Browsing by Author "Ikiror, Juliet"

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    Neonatal tetanus in eastern Uganda: improved outcome following the implementation of a neonatal tetanus protocol
    (Tropical Doctor, 2020) Burgoine, Kathy; Egiru, Emma; Ikiror, Juliet; Acom, Linda; Akol, Sylivia; Olupot-Olupot, Peter
    Neonatal tetanus remains a significant, yet avoidable, cause of neonatal death. Despite the 34,000 deaths that occur globally from neonatal tetanus every year, there has been little research into the management of neonatal tetanus. Until worldwide elimination of neonatal tetanus is achieved, the case management of this devastating illness needs to be improved. We describe an improved outcome of neonatal tetanus following the introduction of a neonatal tetanus protocol including diazepam, magnesium sulphate, bubbl
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    Reagent Strips as an Aid to Diagnosis of Neonatal Meningitis in a Resource-limited Setting
    (Journal of tropical pediatrics, 2019) Burgoine, Kathy; Ikiror, Juliet; Naizuli, Ketty; Achom, Linda; Akol, Sylivia; Olupot-Olupot, Peter
    Without early recognition and treatment, neonatal meningitis (NM) has a high mortality and morbidity. Although some neonates have features of NM, many do not. In many low-resource settings, the laboratory support to diagnose NM is not available, and bedside diagnostics are needed. Methods: This retrospective study was conducted in a neonatal unit in Uganda. Clear cerebrospinal fluid samples were routinely screened for glucose, protein and leukocytes on a ComburVR -10 urinalysis reagent strip. A definitive diagnosis was made using laboratory analysis. The results of the screening and definitive tests were compared. Results: The reagent strip showed moderate sensitivity and high specificity for leukocytes 10 106 cells/l, high sensitivity for protein 100 mg/dl and high specificity for glucose<50 mg/dl. Conclusion: The use of reagent strips has the potential to improve and hasten the diagnosis of probable NM in settings where adequate or timely laboratory support is not available.
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    Staged implementation of a two tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda
    (BMJ global health, 2018) Burgoine, Kathy; Ikiror, Juliet; Akol, Sylivia; Kakai, Margaret; Talyewoya, Sara; Sande, Alex; Otim, Tom; Okello, Francis; Hewitt-Smith, Adam; Olupot-Olupot, Peter
    Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHORecommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in lowresource settings adopt a similar approach.