Georgetown Public Hospital Corporation Research Articles

Factors associated with low birth at the Georgetown Public Hospital Corporation in Guyana: an institution-based cross-sectional study

ABSTRACT Low birth weight (LBW) is a global health issue. We conducted a cross-sectional study to assess factors associated with LBW at Georgetown Public Hospital Corporation (GPHC). We used data from all women who delivered a single live baby as of 28 weeks of gestational age from July to September 2022. 1,304 mothers and their respective live-born babies were included. Logistic regression was used to identify LBW-associated factors at p < .05. The prevalence of LBW was 13.3 percent (95 percent IC: [11.6–15.3]). Women who were primigravida (AOR: 2.18, 95 percent CI = [1.40–3.38]), smoked during pregnancy (AOR: 3.41, 95 percent CI: [1.05–11.03]), had fewer than eight antenatal care visits (AOR: 2.43, 95 percent CI = [1.54–3.83]) were significantly associated with LBW. Similarly, those who had gestational hypertension (AOR: 2.30, 95 percent CI = [1.36–3.80]), urinary tract infections during pregnancy (AOR: 2.91, 95 percent CI = [1.22–2.97]), and gave birth before 37 weeks of gestational age (AOR: 22.65, 95 percent CI = [14.32–35.83]) were more likely to have their babies born with LBW. These findings are crucial for guiding health policies to improve prenatal care access, provide smoking cessation programs, control gestational hypertension, and prioritize early detection and treatment of urinary tract infections, ultimately aiming to reduce preterm births and LBW at GPHC.

Prevalence of early initiation of breastfeeding at Georgetown Public Hospital Corporation in Guyana

AbstractObjectiveTo assess the prevalence and factors associated with early initiation of breastfeeding at Georgetown Public Hospital Corporation (GPHC).MethodsThis study used data from an institution‐based cross‐sectional study conducted at GPHC from July to September 2022. A structured pretested questionnaire was used to collect the data. A total of 1276 mothers were interviewed and provided data on early initiation of breastfeeding. Early initiation of breastfeeding was defined as mothers who breastfed their babies within the first hour after birth. We performed descriptive analyses for both the outcome and the independent variables. Logistic regression and backward selection procedure were used to assess factors associated with early initiation of breastfeeding.ResultsThe prevalence of early breastfeeding at GPHC was 27.8% (95%CI: 25.4–30.3). Mothers who were primigravida (AOR: 0.52; 95%CI: 0.36–0.75), who had urinary tract infections during pregnancy (AOR: 0.72; 95%CI: 0.52–0.99), and who delivered by caesarean section (AOR: 0.06; 95%CI: 0.03–0.11) were less likely to breastfeed their babies in the first hour after birth. Likewise, babies who were diagnosed with any health problems after birth (AOR: 0.34; 95%CI: 0.21–0.54) had a lesser chance to receive breastfeeding in the first hour after birth, compared with their counterparts.ConclusionLess than one‐third of mothers who delivered at GPHC breastfed their babies within the first hour after birth. Targeted intervention focuses on promoting early initiation of breastfeeding, immediate skin‐to‐skin contact between mothers and babies, timely diagnosis and treatment of urinary tract infections during pregnancy are essential to improve the prevalence of early initiation of breastfeeding at GPHC.

