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Global hälsa : en praktisk guide
- 2023. - 2
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Introduktion: Behovet av ett globalt perspektiv på hälsa.Det har gått fem år sedan Global Hälsa – En praktisk guide släpptes. Sedan dess har världen förändrats. Covid-19-pandemin har i grunden påverkat förutsättningarna för den global hälsan och visar på hur svårt det är att isolera sig från globala hälsohot. Hälsokonsekvenserna av klimatförändringarna, liksom hälso- och sjukvårdens klimatpåverkan har tydliggjorts. Fler väpnade konflikter, inklusive kriget i Ukraina, riskerar många år av folkhälsoarbete. I kriser drabbas de fattigaste hårdast. Detta gäller globalt såväl som i Sverige.I årets halvtidsgenomgång av världens utvecklingsagenda, Agenda 2030 och de globala målen, konstateras att många viktiga framsteg har gjorts, men att dessa hotas av det förändrade världsläget. Ett förnyat fokus på globala hälsofrågor krävs och här är svensk kunskap viktig. Många av de utmaningar som Sverige står inför delar vi dessutom med andra länder, såsom till exempel personalbrist, som leder till stängda vårdplatser och för låg täckning i primärvården. Här kan vi lära av varandra.Svenska Läkaresällskapet har sedan 2013 aktivt arbetat med globala hälsofrågor, med övertygelsen om att större medvetenhet om global hälsa kan minska konsekvenserna från världens gemensamma utmaningar. Sedan den förra guiden kom ut har läkaresällskapet bidragit till mobilisering och kunskapsspridning om Covid-19 under pandemin, en hybridkonferens om planetär hälsa har hållits med världsledande forskare, och svensk hälso- och sjukvårds möjligheter att stötta den ukrainska befolkningen under pågående krig har lyfts i en webinarie-serie.Liksom förra gången är guiden framtagen av läkarstudenter och läkare tidigt i karriären under handledning av kommittén för global hälsa. Den är tänkt som ett handfast stöd för de som vill engagera sig för global hälsa – genom klinik, forskning eller folkhälsoarbete och berör bland annat hälso- och sjukvårdens utmaningar i omställningen till ett klimatneutralt samhälle.Fältets ambition om att skapa alltmer jämlika samarbeten, genom att ifrågasätta äldre beslutsstrukturer, berörs också som en röd tråd genom guiden.Därför vill vi rikta ett stort tack till de studenter och yngre läkare som med vägledning av projektledarna har möjliggjort denna nya och förbättrade upplaga av guiden!Tillsammans kan vi verka för förbättrad hälsa, här hemma och utomlands!
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| 3. |
- Miranda, Elizabeth, et al.
(författare)
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Recording Patient Data in Burn Unit Logbooks in Rwanda : Who and What Are We Missing?
- 2021
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Ingår i: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488. ; 42:3, s. 526-532
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Tidskriftsartikel (refereegranskat)abstract
- Systematic data collection in high-income countries has demonstrated a decreasing burn morbidity and mortality, whereas lack of data from low- and middle-income countries hinders a global overview of burn epidemiology. In low- and middle-income countries, dedicated burn registries are few. Instead, burn data are often recorded in logbooks or as one variable in trauma registries, where incomplete or inconsistently recorded information is a known challenge. The University Teaching Hospital of Kigali hosts the only dedicated burn unit in Rwanda and has collected data on patients admitted for acute burn care in logbooks since 2005. This study aimed to assess the data registered between January 2005 and December 2019, to evaluate the extent of missing data, and to identify possible factors associated with "missingness." All data were analyzed using descriptive statistics, Fishers exact test, and Wilcoxon Rank Sum test. In this study, 1093 acute burn patients were included and 64.2% of them had incomplete data. Data completeness improved significantly over time. The most commonly missing variables were whether the patient was referred from another facility and information regarding whether any surgical intervention was performed. Missing data on burn mechanism, burn degree, and surgical treatment were associated with in-hospital mortality. In conclusion, missing data is frequent for acute burn patients in Rwanda, although improvements have been seen over time. As Rwanda and other low- and middle-income countries strive to improve burn care, ensuring data completeness will be essential for the ability to accurately assess the quality of care, and hence improve it.
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- Mukagaju, Francoise, et al.
