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Huxford, Charly; Dunsmuir, Dustin; Pillay, Yashodani; Ashebukara, Ivan Aye; Tusingwire, Fredson; Novakowski, Stefanie; Behan, Justine; Hwang, Bella; Ansermino, Mark; Lester, Deborah; Kissoon, Niranjan; Tagoola, Abner — 2023-11-15 <br /><strong>Objective(s):</strong> The Smart Triage Quality Improvement Training Program covers the basic concepts of the Quality Improvement process and provides a framework and tools that can be used to train staff on QI. Core learning components include: 1) understanding what QI is; 2) the QI model for improvement; and 3) QI methods and tools. <br /> <br /><strong>Data Description:</strong> This dataset includes the following materials for use in the Smart Triage Quality Improvement Training Program: 1) Quality Improvement Guide; 2) QI Activities Workbook. Materials were originally developed through a partnership with Walimu and the University of British Columbia. All materials are provided in the English language. <br /> <br /><strong>Data Limitations:</strong> These materials were designed for the Ugandan context and may not be generalizable to other settings. <br /> <br /><strong>Data Ethics Declaration:</strong> NA <br /> <br /><strong>Funding Source(s):</strong> BC Children's Hospital Foundation; Grand Challenges Canada; Mining4Life; Wellcome <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Wiens, Matthew O; Bone, Jeffrey N; Kumbakumba, Elias; Businge, Stephen; Tagoola, Abner; Sherine, Sheila Oyella; Byaruhanga, Emmanuel; Ssemwanga, Edward; Barigye, Celestine; Nsungwa, Jesca; Olaro, Charles; Ansermino, J Mark; Kissoon, Niranjan; Singer, Joel; Larson, Charles P; Lavoie, Pascal M; Dunsmuir, Dustin; Moschovis, Peter P; Novakowski, Stefanie; Komugisha, Clare; Tayebwa, Mellon; Mwesignwa, Douglas; Knappett, Martina; West, Nicholas; Nguyen, Vuong; Mugisha, Nathan-Kenya; Kabakyenga, Jerome — 2022-12-06 <br /><strong>Background:</strong> Substantial mortality occurs after hospital discharge in children younger than 5 years with suspected sepsis, especially in low-income countries. A better understanding of its epidemiology is needed for effective interventions to reduce child mortality in these countries. We evaluated risk factors for death after discharge in children admitted to hospital for suspected sepsis in Uganda, and assessed how these differed by age, time of death, and location of death. <br /> <br /><strong>Methods:</strong> In this prospective observational cohort study, we recruited 0-60-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. We evaluated the interactive impact of age, time of death, and location of death on risk factors for mortality.<br /> <br /><strong>Findings:</strong> 6,545 children were enrolled, with 6,191 discharged alive. The median (interquartile range) time from discharge to death was 28 (9-74) days, with a six-month post-discharge mortality rate of 5·5%, constituting 51% of total mortality. Deaths occurred at home (45%), in-transit to care (18%), or in hospital (37%) during a subsequent readmission. Post-discharge death was strongly associated with weight-for-age z-scores < -3 (adjusted risk ratio [aRR] 4·7, 95% CI 3·7–5·8 vs a Z score of >–2), referral for further care (7·3, 5·6–9·5), and unplanned discharge (3·2, 2·5–4·0). The hazard ratio of those with severe anaemia increased with time since discharge, while the hazard ratios of discharge vulnerabilities (unplanned, poor feeding) decreased with time. Age influenced the effect of several variables, including anthropometric indices (less impact with increasing age), anaemia (greater impact), and admission temperature (greater impact).<br /> <br /><strong>Data Collection Methods:</strong> All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge.<br /> <br /><strong>Data Processing Methods:</strong> For this analysis, data from both cohorts (0-6 months and 6-60 months) were combined and analysed as a single dataset. We used periods of overlapping enrolment (72% of total enrolment months) between the two cohorts to determine site-specific proportions of children who were 0-6 and 6-60 months of age. These proportions were used to weight the cohorts for the calculation of overall mortality rate. Z-scores were calculated using height and weight. Hematocrit was converted to hemoglobin. Distance to hospital was calculated using latitude and longitude. Extra symptom and diagnosis categories were created based on text field in these two variables. BCS score was created by summing all individual components.<br /> <br /><strong>Abbreviations:</strong><br /> MUAC -mid upper arm circumference<br /> wfa – weight for age<br /> wfl – weight for length<br /> bmi – body mass index<br /> lfa – length for age<br /> abx - antibiotics<br /> hr – heart rate<br /> rr – respiratory rate<br /> antimal - antimalarial<br /> sysbp – systolic blood pressure<br /> diasbp – diastolic blood pressure<br /> resp – respiratory<br /> cap - capillary<br /> BCS - Blantyre Coma Scale<br /> dist- distance<br /> hos - hospital<br /> ed - education<br /> disch - discharge<br /> dis -discharge<br /> fu – follow-up<br /> pd – post-discharge<br /> loc - location<br /> materl - maternal<br /> <br /><strong>Ethics Declaration:</strong> This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).<br /> <br /><strong>Study Protocol & Supplementary Materials:</strong> <br /> <a href = "https://borealisdata.ca/dataset.xhtml?persistentId=doi%3A10.5683%2FSP3%2FQRUMNQ&version=1.0">Smart Discharges to improve post-discharge health outcomes in children: A prospective before-after study with staggered implementation </a><br /> <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Kuhn, Sarah; Song, Andrew; Novakowski, Stefanie; Johnson, Teresa; Dunsmuir, Dustin; Knappett, Martina; Trawin, Jessica; Ansermino, J Mark — 2021-10-28 <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab." Video tutorials on open data and how to navigate and use the Sepsis CoLab's Dataverse.

