Low-income Nations Research Articles

Road traffic injury mortality and morbidity by country development status, 2011-2017

PurposeThis research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 – to halve the number of global deaths and injuries from road traffic accidents by 2020. MethodsData for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. ResultsAge-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%–16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68–1.90 per 100,000 population) and morbidity (110.45–112.72 per 100,000 population for incidence and 487.48–491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07–4.50 per 100,000 population) but the highest morbidity (428.74–467.78 per 100,000 population for incidence and 1025.70–1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. ConclusionGlobal road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Hyperuricemia in Hypertension and Chronic Kidney Disease: Risk Factors, Prevalence and Clinical Correlates: A Descriptive Comparative Study

Introduction: Uric acid is a product of purine metabolism and elevated serum concentration are very common in, and linked with hypertension and chronic kidney disease, conditions associated with heavy health burden and cardiovascular complications particularly in sub Sahara Africa. An assessment of factors relating hyperuricemia to hypertension and chronic kidney disease would therefore be necessary as way of mitigating the poor quality of life, morbidity and mortality associated with these diseases in low income nations. Methods: A single centre, descriptive comparative study in which the demographic, clinical and laboratory data of hypertensive and non-dialyzed chronic kidney disease (CKD) patients were analyzed. Serum biochemical parameters with uric acid, hematocrit and urine dip strip protein were assessed. Predictors of hyperuricemia were determined using multivariate analysis. Results: One hundred and thirty nine hypertensives and 69 CKD were studied. The mean age of the participants was 54.3 ± 11.7 years, hypertensives (52.9 ± 15.7 years) and CKD (57.3 ± 16.1 years). Both groups had more males, P = 0.8. Majority (78.3%) of the CKD cohorts had stage 4 or 5 (non-dialyzed) disease. The systolic and diastolic blood pressure, creatinine and uric acid were lower in hypertension than in CKD, P = 0.07, P = 0.05, P < 0.001 and P = 0.004 respectively. The hematocrit, albumin and GFR were higher in HTN than CKD, P < 0.001, P < 0.001 and P < 0.001 respectively. The prevalence of hyperuricemia was 56.2%. The mean uric acid was 505.9 ± 23.6 mmol/L, 382 7 ± 10.5 mmol/L for hypertensive and 755.9 ± 14.8 mmol/L for CKD, P < 0.001. The prevalence of systolic HTN, proteinuria, hypoalbuminemia and anemia were 51%, 75%, 46% and 59%, and were higher in males. Hyperuricemia was related to advancing age, proteinuria, elevated creatinine, hypoalbuminemia, anemia and hypertriglyceridemia. Proteinuria (OR—4.66, 95% CI—2.42 - 9.65), elevated creatinine (OR—3.12, 95% CI—2.40 - 6.92), hypoalbuminemia (OR—2.92, 95% CI—1.83 - 5.78) and anemia (OR—4.01, 95% CI—3.78 - 7.99) independently predicted hyperuricemia. Conclusion: Hyperuricemia is commoner in CKD than hypertension and was higher in males and positively correlated with the blood pressure, proteinuria and creatinine, but negatively related to hematocrit, albumin and glomerular filtration rate. Independent predictors of hyperuricemia were proteinuria, elevated creatinine, hypoalbuminemia and anemia. Measures are needed to prevent and treat hyperuricemia to reduce the health burden associated with hypertension and CKD.

Mini Craniotomy in the Management of Supratentorial Spontaneous Intracranial Hemorrhage: A Single-Center Outcome of the Minimally Invasive Treatment.

Hemorrhagic stroke accounts for a significant proportion of mortality and confers a poor quality of life with high dependency among survivors. Surgical evacuation of hematoma has the advantage of rapidly controlling the increased intracranial pressure, halting the ongoing herniation syndrome, and mitigating the secondary cascades of events mediated by the inflammatory and blood degradation products. The advantage is hindered by the concurrent insult to the healthy brain tissue while passing through the normal brain tissue. Therefore, minimally invasive approaches to evacuate the hematoma are employed, but the need for an expensive surgical armamentarium and the expert multidisciplinary team is the bottleneck for their application, particularly in low-income nations. We herein performed a study upon the role of mini craniotomy open surgical method of evacuating hematoma in selected patients with supratentorial intracerebral hemorrhage. We found a significant reduction in the surgery length, minimized risk of post-surgery complications, shortened intensive care unit stay, and reduced mortality compared to the full-fledged craniotomy and endoscopy-guided surgery. There is a need for a large-scale randomized multicenter prospective study to verify the advantages of minimally invasive approaches in the management of symptomatic supratentorial intracerebral hemorrhages.