Prevalence and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study

Introduction: Hypertensive disorders of Pregnancy are the major complications that cause about 60%–80% of all maternal deaths. Among the hypertensive disorders, the pre-eclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. Objectives: To assess the prevalence and the maternal outcomes of hypertensive disorders of pregnancy at Georgetown Public Hospital Corporation Obstetrics and Gynecology Department. Design: A retrospective descriptive study. Materials and Method: We looked at 324 women diagnosed with preeclampsia, gestational hypertension, chronic hypertension, and eclampsia that were hospitalized at GPHC between January 2017 and December 2018. Statistical analysis: Data were analyzed using SPSS version 23. Data were expressed in percentages Results: The minimum age was 14 years while the maximum age was 43years, the mean age of the patients was 26.35±6.7 years. (51.7%) were primigravid, and One hundred and fifty-seven (48.3%) were multigravida. The overall prevalence was 2.6 per 1000 deliveries. Gestational hypertension accounted for 70.3%. %. HDU admission n=16(4.9%), n=15(4.6) postpartum hemorrhage, HELLP syndrome n=7(2.2%), eclampsia n=7 (2.1%). DIC with maternal death n=1(0.3%), n=3 (0.9%) placenta abruption, n=1(0.3%) renal failure. There was a statistically significant relationship between hypertensive disorders and maternal outcome p= 0.001. Of the perinatal complications; prematurity accounted for 14.2%, NICU admissions n=20 (6.2%) fetal growth restriction=8(2.4%), and Stillbirth n=4(1.2%). Apgar score &lt; 5 in the first minute of life accounted for 4.3%. This Apgar score was statistically significant for perinatal outcome p=0.005. Conclusion: The prevalence of hypertensive disorder of pregnancy was low in our study. The most prevalent form of hypertensive disorder of pregnancy at Georgetown Public Hospital Corporation was Gestational hypertension. Hypertensive disorders were statistically significant for maternal outcomes. Recommendations: Routine anthropometric measures and blood pressure checks should be part of every appointment. Promoting early hospital referrals is crucial. Keywords: Hypertensive disorders of Pregnancy, Gestational hypertension.

Prevalence of Psychoactive Substance use among Adults Ages of 20 to 40 Years at the Georgetown Public Hospital Corporation

Background: Guyana is a developing nation with a population of under one million. Yet, 15 to 20 percent of the population suffer from some form of mental health condition. Oftentimes persons turn to psychoactive substances to deal with their mental health condition. This study aimed to investigate the prevalence of psychoactive substance use, as well as, to identify psychoactive substances and risk factors among adults attending the psychiatric outpatient clinic at the Georgetown Public Hospital (GPHC). Methodology: A review of outpatient clinic charts belonging to patients ages 20 to 40 years, who were enrolled from January 1st to December 31st, 2019 at the psychiatric clinic (GPHC) regardless of their presenting complaint or diagnosis was carried out. Those that had records of psychoactive substance use were collected for analysis in this study. Sociodemographic characteristic and type of psychoactive substances were assessed using descriptive analysis. Results: Of 200 patient charts reviewed, 150 (75%) had records of psychoactive substance use. The majority of psychoactive substance users were Afro-Guyanese (42.7%), Christians (71.3%) and male (76.7%) with an average age of 28 years. Additionally, most patients had only primary education (59.3%) and were not in a relationship (80.7%). Moreover, the majority patients experienced a major traumatic life event (60%) and were from dysfunctional families (13.3%). The findings also showed that 47.3% of persons with a previous psychiatric history used psychoactive substances, while 36% developed a substance-induced psychotic disorder. Cannabis (78%) was identified as the most frequently used drug, followed by alcohol (50.7%) and tobacco (45.3%). Conclusion: There was a high prevalence of psychoactive substance use among patients enrolled in the psychiatric clinic, GPHC. With the majority of patients having known risk factors for psychoactive substance use. Also, results highlighted that some patients developed psychotic disorders post substance use. This emphasizes the need for more mental health awareness strategies targeted at adults and the need for effective drug rehabilitation programs, which can help reduce the use of psychoactive substances among adults in Guyana. Keywords: Young Adults, Psychoactive Substance, Mental Health, Guyana

Anxiety and Depressive Disorder Admissions to the Georgetown Public Hospital Corporation’s Psychiatric Outpatient Clinic - A Descriptive Study

