Search

BACKGROUND: Respiratory distress is a leading cause of neonatal death in low-income and middle-income countries. CPAP is a simple and effective respiratory support modality used to support neonates with respiratory failure and can be used in low-income and middle-income countries. The goal of this study was to describe implementation of the Silverman-Andersen respiratory severity score (RSS) and bubble CPAP in a rural Ugandan neonatal NICU. We sought to determine whether physicians and nurses in a low-income/middle-income setting would assign similar RSS in neonates after an initial training period and over time. METHODS: We describe the process of training NICU staff to use the RSS to assist in decision making regarding initiation, titration, and termination of bubble CPAP for neonates with respiratory distress. Characteristics of all neonates with respiratory failure treated with bubble CPAP in a rural Ugandan NICU from January to June 2012 are provided. RESULTS: Nineteen NICU staff members (4 doctors and 15 nurses) received RSS training. After this, the Spearman correlation coefficient for respiratory severity scoring between doctor and nurse was 0.73. Twenty-one infants, all < 3 d of age, were treated with CPAP, with 17 infants starting on the day of birth. The majority of infants (16/21, 76%) were preterm, 10 (48%) were <1,500 g (birthweight), and 13 (62%) were outborn. The most common diagnoses were respiratory distress syndrome (16/21, 76%) and birth asphyxia (5/21, 24%). The average RSS was 7.4 ± 1.3 before starting CPAP, 5.2 ± 2.3 after 2– 4 h of CPAP, 4.9 ± 2.7 after 12–24 h of CPAP, and 3.5 ± 1.9 before CPAP was discontinued. Duration of treatment with CPAP averaged 79 ± 43 h. Approximately half (11/21, 52%) of infants treated with CPAP survived to discharge. CONCLUSIONS: Implementing bubble CPAP in a low-income/middle-income setting is feasible. The RSS may be a simple and useful tool for monitoring a neonate’s respiratory status and for guiding CPAP management. [ABSTRACT FROM AUTHOR]

In northern Uganda, incisions called tea tea are commonly placed on the chests of children outside of the biomedical setting to relieve respiratory distress. To better characterize tea tea, we administered a questionnaire to 224 caretakers, whose children had evidence tea tea cuts. In 148 cases (66.4%), the grandparents made the decision to have the cuts performed, at times against the wishes of the caretakers. One seventy-six (80.0%) of the patients were seen by a medical professional just prior to receiving the cuts. Traditional healers and grandmothers, respectively, performed the cuts in 164 (73.5%) and 42 (18.8%) cases. Caretakers paid at least 500 USh (US$0.29) for tea tea in 129 cases (57.8%) and nothing in 71 cases (31.4%). This study shows that tea tea is a healing practice with associated costs that is regularly advocated for and performed by grandmothers and traditional healers. [ABSTRACT FROM AUTHOR]