Objective of the Peads Network to Evaluate the Performance of Active Monitoring of Children Hospital Encephalitis

Aim: Additionally, in case of lack of tools for normalized information supply, the study on the transmission of diseases, pathogens, executives and outcomes of cerebral paralysis in poor-income nations, especially Pakistan, is opaque. Methods: In this research we draw the convention to promote a clinical observation framework proven in Australia on the framework for pediatric active improved infection surveillance. The etiology, engine capacity and its severity, associated impedances, and the health and rehabilitation status of young people with CP in Lahore, Pakistan will describe the PAEDSPakistan use. Our current research was conducted at Jinnah Hospital, Lahore from March 2020 to February 2021. These basic patterns of information will provide light on future well-being management, good education, preparation and support for family life. This is an intended medical clinical recognition of CP children who have introduced restorative science, nervous system science, and pediatric services in general at the National Children's Hospital and the Lahore St INTRODUCTION The primary cause of juvenile incapacity in the globe is cerebral paralysis (CP). This is the world's largest cause of young people's impairment. It effects up to 19 million people throughout the world, with a prevalence of about 2 per 1500 of about 2 per 1,050 new births, according to information received from nations where treatment is crucial [1]. PC's pervasiveness in low-income nations is four to multiple times greater, and there's little trustworthy information accessible in any case. In Pakistan, there are around 600,000 CP residents and 35 to 45% of all impairments. The incidence of CP probably varies throughout Pakistani areas. Pakistan regions. For instance, in the all-inclusive village of Lahore the prevalence of CP was 0.6 per 1000 of the population in Lahore and 1.6 per 2000 [2]. The methodological character of the research, the methodological character of the study, the small number of cases and the potential defect in CP frequency limit the information. The methodological aspect of the investigation is based on this information. In one treatment in Pakistan an increase in the incidence of CP patients has been seen. At that point in 2018, there were 394 (25.7 percent) of all CP children awarded CP. This number multiplied to 916 (48.4%) of all confirmations in 2020. This number was increased repeatedly. The number of CP-sufficient children in Pakistan of CP-sufficient children is expected to range between 34% and 75%, however without detailed epidemiological data this could not be reliably verified [3]. No big epidemiological information. To yet, the CP assistance conveyance has been seen as a priority by the Pakistani health ministry. In addition, Pakistan's new welfare shift in wellbeing has established an overall inclusion of Paul Urgency Clinic. For all CP-mature children <18 years who are hospitalized or present to surgical offices we will use dynamic case-finding day by day. Information is collected from the Australian cerebral palsy register by using the modified variation following parental consent. In interviews with neighborhood and international professionals the information range structure was established and translated into Urdu. Results: The collected data will include socio-economics, maternal welfare as well, birth history, type and severity of CP, recognized CP risk factors as well as the status of feeding, immunization, training and restoration. Conclusion: The PAEDS-Pakistan Foundation will provide Pakistan with unprecedented hospital-based CP recognition.

Utilizing Geospatial Tools to Assign Unique Identifiers to Water Bodies in a Low-Income Country

Inland waters support the growth of several sectors including mining, agriculture, and health. This makes it crucial to have sustainable quantity and quality through conservation practices. Achieving sustainability requires information on the spatial distribution of water bodies. This requirement is particularly critical in low-income nations where dependence on natural resources is a key driver to economic growth. Unfortunately, these nations lack the resources to promote costly waterbody characterization. This study pre-sents a cost-effective approach in assigning Unique Identifiers (UIDs) that define locations and characteristics of rivers and streams. Our objective is to develop a scheme that can be used to identify and characterize rivers and streams in a nation. We utilized an open-source Digital Elevation Model (DEM) of NASA’s ASTER satellite and the hydrology tool in ArcGIS 10.7.1. The DEM was imported to ArcGIS followed by delineation of hydrologic regions, subregions, and stream orders. Each stream segment was given a UID based on its region and Strahler’s stream order system. We present a case study analysis for two regions within Sierra Leone using water quality data of selected rivers and streams. These will lay the foundation for a nationwide coding exercise and provide a useful reference for water resource practitioners.