The objective of this study was to determine the incidence of anxiety and depressive disorders at the GPHC POC 2019 -2021; and the percentage of these patients who were healthcare workers. This is a cross sectional study involving 3170 charts, 68 charts were identified for analysis. Variables were collected and the incidence of disorders calculated. Data was analyzed using Microsoft excel. The incidence of each disorder was as follows (the percentage of patients who were healthcare workers are listed in brackets): anxiety disorder - 2019 8% (32%), 2020 9% (15%), 2021 11% (18%); depressive disorders - 2019 13% (45%), 2020 17% (38%), 2021 16% (18%). Data for the health care group: 15% depressive illness and 9% anxiety illness. By sex: 2019 64% females, 36% males, 2020 46% females and 54% males, 2021 58% females and 42% males. By age group: 16-25 24%, 25-35 21%, 36-45 14%, 46-55 16%, &gt;55 24%. Relationship status: 2019 68% single, 2020 69% single, 2021 55% single. Most affected: nurses 2019 31%, doctors 2020 38%, nurses 2021 36%. The incidence of anxiety disorders increased progressively during the years of the pandemic. The incidence of depressive disorders increased significantly in 2020 and then had a small decrease in 2021. In 2020, more doctors and males sought help than nurses and females. Nurses and females sought more help in 2021. Healthcare workers who were single, young, and completed tertiary level of education were most affected. Keywords: Anxiety disorders, Depressive disorders, Incidence, Healthcare workers, Pandemic.

Training and implementation of handheld ultrasound technology at Georgetown Public Hospital Corporation in Guyana: a virtual learning cohort study

A virtual point-of-care ultrasound (POCUS) education program was initiated to introduce handheld ultrasound technology to Georgetown Public Hospital Corporation in Guyana, a low-resource setting. We studied ultrasound competency and participant satisfaction in a cohort of 20 physicians-in-training through the urology clinic. The program consisted of a training phase, where they learned how to use the Butterfly iQ ultrasound, and a mentored implementation phase, where they applied their skills in the clinic. The assessment was through written exams and an objective structured clinical exam (OSCE). Fourteen students completed the program. The written exam scores were 3.36/5 in the training phase and 3.57/5 in the mentored implementation phase, and all students earned 100% on the OSCE. Students expressed satisfaction with the program. Our POCUS education program demonstrates the potential to teach clinical skills in low-resource settings and the value of virtual global health partnerships in advancing POCUS and minimally invasive diagnostics.

MP49-11 MEDICAL AND ECONOMIC JUSTIFICATION FOR MINIMALLY INVASIVE SURGERY SPECIFIC TO URINARY STONE DISEASE AT GEORGETOWN PUBLIC HOSPITAL CORPORATION IN GUYANA

You have accessJournal of UrologyCME1 Apr 2023MP49-11 MEDICAL AND ECONOMIC JUSTIFICATION FOR MINIMALLY INVASIVE SURGERY SPECIFIC TO URINARY STONE DISEASE AT GEORGETOWN PUBLIC HOSPITAL CORPORATION IN GUYANA Dominique Sherry, Budheshwar Ramsukh, Ava Yap, Chris Prashad, and David Bayne Dominique SherryDominique Sherry More articles by this author , Budheshwar RamsukhBudheshwar Ramsukh More articles by this author , Ava YapAva Yap More articles by this author , Chris PrashadChris Prashad More articles by this author , and David BayneDavid Bayne More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In high income countries, minimally invasive surgery (MIS) to treat urinary stone disease (USD) has demonstrated better health outcomes and lower costs. However, open surgery is still commonplace in low and middle income countries (LMICs) such as Guyana due to inequities in access to equipment, training and resources. We analyzed the current open surgeries for USD at Georgetown Public Hospital Corporation (GPHC) in Guyana and quantified the theoretical change in costs and health outcomes using MIS techniques. METHODS: Case logs of all urology patients at GPHC from January 2018 to July 2022 were retrospectively reviewed. A total of 211 patients with USD were identified and stratified based on procedure. A decision tree analysis was performed to ascertain the cost effectiveness of replacing open surgery with MIS. The analysis included surgical, hospital, complication, transfusion, and convalescence costs. GPHC data was used for hospital length of stay (LOS) and convalescence time. Data on outcome probabilities, hospital costs (scaled for Guyana), life expectancy, complications, transfusion rates and mortality were derived from publications conducted in LMICs similar to Guyana. Disability adjusted life years (DALYs) averted were calculated based on LMIC data and GPHC average patient age. RESULTS: 48% of USD procedures at GPHC were open surgery. Pyelolithotomy was the most common open procedure during the 5-year study period and 51 pyelolithotomy cases were identified that could be replaced by percutaneous nephrolithotomy (PCNL) (50.5% of open cases). A decision tree analysis showed that open surgery was 1.9 times more expensive ($2082 vs $1102) than the replaceable PCNL. A sensitivity analysis showed the higher cost of open surgery was predominantly a result of its longer hospital LOS. A cost effectiveness analysis showed the ICER was in the southeast quadrant of the cost effectiveness plane as PCNL costs $862 less than open surgery for every DALY averted. CONCLUSIONS: This study shows that PCNL is a cost-effective alternative to open surgery at GPHC and demonstrates an opportunity to improve standards of care for urological disease in LMICs. Source of Funding: UCSF School of Medicine Inquiry Funding Office & Harold Varmus Global Heath Scholars Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e682 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominique Sherry More articles by this author Budheshwar Ramsukh More articles by this author Ava Yap More articles by this author Chris Prashad More articles by this author David Bayne More articles by this author Expand All Advertisement PDF downloadLoading ...

