Tropical medicine & international health : TM & IH
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Trop. Med. Int. Health · Apr 2016
Caring for patients with rabies in developing countries - the neglected importance of palliative care.
Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. ⋯ Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries.
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Trop. Med. Int. Health · Apr 2016
ReviewClinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review.
Participation in primary care-focused medical service trips (MSTs) by North American providers is increasingly common, with many of these being conducted in Latin America. The literature has yet to comprehensively explore the nature of MST practice, including the use of evidence-based clinical guidelines. This integrative review presents an analysis of guidelines employed in MSTs in Latin America. ⋯ Existing literature demonstrates minimal development or use of clinical guidelines on MSTs in Latin America. Future work must focus on the development, implementation, and evaluation of culturally sensitive, evidence-based guidelines for the management of patients receiving care from MSTs.
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Trop. Med. Int. Health · Apr 2016
Comparative StudyFamily planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries.
The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position. ⋯ The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision.
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Trop. Med. Int. Health · Apr 2016
Criteria-based audit of caesarean section in a referral hospital in rural Tanzania.
WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. ⋯ Caesarean section rate is not an useful indicator to monitor quality of EmOC as a high rate of unnecessary and potentially preventable CS was identified in this audit.
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Trop. Med. Int. Health · Dec 2015
Randomized Controlled TrialTuberculin reaction and BCG scar: association with infant mortality.
To test the hypothesis that having a scar and a positive tuberculin skin test (TST) response after vaccination with Bacille Calmette-Guérin (BCG) is associated with reduced infant mortality. ⋯ We confirmed previous observations that having a scar and a TST response after BCG vaccination is associated with lower mortality risk. The possibility of revaccinating scar-negative children should be considered.