Low-resource Countries Research Articles

P-294. The pathway to a decade of carbapenem-resistant Enterobacterales (CRE) : A 9-years experience in a teaching hospital in the Dominican Republic

Abstract Background WHO warns about carbapenem-resistant Enterobacterales (CRE) and carbapenemase production, posing challenges in hospitals owing to treatment failure and rapid dissemination. In order to design adequate infection control and prevention strategies and local treatment guidelines, it is important to characterize the prevalence of these isolates. We aimed to assess the frequency of CRE and carbapenemase production in hospitalized patients between October 2015- March 2024. Methods A retrospective, descriptive and longitudinal study was conducted including all patients with positive CRE cultures, from January 2015 to March 2024, in a 289-bed tertiary hospital in the Dominican Republic. A database of susceptible and resistant Enterobacterales isolates was obtained, reviewing electronic records for culture origin, microorganisms, and carbapenemase production. Annual CRE rates were calculated including all hospitalized patients with Enterobacterales isolates. Results The CRE rate over a 9-years period was 1.7% (83/4843). A slight decrease was observed from years 2015 to 2017, followed by the lowest CRE rate in 2018 (0.2%). 2020 reported an increase of 160% in the CRE rate when compared to 2019, peaking at 3.5% in 2022. The most common microorganisms isolated were Klebsiella spp. (42.6%; 43/101) and Enterobacter cloacae complex (33,7%; 34/101) while the most common carbapenemase produced was KPC (39.4%; 39/99) followed by MBL (21.2%; 21/99). Urine cultures were the most common samples to isolate CRE, but a shift in the trend was observed in 2020, with blood cultures becoming the most common source of CRE. Sequencing of a small sample as part of a previous study reported the presence of KPC2 and KPC3. Conclusion Despite being in a low resource country, infection prevention and control strategies have managed to limit the spread reported in other hospital settings in Latin America. The increase seen post pandemic emphasizes this importance. Although KPC is the most common carbapenemase type, NDM has been increasing, posing a major growing concern on treatment failure. Laboratory methods stand as a fundamental tool to understand the magnitude of dissemination, to elaborate clinical guidelines and improve diagnosis and patients outcomes. Disclosures Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria

Unmet Social Needs of Older Adults With Mobility Limitations Following Inpatient Rehabilitation Discharge in Nigeria: A Qualitative Narrative Inquiry Study.

Approximately, 30% to 60% of older adults experience functional decline following hospitalization, which has implications for their ability to meet social needs after discharge. Exploring the unmet social needs of older adults following discharge is warranted to rethink the elements of hospital discharge in low-resource countries. This study explored the unmet social needs of older adults with mobility limitations following discharge from an inpatient rehabilitation unit in a state hospital in Northern Nigeria. This narrative qualitative study is based on the social constructivism paradigm guided by the 3-Dimensional Narrative Inquiry Space (3-D NIS) methodology. We purposively selected and conducted telephone interviews with 12 older adults, aged 55years and older, with mobility limitations and discharged from inpatient rehabilitation units. The 3-D NIS guided the thematic analysis of the data. Two author coders independently conducted a thematic analysis of the transcripts. Reflexivity was maintained throughout the research process. Two related themes [6 sub-themes] emerged: "limitations in social functioning" [leisure activity, religious engagement, and instrumental activities of daily living modifications]; and "accepting the status quo" [Care/support from relatives, friends, and strangers, regrets and aspirations, and adaptation to psychological needs]. Seven tensions from the participants' transcripts were embedded in emotions, focused on belief, well-being, and spirituality, COVID-19 pandemic impact, desire to be "normal," limited finance, non-age-friendly homes and community settings, and undetailed rehabilitation discharge planning. This study highlights the substantial unmet social needs of older adults with mobility limitations following discharge from inpatient rehabilitation units in Northern Nigeria, underscoring the importance of a holistic approach to hospital discharge planning. Future research in low-resource countries should delve deeper into developing comprehensive discharge strategies that integrate social workers and rehabilitation professionals to effectively address these multifaceted social needs.

An Alternative for Endotracheal Tube Holders In Resource-Limited Settings

Background: Endotracheal intubation (ETT) is a procedure that is lifesaving and performed in intensive care units, in operating theatres to facilitate surgery, and in emergency departments. Unplanned extubation causes hypoxia and death. The Advanced Cardiac Life Support Guidelines in 2005 by the American Heart Association recommend using either an adhesive tape or ETT holder to secure the ETT. The commercially available single-use adult ETT holders cost approximately 2000-2500 LKR. Purpose: The objective of this report is to highlight how a low-cost ETT holder can be created in a low-resource country as a substitute for commercially available ETT holders during an economic crisis.Procedure: A polyvinyl-chloride (PVC) female pipe adapter with a slit on the thread end, and a male adapter were used. The ETT was placed vertically within the slit of the female adaptor. The adapters were screwed together to hold the ETT. Two separate cylindrical PVC pipes with a hole on each end were attached to either side of the female and male pipe adapters. Fabric threads were passed through the openings of the cylindrical pipes to create a harness. Results: Our device secured the placement of ETT without dislodgement. Material for each ETT costs 400-500 LKR and can be constructed within 30 minutes. They can be autoclaved and reused.Conclusion: A low-cost locally manufactured PVC ETT holders can be an ideal substitute for the commercially available ETT holders.

Dent Disease 1 Presented Early with Bartter-Like Syndrome Features and Rickets: a Case Report

Introduction: Dent disease (DD) is characterized by a triad of low-molecular-weight proteinuria, hypercalciuria, and nephrocalcinosis/nephrolithiasis. However, some cases were confounded by other clinical symptoms and signs, namely hypokalemia and rickets, which resulted in misleading diagnoses. A diagnosis of DD could be delayed even in high-resource countries due to its variability of phenotypes and rarity, causing a lack of awareness in both medical practitioners and parents. Moreover, in low-resource countries, laboratory test limitations can hinder the diagnosis. Case presentation: A thirteen-year-old boy presented with an acute episode of severe hypokalemia following vomiting due to COVID medication side effects. He had lower extremities weakness, salt craving, and polydipsia since childhood which were not thought to be unusual by the parents. He had a history of intrauterine polyhydramnios and maternal miscarriages. A physical examination showed hypotension, short stature, and genu valgum. His laboratory workup displayed hypokalemic metabolic alkalosis and increased urine potassium, chloride, transtubular potassium gradient, and calcium/creatinine ratio. He also had hypophosphatemia, hypomagnesemia, and decreased kidney function. Severe osteopenia was prominent on radiologic examination of all extremities. Subsequent laboratory samples sent overseas revealed low-molecular-weight proteinuria and a pathogenic variant in the CLCN5 gene confirming X-linked Dent disease 1. Conclusion: This case report highlights the importance of considering DD in differential diagnoses of children with the pseudo-Bartter syndrome, that is, renal salt and potassium wasting, with or without hypercalciuria and nephrocalcinosis. Additionally, in children with rickets and proteinuria, urinary low-molecular-weight protein measurement could assist in screening for the possibility of DD, particularly in low-resource settings.

Efficacy of Intermittent Peritoneal Dialysis in Pre Renal and Renal Acute Kidney Injury in Children

Background: Acute kidney injury (AKI) is a major health problem in children worldwide. Intermittent Peritoneal Dialysis (IPD) has been reported as the preferred modality for the management of AKI in low-resource setting countries like Bangladesh. Its efficacy in different varieties of AKI is less emphasized. This study aims to assess the efficacy of IPD in pre renal and renal causes of AKI in children. Methods: This prospective, interventional study was conducted at Department of Paediatric Nephrology, Bangladesh Shishu Hospital and Institute from January 2020 to December 2021. Total 56 children aged between 1 month to 12 years of either sex, diagnosed as AKI stage 2 or 3 due to pre renal and renal causes who required IPD were included. All patients got IPD for 72 hours. Clinical and laboratory parameters were measured daily and compared between pre renal and renal group on day 3 to assess efficacy. Results: In the pre renal group, 65.4% of patients were infants while in the renal group, 51.9% were aged 1-5 years. After 3 days of IPD, oedema improved in both groups but in renal group, more patients were still oedematous (p<0.001). Serum creatinine, blood urea levels and urea reduction ratio improved significantly in both groups with greater changes in pre renal group (p<0.001). In the renal group, 29.63% patients required hemodialysis and 7.4% required further IPD, whereas all pre renal patients improved with a single course of IPD without hemodialysis. Conclusion: Intermittent Peritoneal Dialysis is more effective in the treatment of pre renal AKI in children.