Structural Transformation, Agriculture, Climate and the Environment

This paper reviews the feedbacks between structural transformation and agriculture, on the one hand, and climate and the natural environment, on the other. The longstanding, dominant economic development narrative largely ignores nature’s influence on factor productivity and stocks, even as it increasingly illustrates how agricultural technological change and economic growth affect nature. We articulate some of the missing linkages and pose a range of policy research questions worth exploration concerning structural transformation and the complex feedback among agriculture, nature, and economic growth processes, especially in the low-income agrarian nations of the Global South.

One-Year In: COVID-19 Research at the International Level in CORD-19 Data

The appearance of a novel coronavirus in late 2019 radically changed the community of researchers working on coronaviruses since the 2002 SARS epidemic. In 2020, coronavirus-related publications grew by 20 times over the previous two years, with 130,000 more researchers publishing on related topics. The United States, the United Kingdom and China led dozens of nations working on coronavirus prior to the pandemic, but leadership consolidated among these three nations in 2020, which collectively accounted for 50% of all papers, garnering well more than 60% of citations. China took an early lead on COVID-19, but dropped rapidly in production and participation through the year. Europe showed an opposite pattern, beginning slowly but growing in contributions during the year. The rate of internationally collaborative publications dropped overall; single-authored publications grew. For all nations, including China, the number of publications about COVID track closely with the outbreak of COVID-19 cases. Lower-income nations participate very little in COVID-19 research in 2020. Topic maps of internationally collaborative work show the rise of patient care and public health clusters—two topics that were largely absent from coronavirus research in the two years prior to 2020.

Assessment of Scientific Reasoning: Development and Validation of Scientific Reasoning Assessment Tool

Studies indicate that the failure of science education to meet the needs of the 21st century is to some extent due to the inability to incorporate scientific reasoning and higher order assessments in the school instruction. Though the outcomes of education seek higher-order thinking abilities there is a lack of high ability assessments in low-income nations. This study aimed to develop and validate Scientific Reasoning Progress Tool (SRPT) that measures students’ reasoning abilities. In this study, 40 items were developed, pilot-tested, and administered to 242 students from grade eight. The SRPT was a valid and reliable instrument. It was also found that the reasoning ability of grade 8 students’ is limited to the lower levels of reasoning. It is recommended that further study is essential through the adoption of the framework and the design to develop additional instruments and investigation of the progression of students’ scientific reasoning ability.

Therapeutic Adherence among Elderly with Chronic Diseases Residing in Urban Area of South India – A Descriptive Cross Sectional Study

Non-communicable diseases (NCDs) are no longer confined to urban and rich persons. They impose a great risk in the low-income nations due to epidemiological and demographic transition. Adherence to medication is key factor in improving the quality of life and preventing complications of NCDs. This study was carried out to study the prevalence of medication adherence and factors determining non-adherence in elderly population with chronic diseases. A community based cross sectional study was conducted with 400 elderly aged 60 years and above. Data was collected by using a pretested questionnaire, which included socio-demographic variables, co-morbidities and details of their medication. Therapeutic adherence was assessed by modified Morisky-Green test, level of cognitive impairment by Pfeiffer’s short portable mental status questionnaire and functional dependence in activities of daily living by Katz Index. Statistical analysis was done using chi-square test. In our study, out of 400 participants, male participants were 184 (48%) and female participants were 216 (52%). 58.5% of them were adherent to their respective treatment medication. Male gender, low level of education, lower socio-economic status and cognitive impairment were the factors associated with therapeutic non-adherence. Therapeutic non-adherence is highly prevalent among elderly persons and is multi-factorial in origin. Interventions to increase adherence among elderly might effective if they are provided with proper guidance and education on the indications of individual treatments, their adverse effects, importance of adherence to medications and various consequences of non-adherence to the therapy.

Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States.

Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.

