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Management of Congenital Disorders in a Resource-Limited Country: Organizational Model of a Specialized Working Group within a Perinatal Network  [PDF]
Mame Diarra Ndiaye, Lissoune Cisse, Daouda Ndour, Yaye Joor Dieng, Hélène Chami, Mamadou Mour Traore, Maguette Mbaye, Pape Moctar Faye
Open Journal of Obstetrics and Gynecology (OJOG) , 2025, DOI: 10.4236/ojog.2025.151002
Abstract: Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.
A Life-cycle Approach to Improve the Sustainability of Rural Water Systems in Resource-Limited Countries
Sharon A. Jones,Abseen Anya,Nicholas Stacey,Lindsay Weir
Challenges , 2012, DOI: 10.3390/challe3020233
Abstract: A WHO and UNICEF joint report states that in 2008, 884 million people lacked access to potable drinking water. A life-cycle approach to develop potable water systems may improve the sustainability for such systems, however, a review of the literature shows that such an approach has primarily been used for urban systems located in resourced countries. Although urbanization is increasing globally, over 40 percent of the world’s population is currently rural with many considered poor. In this paper, we present a first step towards using life-cycle assessment to develop sustainable rural water systems in resource-limited countries while pointing out the needs. For example, while there are few differences in costs and environmental impacts for many improved rural water system options, a system that uses groundwater with community standpipes is substantially lower in cost that other alternatives with a somewhat lower environmental inventory. However, a LCA approach shows that from institutional as well as community and managerial perspectives, sustainability includes many other factors besides cost and environment that are a function of the interdependent decision process used across the life cycle of a water system by aid organizations, water user committees, and household users. These factors often present the biggest challenge to designing sustainable rural water systems for resource-limited countries.
Challenges in the Management of Sepsis in a Resource-Poor Setting  [PDF]
Paul Ni, Yaguo-Ide Le
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.86039
Abstract: Background: Sepsis is a deleterious host reaction to microorganism and can lead to high mortality rate. Early recognition and prompt treatment increases the chances of survival. Objective: To outline the challenges in the management of sepsis in a resource limited setting and make appropriate recommendations. Methodology: The data was collected through an online literature search for cases of sepsis managed in resource limited settings from 1990 to 2015. Search terms used included: “sepsis”, “septicaemia”, “incidence”, “prevalence”, “morbidity”, “mortality” and “management challenges” using the English and American spellings. Studies from peer reviewed journals or those presented in professional conferences were selected. Finally, studies with proper definition of sepsis and positive blood cultures were selected. Result: Twenty one studies from eleven resource limited settings were found. A total of 14,862 cases of sepsis were studied with 9260 (62.3%) of neonatal sepsis and 5602 (37.7%) of post neonatal sepsis. Challenges in the management of sepsis that were identified at the community level included: false cultural beliefs and practices, ignorance and poverty, poor health seeking behavior, late presentation, lack of access to skilled care and patronage of unskilled medical practitioners. While challenges identified at the hospital level include: poor knowledge skills of the health workers, delay in making a diagnosis and initiating treatment, poorly equipped laboratory materials and personnel, no protocol for management of sepsis, limited supply of bedside monitoring equipment, poor staffing, repeated industrial actions, use of fake drugs and high cost of care and drugs. Conclusion and recommendation: Management of sepsis in resource limited settings is an uphill task and requires health education and re-orientation of the people. To significantly reduce the mortality associated with sepsis, there is a need to bring health care services to the communities where the people are, improve the management skills of health professionals and translate major components of sepsis management to resource limited settings.
Glioblastoma Management in Togo: Challenges and Neurosurgical Perspectives  [PDF]
Agbéko Komlan Doléagbénou, Ablavi Adani-Ifè, Ben Ousmane Djoubairou, Essossinam Kpelao
Open Journal of Modern Neurosurgery (OJMN) , 2026, DOI: 10.4236/ojmn.2026.162016
Abstract: Background: Glioblastoma is the most common and aggressive primary malignant brain tumor in adults. In Togo, its management is challenged by late diagnosis, limited neurosurgical resources, and scarce access to adjuvant therapies. Methods: We retrospectively reviewed patients with histologically confirmed glioblastoma managed at Sylvanus Olympio University Teaching Hospital, Lomé, between 2018 and 2022. Clinical, radiological, surgical, and therapeutic data were analyzed. Results: Forty-three patients were included (mean age 48 years; male-to-female ratio 1.3). Most presented late, after more than three months of symptoms. Seizures (65%) and intracranial hypertension (46%) were common. Surgery consisted of biopsy (35%), subtotal resection (46%), or gross total resection (19%). Postoperative complications included seizures (25%) and intracranial hypertension (13%). Only one patient received the full Stupp protocol. Conclusion: Glioblastoma management in Togo remains limited, with poor access to adjuvant therapy. Expanding neurosurgical capacity and radiotherapy availability is crucial for improving outcomes.