ASA Global Health-Guyana Partnership Celebrates Accomplishments

Features| April 2023 ASA Global Health-Guyana Partnership Celebrates Accomplishments Alexandra Harvey, MD, DM; Alexandra Harvey, MD, DM Search for other works by this author on: This Site PubMed Google Scholar Reema I. Sanghvi, MD; Reema I. Sanghvi, MD Search for other works by this author on: This Site PubMed Google Scholar Mark A. Singleton, MD, FASA Mark A. Singleton, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2023, Vol. 87, 23. https://doi.org/10.1097/01.ASM.0000924984.44063.2d Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Alexandra Harvey, Reema I. Sanghvi, Mark A. Singleton; ASA Global Health-Guyana Partnership Celebrates Accomplishments. ASA Monitor 2023; 87:23 doi: https://doi.org/10.1097/01.ASM.0000924984.44063.2d Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: guyana, partnerships Still in its first decade, the residency program in anesthesiology at the Georgetown Public Hospital Corporation (GPHC) affiliate program of the University of Guyana has had remarkable success in graduating multiple classes of fully trained and certified anesthesiologists from among this South American country's aspiring medical graduates. During this time, through the initiative of program director Alexandra Harvey, Canadian and ASA member physicians have had the very rewarding opportunity to volunteer as visiting faculty at GPHC. This partnership is one of the many activities overseen by the ASA Committee on Global Health and has been featured in Monitor articles over the past years. In this issue, we would like to update those reports by looking at the various paths these young Guyanese anesthesiologists have taken since we first met them during their training in 2017 (see photo above). In the following paragraphs, we wish to highlight their accomplishments and developments... You do not currently have access to this content.

Implementation of a Level III neonatal intensive care unit was associated with reduced NICU mortality in a resource limited public tertiary care hospital in Guyana, South America.

Neonatal mortality is a significant contributor to child mortality, and there is increasing interest in low resource settings to implement neonatal intensive care practices to lower neonatal mortality. In Guyana, South America neonatal mortality remains relatively high. At Georgetown Public Hospital Corporation (GPHC), the only tertiary referral hospital in Guyana, a Level III NICU was developed starting in January, 2012 with full implementation in September, 2015. In this study, we report the association of the implementation of a Level III NICU with in-hospital neonatal survival at GPHC. Using an observational study design, available data were collected from January 1, 2015 through September 30, 2020. During the study period, there were 30,733 deliveries at GPHC and 4,467 admissions to the NICU at GPHC. There were no significant changes in the numbers of births or NICU admissions during the time of the study. The survival rate for patients admitted to the NICU was ~64% during the first 3 quarters of 2015 with most deaths were caused by sepsis or respiratory failure. By the last quarter of 2015, the NICU survival rate increased dramatically and has been sustained at ~87% (p<0.0001). The inborn mortality rate at GPHC, calculated as a percentage of all live births at GPHC, was 2.9% prior to the full implementation of the NICU and was 1.4% after the full implementation of the NICU (p<0.0001). These findings suggest that the implementation of a Level III NICU at GPHC was associated with an improvement in survival to NICU discharge in a resource limited setting.