Huxford, Charly; Dunsmuir, Dustin; Pillay, Yashodani; Ashebukara, Ivan Aye; Tusingwire, Fredson; Novakowski, Stefanie; Behan, Justine; Pallot, Katija; Hwang, Bella; Ansermino, Mark — 2023-11-08 <br /><strong>Objective(s):</strong> The Smart Triage Health Worker Training Program uses a train-the-trainer model to improve the quality of triage care. Core learning components include: 1) understanding what triage is; 2) effective triaging using the Smart Triage platform; and 3) best practices for health workers. <br /> <br /><strong>Data Description:</strong> This dataset includes the following materials for use in the Smart Triage Training Program: 1) Health Workers Guide; 2) Smart Triage Handbook; 3) Caregivers counselling card Materials were originally developed through a partnership with Walimu and the University of British Columbia. All materials are provided in the English language. <br /> <br /><strong>Data Limitations:</strong> These materials were designed for the Ugandan context and may not be generalizable to other settings. <br /> <br /><strong>Data Ethics Declaration:</strong> NA <br /> <br /><strong>Funding Source(s):</strong> BC Children's Hospital Foundation; Grand Challenges Canada; Mining4Life; Wellcome <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Asdo, Ahmad; Mawji, Alishah; Omara, Isaac; Aye Ishebukara, Ivan Aine; Komugisha, Clare; Novakowski, Stefanie; Pillay, Yashodani; Wiens, Matthew O; Akech, Samuel; Oyella, Florence; Tagoola, Abner; Kissoon, Niranjan; Ansermino, J Mark; Dunsmuir, Dustin — 2024-03-14 <br /><strong>Background:</strong> Pneumonia is the leading cause of death in children globally. In low- and middle-income countries the diagnosis of pneumonia relies heavily on an accurate assessment of respiratory rate, which can be unreliable in nurses and clinicians with less advanced training. In order to inform more accurate measurements, we investigate the repeatability of the RRate app used by nurses in district hospitals in Uganda. <br/> <br /><strong>Methods:</strong> This planned secondary analysis included 3679 children aged 0-5 years. The dataset had two sequential measurements of respiratory rate using the RRate app. We measured the agreement between respiratory rate observations and clustering around fixed thresholds defined by WHO for fast breathing, which are 60 breaths per minute (bpm) for under two months (Age-1), 50 bpm for two to 12 months (Age-2), and 40 bpm for 12.1 to 60 months (Age-3). We then assessed the repeatability of the paired measurements using the Intraclass Correlation Coefficient (ICC). <br/> <br /><strong>Results:</strong> The respiratory rate measurement took less than 15 seconds for 7,277 (98.9%) of the measurements. Despite respiratory rates clustering around the WHO fast-breathing thresholds, the breathing classification based on the thresholds was changed in only 12.6% of children. The mean (SD) respiratory rate by age group was 60 (13.1) bpm for Age-1, 49 (11.9) bpm for Age-2, and 38 (10.1) for Age-3, and the bias (Limits of Agreements) were 0.3 (-10.8 – 11.3), 0.4 (-8.5 – 9.3), and 0.1 (-6.8, 7.0) for Age-1, Age-2, and Age-3 respectively. Most importantly, the repeatability of the two respiratory rate measurements for the 3,679 children was high, with an ICC value (95% CI) of 0.95 (0.94 – 0.95). <br/> <br /><strong>Discussion:</strong> The RRate measurements were both efficient and repeatable. The simplicity, repeatability, and efficiency of the RRate app used by healthcare workers in LMICs supports more widespread adoption for clinical use. <br/> <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Wiens, Matthew; Businge, Stephen; Larson, Charles P; Moschovis, Peter P; Singer, Joel; Kumbakumba, Elias; Novakowski, Stefanie; Lavoie, Pascal; Dumont, Guy AM; Ansermino, J Mark; Kabakyenga, Jerome; Kissoon, Niranjan — 2021-05-04 <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab." This data is a subset of the Smart Discharges Uganda Under 5 years parent study and is specific to the Phase I observational cohort of children aged 6-60m. <br> <br/><strong>Objective(s):</strong> Used as part of the Smart Discharge prediction modelling for adverse outcomes such as post-discharge death and readmission. <br> <br /><strong>Data Description:</strong> All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge. . <br> <br /><strong>Data Processing:</strong> Created z-scores for anthropometry variables using height and weight according to WHO cutoff. Distance to hospital was calculated using latitude and longitude. Extra symptom and diagnosis categories were created based on text field in these two variables. BCS score was created by summing all individual components.<br> <br /><strong>Limitations:</strong> There are missing dates and the admission, discharge, and readmission dates are not in order. <br> <br /><strong>Ethics Declaration:</strong> This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).