Development of a pharmacovigilance system in a resource-limited country: the experience of the Democratic Republic of Congo
Aline Engo,Andrea Kuemmerle,Bibiche Mvete,Christian Burri,Didier Nzolo,Gaston Tona,Gauthier Mesia,Jerry Liwono,Mariano Lusakibanza,Nsengi Ntamabyaliro,Samuel Mampunza,Yves Lula
- , 2019, DOI: 10.1177/2042098619864853
Abstract: Implementation of pharmacovigilance (PV) systems in resource-limited countries is a real endeavor. Despite country- and continent-specific challenges, the Democratic Republic of the Congo (DRC) has been able to develop one of the most active PV systems in the sub-Saharan Africa. The World Health Organization (WHO) regional Office identified the DRC experience to set up a PV system for antimalarial drugs safety monitoring as a ‘best practice’ that needed to be documented in order to help DRC improve its PV system and to be scaled up in other African countries. In response to the WHO request, a best practices and bottlenecks analysis was conducted in 2015. This analysis was updated in 2018 in the light of the minimum requirements of the WHO to set up a PV system taking into account other guidance for PV systems. The following themes were retained for analysis: (1) creation of the national PV center; (2) implementation of PV in the health system; (3) data collection and analysis; (4) collaboration with public health programs; (5) collaboration with the National Regulatory Authority. Lessons learnt from the DRC experience show that it is possible to implement PV systems in order to promote patients’ safety in resource limited sub-Saharan African countries with no guaranteed funding. The ability of national PV centers to collaborate with Public health stakeholders, including public health authorities at all levels as well as public health programs, and to use existing health information systems are considered the main key to success and may substantially reduce the cost of PV activities
Virological outcome and patterns of HIV-1 drug resistance in patients with 36 months’ antiretroviral therapy experience in Cameroon
Avelin F Aghokeng,Charles Kouanfack,Sabrina Eymard-Duvernay,Christelle Butel
Journal of the International AIDS Society , 2013, DOI: 10.7448/ias.16.1.18004
Abstract: Introduction: The current expansion of antiretroviral treatment (ART) in the developing world without routine virological monitoring still raises concerns on the outcome of the strategy in terms of virological success and drug resistance burden. We assessed the virological outcome and drug resistance mutations in patients with 36 months’ ART experience, and monitored according to the WHO public health approach in Cameroon. Methods: We consecutively recruited between 2008 and 2009 patients attending a national reference clinic in Yaoundé – Cameroon, for their routine medical visits at month 36±2. Observance data and treatment histories were extracted from medical records. Blood samples were collected for viral load (VL) testing and genotyping of drug resistance when HIV-1 RNA≥1000 copies/ml. Results: Overall, 376 HIV-1 infected adults were recruited during the study period. All, but four who received PMTCT, were ART-na ve at treatment initiation, and 371/376 (98.7%) started on a first-line regimen that included 3TC +d4T/AZT+NVP/EFV. Sixty-six (17.6%) patients experienced virological failure (VL≥1000 copies/ml) and 53 carried a resistant virus, thus representing 81.5% (53/65) of the patients who failed. Forty-two out of 53 were resistant to nucleoside and non-nucleoside reverse-transcriptase inhibitors (NRTIs+NNRTIs), one to protease inhibitors (PI) and NNRTIs, two to NRTIs only and eight to NNRTIs only. Among patients with NRTI resistance, 18/44 (40.9%) carried Thymidine Analog Mutations (TAMs), and 13/44 (29.5%) accumulated at least three NRTI resistance mutations. Observed NNRTI resistance mutations affected drugs of the regimen, essentially nevirapine and efavirenz, but several patients (10/51, 19.6%) accumulated mutations that may have compromised etravirine use. Conclusions: We observed a moderate level of virological failure after 36 months of treatment, but a high proportion of patients who failed developed drug resistance. Although we found that for the majority of patients, second-line regimens recommended in Cameroon would be still effective, accumulated resistance mutations are of concern and may compromise future treatment strategies, stressing the need for virological monitoring in resource-limited settings.
Uterine choriocarcinoma: A gynaecological masquerader case report and review of the literature  [PDF]
Eguzo Kelech, Chisara C. Umezurike, Emmanuel Akwuruoha
Modern Chemotherapy (MC) , 2013, DOI: 10.4236/mc.2013.24009
Abstract: Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcinoma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilutions. She was treated with chemotherapy involving Adriamycin, Cyclophosphamide, Methotrexate and Folinic acid. Conclusion: The diagnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring.