(författare)
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What is Known About Burns in East Africa? A Scoping Review
- 2021
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Ingår i: Journal of Surgical Research. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0022-4804 .- 1095-8673. ; 266, s. 113-124
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Forskningsöversikt (refereegranskat)abstract
- Background: Bums are a global public health concern, with the majority of the disease burden affecting low-and middle-income countries. Yet, as suggested by previous publications, there is a widespread belief that literature about burns in low-and middle-income countries is lacking. Therefore, we aimed to assess with a scoping review, the extent of the literature output on bums in East Africa, and to investigate patient demographics, injury characteristics, treatment and outcomes, as reported from the existing publications. Methods: Studies discussing bums in East Africa were identified by searching PubMed / Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO), and Global Index Medicus on December 12, 2019. Controlled vocabulary terms (i.e., MeSH, EMTREE, Global Health thesaurus terms) were included when available and appropriate. No year restrictions were applied. Results: A total of 1,044 records were retrieved from the database searches, from which 40 articles from 6 countries published between 1993 and 2019 were included in the final review. No studies were found from five East African countries with the lowest GDP. Most papers focused on pediatric trauma patients or tertiary hospital settings. The total number of burn patients recorded was 44,369, of which the mean proportion of males was 56%. The most common cause of injury was scalds (61%), followed by open flame (17%). Mortality rate ranged from 0-67%. The mean length of stay in hospital was between 9-60 d. Conclusions: Burn data is limited in the East African region, with socio-economically weak countries being particularly underrepresented. This scoping review has identified the largest set of literature on burns in East Africa to date, indicating the importance of reviewing data at a regional or local level, as "global" studies tend to be dominated by high-income country data. Data collection in specific registries is needed to better characterize the exact burden of burn injuries in East Africa. (c) 2021 Elsevier Inc. All rights reserved.
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- Nezerwa, Yves, et al.
(författare)
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Referral of Burn Patients in the Absence of Guidelines: A Rwandan Study
- 2022
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Ingår i: Journal of Surgical Research. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0022-4804 .- 1095-8673. ; 278, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The management of severe burns and pediatric burns requires an organized system of care delivery, which includes referral guidelines. In Rwanda, the burn unit at the University Teaching Hospital of Kigali (CHUK) is the only dedicated burn unit in the country and admits patients of all ages referred from the other provinces. However, since there are no official referral guidelines, it is unknown whether patients with burns are appropriately referred. This study aims to analyze referral patterns among burn patients admitted at the CHUK burn unit and their adherence to the referral criteria listed by the American Burn Association (ABA), comparing patients transferred to the burn unit from facilities within Kigali and those referred from facilities outside Kigali. Methods: This retrospective study included all patients with acute burns admitted to the CHUK burn unit with data available on the province of origin from 2005 to 2019. Patients with burns younger than 16 y were defined as pediatric burns, as per the CHUK routines. Characteristics of all burns referred from a facility within Kigali (Pat-K) and facilities outside Kigali (Pat-O) were compared using Fishers exact test for categorical variables or Wilcoxon rank-sum test for continuous variables. The adherence to ABA referral criteria was assessed for variables with available data, which were total burnt surface area %, burn thickness, cause of burn, and age. Results: The study population consisted of 1093 patients, of which 1064 had data regarding if they were referred from other facilities to CHUK. Overall, the median age was 3 y (2-16 y), with Pat-O being older than Pat-K (P < 0.001). Scalds were the dominant cause of injury in both groups; flame was more common among Pat-O than among Pat-K (in 25.5% versus 10.6%, P < 0.01). Burns of larger size and depth were more common among Pat-O, as compared to the Pat-K group [median total burnt surface area % = 19% versus 15.5%, respectively ( P < 0.001); presence of full-thickness burns = 55.6% versus 29.7 %, respectively (P < 0.001)]. Hospitalization was longer and in-hospital mortality higher in Pat-O than in Pat-K [LOS = 42 d (interquartile range 11-164) versus 28 d (interquartile range 9-132), P < 0.05; in-hospital mortality = 18.9% versus 10.1%, P < 0.001]. Among Pat-O, 85% had characteristics that mirrored one or more of the analyzed ABA criteria. Conclusions: Although there are no clear guidelines, referral patterns indicate that patients are being appropriately referred for specialized burn care in Rwanda. Compared to patients from Kigali, rural patients had larger and more severe injuries, needed more surgical interventions, and had worse outcomes. Most of referred patients matched criteria listed among international referral guidelines. However, the statement of national referral criteria is essential to improve timely access to adequate care. (C) 2022 Elsevier Inc. All rights reserved.
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- Nkurunziza, Theoneste, et al.
