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  • Interpretation Patient centred medical education

    2019-06-13

    Interpretation Patient-centred medical education can improve overall satisfaction and sustained disease-specific knowledge in patients in Uganda. Our results show that printed booklets are accepted by patients and feasible to implement in a LMIC outpatient setting. Funding Trishul Siddharthan received funding in part from a Fulbright Scholar Award and from the Fogarty International Center of the National Institutes of Health under Award No. 5R25TW009340. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or respective government organisations. Declaration of interests
    Abstract Background Postpartum haemorrhage is a leading cause of death in low-income and middle-income countries, but it is also largely preventable. As a potential solution for restoring blood volume in women with life-threatening haemorrhage in low-resource settings, a vaginal blood collection drape with adaptations for autotransfusion has been created. In this study, we aimed to assess the LKB1 function of the autotransfusion system prototype and to determine the degree to which the filter removes surrogate markers for amniotic fluid, fetal cells, and inhibin A, as well as to quantify the reduction of bacterial contaminants in postpartum blood after vaginal delivery. Methods We collected postpartum blood from four women who had normal spontaneous vaginal delivery of a term pregnancy using an adapted obstetrical blood collection drape. Immediately after the delivery, the research drape was placed under the buttocks of the participant and postpartum blood was collected. The blood entered a sterile system and was filtered through a Pall LeukoGuard BC2 Cardioplegia filter via a negative pressure pump. We tested prefiltration and post-filtration samples for the presence of fetal cells, inhibin A, and surrogate markers for amniotic fluid contamination. Cultures of prefiltered and post-filtered blood underwent qualitative analysis, to identify specific bacterial species present, and quantitative analysis. Findings We identified Escherichia coli, Bacteroides fragilis, Klebsiella pneumoniae, Enterococcus faecalis, Corynebacterium jeikeium, Lactobacillus spp, and Staphylococcus spp in prefiltration blood samples. In samples from three of the four participants, bacterial load decreased after filtration. However, complete elimination of a bacterial species did not occur in two participants\' post-filter cultures. Fetal cells were present in one prefiltration sample and decreased but remained present after filtration. Reduction in α-fetoprotein and inhibin A varied between the four participants\' post-filtration samples. Interpretation The filter tested in the autotransfusion system prototype did not significantly reduce the surrogate markers tested nor eliminate bacteria in the four samples, although selective removal of Staphylococcus spp might have occurred. The system remains a promising solution to improve health outcomes of women who give birth in low-resource settings but improved filter function does need to be addressed. Future studies will test a leucocyte depletion filter, previously shown to successfully remove bacterial contaminants, as well as alter device flow rates for optimum filter function. Funding UIC Chancellor\'s Innovation Fund: Spring 2014 Proof-of-Concept Award (V Dobiesz), UIC College of Medicine Craig Fellowship (B Collofello). Declaration of interests
    Abstract Background Sustainable Development Goals (SDG) for the universal provision of safe drinking water in the household focus on the need for sustainable, effective, and acceptable household water treatment. In this study we aimed to: understand baseline practices and knowledge related to household water supply, safety of drinking water, and hygiene and sanitation; and compare the efficacy and acceptance of three different point-of-use water treatment interventions. Methods We undertook a field study of 30 households in a peri-urban neighbourhood adjacent to the city of Mzuzu, Malawi. We used a random number generator to assign households to one of three water purification interventions: boiling, Waterguard chlorine solution (PSI/Malawi, Blantyre, Malawi), or Tulip table-top ceramic filter. We analysed samples taken from a drinking-water storage container in each household at baseline and 2 weeks after baseline, and recorded total coliform and Escherichia coli counts. Participants completed an initial structured questionnaire about water sources used, sanitation, health, water consumption patterns, and socioeconomic variables in their household. Follow-up questionnaires at 1 week and 2 weeks after the intervention, focused on use and acceptance of the assigned treatment modality. We used WHO health risk standards, and correlated drinking water quality with the questionnaire responses. We used Fisher\'s exact test for data analysis.