PAP Smear in Pregnant Women: A Hospital Based Study

Introduction: Pregnancy provides an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A Papanicolaou(Pap) smear is simple, cost effective and safe during pregnancy. In low resource countries, this may be the only opportunity when woman visits a health care centre. Objective of this study is to use Pap smear as a cervical cancer screening test in pregnant women and to determine the prevalence of abnormal Pap smear among pregnant women attending the antenatal outpatient department. Methods: A prospective study conducted in the department of Obstetrics and Gynaecology of Shree Birendra Hospital for a period of 12 months from September 2020 to August 2021. Inclusion criteria was pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or normal Pap smear in last 3 years. Ayre’s spatula was used to conduct smear test in this study. All the smears were immediately fixatived in 95% ethanol and sent to the department of pathology. The cytological result were reported on the Bethesteda classification system 2014. Results: Out of 300 pregnant women enrolled in the study, the Pap smear report revealed that 28.3% of the study subjects had inflammatory smear 65.7% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.3% of subjects had Atypical Squamous Cells of Undetermined Significance (ASCUS). No satisfactory sample was reported in 5.7% of the subjects. Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix. Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

Successful arm replantation using traditional surgical techniques: a case report from a low-resource country

Introduction: Upper limb replantation requires rapid intervention by a multidisciplinary team and appropriate equipment to rescue the limb. Note that the success of the operation and the decision to perform it depend on several factors. This case report presents an upper limb replantation performed using traditional surgical techniques. Case presentation: A 12-year-old boy presented to our hospital with a crushing injury to the right upper arm, which was amputated at the lower third of the humerus, with the biceps brachii tendon remaining intact. The first aid included resuscitation and intravenous fluid administration to maintain hemodynamic stability. The surgeons replanted the arm by immobilizing the fracture with Kirschner wires, performing several arterial and venous anastomoses, and suturing the damaged nerve and muscle aponeurosis in a 3-h operation. The patient was discharged after 5 days without any complications but was recommended to undergo physical therapy to regain his arm movement and is currently undergoing monthly follow-ups to ensure the required improvement. Discussion: Upper limb replantation is a complicated process that enables the conservation of arm function and appearance. This requires rapid intervention by a multidisciplinary team. Additionally, advanced equipment, such as microsurgical tools, provides greater success and ease of revascularization. Conclusion: To successfully re-implant an amputated limb, several factors must be considered: surgeon experience, availability of necessary equipment, and provision of post-operative care. Despite lacking advanced tools, surgeons can rely on their surgical skills to overcome this challenge.

Addressing Neurological Inequities in Developing Countries: Challenges and Strategic Solutions

Abstract Neurological disorders pose one of the most urgent healthcare challenges globally, with a particularly severe impact on low-resource settings. Effective responses to this crisis require timely, intersectoral strategies, and coordinated actions to drive substantial positive changes. Political determinants of health play a crucial role in advancing initiatives in surveillance, prevention, acute care, and rehabilitation for neurological conditions. An essential life-course approach to brain health focuses on early intervention and sustained care throughout an individual’s lifespan. Building a comprehensive system of care, underpinned by robust policies and financial investments, is critical for progress in low-resource countries. In addition, urgent reforms in education are needed to cultivate a skilled neurological workforce that is equipped to meet the demands of these regions. Intersectoral strategies, including telemedicine, mobile health, organized systems of care, helicopter ambulance services, and widespread public awareness campaigns, are vital components for creating an equitable and responsive neurological healthcare framework.

Surgical Practice in Resource-Limited Settings: Perspectives of Medical Students and Early Career Doctors: A Narrative Review.