Prevalence of Cesarean Section at Georgetown Public Hospital Corporation, Guyana: An Institution-Based Cross-Sectional Study

Prevalence of Cesarean Section at Georgetown Public Hospital Corporation, Guyana: An Institution-Based Cross-Sectional Study

Cervical Cancer: Incidence, Clinical Staging at Presentation and Treatment Modality from October 2020-March 2021

Objective: The aim of the research is to attempt to ascertain the incidence of cervical cancer at GPHC, most common clinical stage and histologic types at presentation and treatment modalities offered for different stages of the disease at the national referral hospital in Guyana. Methodology: A retrospective chart review of the registry from the gynecology-oncology clinic of the Georgetown Public Hospital Corporation from October 1st, 2020 to March 31st 2020. Results: There were a total of 33 new cases of cervical cancer admitted into the registry of the gynecology-oncology clinic of the Georgetown Public Hospital Corporation for the study period. The modal age of presentation was 41-50 years. Women of African and East Indian descent (36.36% each) accounted for the highest pool of disease among the six (6) races in Guyana. The International Federation of obstetrics and Gynecology (FIGO) Stage III disease was the predominant stage at presentation (42.4%). Squamous cell carcinoma (SCC) accounted for 93.94% of histologic diagnoses. Conclusion: The late presentation (stage III) of 42.4% of patients with a tissue diagnosis of SCC (93.94% of the study cohort) of predominantly of African and East Indian descents and between the modal ages of 41-50 years were the main findings of this study. Preventative and pragmatic programs targeting these demographic subsets will go a long way in reducing the burden of disease in Guyana. Keywords: Cervical Cancer, Stage; Histology; Treatment

The Incidence and Causes of Maternal Near Miss in a Pandemic at Georgetown Public Hospital Corporation

Objective: This article determines the incidence, causes and socio-demographics factors of Maternal Near Miss at GPHC from June 1, 2021 to December 31, 2021. Design and Method: A retrospective descriptive chart review was conducted during a seven-month period from June 1st, 2021 to December 31st, 2021 of all the pregnant patients who had suffered a Maternal Near Miss. A purposive sampling technique was employed in this study. Eligible patients were identified using a modified World Health Organization Maternal Near Miss criterion that Guyana has implemented. The data was collected and analyzed in an Excel format. Results: There were a total of 4636 admissions during the study period with 2984 live births and 32 maternal near misses which accounted for 0.7% of all births. The Maternal Near Miss incidence ratio was 10.7 MNM/LB which indicates that for every 1000 live births there were 11 maternal near misses. There was a total of 9 maternal deaths that occurred during the study period. The Maternal Near Miss to Mortality Ratio was 32:9, resulting in a proportion of 3.5 MNM per MD. The primary causes of maternal near misses in the patients in this study were: obstetric hemorrhage, hypertensive disorder, ectopic or abortion and infection. Anemia was the main secondary cause of maternal near misses and ICU admissions. Conclusion: The maternal near miss ratio in this research was slightly lower (10.7MNM/LB) than the study conducted at GPHC in 2019, which recorded a maternal near miss of 12.7 MNM/LB. There was an increase in obstetrical hemorrhage and a decrease in Hypertensive disorders which were main indications of MNM. This study discovered that for every maternal death, 4 mothers were saved whereas the 2019 study revealed 5 mothers were saved. It can be concluded that MNM rates remained stable during the pandemic compared to pre-pandemic period. Keywords: Maternal Near Miss, Pandemic, Georgetown Public Hospital Corporation, GPHC