Piloting PISA for development to success: an analysis of its findings, framework and recommendations

ABSTRACT In 2018 the OECD published the findings of its PISA for Development (PISA-D) pilot project which was undertaken to make the regular PISA framework more accessible and relevant to low- and middle-income nations. This would encourage such nations to join PISA as part of the OECD’s Learning Framework 2030 and provide them with ‘contextualised’ policy recommendations. In 2019 the OECD declared the project a success. We analyse and compare the PISA-D reports as well as its portrayal as a success. We suggest that, whilst PISA-D clearly made technical adjustments relating to the longstanding challenges which face low-income nations engaging in comparative assessments it replicates rather than addresses those challenges. Drawing on literature on organisational legitimacy and the politics of expertise, we interpret the PISA-D pilot as a political strategy primarily deployed to legitimate and extend rather than evaluate the project.

The health and economic burden of the coronavirus in sub-Saharan Africa.

The current coronavirus (COVID-19) pandemic continues to overwhelm healthcare systems and to exert a negative influence on the global economy. Of particular concern is the impact of COVID-19 in low-income settings - especially in terms of their capacity to mitigate a surge in COVID-19 cases. Indeed, response measures currently in place to tackle the spread of COVID-19 in geographic regions predominantly consisting of low-income nations, such as Sub-Saharan Africa (SSA), remain tenuous and will require context-appropriate interventions. Control measures to tackle COVID-19 in SSA should therefore be informed through lessons learned from past outbreaks and emergencies on the continent. These lessons will represent a key source of guidance for the strategic implementation and promotion of public health interventions to assist scale-up of COVID-19 case management, infection prevention and control. Importantly, as governments in SSA continue to combat the spread of COVID-19, there will be a need to expand the coverage of social safety net programs and fiscal policy responses to tackle the socio-economic and health impact of COVID-19.

The future urban heat-wave challenge in Africa: Exploratory analysis

Urbanization and climate change are among the most important global trends affecting human well-being during the twenty-first century. One region expected to undergo enormous urbanization and be significantly affected by climate change is Africa. Studies already find increases in temperature and high temperature events for the region. How many people will be exposed to heat events in the future remains unclear. This paper attempts to provide a first estimate of the number of African urban residents exposed to very warm 15-day heat events (>42 °C). Using the Shared Socio-economic Pathways and Representative Concentration Pathways framework we estimate the numbers of exposed, sensitive (those younger than 5 and older than 64 years), and those in low-income nations, with gross national products of $4000 ($2005, purchasing power parity), from 2010 to 2100. We examine heat events both with and without urban heat island estimates. Our results suggest that at the low end of the range, under pathways defined as sustainable (SSP 1) and low relative levels of climate change (RCP 2.6) without including the urban heat island effect there will be large populations (>300 million) exposed to very warm heat wave by 2100. Alternatively, by 2100, the high end exposure level is approximately 2.0 billion for SSP 4 under RCP 4.5 where the urban heat island effect is included.

Virtual learning during the COVID-19 pandemic: a turning point in neurosurgical education.

The coronavirus disease 2019 (COVID-19) pandemic has caused dramatic changes in medical education. Social distancing policies have resulted in the rapid adoption of virtual learning (VL) by neurosurgeons as a method to exchange knowledge, but it has been met with variable acceptance. The authors surveyed neurosurgeons from around the world regarding their opinions about VL and how they see the future of neurosurgical conferences. The authors conducted a global online survey assessing the experience of neurosurgeons and trainees with VL activities. They also questioned respondents about how they see the future of on-site conferences and scientific meetings. They analyzed responses against demographic data, regions in which the respondents practice, and socioeconomic factors by using frequency histograms and multivariate logistic regression models. Eight hundred ninety-one responses from 96 countries were received. There has been an increase in VL activities since the start of the COVID-19 pandemic. Most respondents perceive this type of learning as positive. Respondents from lower-income nations and regions such as Europe and Central Asia were more receptive to these changes and wanted to see further movement of educational activities (conferences and scientific meetings) into a VL format. The latter desire may be driven by financial savings from not traveling. Most queried neurosurgeons indicated that virtual events are likely to partially replace on-site events. The pandemic has improved perceptions of VL, and despite its limitations, VL has been well received by the majority of neurosurgeons. Lower-income nations in particular are embracing this technology. VL is still evolving, but its integration with traditional in-person meetings seems inevitable.

