Shifting the Paradigm of Emergency Care in Developing Countries.

Background The global agenda does not address a significant amount of preventable death in low- and middle-income countries (LMICs). While illnesses requiring acute care are increasing at an alarming rate in these countries, there are inadequate numbers of physicians or nurses to deal with the growing burden. Many people feel that emergency systems are too expensive and restricted in scope to have public health implications in resource-limited areas. Little empirical data exists to suggest otherwise. The goal of this study was to delineate the type and frequency of emergency conditions and define a novel method to estimate the burden of emergency diseases in Fort Liberte, Haiti. Methods A retrospective, cross-sectional medical record review was performed on all emergency room visits to Fort Liberte Hospital in 2009 and 2010. The type, frequency, and annual incidence of emergency conditions were identified and used to determine the burden of emergency disease. A disability-adjusted life year (DALY) calculation was estimated using a variation on a model of indirect national data extrapolation to cities. Results Nineteen months of data available yielded 2000 charts with 2284 diagnoses in total. Trauma was the most common illness at 13% of all charts, followed by abdominal pain at 11%, gastroenteritis at 8%, skin and soft tissue infections at 7%, and hypertension at 6%. The DALY calculation showed disability from emergency conditions to be five times that of HIV, malaria, and TB combined. Conclusions Sufficient emergency burden of disease affects population health in Fort Liberte, Haiti to warrant addressing it as a public health concern. The kinds of conditions described in this review may be amenable to task shifting as a feasible, sustainable, and scalable way to address the burden in a cost-effective manner.

The Role of the Nonpneumatic Antishock Garment in Reducing Blood Loss and Mortality Associated with Post-Abortion Hemorrhage.

Maternal mortality attributable to post-abortion hemorrhage is often associated with delays in reaching or receiving definitive care. The nonpneumatic antishock garment (NASG), a low-technology first-aid device, has been shown to decrease blood loss and mortality among women experiencing hypovolemic shock secondary to obstetric hemorrhage etiologies. Women experiencing post-abortion hemorrhage face longer delays in receiving definitive treatment as a result of abortion-related stigma and lack of access to quality abortion care; thus the NASG has the potential to make an even greater impact within this population. We conducted a secondary analysis of data collected in Egypt, Nigeria, Zambia, and Zimbabwe in NASG trials, limiting our analytic sample to women who experienced post-abortion hemorrhage (n = 953). Blood loss significantly decreased when the NASG was added to standard hemorrhage management during the intervention phase, and there was a large, although not statistically significant, 52 percent decrease in mortality during the NASG phase. The results indicate that adding the NASG to post-abortion care among women experiencing severe hemorrhage and hypovolemic shock would decrease blood loss and mortality.

Solutions that stick: activating cross-disciplinary collaboration in a graduate-level public health innovations course at the University of California, Berkeley.

Since 2011 we have taught a public health innovations course at the University of California, Berkeley. Students gain skills in systematic innovation, or human-centered design, while working in small interdisciplinary teams on domestic and global health projects with client organizations. To support acquisition of meaningful problem-solving skills, we structured the course so that the majority of learning happens in scenarios that do not involve faculty. Taken by students representing 26 graduate programs (as diverse as epidemiology, city planning, and mechanical engineering), it is one of the 10 highest-rated courses offered by the School of Public Health. We present the blueprints for our course with the hope that other institutions whose students could benefit will borrow from our model.

First ovulation in lactating mothers: a study conducted at the University Hospital of the West Indies

Sixty-seven endometrial biopsies were obtained from randomly selected lactating mothers at six weeks post-partum and examined histologically. There was evidence of ovulation (secretory activity) in 3 cases (4.5 percent) and endometritis in 9 (13.4 percent). Breastfeeding more than 5 times per day did not prevent ovulation in 5.4 percent of cases. However, a history of recent vaginal bleeding was correlated with an increased risk on both ovulation and endometritis. We do not recommend the use of additional contraceptives in women without a history of vaginal bleeding as the risk of ovulation is only 2 percent. However, we have discussed the guidelines for the use of additional contraceptives in women with a history of vaginal bleeding as the risk increases to 11.8 (AU)

Antibodies to herpes simplex virus (types 1 and 2) in Jamaican patients with cervical dysplasia and neoplasia

Antibody activity to Herpes simplex virus (HSV) types 1 and 2 was measured in sera from women with cervical dysplasia (19 cases), squamous-cell carcinoma, stages 0-4 (54 cases), other genital tumours (15 cases) and matched controls (60 cases) by the indirect immunofluorescent (IFA) test. The frequency of HSV-2 antibody activity was significantly greater in women with cervical cancer than in those with other genital tumours and in matched controls (p<0.05). No significant difference was observed for the HSV-2 antibody activity between women with cervical dysplasia and matched controls. The mean antibody titres to HSV-1 and HSV-2 were significantly higher in cancer cases than the respective titres in control groups (p<0.05). The cervical cancer cases were also analysed according to their clinical stage (Stages 0-4), and there was no significant variation either in frequency of antibody activity, or mean HSV-2 antibody titres. These preliminary findings suggest that there may be an association between HSV-2 and squamous cell carcinoma of uterine cervix in Jamaican women but further studies are required for meaningful conclusions to be drawn (AU)

A comparative analysis of breech deliveries between 1974/1975 and 1979/1980 at the University Hospital of the West Indies

Comparative data for breech deliveries at the University Hospital of the West Indies for the years 1974/1975 and 1979/1980 are presented. An increase in the Caesarean section delivery rate to 36 per cent is noted. Birthweight, route of delivery and parity are analysed with respect to perinatal outcome. Whereas the perinatal mortality rates are comparable to international standards for the greater than 2.0 kg neonate, there seems to be room for improvement in the 1.5-1.99 kg birthweight category. To this end, individualization with a more liberal attitude towards abdominal delivery in this group is recommended (AU)

Perirenal abscess and urinary calculus in pregnancy

Urinary calculi complicating pregnancy are an infrequent occurrence. In this paper, we report a case of right-sided pelvi-calyceal calculus in a 25-year-old multiparous woman. She was initially diagnosed as having recurrent right pyelonephritis, and renal angle ultrasound confirmed the presence of a calculus. She later developed a right perirenal abscess which was surgically drained. The clinical presentation and the outcome of the case are discussed in the context of other reports in the literature (AU)

Hysterosalpingography at the University Hospital of the West Indies

One hundred consecutively done hysterosalpingograms are analysed and compared with recent reports in the literature. These hysterosalpingograms were done primarily as part of an infertility investigation. A high rate of tubal occlusion was noted (51 per cent). Uterine fibroids did not adversely affect tubal patency, and there is a significantly high risk of contralateral tubal pregnancies. Because of the high rate of occlusion, hysterosalpingography may be used as a cost-efficient screening test in infertility investigation (AU)