Evaluating the Impact of Interventions for the Prevention and Management of Malaria in Pregnancy in Guyana

Objective: To evaluate the impact of collaborative interventions between the Ministry of Health (MOH) and the Georgetown Public Hospital Corporation (GPHC), in consultation with the GPHC ObGyn Residency program, on the incidence of Malaria in Pregnancy and associated maternal mortality in Guyana between 2012 and 2014. Design &amp; Methods: This was a retrospective observational study that analyzed data collected from the MOH Vector Control Unit and GPHC maternal mortality statistics. Pre- and post-intervention data were collectively analyzed. Results: The results showed a steady rise in incidence of MIP per region prior to the introduction of the interventions in 2012. During and after implementation of the interventions, there was both an immediate (52%) and sustained (&gt;20%) decrease in the number of new cases of MIP. While absolute numbers of maternal mortality secondary to MIP at GPHC were low (1 case per year), they contributed 50-100% of indirect maternal deaths in the years immediately prior to development of the MIP treatment guidelines at GPHC. After these guidelines were officially adopted in 2014, there have been no further maternal deaths associated with malaria. Conclusions: These results suggest that the MOH and GPHC interventions are associated with significant decreases in both incidence of MIP on a national scale and maternal mortality at the institutional level. Future studies are needed to identify the impact of specific components of these interventions to guide future interventions aimed at eliminating both maternal morbidity and mortality associated with MIP in Guyana. Keywords: Malaria-In-Pregnancy (MIP); Insecticide Treated Nets (ITNs); Interventions.

The Maternal and Perinatal Outcomes of Pregnancies Complicated by Covid-19: A Retrospective Study at a Tertiary Facility in Guyana (Georgetown Public Hospital Corporation)

Background: In December 2019, there was an outbreak of pneumonia cases in the city of Wuhan, China. The outbreak was first manifested as a cluster of mysterious pneumonia cases mostly related to the Huanan Seafood market in Wuhan, the capital of Hubei Province. Genomic investigations of the pathogen found that the disease was caused by a new strain of coronaviruses and the disease was given the name “Covid 19”. Pregnant women with Covid-19 may be at greater risk of severe illness although the full impact of the infection in pregnancy is unknown. Amongst the Guyanese population, several pregnant mothers have tested positive to Covid-19 thereby generating major concerns. Objectives: To ascertain the maternal, perinatal and immediate neonatal outcomes of pregnancies complicated by Covid-19 infection at the Georgetown Public Hospital Corporation, Guyana. Method: This study is a retrospective chart review of pregnant patients who were diagnosed with Covid-19 from August, 2020 to April 2021 and delivered at GPHC. The data collected include socio-demographics of patients, parity, gestational age at delivery, birth weight amongst others. Results: This retrospective study was able to show the outcomes of Covid-19 in pregnant patients at the Georgetown Public Hospital from August, 2020 to April, 2021. During this study period, the total study population of this research was 4,686 of which only seventy-nine (79) participants fit the study criteria. Conclusion: This retrospective study shows there was no statistically significant impact seen in the maternal and neonatal outcomes of pregnancies complicated by Covid-19 infection at Georgetown Public Hospital Corporation (GPHC). Keywords: Maternal and Perinatal Outcomes of Pregnancies, Covid-19, Georgetown Public Hospital Corporation

Use of Daily Low-Dose Aspirin in Pregnancy for Women at High Risk of Preeclampsia at Georgetown Public Hospital Corporation