(författare)
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mHealth-community health worker telemedicine intervention for surgical site infection diagnosis : a prospective study among women delivering via caesarean section in rural Rwanda
- 2022
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Ingår i: BMJ Global Health. - : BMJ Publishing Group. - 2059-7908. ; 7:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Surgical site infections (SSIs) cause a significant global public health burden in low and middle-income countries. Most SSIs develop after patient discharge and may go undetected. We assessed the feasibility and diagnostic accuracy of an mHealth-community health worker (CHW) home-based telemedicine intervention to diagnose SSIs in women who delivered via caesarean section in rural Rwanda. Methods This prospective cohort study included women who underwent a caesarean section at Kirehe District Hospital between September 2019 and March 2020. At postoperative day 10 (+/- 3 days), a trained CHW visited the woman at home, provided wound care and transmitted a photo of the wound to a remote general practitioner (GP) via WhatsApp. The GP reviewed the photo and made an SSI diagnosis. The next day, the woman returned to the hospital for physical examination by an independent GP, whose SSI diagnosis was considered the gold standard for our analysis. We describe the intervention process indicators and report the sensitivity and specificity of the telemedicine-based diagnosis. Results Of 787 women included in the study, 91.4% (n=719) were located at their home by the CHW and all of them (n=719, 100%) accepted the intervention. The full intervention was completed, including receipt of GP telemedicine diagnosis within 1 hour, for 79.0% (n=623). The GPs diagnosed 30 SSIs (4.2%) through telemedicine and 38 SSIs (5.4%) through physical examination. The telemedicine sensitivity was 36.8% and specificity was 97.6%. The negative predictive value was 96.4%. Conclusions Implementation of an mHealth-CHW home-based intervention in rural Rwanda and similar settings is feasible. Patients acceptance of the intervention was key to its success. The telemedicine-based SSI diagnosis had a high negative predictive value but a low sensitivity. Further studies must explore strategies to improve accuracy, such as accompanying wound images with clinical data or developing algorithms using machine learning.
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| 7. |
- Qin, Rennie X., et al.
(författare)
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Building sustainable and resilient surgical systems : A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region
- 2022
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Ingår i: The Lancet Regional Health. Western Pacific. - : The Lancet Publishing Group ; Elsevier. - 2666-6065. ; 22
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Forskningsöversikt (refereegranskat)abstract
- Five billion people lack access to surgical care worldwide; climate change is the biggest threat to human health in the 21st century. This review studies how climate change could be integrated into national surgical planning in the Western Pacific region. We searched databases (PubMed, Web of Science, and Global Health) for articles on climate change and surgical care. Findings were categorised using the modified World Health Organisation Health System Building Blocks Framework. 220 out of 2577 records were included. Infrastructure: Operating theatres are highly resource-intensive. Their carbon footprint could be reduced by maximising equipment longevity, improving energy efficiency, and renewable energy use. Service delivery Tele-medicine, outreaches, and avoiding desflurane could reduce emissions. Robust surgical systems are required to adapt to the increasing burden of surgically treated diseases, such as injuries from natural disasters. Finance: Climate change adaptation funds could be mobilised for surgical system strengthening. Information systems: Sustainability should be a key performance indicator for surgical systems. Workforce: Surgical providers could change clinical, institutional, and societal practices. Governance: Planning in surgical care and climate change should be aligned. Climate change mitigation is essential in the regional surgical care scale-up; surgical system strengthening is also necessary for adaptation to climate change. Copyright Crown Copyright (C) 2022 Published by Elsevier Ltd.
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| 8. |
- Rönnerfalk, Mattias, et al.
(författare)
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Autologous Bone Graft From the Ipsilateral Distal Femur in Tibial Condyle Fractures
- 2023
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Ingår i: Journal of Orthopaedic Trauma. - : LIPPINCOTT WILLIAMS & WILKINS. - 0890-5339 .- 1531-2291. ; 37:9, s. E377-E381
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Tidskriftsartikel (refereegranskat)abstract
- Fractures of the proximal tibia often require void filling to support articular fragments in combination with internal fixation. The most common techniques are iliac autograft, allograft, or synthetic bone graft substitutes.The distal femur and its large volume condyles are a source of cancellous bone graft within the surgical site of an open reduction and internal fixation procedure. We have used a minimally invasive technique to harvest bone graft from the distal femur, using a bone graft drill. We performed this investigation to determine whether our technique of using distal femoral autograft to fill bone voids when treating proximal tibial fractures with open reduction and internal fixation is effective and safe. We also sought to determine the degree to which the bone graft incorporates into the tibia during fracture healing, the degree to which the harvest site heals, and the degree of secondary joint line depression.In all 12 patients, the bone graft had sufficient volume to fill the subchondral void in the proximal tibia, all fractures had healed at follow-up, and fracture reduction was maintained in most cases. We found no pain at the harvest site during follow-up, and there were no signs of drill penetration in articular or cortical structures. Drill holes at the harvest site showed sparse amounts of newly formed bone on CT in most of its circumference in all patients.There were no pathological changes in the femoral condyles with relation to the bone grafting procedure, and 5 patients showed radiographic signs of osteoarthritis in one or more joint compartments of the knee. The results showed this technique to provide similar success as reported alternatives without major complications and we continue to use this technique of harvesting distal femoral autograft to supplement open reduction and internal fixation of selected proximal tibial fractures.
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| 9. |
- Shyaka, Ian, et al.
(författare)
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Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital
- 2024
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Ingår i: International Journal of Burns and Trauma. - : E-CENTURY PUBLISHING CORP. - 2160-2026. ; 14:1, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze inhospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda. Methods: This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression. Results: Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104. Conclusion: Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.
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