Recherche

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; Kenya-Mugisha, Nathan; Namala, Angella; Tagoola, Abner; Bebell, Lisa; Pillay, Yashodani; Ansermino, J Mark; Kissoon, Niranjan; Payne, Beth A; Vidlern, Marianne; Christoffersen-Deb, Astrid; Lavoie, Pascal; Bone, Jeffrey — 2023-05-15 <br /><strong>Dataset Description:</strong> This dataset contains materials from the Smart Discharges for Mom & Baby parent study within the <a href = "https://bcchr.ca/smart-discharges">Smart Discharges</a> program of research. Materials include the parent study ethics protocol and associated documents. See the Metadata section below for links to related publications and datasets.<br /> <br /><strong>Background:</strong> In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine post-discharge follow-up, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and facilitating a patient-centered approach to postnatal care. <br /> <br /><strong>Methods:</strong> This is a mixed-methods study to explore and map the current postnatal discharge processes in Uganda.We will conduct an observational cohort study (Phase I) to develop and internally validate our risk score and aim to recruit 7,000 mother and newborn dyads from Jinja Regional Referral Hospital and Mbarara Regional Referral Hospital. We will also engage with patients, families, and health workers through patient journey mapping and focus group discussions (Phases II-IV) to identify barriers and facilitators to inform the development of an evidence- and risk-based bundle of interventions to improve postnatal care (PNC) for dyads. <br /> <br />The primary outcome is maternal and/or neonatal death or need for re-admission within six weeks of birth. <br /> <br />Secondary outcomes include:<br /> 1. Post-natal care visits during the 6-week post-discharge period <br /> 2. Post-discharge health seeking practices for mothers/newborns during the 6-week post-discharge period<br /> 3. Causes of readmission/mortality among those who experience such outcomes, based on verbal autopsies and admission symptom/diagnosis questionnaires.<br /> <br /><strong>Data Collection Methods:</strong> All data will be collected at the point of care using encrypted study tablets. These data will be 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 will systematically collect data on clinical, social and demographic variables. Following discharge, field officers will contact mothers at 6-weeks post-discharge, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for participants who had died following discharge.<br /> <br /> Direct observation and interviews will be conducted on a sub-set of participants to collect process outcomes and barriers and facilitators to the patient's journey. FGDs will be digitally recorded, transcribed verbatim in the language spoken during the recording and analyzed for emerging themes. <br /> <br /><strong>Ethics Declaration:</strong> Ethics approvals have been obtained from the Makerere University School of Public Health (MakSPH) Institutional Review Board (SPH-2021-177), the Uganda National Council of Science and Technology (UNCST) in Uganda (HS2174ES) and the University of British Columbia in Canada (H21-03709). This study has been registered at clinicaltrials.gov (NCT05730387).<br /> <br /><strong>Associated datasets:</strong> <br /> Pending publication <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."

Kissoon, Niranjan; Fung, Jollee; Hwang, Bella; Trawin, Jessica; Symonds, Nicola; Knappett, Martina; Krepiakevich, Alexia; Liu, Christine; Businge, Stephen; Jabornisky, Roberto; Suiyven, Dzelamunyuy; Talla, Emmanuela; Nwankwor, Odiraa; Tagoola, Abner; Oguonu, Tagbo; Karlovich, Gabrielle; Kenechi, Onah Stanley; Dunsmuir, Dustin; Wiens, Matthew; Ansermino, J Mark — 2020-04-17 The purpose of this environmental scan is to support health facilities in identifying and assessing quality improvement (QI) priorities and initiatives to treat children with sepsis. <br /> <br /><strong><u>Tools Description:</strong></u> <br /><strong>Step 1 Environmental Scan</strong> - A health facility survey that gathers information regarding (1) the availability of resources and services in the health facility and (2) the readiness of the health facility to provide specific services to a defined minimum standard. <br /><strong>Step 2 Technology Readiness Scan</strong> - A short survey that aims to assess a facility’s level of technological preparedness for facilitating standard triage and discharge processes. Ultimately, it determines what technology is needed in order to effectively implement quality improvement intervention. <br /><strong>Step 3a-f Observational Scan</strong> - Assesses the quality and safety of care through observation of a health worker in suspected cases of pneumonia, diarrhea, and malaria, in order to assess adherence to standards in the patient care process. <br /><strong>Step 4 Caretaker Satisfaction Questionnaire</strong> - Assesses the patient-caretakers’ perspective of the quality of care they/their child received while at the facility. <br /><strong>Step 5 Health Worker Satisfaction Questionnaire</strong> - Assesses health workers’ perspectives of the quality of care provided at the facility. <br /><strong>Environmental Scan Feedback Survey</strong> - To be completed by data collector(s) and asks questions pertaining to the Scan’s relevancy and usability. The intention of this form is to collect suggestions on what elements of the Scan to add, eliminate, or modify to inform future module updates. <br /><strong>Written Report Of Results Feedback Survey</strong> - This survey asks questions pertaining to the presentation and value of the results report. <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."

