Global burden of childhood pneumonia and diarrhoea.
ABSTRACT Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and pneumonia in 2010-11 to inform the planning of integrated control programmes for both illnesses. We estimated that, in 2010, there were 1·731 billion episodes of diarrhoea (36 million of which progressed to severe episodes) and 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years. We estimated that, in 2011, 700 000 episodes of diarrhoea and 1·3 million of pneumonia led to death. A high proportion of deaths occurs in the first 2 years of life in both diseases-72% for diarrhoea and 81% for pneumonia. The epidemiology of childhood diarrhoea and that of pneumonia overlap, which might be partly because of shared risk factors, such as undernutrition, suboptimum breastfeeding, and zinc deficiency. Rotavirus is the most common cause of vaccine-preventable severe diarrhoea (associated with 28% of cases), and Streptococcus pneumoniae (18·3%) of vaccine-preventable severe pneumonia. Morbidity and mortality from childhood pneumonia and diarrhoea are falling, but action is needed globally and at country level to accelerate the reduction.
SourceAvailable from: Shuyu Wu
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ABSTRACT: Oxygen is an essential medicine for the treatment of pneumonia, the leading cause of death in children under five worldwide. Yet, providing a sufficient and reliable supply of oxygen is a major challenge for many health facilities in the developing world, particularly in paediatric care units. The cost-effectiveness of oxygen concentrators versus compressed gas cylinders as a source of oxygen in low-resource health facilities has been demonstrated, but evidence of their long- term functionality is scarce. The Biomedical Engineering De- partment at the Medical Research Council Unit in The Gam- bia manages and maintains 27 oxygen concentrators at several sites across the country, and has kept electronic records of all preventive maintenance checks and repairs on these devices since 2006. Through a retrospective analysis of these mainte- nance records, the objective of this study was to assess the long-term reliability and maintenance needs of oxygen con- centrators in a low-income setting with biomedical engineer- ing technologist support. We found that the majority of B. D. Bradley : S. Chow : Y.<L. Cheng Centre for Global Engineering, University of Toronto, Toronto, Canada B. D. Bradley (*) : Y.<L. Cheng Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada e-mail: email@example.com E. Nyassi Biomedical Engineering Department, Medical Research Council Unit The Gambia, Fajara, The Gambia D. Peel Ashdown Consultants, East Sussex, UK S. R. C. Howie Child Survival Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia concentrator repairs are low-cost and require a low experience level to complete. We estimate that the useful lifespan of ox- ygen concentrators in low-resource settings could reasonably exceed 7 years provided a system is in place for routine pre- ventive maintenance. We conclude the paper with additional insights on the broader support ecosystem required to manage and maintain oxygen concentrators in low-resource settings.
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ABSTRACT: Title: Oxygen concentrator maintenance needs in a low-resource setting and implications for technician training: Experience from The Gambia Authors: Beverly D Bradley1, Ebrima Nyassi2, David Peel3, Yu-Ling Cheng4, Stephen RC Howie2 Affiliations: 1 CMBES, University of Toronto, Toronto, Canada, firstname.lastname@example.org, +1 647 927 3287 2 Medical Research Council Unit, Fajara, The Gambia 3 Ashdown Consultants, Essex, United Kingdom 4 University of Toronto, Toronto, Canada Abstract: Oxygen is an essential medicine for the treatment of pneumonia, the leading cause of death in children under five worldwide. Yet, providing a sufficient and reliable supply of oxygen is a major challenge for many health facilities in the developing world, particularly in paediatric care units. The cost-effectiveness of oxygen concentrators versus compressed gas cylinders as a source of oxygen in low-resource health facilities has been demonstrated. However, some maintenance and repairs are required to optimize their longevity, and evidence of their long-term functionality in the field has been scarce. The Biomedical Engineering Department at the Medical Research Council Unit in The Gambia manages and maintains 27 oxygen concentrators at several sites across the country, and has kept electronic records of all repairs and preventive maintenance (PM) checks on these devices since 2006. Through a retrospective analysis of about 800 repair and PM records between 2006 and 2013, we found that the majority of concentrator repairs were low-cost and required a low experience level to complete. For example, the most common repairs were filter, battery or valve replacements, and faulty tubing - all were repairable for less than US $10 each. On an individual concentrator basis, median cost of replacement parts over the entire analysis period was US $9.44 per concentrator [interquartile range: US $0, US $63.40]. Seventy-one per cent of all parts replaced contributed only 7% (approximately US $135) to the total amount spent on parts since 2006. More expensive and complex repairs were rare, and typically occurred after 2.5 years of operation. The concentrators had received an average of over three PM checks per year. Of the 27 concentrators introduced since 2006, 85% are still in service with a median age of over 6 years. We estimate that the useful lifespan of oxygen concentrators in this context could reasonably exceed 7 years provided a system is in place for repairs and routine preventive maintenance. Additionally, we used these repair data for a skill-mapping analysis whereby we identified 31 basic technician skills that would be sufficient for the repair of over 90% of observed oxygen concentrator failures. Most of the skills identified were drawn from the library of Biomedical Technician Assistant (BTA) skills developed by the Developing World Healthcare Technologies Lab and Engineering World Health (http://library.ewh.org). Each skill could be taught to a BTA in 2 hours. We used this skill-mapping analysis to propose an evidence-based training curriculum specifically tailored to the maintenance of oxygen concentrators in low-resource settings. This work has provided insight into on the broader support ecosystem required to manage and maintain oxygen concentrators in low-resource settings. Specifically, some of the key elements for the successful use of oxygen concentrators in our Gambian setting have been: uniform and context-appropriate equipment selection; trained technicians and an established health technology management program; a system for routine preventive maintenance; and resources for and access to spare parts. With this support ecosystem in place, oxygen concentrators can be an appropriate and low-cost technology for supplying medical oxygen in low-resource settings.The IUPESM World Congress (WC) on Medical Physics (MP) and Biomedical Engineering (BME), Toronto, Canada; 06/2016