Greenhouse gas emission analysis of upgrading from an open dump to a semi-aerobic landfill in Mozambique – the case of Hulene dumpsite

Halting the unsustainable solid waste disposal practices has been a concerning issue due to the severe implications to public safety, health and the adverse impacts on the environment.As such, in lower-income nations where dumpsites are the leading waste disposal structures, there is an ongoing effort to upgrade to more sustainable options. In Mozambique, a semi-aerobic landfill, also known as the Fukuoka method, was selected to replace the key dumpsite located in the capital. Nevertheless, limited information is available on the prospective environmental impacts resulting from the planned upgrade. This study aims to assess the greenhouse gas emissions from Hulene dumpsite in Maputo City, Mozambique, operating under anaerobic conditions and the changes after the upgrade to a semi-aerobic landfill, employing the Intergovernmental Panel on Climate Change (IPCC) methodologies. The emissions from 1980 to 2030 in the dumpsite totaled 2,455 Gg CO2-eq, which 568 Gg CO2-eq corresponds to the contribution from open-burning activities. On the other hand, emissions for the semi-aerobic landfill from 2020 to 2030 were 685 Gg CO2-eq, 40% less than the total emissions from open dumping in the same period. The findings suggest that transitioning to a semi-aerobic landfill can significantly reduce GHG emissions, improve the local environment, and protect human health.

Trace Element Exposures and Blood Pressure along the Interoceanic Highway, Madre de Dios, Peru

Urbanization and economic development in lower and middle income nations (LMICs) have facilitated epidemiologic and nutritional transitions. Cardiovascular disease is the leading cause of death worldwide and prevalence of hypertension, a main risk factor, is projected to grow 80% by 2025 in LMICs. The completion of the Interoceanic Highway in 2011 in the Amazonian Department of Madre de Dios (MDD), Peru spurred rapid development, leading to population health concerns over environmental contamination due to gold mining. In addition to lifestyle exposures, elevated levels of lead, mercury, cadmium, and arsenic have been associated with hypertension in both animal studies and epidemiological analyses, although some population-based studies have failed to measure a statistically significant association. The essential element selenium potentially exerts a protective influence on hypertension. To gain insight into these potentially complex relationships, we analyzed joint arsenic, cadmium, mercury, lead, and selenium exposures in nails and systolic and diastolic blood pressure (SBP, DBP) of 389 adults in the Investigacion de Migracion, Ambiente, y Salud (IMAS) (Migration, Environment, and Health Study) conducted in MDD. Relationships were analyzed using linear mixed models with a household random intercept, and Bayesian kernel machine regressions (BKMR) to capture potential interactive and non-linear effects with trace elements. Visual inspection of the exposure-response surface estimated under BKMR, and estimation of parameters quantifying potential interaction, did not reveal evidence of interactive effects. In the linear mixed model, SBP was significantly associated with age (B=0.19, SE=0.06, p=.0025), female sex (B=-14.08, SE=4.2, p=.0011) and BMI (B=.48, SE=0.15, p=0017). Positive associations were observed between DBP and BMI (B=0.34, SE=0.10, p=.0010) and log mercury (ng/g) (B=1.08, SE=0.56, p=.0586). When stratified by sex there were additional suggested inverse associations between SPB and Western diet and selenium among men. The prevalence of artisanal gold mining and resultant mercury contamination in the region warrants further investigation.

Autocratisation and universal health coverage: synthetic control study

ObjectiveTo assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress...

Prevalence, Associated Risk Factors and Rifampicin Resistance Pattern of Pulmonary Tuberculosis Among Children at Debre Markos Referral Hospital, Northwest, Ethiopia.

BackgroundTuberculosis presents a heightened threat to community health throughout the world but disproportionately afflicts low-income nations. In Ethiopia, TB is a significant health problem in children causing significant morbidity and mortality. Therefore, this study aimed to determine the prevalence, risk factors, and rifampicin resistance of pulmonary tuberculosis among children.MethodsA hospital-based cross-sectional study was conducted on 384 children less than 15 years of age at Debre Markos Referral Hospital from February to May 2019. Sputum and gastric lavage samples were used to detect Mycobacterium tuberculosis and its rifampicin resistance pattern. MTB/RIF GeneXpert assay was used for the laboratory diagnosis.ResultsThe prevalence of pulmonary tuberculosis and rifampicin resistance was 22 (5.73%) and 2 (0.52%), respectively. Educational status of the family (P = 0.02; AOR = 4.12; CI = 1.28–13.15), residence (P = 0.04; AOR = 3.09; CI =1.05–9.06), history of tuberculosis contact (P ≤ 0.001; AOR = 14.78; CI = 4.43–49.26), HIV infection (P ≤ 0.001; AOR = 5.51; CI = 1.72–17.7), malnourished status (P = 0.01; AOR = 4.11; CI = 1.33–12.65), duration of cough greater than 3 weeks (P = 0.04; AOR = 3.2; CI = 11.05–9.78), weight loss (P ≤ 0.001; AOR = 307.8; CI = 32–2980), and children with mucoid sputum (P = 0.02; AOR = 3.76; CI = 1.2–12.2) were significantly associated with tuberculosis infection.ConclusionThis study showed a high prevalence of pulmonary tuberculosis infection among children. Residence, educational status of the family, contact history with tuberculosis cases, HIV, and malnutrition were risk factors for tuberculosis infection. Therefore, periodic surveillance of tuberculosis and assessing risk factors among children should be addressed. Moreover, a regular large scale survey should be conducted to assess the burden and intervene accordingly.

A Case Study of a Point-of-Care Electronic Medical Record [SABER] in Totonicapán, Guatemala: Benefits, Challenges, and Future Directions.

Background:The adoption of electronic medical records (EMRs) in lower-income nations has progressed slowly due to the lack of adequate infrastructure, funding, and training. However, EMRs have been successfully implemented previously in resource-limited health systems in South Africa, Haiti, Cameroon, Kenya, and Peru. Detailed, organized, and easily accessible medical records are particularly important in emergency departments due to the volume and acuity of the patient population.Methods:In order to further study the plausibility of an EMR in a resource-limited emergency department, a web-based, Spanish-language EMR known as SABER was developed for use in Hospital Nacional José Felipe Flores in Totonicapán, Guatemala. The software collects patient data including demographics, triage, initial evaluation, review of systems, physical exam, and evaluation and plan. It then generates a .pdf file consistent with information requirements of the Guatemalan Ministry of Health. Local physicians, medical students, and nurses were trained in the use of the software, which debuted in July 2016. To assess the effectiveness of SABER as an EMR, focus groups and Likert scale surveys were conducted with six physicians and 31 medical students working in the Hospital Nacional emergency department.Results:Thirty of 32 medical students and six of six doctors would recommend SABER to another provider. Positive aspects identified by staff include ease of use, quick data entry, and the potential for large data set research.Discussion:Remaining challenges include incorporating electronic nursing orders and lab results, troubleshooting technology problems including printer difficulties, a lack of electronic signature capability, and lack of integration with the rest of the hospital. Our study is consistent with other studies that show use of an EMR may help to reduce health disparities through improved patient records, medical data collection, and organization.

Mortality and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory diseases in Jimma Medical Center; Jimma, Ethiopia: Prospective observational study.

Chronic obstructive pulmonary disease (COPD) and asthma exacerbations are associated with ill health, increased mortality, and health care costs. However, there is limited evidence regarding mortality and its predictors among patients treated for COPD and asthma exacerbations in low-income nations, particularly in Ethiopia. A-6 month prospective observational study was conducted from April 20-September 20, 2019. Data were collected on socio-demographic, baseline clinical characteristics and outcomes of asthma and COPD exacerbations. Data were entered into Epi-Data version 4.02.01 for cleaning and exported to STATA 14.0 for analysis. Kaplan-Meier (Log-rank test) was used to compare the baseline survival experience of the study participants and Cox proportional hazard regression analysis was conducted to determine the predictors of mortality. Adjusted hazard ratios (AHRs) with two-sided p-value <0.05 were considered statistically significant. A total of 130 patients (60% males) were included. The median (interquartile range (IQR)) age of the study participants was 59(50-70) years. The median (IQR) survival time to death was 17.5 (10-26) days. The total proportion of in-hospital mortality was 10.78% (14/130), and the incidence rate of mortality was 2.56 per 1000 person-years. The duration of oxygen therapy ≥16hours/day (AHR = 6.330, 95% CI [1.092-36.679], and old age (AHR = 1.066, 95% CI [1.0001-1.136] were the independent predictors of in-hospital mortality. In this study, the in-hospital mortality rate was very high. Moreover, prolonged oxygen therapy (≥16hours/day) and old age were independently associated with in-hospital mortality. Therefore, special attention should be given to recipients of prolonged oxygen therapy and the elderly during hospital stay.