Surgical practices in low-resource countries often fail to meet established standards. Both doctors and medical students have limited exposure to surgical cases, which hinders training and the development of surgical specialization. This study highlights the current state of surgical practice from a trainee's perspective, explores existing gaps in training and capacity building, and recommends practical solutions. We conducted a literature search on PubMed, Google Scholar, and other scientific databases using search terms such as "surgical practice," "doctors' perspectives in surgical practice," "surgery in low- and middle-income countries," and "solutions to surgical inadequacy." We included studies published from 2015 to 2024, with exceptions for a few highly relevant studies published prior to 2015. We outline the limitations identified in the literature concerning surgical training and healthcare in low- and middle-income countries. Many centers lack adequate infrastructure, human resources, and training. These challenges negatively affect the skills and quality of surgical care. However, some centers demonstrate that surgical practice is feasible through collaboration with institutions established in higher-income contexts. Telesurgery, task shifting and sharing, high-impact, low-cost surgeries, and collaborations with more developed health systems could effectively bridge the gap in surgical availability in LMICs.

Conducting Clinical Research in Low Research Resource Countries: Lessons Learned From the International Registry of Men With Advanced Prostate Cancer Study in Nigeria.

There is limited cancer clinical research in sub-Saharan African countries despite the significant burden of cancers. The primary objective of this strengths, weaknesses, opportunities, and threats (SWOT) analysis was to understand and document factors affecting the successful implementation of prostate cancer (CaP) clinical research in Nigeria. The research team used a qualitative design involving International Registry of Men with Advanced Prostate Cancer (IRONMAN) study team members as participants from four regional sites in Nigeria. One-hour listening sessions were conducted via Zoom at each site, focusing on SWOT related to the IRONMAN study. All sessions were recorded, transcribed, and analyzed. Themes were inductively coded and then synthesized across all four sites. The study teams identified several strengths and weaknesses in conducting the IRONMAN study at their respective sites. Key strengths included access to robust patient population for recruitment and the availability of essential resources, such as lab space, clinical knowledge, and adequate staffing. Weaknesses centered on the social determinants of health that hinder patient participation, such as transportation challenges, distance to clinics, limited access to care, and insufficient biorepository space for sample storage. A prominent opportunity identified was the potential for Nigerian institutions to engage in more clinical research, particularly multisite global trials. Threats included difficulties in retaining research staff and political instability. This study highlights the promising research opportunities in Nigeria. The lessons learned from the IRONMAN study provide valuable insights into the feasibility of conducting CaP clinical research and trials tailored to the needs of Black men in sub-Saharan Africa. These findings offer a roadmap for future research efforts, with the potential to expand clinical trials and improve health outcomes across the region.

Design, methodology, and early findings of an autism registry program: ABBILAR project.

The autism spectrum disorder (ASD) registry program presents a unique opportunity to facilitate advanced research in various aspects of ASD, particularly in low-resource countries like Iran. Given the international significance of autism research, registry programs play a critical role in data sharing. ASD registry programs have been effectively established in high-income countries over a few decades; however, there are limited examples from low- and middle-income countries. This study presents a firsthand description of the design and primary findings of a 9-year established ASD registry program from the northwest of Iran. It elucidates the program's feasibility for other low-income settings, providing valuable insights for researchers and policymakers.

Barriers and facilitators in the acquisition of diabetes knowledge among tertiary-care nurses in central and southern Malawi: an exploratory-descriptive qualitative study

BackgroundNumerous studies report low diabetes knowledge among nurses in sub-Saharan Africa. However, little is known about the factors that hinder and promote their acquisition of knowledge on diabetes mellitus. Understanding these factors is a pivotal step towards ensuring that nurses are knowledgeable and competent in the provision of care and education for patients with diabetes mellitus.MethodsThe study employed an exploratory-descriptive qualitative (EDQ) approach. Participants were identified from two tertiary hospitals. Twenty-six participants were purposively selected from these facilities. Data were collected through focus group discussions and analysis was done using Braun and Clarke’s approach to thematic analysis.ResultsThe following themes relating to barriers and facilitators in the nurses’ acquisition of diabetes knowledge emerged from the study: (a) individual hindrances; (b) organizational drawbacks; (c) personal ways of knowing; (d) organizational factors enhancing knowledge; and (e) suggestions for improving the nurses’ knowledge.ConclusionsThe study brings to light various challenges and opportunities in the acquisition of diabetes knowledge among tertiary-care nurses in Malawi. Given our study results, we believe that cost-effective measures can be utilised to address the barriers to the acquisition of diabetes knowledge among nurses. This is a crucial step towards ensuring that nurses are knowledgeable and competent in the provision of care for patients with diabetes in low-resource countries.

Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?

BackgroundWhile patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.MethodsWe conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.ResultsNHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.ConclusionThere is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.

Neurological Recovery Following Surgical Intervention in Patients with Traumatic Spinal Cord Injury at the University Teaching Hospital in Zambia

Introduction Traumatic spinal cord injuries cause long-term disability and functional impairment. Timely and proper surgical treatment improves neurological recovery and functional outcomes. However, in low-resource setting countries, surgical intervention is usually delayed raising concerns about the recovery of patients. Hence, this study investigated the neurological improvement of patients undergoing surgery for traumatic spinal cord injuries at the University Teaching Hospital in Lusaka, Zambia. Methods This was a retrospective study that included all eligible patients with traumatic spinal cord injury managed surgically at the University Teaching Hospital between 2018 and 2022. The study assessed neurological improvement by comparing the American Spinal Injury Association’s neurological grading before surgery to that at discharge. Data was analysed using Stata 17, and the level of significance was set at 5%. Results Out of the 96 patients in the study, 45.8% showed neurological improvement of at least one grade after surgery. Patients with thoracic injuries showed lower improvement rates (25.0%) than those with cervical (55.0%) or lumbar injuries (65.0%), while those with incomplete injuries showed higher improvement rates (78.7%) (p <0.05). Thoracic injuries were associated with reduced neurological improvement (AOR 0.21; 95% CI: 0.04 – 0.95, p = 0.043), while incomplete injuries were associated with higher neurological improvement (AOR 18.58; 95% CI: 6.11 – 56.51, p < 0.001). Conclusion Neurological improvement was poor for thoracic injuries and complete injuries, highlighting the necessity for further investigation into the specific structural features and mechanisms of injury that contribute to poor neurological improvement in thoracic injuries and the identification of effective recovery approaches for these patients.

Trends and Outcomes of Laparoscopic Surgery in Low‐Resource Settings: Lessons From Two African Healthcare Systems–A Narrative Review

ABSTRACTIntroductionLaparoscopic surgery (LS) has been a promising development in surgical practice globally ever since its introduction. LS has exhibited many an advantage, including bettering patient outcomes, lowering the risk of postoperative infection, and displaying economical affluence. However, its implementation in the African continent still faces various challenges. In this review, we investigated the status of laparoscopic surgery integration in Africa.ObjectivesIn this review, we aimed to investigate the challenges posed by the implementation of LS in low resource countries as well as critically evaluating initiatives and their impact within said domiciles. We also provide recommendations that may assist in LS prosperity in these settings by focusing efforts on improving training and financial incentives.MethodsA comprehensive literature review was conducted to garner up‐to‐date evidence concerning the fate of LS adoption in low‐ to middle‐income countries. This comprised the analysis of different case studies from countries including Nigeria and Botswana, and investigated relevant recommendations and policies provided by other African countries.ResultsVarious challenges face the implementation of LS in countries with low resources comprising poor infrastructure, scarce training programs, and expert training personnel alongside financial boundaries. The adoption of LS in Africa has proved its benefits in improving patient outcomes and reducing hospital admissions. From a perspective of policy, it is crucial to sustain strong ties amongst institutions, stressing the importance of dynamic collaboration and locally tailored policies.ConclusionIt has been demonstrated that LS implementations in African nations lower infection rates and expedite recovery. A strong collaboration between governments, stakeholders, and healthcare providers is fundamental for successful integration of LS. Such extension in low‐resource environments may be achieved by providing proper training programs, funding infrastructure and equipment, and fostering effective financial initiatives.

