The Outcome of Operated Neonates with an Isolated Congenital Diaphragmatic Hernia in a Limited Resource Scenario: A Critical Analysis.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is one of the most common neonatal emergencies, and the ideal current therapy requires high standards of neonatal care and advanced facilities. However, majority of neonates born with CDH are treated in public sector hospitals, with limitations in resources and workforce. OBJECTIVES: The aim of the study was to review and analyze the outcome of operated neonates with isolated CDH in a public sector hospital and medical college where a standard protocol of management was followed, considering the need for optimization of therapy in view of the resource constraints. MATERIALS AND METHODS: A retrospective chart review and analysis of the antenatal, preoperative, operative, and postoperative records of all neonates with operated CDH during the 3-year period from June 2015 to June 2018 at the hospital was done. The standard institutional protocol being followed included preoperative stabilization, risk stratification for patient selection, early decision regarding operative intervention, and continued postoperative ventilation. RESULTS: During the 3-year period, 78 children were admitted with CDH, of which 40 newborns with operated CDH were studied. The mean age at surgery was 72 h. Thirty-five of these 40 cases (87.5%) made an uneventful recovery, while mortality was 5/40 (12.5%). All mortalities (5/40) occurred during the postoperative period after 3 days due to respiratory failure while being ventilated. CONCLUSION: The strategy of a uniform protocol in the management of CDH adapted to the practical constraints of the institution yielded good results in the low-to-moderate risk group of neonatal CDH. The approach also facilitated the segregation of high-risk cases and optimal utilization of available facilities in a limited resources scenario.

Building a consumer market for ethanol-methanol cooking fuel in Lagos, Nigeria.

A recently completed randomized controlled study in Nigeria that transitioned pregnant women from traditional fuels to ethanol in their cook stoves demonstrated improved pregnancy outcomes in mothers and children. We subsequently conducted a pilot study of 30 households in Lagos, Nigeria, to determine the acceptability of blended ethanol/methanol as cooking fuel and willingness to pay for the Clean Cook stove. A third of the pilot participants expressed a willingness to purchase the stove for the minimum price of 42 USD or more. Fuel sales data suggest sustained, but non-exclusive, use of the CleanCook stove. These results will influence the final design and implementation of a planned 2500 stove commercial pilot that is scheduled to start in Nigeria in August 2018.