, portending deficits in the dissemination of this important intervention. Methods. A pilot study to compare in-person versus virtual HBB training among US-based pediatric and family medicine residents. Two HBB master trainers condensed the curriculum into an abbreviated course that was offered to 14 learners in-person (n = 6) and virtually via Zoom (n = 8). A standardized 10-item survey was administered before and after the session to measure reported self-efficacy of critical elements of HBB. Difference of difference analysis was performed to detect differences in post vs pre-training results among the 2 groups using STATA MP 15. Results. All learners showed improvement in preparedness, assessment, and skills subcomponents of self-efficacy with no notable differences based on the type of learning medium. At baseline, in-person learners had a 7-point higher self-efficacy score (69.7) in comparison to virtual learners (62.8; P = .26). After training, the confidence score improved significantly; by 14.3 units for in-person learners (P = .01) and 12.9 for virtual learners (P = .04). There was no statistically significant difference in improvement between the 2 groups (P = .67). Furthermore, all learners passed the post-training knowledge assessment. Discussion. Virtual learning of HBB may be an alternative option in the setting of resource and travel limitations. Future work needs to assess possible differences in attainment of assessment skills and retention of the HBB curriculum among virtual learners.

Presentation and Treatment Outcomes of Liberian Children Age 5 Years and Under Diagnosed With Severe Malaria.

Malaria is endemic in Liberia with a prevalence rate of up to 60% in some regions, and it has been a major cause of death in children under 5 years of age. Prior to the recent Ebola epidemic, we undertook a prospective, hospital-based pilot study at the National Referral Hospital in Monrovia, to characterize the presentation, accuracy of diagnosis, and treatment outcomes of children presenting for treatment of malaria. From June 2013 to May 2014, we recruited children 5 years and under who presented to the JFK Medical Center with suspected malaria. We collected both clinical and laboratory data on admission and on discharge. We enrolled 477 patients with an average age of 1.6 years. Demographic factors associated with testing negative for malaria included regular bed net use and prior treatment for malaria. The most common presenting symptoms of severe malaria in this population were headache and seizures. Of 246 patients admitted and treated for severe malaria, 33% tested negative by rapid diagnostic test and blood smear for malaria. The case fatality rate was higher for the patients who tested negative for malaria (4.9%) versus those who tested positive (0.6%). Three children who tested negative for malaria showed evidence of undiagnosed Salmonella typhi infection. These results suggest that malaria may be overdiagnosed and that the diagnoses of other infectious diseases, which present in a similar fashion, may be neglected. These findings underscore the need to develop rapid diagnostic tests to screen for alternative causes of febrile illness.

Academic Medical Support to the Ebola Virus Disease Outbreak in Liberia.

During the Ebola Virus Disease (EVD) epidemic in West Africa (2014-2016), many faculty, staff, and trainees from U.S. academic medical centers (i.e., teaching hospitals and their affiliated medical schools; AMCs) wished to contribute to the response to the outbreak, but many barriers prevented their participation. Here, the authors describe a successful long-term academic collaboration in Liberia that facilitated participation in the EVD response. This Perspective outlines the role the authors played in the response (providing equipment and training, supporting the return of medical education), the barriers they faced (logistical and financial), and elements that contributed to their success (partnering and coordinating their response with both U.S. and African institutions). There is a paucity of literature discussing the role of AMCs in disaster response, so the authors discuss the lessons learned and offer suggestions about the responsibilities that AMCs have and the roles they can play in responding to disaster situations.

Health-Care Access during the Ebola Virus Epidemic in Liberia.

The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia. A cluster sampling strategy was used to administer a structured in-person survey to heads of households located within the catchment areas surrounding all 21 government hospitals in Liberia. A total of 543 heads of household from all 15 counties in Liberia participated in the study; more than half (67%) of urban respondents and 46% of rural respondents stated that it was very difficult or impossible to access health care during the epidemic. In urban areas, only 20-30% of patients seeking care during the epidemic received care, and in rural areas, only 70-80% of those seeking care were able to access it. Patients requiring prenatal and obstetric care and emergency services had the most difficulty accessing care. The results of this survey support the observation that basic health care was extremely difficult to access during the EVD epidemic in Liberia. Our results underscore the critical need to support essential health-care services during humanitarian crises to minimize preventable morbidity and mortality.

RAHI-SATHI Indo-U.S. Collaboration: The Evolution of a Trainee-Led Twinning Model in Global Health Into a Multidisciplinary Collaborative Program.

BACKGROUND: In recent years there has been a surge in the number of global health programs operated by academic institutions. However, most of the existing programs describe partnerships that are primarily faculty-driven and supported by extramural funding. PROGRAM DESCRIPTION: Research and Advocacy for Health in India (RAHI, or "pathfinder" in Hindi) and Support and Action Towards Health-Equity in India (SATHI, or "partnership" in Hindi) are 2 interconnected, collaborative efforts between the University of Massachusetts Medical School (UMMS) and Charutar Arogya Mandal (CAM), a medical college and a tertiary care center in rural western India. The RAHI-SATHI program is the culmination of a series of student/trainee-led research and capacity strengthening initiatives that received institutional support in the form of faculty mentorship and seed funding. RAHI-SATHI's trainee-led twinning approach overcomes traditional barriers faced by global health programs. Trainees help mitigate geographical barriers by acting as a bridge between members from different institutions, garner cultural insight through their ability to immerse themselves in a community, and overcome expertise limitations through pre-planned structured mentorship from faculty of both institutions. Trainees play a central role in cultivating trust among the team members and, in the process, they acquire personal leadership skills that may benefit them in their future careers. CONCLUSION: This paradigm of trainee-led twinning partnership promotes sustainability in an uncertain funding climate and provides a roadmap for conducting foundational work that is essential for the development of a broad, university-wide global health program.

A Successful US Academic Collaborative Supporting Medical Education in a Postconflict Setting.

This article describes a model employed by the Academic Collaborative to Support Medical Education in Liberia to augment medical education in a postconflict setting where the health and educational structures and funding are very limited. We effectively utilized a cohort of visiting US pediatric faculty and trainees for short-term but recurrent clinical work and teaching. This model allows US academic medical centers, especially those with smaller residency programs, to provide global health experiences for faculty and trainees while contributing to the strengthening of medical education in the host country. Those involved can work toward a goal of sustainable training with a strengthened host country specialty education system. Partnerships such as ours evolve over time and succeed by meeting the needs of the host country, even during unanticipated challenges, such as the Ebola virus outbreak in West Africa.

Fever in the pediatric patient.

Fever is the most common reason that children and infants are brought to emergency departments. Emergency physicians face the challenge of quickly distinguishing benign from life-threatening conditions. The management of fever in children is guided by the patient's age, immunization status, and immune status as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views. In this article, the evaluation and treatment of children with fevers of known and unknown origin are described. Causes of common and dangerous conditions that include fever in their manifestation are also discussed.