Wiens, Matthew O; Nguyen, Vuong; Bone, Jeffrey N; Kumbakumba, Elias; Businge, Stephen; Tagoola, Abner; Sherine, Sheila Oyella; Byaruhanga, Emmanuel; Ssemwanga, Edward; Barigye, Celestine; Nsungwa, Jesca; Olaro,Charles; Ansermino, J Mark; Kissoon, Niranjan; Singer, Joel; Larson, Charles P; Lavoie, Pascal M; Dunsmuir, Dustin; Moschovis, Peter P; Novakowski, Stefanie; Komugisha, Clare; Tayebwa, Mellon; Mwesigwa, Douglas; Knappett, Martina; West, Nicholas; Kenya-Mugisha, Nathan; Kabakyenga, Jerome — 2024-07-16 <br/><strong>Background:</strong> In many low-income countries, over five percent of hospitalized children die following hospital discharge. The lack of available tools to identify those at risk of post-discharge mortality has limited the ability to make progress towards improving outcomes. We aimed to develop algorithms designed to predict post-discharge mortality among children admitted with suspected sepsis.<br /> <br /><strong>Methods:</strong> Four prospective cohort studies of children in two age groups (0–6 and 6–60 months) were conducted between 2012–2021 in six Ugandan hospitals. Prediction models were derived for six-months post-discharge mortality, based on candidate predictors collected at admission, each with a maximum of eight variables, and internally validated using 10-fold cross-validation.<br /> <br /><strong>Findings:</strong> 8,810 children were enrolled: 470 (5.3%) died in hospital; 257 (7.7%) and 233 (4.8%) post-discharge deaths occurred in the 0-6-month and 6-60-month age groups, respectively. The primary models had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95%CI 0.74–0.80) for 0-6-month-olds and 0.75 (95%CI 0.72–0.79) for 6-60-month-olds; mean AUROCs among the 10 cross-validation folds were 0.75 and 0.73, respectively. Calibration across risk strata was good: Brier scores were 0.07 and 0.04, respectively. The most important variables included anthropometry and oxygen saturation. Additional variables included: illness duration, jaundice-age interaction, and a bulging fontanelle among 0-6-month-olds; and prior admissions, coma score, temperature, age-respiratory rate interaction, and HIV status among 6-60-month-olds.<br /> <br /><strong>Data Processing Methods:</strong> The post-processed data files were created using R version 4.2.2. (R Foundation for Statistical Computing, Vienna, Austria) and briefly involved renaming columns from the different datasets so that they are consistent, converting categories coded as “unknown”, “don’t know”, or “missing” to NA, creating new columns, calculating z-scored variables, and converting relevant columns to factors or dates. <br /> <br /><strong>Ethics Declaration:</strong> These studies were approved by the Mbarara University of Science and Technology (No. 15/10-16), the Uganda National Council for Science and Technology (HS 2207), and the University of British Columbia (H16-02679).<br />

Wiens, Matthew; Businge, Stephen; Tagoola, Abner; Larson, Charles P; Moschovis, Peter P; Singer, Joel; Kumbakumba, Elias; Novakowski, Stefanie; Lavoie, Pascal; Dumont, Guy AM; Ansermino, J Mark; Kabakyenga, Jerome; Kissoon, Niranjan — 2024-10-22 This data is a subset of the Smart Discharges Uganda Under 5 years parent study and is specific to the Phase I observational cohort of children aged 0-6 months. <br> <br/><strong>Objective(s):</strong> Used as part of the Smart Discharge prediction modelling for adverse outcomes such as post-discharge death and readmission. <br> <br /><strong>Data Description:</strong> All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge. . <br> <br /><strong>Data Processing:</strong> Created z-scores for anthropometry variables using height and weight according to WHO cutoff. Distance to hospital was calculated using latitude and longitude. Extra symptom and diagnosis categories were created based on text field in these two variables. BCS score was created by summing all individual components.<br> <br /><strong>Limitations:</strong> There are missing dates and the admission, discharge, and readmission dates are not in order. <br> <br /><strong>Ethics Declaration:</strong> This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab."