Papers by Everlisto Phiri
F1000Research, Aug 28, 2023
Background: Mortality among children with acute illness in lowincome countries remains high. Refe... more Background: Mortality among children with acute illness in lowincome countries remains high. Referral issues and limitations in emergency care are major challenges to child health and a hypothesis is that care at lower-level facilities delays quality emergency care. This study investigates the extent of care-seeking at health centres prior to hospital admission for sick children, and its association with inpatient mortality in Malawi. Methods: We conducted a retrospective cohort study of children aged 0-12 years admitted to hospitals in Mchinji district, Malawi. Data was collected from September 2019 to April 2020 from one district hospital and three community hospitals. Information was collected from caregivers of admitted children, patient files and ward admission registers. The primary analysis assesses the association between referral from a health centre and in-hospital outcomes using logistic regression. Result: A total of 4926 children were included. The majority (n=4265, 86.6%) had gone straight to hospital without being referred from another health facility. The most common diagnoses were malaria (n= 3345, 67.9%), meningitis or sepsis (n= 1047, 21.3%) and pneumonia (n= 656, 13.3%). Children that were referred from a health centre had a case fatality rate of 5.3%, while those that came straight to the hospital had a case fatality rate of 2.5%. Children who had been referred from a health centre had higher odds of dying (AOR: 2.0, CI
Bulletin of The World Health Organization, May 1, 2022
Objective To investigate survival in children referred from primary care in Malawi, with a focus ... more Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO 2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO 2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO 2 : 90-93%) in 13.1% (108/826) and severe (SpO 2 : < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5-4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.
PLOS Global Public Health
Hypoxemia and hypoglycemia are known risks for mortality in children in low-income settings. Rout... more Hypoxemia and hypoglycemia are known risks for mortality in children in low-income settings. Routine screening with pulse oximetry and blood glucose assessments for outpatients could assist in early identification of high-risk children. We assessed the prevalence of hypoglycemia and hypoxemia, and the overlap with Integrated Management of Childhood Illness (IMCI) general danger signs, among children seeking outpatient care in Malawi. A cross-sectional study was conducted at 14 government primary care facilities, four rural hospitals and one district referral hospital in Mchinji district, Malawi from August 2019—April 2020. All children aged 0–12 years seeking care with an acute illness were assessed on one day per month in each facility. Study research assistants measured oxygen saturation using Lifebox LB-01 pulse oximeter and blood glucose was assessed with AccuCheck Aviva glucometers. World Health Organization definitions were used for severe hypoglycemia (<2.5mmol/l) and hypo...
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Papers by Everlisto Phiri