Lester, Deborah; Ansermino, J Mark; Kissoon, Niranjan (Tex); Tagoola, Abner — 2021-06-09 Smart Triage QI is a quality improvement training package tailored for Uganda and supported by the Smart Triage platform. The package, including four slides decks with speaker notes and accompanying training manual, cover the basic concepts of the Quality Improvement process and provide a framework and tools that can be used to train staff on QI. <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."

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>.

Mawji, Alishah; Longstaff, Holly; Trawin, Jessica; Komugisha, Clare; Novakowski, Stefanie K.; Wiens, Matt; Akech, Samuel; Tagoola, Abner; Kissoon, Niranjan; Ansermino, Mark J. — 2023-03-15 <strong>Objective(s):</strong> Data sharing has enormous potential to accelerate and improve the accuracy of research, strengthen collaborations, and restore trust in the clinical research enterprise. Nevertheless, there remains reluctancy to openly share raw data sets, in part due to concerns regarding research participant confidentiality and privacy. We provide an instructional video to describe a standardized de-identification framework that can be adapted and refined based on specific context and risks.<br /> <br /><strong>Data Description:</strong> Training video, presentation slides.<br /> <br /><strong>Related Resources:</strong> The data de-identification algorithm, dataset, and data dictionary that correspond with this training video are available through the <a href = "https://borealisdata.ca/dataset.xhtml?persistentId=doi:10.5683/SP3/MSTH98 ">Smart Triage sub-Dataverse.</a> <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."

Kissoon, Niranjan; Fung, Jollee; Hwang, Bella; Trawin, Jessica; Krepiakevich, Alexia; Symonds, Nicola; Knappett, Martina; Liu, Christine; Businge, Stephen; Jabornisky, Roberto; Suiyven, Dzelamunyuy; Talla, Emmanuela; Nwankwor, Odiraa; Tagoola, Abner; Oguonu, Tagbo; Karlovich, Gabrielle; Kenechi, Onah Stanley; Dunsmuir, Dustin; Wiens, Matthew; Ansermino, J Mark — 2021-06-24 The purpose of this environmental scan is to support health facilities in identifying and assessing quality improvement (QI) priorities and initiatives to treat children with sepsis. This dataset contains training materials for project setup and data collection. <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."

Kissoon, Niranjan; Fung, Jollee; Hwang, Bella; Trawin, Jessica; Symonds, Nicola; Knappett, Martina; Krepiakevich, Alexia; Liu, Christine; Businge, Stephen; Jabornisky, Roberto; Suiyven, Dzelamunyuy; Talla, Emmanuela; Nwankwor, Odiraa; Tagoola, Abner; Oguonu, Tagbo; Karlovich, Gabrielle; Kenechi, Onah Stanley; Dunsmuir, Dustin; Wiens, Matthew; Ansermino, J Mark — 2021-08-03 The purpose of this environmental scan is to support health facilities in identifying and assessing quality improvement (QI) priorities and initiatives to treat children with sepsis. This dataset contains generic protocol and templates, written consent form templates, and verbal consent scripts to assist project teams in the ethics application process. <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."

Kumbakumba, Elias; Kabakyenga, Jerome; Wiens, Matthew; Lavoie, Pascal; Businge, Stephen; Tagoola, Abner; Kenya Mugisha, Nathan; Ansermino, J Mark; Kissoon, Niranjan (Tex) — 2021-03-30 Pulse oximetry dataset from Smart Discharges <6m observational study. May 2017 to March, 2020 (Thrasher - <6m - Phase 1) <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."

Kumbakumba, Elias; Kabakyenga, Jerome; Wiens, Matthew; Lavoie, Pascal; Businge, Stephen; Tagoola, Abner; Kenya Mugisha, Nathan; Ansermino, J Mark; Kissoon, Niranjan (Tex) — 2021-04-20 Clinical outcome dataset #1 from Smart Discharges <6m observational study. May 2017 to March, 2020 (Thrasher - <6m - Phase 1). <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."

Ansermino, J Mark; Tagoola, Abner; Akech, Samuel; Mawji, Alishah; Wiens, Matthew O; Kissoon, Niranjan; Li, Edmond; Kenya-Mugisha, Nathan — 2024-11-20 This data is the Saving young lives: Triage and treatment using the pediatric rapid sepsis trigger (PRST) tool study. Data collected for this study occurred from April 2020 to April 2022. <br> <br/><strong>Objective(s):</strong> This is a pre-post intervention study involving pediatric patients presenting to the study hospitals in seek of medical care for an acute illness. The purpose of this study was to develop a prediction model and to perform clinical validation of a digital triage tool to guide triage and treatment of children at health facilities in LMICs with severe infections/suspected sepsis. The study involved three phases: (I) Baseline Period, (II) Interphase Period, (III) Intervention Period. The study hospitals include 2 sites in Kenya (1 control site, 1 experimental site) and 2 in Uganda (1 control site, 1 experimental site). <br> <br /><strong>Data Description:</strong> Predictor variables were collected at the time of triage by trained study nurses using a custom-built mobile application. All data entered into the mobile application was stored an encrypted database. Data was uploaded directly from the mobile device to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). Outcomes were obtained from facility records or telephone follow-up at 7-10 days and the data was collected electronically. Time-specific outcomes were tracked using an RFID tagging system with study personnel as backup. <br> <br /><strong>Limitations:</strong> There is missing data and some variables were not collected at all sites. <br> <br /><strong>Ethics Declaration:</strong> This study was approved by the Makerere University Higher Degrees research and Ethics Committee (No. 743), the Uganda National Institute of Science and Technology (HS 528ES), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H19-02398 & H20-00484). <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; Tagoola, Abner; Kissoon, Niranjan; Ansermino, J Mark; Oyella Sherine, Sheila; Byaruhanga, Emmanuel; Ssemwanga, Edwards; Zhang, Cherri; Nguyen, Vuong; Bone, Jeffery N; Kenya Mugisha, Nathan; Kumbakumba, Elias; Kabakyenga, Jerome — 2024-07-22 <br/><strong>Background:</strong> In Sub-Saharan Africa, pediatric post-discharge death is increasingly recognized as an important contributor to mortality. Current studies evaluating interventional approaches for post-discharge mortality focus on pharmacologic therapy, though only malaria prophylaxis post-discharge appears effective. Approaches to reduce vulnerability through health system strengthening approaches may further help to improve outcomes. This study aimed to evaluate the impact of a risk-differentiated approach to improved peri-discharge care on post-discharge mortality among children under 60 months.<br /> <br /><strong>Methods:</strong> We conducted a prospective parallel cluster crossover trial at 6 hospitals in Uganda. Children <60 months admitted due to suspected infectious illness were eligible for enrollment. Phase 1 was a comparative control. During phase 2, enrolled children were screened for post-discharge mortality risk at admission using a multivariable risk algorithm. All children received counselling on post-discharge care practices during admission and at discharge. High-risk children received referrals and automated SMS engagement at 2, 7 and 14 days at a clinic of their choice, or by a community health worker. Survival analysis, adjusting for age, sex, site, period time and predicted risk of mortality was used to estimate the effect of the intervention on 6-month all-cause post-discharge mortality.<br /> <br /><strong>Findings:</strong> 13,050 patients were enrolled (phase 1: n=6954; phase 2: n=6096) and had complete 6-month follow-up. Baseline characteristics were similar between groups. The median age was 0.8 months (IQR: 0.2-1.7), with 56% of participants male. The multivariable risk algorithm gave a mean predicted risk of post-discharge mortality of 6.1% in phase 1 and 5.9% in phase 2. The rate of post-discharge mortality was 6.0% during phase 1 and 4.9% during phase 2, with an adjusted hazard ratio of 0.77 (95% CI – 0.90), favoring the intervention. Additional sensitivity analysis using different sets of covariates in the model showed similar results. <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 /> <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 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."

Li, Edmond C. K.; Tagoola, Abner; Komugisha, Clare; Nabweteme, Annette Mary; Pillay, Yashodani; Ansermino, J. Mark; Khowaja, Asif R. — 2023 Additional file 1: Supplementary table 1. Program costs of Smart Triage in 2021 United States Dollars. Costs marked with * were originally incurred in 2021 Ugandan Shillings and were converted into USD by the average conversion rate in 2021 as per the World Bank (3587.075 Ugandan Shillings to 1 USD). Abbreviations: USD = United States Dollar, JRRH = Jinja Regional Referral Hospital. https://creativecommons.org/licenses/by/4.0/legalcode

Li, Edmond C. K.; Tagoola, Abner; Komugisha, Clare; Nabweteme, Annette Mary; Pillay, Yashodani; Ansermino, J. Mark; Khowaja, Asif R. — 2023 Additional file 2: Supplementary table 2. Detailed Monte Carlo simulation results from societal, government, and patient perspectives. Costs in 2021 USD. Abbreviations: YLL averted = years of life lost averted, ICER = incremental cost effectiveness ratio, USD = United States dollars. https://creativecommons.org/licenses/by/4.0/legalcode

Li, Edmond C. K.; Tagoola, Abner; Komugisha, Clare; Nabweteme, Annette Mary; Pillay, Yashodani; Ansermino, J. Mark; Khowaja, Asif R. — 2023 Additional file 3: Supplementary table 3. Details of Monte Carlo simulations for sensitivity analyses. Abbreviations: USD = United States dollars, YLL averted = years of life lost averted, ICER = incremental cost-effectiveness ratio. https://creativecommons.org/licenses/by/4.0/legalcode