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1. Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study.

Author

Eric D McCollum, Bejoy Nambiar, Rashid Deula, Beatiwel Zadutsa, Austin Bondo, Carina King, James Beard, Harry Liyaya, Limangeni Mankhambo, Marzia Lazzerini, Charles Makwenda, Gibson Masache, Naor Bar-Zeev, Peter N Kazembe, Charles Mwansambo, Norman Lufesi, Anthony Costello, Ben Armstrong, and Tim Colbourn

Subjects
Medicine, Science
Abstract

The pneumococcal conjugate vaccine's (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction in Malawi in November 2011, we evaluated the case burden and rates of childhood pneumonia.Between January 1, 2012-June 30, 2014 we conducted active pneumonia surveillance in children 75% three-dose PCV13 coverage (post). We also used multivariable time-series regression, adjusting for autocorrelation and exploring seasonal variation and alternative model specifications in sensitivity analyses. The early versus post analysis showed an increase in cases and rates of total, fast breathing, and indrawing pneumonia and a decrease in danger sign and hypoxemic pneumonia, and pneumonia mortality. At 76% three-dose PCV13 coverage, versus 0%, the time-series model showed a non-significant increase in total cases (+47%, 95% CI: -13%, +149%, p = 0.154); fast breathing cases increased 135% (+39%, +297%, p = 0.001), however, hypoxemia fell 47% (-5%, -70%, p = 0.031) and hospital deaths decreased 36% (-1%, -58%, p = 0.047) in children

Published
2017
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2. The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings:a multi-site evaluation

Author

Laura Jones, Harry Liyaya, William Parry-Smith, Abi Merriel, Helen Williams, Tarcizius Phiri, Bejoy Nambiar, Arri Coomarasamy, Aurelio Tobias, Adam J. Devall, Charles Makwenda, Ioannis D. Gallos, James Cheshire, David Lissauer, Amie Wilson, Laura Munthali, Catherine Dunlop, and Christopher Kamphinga

Subjects
medicine.medical_specialty, Malawi, Low resource, Population, Vital signs, complex intervention, Sepsis, Pregnancy, Intervention (counseling), Management of Technology and Innovation, Health care, Medicine, Humans, Care bundle, Pregnancy Complications, Infectious, education, education.field_of_study, business.industry, Vital Signs, Process Assessment, Health Care, Multi site, Obstetrics and Gynecology, feasibility study, medicine.disease, Anti-Bacterial Agents, Early Diagnosis, Emergency medicine, Feasibility Studies, Fluid Therapy, Female, care bundle, low-resource setting, Triage, business, maternal sepsis, Patient Care Bundles
Abstract

ObjectiveTo evaluate whether the implementation of the FAST‐M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low‐resource setting.DesignA before‐and‐after design.SettingFifteen government healthcare facilities in Malawi.PopulationWomen suspected of having maternal sepsis.MethodsThe FAST‐M complex intervention consisted of the following components: the FAST‐M maternal sepsis treatment bundle and the FAST‐M implementation programme. Performance of selected process outcomes was compared between a 2‐month baseline phase and 6‐month intervention phase with compliance used as a proxy measure of feasibility.Main outcome resultCompliance with vital sign recording and use of the FAST‐M maternal sepsis bundle.ResultsFollowing implementation of the FAST‐M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P P P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis.ConclusionImplementation of the FAST‐M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low‐resource setting such as Malawi.Tweetable AbstractImplementation of a sepsis care bundle for low‐resources improved recognition & management of maternal sepsis.

Published
2021
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