Objective: To Determine what proportion of eligible high-risk women diagnosed with preeclampsia received low dose aspirin during antepartum care. Design &amp; Methods: This was a retrospective chart review of all patients who delivered at Georgetown Public Hospital Corporation between September to December 2017 and were diagnosed with a hypertensive disorder in pregnancy. The primary outcome was the fraction of women diagnosed with preeclampsia, eclampsia or HELLP syndrome who met the U.S. Preventive Task Force criteria to be started on aspirin and were started on aspirin between 12 and 28 weeks of gestation. Maternal secondary outcomes included: Intensive care unit admissions, end organ injury, placental abruption and death. Neonatal secondary outcomes included: Neonatal intensive care unit admissions, fetal growth restriction, preterm births, stillbirths and neonatal death. Data was organised and analysed in Microsoft Excel 2016. Results: Of the 2,452 deliveries, 2,160 (88%) charts were found and reviewed. 14.3% were diagnosed with a hypertensive disorder in pregnancy. Of these, 37% had preeclampsia, eclampsia or HELLP syndrome. Among these, 36.8% met criteria to receive low dose aspirin antepartum but only 4.8% received aspirin. Of the secondary outcomes, one death occurred because of a haemorrhagic CVA. 42.1% of neonates were born prematurely of which 4 were stillbirths and 4 were neonatal deaths. Conclusions; The routine use of a low dose of aspirin among pregnant women who met the criteria to be started on was low. Recommendations: All women should be screened for the risk of developing preeclampsia and if needed, aspirin should be started between 12-28 weeks of gestation to get the best effects. Keywords: preeclampsia, aspirin in pregnancy, GPHC

A Retrospective Chart Review Study Title of Project: Analysis of Caesarean Sections Using Robson 10-Group Classification System at the Georgetown Public Hospital Corporation, Georgetown, Guyana, South America

Background: The WHO recommends a cesarean delivery rate (CDR) of less than 15%. The CDR at GPHC increased from 17.8% in 2010 to a peak of 26.1% in 2019, nearly twice the WHO recommendation. The purpose of this study is to analyze trends of and the CDR using Robson 10-group classification system (R-TGCS) at a tertiary facility in Guyana (Georgetown Public Hospital Corporation). Methods: This study is a facility based, one-year retrospective chart review of patients who had cesarean deliveries (CDs) between January 1st, 2019 and December 31st, 2019. Pertinent information including maternal age, gestational age at delivery, gravidity and parity and indication for CD, were collected. The overall CDR was calculated and information on each patient was used to allot the patients into one of the ten R-TGCS. The dependent variable was Robson classification group. Results: The total number of CDs for the period was 1641 out of 6277 deliveries above 28 weeks gestational age. Demographically, the most common age range of the cohort was 20-34 years, accounting for 73.8% of the cohort. The mean duration of hospitalization after CD was 3.5 (±3) days. The mean gestational age at delivery was 38 (±2.2) weeks. The most common indications for CD were non reassuring fetal heart tracings (32.2%), previous CD pre-labor (17.9%) and previous CS in labor (9.3%). The most common R-TGCS groups Conclusion: The study showed that groups 5 (multipara with scarred uterus/previous CD), 1 (nullipara in labor) and 3 (multipara without scarred uterus/previous CD) were the major contributors to the overall CDR, with group 5 alone contributing one-quarter to the CDR. Keywords: Robson’s Ten-Group Classification, Cesarean delivery.

Physician Burnout at Georgetown Public Hospital (GPHC): The Hidden Health Worker Crisis

Objective: This article reviews the prevalence and influencing factors of physician burnout. Design &amp; Methods: A cross-sectional study was conducted using a hard copy of the Maslach Burnout Inventory (MBI) during April, 2021 at Georgetown Public Hospital Corporation. Participants included 250 physicians from 18 departments. Questionnaires were contested voluntarily and anonymously. The MBI items were rated on a Likert scale from 0 to 6. It access: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), each dimension is classified into severe, moderate or low burnout. Data was analyzed using Microsoft Excel 2016 and SPSS statistics. Results: The prevalence of burnout for each dimension was: 79.8% (n=138) for EE, 67% (n=116) for DP and 69.9% (n=121) for PA with an average score of 30 (0-52); 10.3 (0-57) and 34.9 (59-1) respectively. Contributing factors to burnout were: physicians working shift, female gender, single status and ages of 30-39. Conclusions: The prevalence of burnout at GPHC was high. Contributing factors were working a shift system, attending to &gt;20 patients daily, working &gt;65 hours weekly and not partaking in recreational activities. Recommendation: Implementing measures to combat burnout is paramount to maintain physician’s health. Provision of areas for recreational activities, a food court with healthy food options, providing psychologists/counsellors for physicians in each department and wellness activities can be beneficial in the future. Keywords: Burnout; Maslach burnout inventory; Physician burnout, GPHC