Improving Clinical Documentation through Monthly Audits in Butare Teaching Hospital, Rwanda  [PDF]
Joyce Kamanzi, Abraham Megentta, Wilson Nsabiyumva, Augustin Sendegeya, Rex Wong
Journal of Service Science and Management (JSSM) , 2015, DOI: 10.4236/jssm.2015.86086
Abstract: Creditable and timely clinical documentation is an essential component in patient care quality improvement. We designed and implemented a practical clinical audit process as a way of measuring and improving quality of clinical care in Rwanda; as well as to enhance the compliance score according to the hospital accreditation standards. The project took place at Central University Hospital in Butare (CHUB). A pre- and post-intervention study was used to examine the impact of creating a standardized auditing system on the department clinical auditing completion rate and the accreditation standards compliance rate. Once audit results are entered into the MS Excel tool created, the completion and accreditation compliance rate are automatically computed by the system. The results were presented in the monthly QI meeting as feedback. Two sets of measures were collected: 1) department clinical auditing completion rate, and 2) the COHSASA standards compliance rate. The completion rate of monthly audit reports increased from 57% (pre-intervention) to 96% (post-intervention), P < 0.000. The hospital-wide average accreditation standards compliance rate for clinical documentation also significantly improved from 27% to 60%, P = 0.000. Providing departments a simple and user-friendly clinical documentation auditing tool can enhance the completion rate of audit reporting at no additional cost to the hospital. Hospital leadership plays to support and organize the system are crucial. These data can be used for evidence-based decision making to improve completeness and accuracy of clinical documentation and thus comply with accreditation standards.
Clinical Profile and Outcome of Acute Kidney Injury in Children Less than 5 Years: A Two-Year Retrospective Study in a Resource Limited Setting  [PDF]
Denis Georges Teuwafeu, Yolande Djike Puepi, Ange Erica Maguipa Tsasse, Mbua Ronald Gobina, Leslie Tasha Mbapah, Marie-Patrice Halle
Open Journal of Pediatrics (OJPed) , 2025, DOI: 10.4236/ojped.2025.152021
Abstract: Background: Younger children are more vulnerable to acute kidney injury. We aimed to determine the prevalence, aetiological factors, clinical features, and outcome of acute kidney injury (AKI) in children aged 29 days to 5 years. Method: We retrospectively reviewed hospital records of children less than 5 years admitted in the paediatrics ward and the Intensive care unit from the 1st of January 2021 to the 1st of March 2023. We defined AKI using the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Our outcomes of interest were the need for dialysis, death, and renal recovery at discharge. Data were analysed using STATA version 17 SE. A p-value of less than 0.05 was considered statistically significant. Results: Out of 3393 patients, 54 (1.6%) had AKI either on admission or during the course of treatment. The median age of our participants was 22 months. Sepsis (n = 47; 87%), severe malaria (n = 17; 31.5%), and the use of nephrotoxins (n = 15; 27.8%) were the most common aetiologies of AKI. All but one of our participants was in KDIGO stage 3 AKI. Dialysis was indicated for 75.9% (n = 41) of the patients. But done only in 32% (n = 13). The reasons for no dialysis were inappropriate logistics (n = 16, 57.1%), death before initiation of dialysis (n = 8, 28.6%), and family refusal (n = 4, 14.3%). The mortality rate was 66.7% (n = 36). Conclusion: About 15 in a thousand children aged 29 days to 5 years developed AKI during hospital stay. Sepsis, severe malaria, and the use of nephrotoxins were the most common aetiologies of AKI. Dialysis was often needed and not done, and the mortality rate was high.
A Case Study and the Lessons Learned from In-House Alcohol Based Hand Sanitizer Production in a District Hospital in Rwanda  [PDF]
April Budd, Stephanie Lukas, Unarose Hogan, Kamugisha Priscille, Kanamugire Fann, Pauline Hill, Ndikumana Edouard, Jean Bosco Byukusenge, Ntigurirwa Placide, Mutayomba Aimable, Rex Wong
Journal of Service Science and Management (JSSM) , 2016, DOI: 10.4236/jssm.2016.92019
Abstract: Health-care-associated infections (HCAIs) are a major global safety concern for patients, health- care professionals and public health particularly in developing countries where access to hand washing facilities is limited due to infrastructure. Alcohol-based hand sanitizer offers a viable alternative where water sources are unreliable or insufficient. However, in resource-limited settings, the introduction of alcohol-based hand sanitizer has been slow due to economic, manufacturing and procurement challenges compounded by the lack of evidence as to its acceptability in varying organizational cultures. This case study describes the process of producing, educating, distributing, scaling up and monitoring the impact of a quality improvement project to locally produce alcohol based hand sanitizer using the formula provided by the World Health Organization in a district hospital in Rwanda. During a 10-month implementation, hand sanitizer was made available to all departments of the hospital and all hospital staff received training on the proper use and ordering of the product. The overall hand hygiene compliance using any method significantly increased from 59% pre intervention to 67% post intervention (P < 0.001). Specifically, the use of hand sanitizer for hygiene significantly increased from 46% to 58% (P < 0.001). By producing hand sanitizer in-house, the hospital saved 71% when compared to purchasing commercial products. The use of hand sanitizer is not a replacement for running water in the hospital. However, with the lack of proper infrastructure, making hand sanitizer available is an acceptable alternative to improve the infection prevention and control standard. The production of hand sanitizer within a health care facility is cost effective and is feasible to integrate into existing operations. The team is working with the Rwandan Ministry of Health to introduce the program to all public hospitals as a national program.
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