Patología importada en urgencias

Introduction: the increase in migratory movements and travel to low-resource countries in recent years has led to an increase in the incidence of infectious diseases that are uncommon in Spain. The objective of the study was to describe the characteristics of patients with imported disease in the emergency room. Methods: a retrospective study was conducted between 2012-2019. The study included children under 16 years of age with a history of international travel in the past 3 months managed in the emergency department of the Hospital de Torrejón. We collected demographic and clinical data. Diagnoses were grouped into three categories: tropical infection (typically imported from tropical areas), communicable infections (including infections with global distribution and a greater prevalence in tropical areas, such as tuberculosis) and common infections. Results: the sample included 100 children were included. The median age was 3 years, and 53% were female. Eighty-seven percent had visited sub-Saharan Africa. The reason for the trip was to visit friends and relatives in 43% of cases, immigration in 45% and tourism in 9%. Four percent received prophylaxis against malaria. Twenty-four received a diagnosis of malaria, without a history of fever in 6. Other tropical infections included dengue, chikungunya and liver abscess. Five children received diagnoses of communicable infections (HIV, tuberculosis, meningitis, hepatitis A, giardiasis), and 67 children of common infections. Conclusions: malaria was the second most frequent diagnosis in children with fever following travel to an endemic area, after common infections. In our study, the initial presentation of life-threatening imported diseases were indistinguishable from those banal infections.

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies.

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

Scaling cervical cancer screening in Mozambique: analysis of loop electrosurgical excision procedure (LEEP) specimens

ObjectivesAs cervical cancer screening programs are implemented and expanded, an increasing number of women require loop electrosurgical excision procedure (LEEP) for treatment of pre-invasive cervical disease. Our objective was to...

Asymptomatic bacteriuria screening for developing countries using a modified water quality test kit.

Between 2% and 15% of pregnant women unknowingly experience asymptomatic bacteriuria (ASB), defined as ≥105 CFU per milliliter of urine in the absence of symptoms. ASB increases the risk of adverse pregnancy outcomes including pyelonephritis, preterm labor, and low-birth weight infants. While pregnant women in the United States are routinely screened for ASB, those in developing countries with limited resources and funding lack an accurate mechanism for ASB screening. Aquagenx water quality test kits detect Escherichia coli, the most common causative agent of ASB, and total coliform bacteria in drinking water via colorimetric and fluorescent indicators. We found that the Aquagenx system is compatible with human urine and then proceeded to develop an ASB screening protocol using disposable inoculating loops. Our protocol diagnosed artificial ASB- samples (104 CFU/mL E. coli) with a false positive (FP) rate of 33% (n = 18) and ASB+ (105 CFU/mL E. coli) with a false negative (FN) rate of 5.6% (n = 18). Clinical sample testing with our protocol revealed a FP rate of 0% in ASB- samples (n = 28) and a FN rate of 0% in ASB+ samples caused by coliforms (n = 13). Aquagenx did not detect ASB in nine clinical samples with non-coliform etiological agents due to the limitations of the technology. However, with very high accuracy for detection of E. coli and other causative agents that collectively account for 90.1% of ASB cases, these kits could be used as a diagnostic ASB screening tool in developing countries in which there is currently no alternative to urine culture.IMPORTANCEAsymptomatic bacteriuria (ASB) affects 2%-15% of pregnant women and can result in adverse maternal and fetal outcomes if left undetected and untreated. In the United States and other developed nations, pregnant women are regularly screened for ASB via urine culture. However, in low-resource countries where bacterial culture is not available, dipstick testing is used. Although accurate in cases of symptomatic bacteriuria, dipstick detection is ineffective for detecting ASB. Here, we made use of an existing water quality field test for ASB urine screening, which would be readily deployable in low-resource settings. We optimized a dilution protocol for sampling patient urine within the detection limits of the Aquagenx kit technology. Overall, we were able to detect ASB samples with Gram-negative pathogens that collectively account for 90% of all ASB cases. Utilization of this repurposed technology for proactive medical screening may help prevent adverse pregnancy and birth outcomes due to ASB.

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49