Acupuncture and Global Health: Providing Medical Acupuncture Education and Service in Georgetown, Guyana.

Objective: Guyana is located on the north coast of the South American continent and is a middle-income developing country in the Caribbean. There is little educational opportunity for individuals interested in medical acupuncture. The aim of this project was to develop an introductory medical acupuncture curriculum for perioperative use. Materials and Methods: Through a carefully coordinated teaching-and-care plan, with support from physicians and various medical organizations, an educational opportunity in medical acupuncture was established at the Georgetown Public Hospital Corporation, a medical university teaching hospital in Georgetown, Guyana. The project involved development of a medical acupuncture curriculum, as well as teaching and patient care. Anesthesia staff members, resident trainees, and perioperative and pain-clinic patients participated. Results: Medical acupuncture-trained physicians were able to provide medical acupuncture education and services in a third-world country because of this project. Conclusion: This project is an ideal example of utilizing medical acupuncture for promoting global heath.

Cross-sectional prospective feasibility study of newborn screening for sickle cell anaemia and congenital hypothyroidism in Guyana

IntroductionNewborn screening (NBS) is a test done shortly after birth to detect conditions that cause severe health problems if not treated early. An estimated 71% of babies worldwide are born...

Risk factors associated with COVID-19 Intensive Care Unit hospitalisation in Guyana: A cross-sectional study

Objective The purpose of the study was to determine risk factors associated with COVID-19 ICU hospitalisation at Georgetown Public Hospital Corporation (GPHC), Guyana. Methods A retrospective chart-review was conducted on all COVID-19 admissions from March to September 2020. The predictive factors were demographics, comorbidities, signs and symptoms of COVID-19 and laboratory findings on admission. Descriptive frequency analysis was done for all independent variables and the Chi-square test was used to compare differences between groups where suitable. Univariate and multivariate binary logistic regression was used to examine the association between the independent variables and the risk for ICU hospitalisation. Results There were 136 patients with COVID-19 at GPHC during March to September 2020 and after exclusion, 135 patients were used in the study. There were 72 (53.4%) patients who required non-ICU care, while 63 (46.6%) ICU care and average age ± SD (median) was 51 ±16 (n= 49) and 56 ±18 (n= 60), respectively. In the multivariate regression model, the odds of ICU admission for those aged 40-65 was 0.14 (p &lt;.01) compared to those &gt; 65 years. Patients with class 2 and above obesity had higher odds of ICU admission compared to non-obese patients OR 11.09 (p= .006). Patients with 2 and 3 or more comorbidities also had higher odds of ICU admission compared to those with no comorbidities OR 7.83 (p= .03) and 132 (p &lt;.001), respectively. Patients with LDH 228-454 U/L and &gt; 454 U/L on admission had higher odds of ICU admission compared to those with normal LDH OR 19.88 (p= .001) and 23.32 (p= .001), respectively. Patients with albumin &lt; 3.50 mg/dL on admission also had higher odds of ICU admission compared to those with normal albumin OR 5.78 (p= .005). Conclusion Risk factors associated with ICU hospitalisation were advanced age, obesity, multiple comorbidities, elevated LDH and low albumin. Protecting the population at risk for ICU admission and prioritizing them for vaccination is recommended to reduce the risk of running out of ICU capacity.