<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">McCollum, Eric D</style></author><author><style face="normal" font="default" size="100%">Nambiar, Bejoy</style></author><author><style face="normal" font="default" size="100%">Deula, Rashid</style></author><author><style face="normal" font="default" size="100%">Zadutsa, Beatiwel</style></author><author><style face="normal" font="default" size="100%">Bondo, Austin</style></author><author><style face="normal" font="default" size="100%">King, Carina</style></author><author><style face="normal" font="default" size="100%">Beard, James</style></author><author><style face="normal" font="default" size="100%">Liyaya, Harry</style></author><author><style face="normal" font="default" size="100%">Mankhambo, Limangeni</style></author><author><style face="normal" font="default" size="100%">Lazzerini, Marzia</style></author><author><style face="normal" font="default" size="100%">Makwenda, Charles</style></author><author><style face="normal" font="default" size="100%">Masache, Gibson</style></author><author><style face="normal" font="default" size="100%">Bar-Zeev, Naor</style></author><author><style face="normal" font="default" size="100%">Kazembe, Peter N</style></author><author><style face="normal" font="default" size="100%">Mwansambo, Charles</style></author><author><style face="normal" font="default" size="100%">Lufesi, Norman</style></author><author><style face="normal" font="default" size="100%">Costello, Anthony</style></author><author><style face="normal" font="default" size="100%">Armstrong, Ben</style></author><author><style face="normal" font="default" size="100%">Colbourn, Tim</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study.</style></title><secondary-title><style face="normal" font="default" size="100%">PLoS One</style></secondary-title><alt-title><style face="normal" font="default" size="100%">PLoS ONE</style></alt-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Child</style></keyword><keyword><style  face="normal" font="default" size="100%">Child Mortality</style></keyword><keyword><style  face="normal" font="default" size="100%">Cost of Illness</style></keyword><keyword><style  face="normal" font="default" size="100%">Dose-Response Relationship, Immunologic</style></keyword><keyword><style  face="normal" font="default" size="100%">Geography</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Hypoxia</style></keyword><keyword><style  face="normal" font="default" size="100%">Malawi</style></keyword><keyword><style  face="normal" font="default" size="100%">Pneumococcal Vaccines</style></keyword><keyword><style  face="normal" font="default" size="100%">Pneumonia, Pneumococcal</style></keyword><keyword><style  face="normal" font="default" size="100%">Time Factors</style></keyword><keyword><style  face="normal" font="default" size="100%">Vaccines, Conjugate</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2017</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2017</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">12</style></volume><pages><style face="normal" font="default" size="100%">e0168209</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;b&gt;BACKGROUND: &lt;/b&gt;The pneumococcal conjugate vaccine's (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction in Malawi in November 2011, we evaluated the case burden and rates of childhood pneumonia.&lt;/p&gt;&lt;p&gt;&lt;b&gt;METHODS AND FINDINGS: &lt;/b&gt;Between January 1, 2012-June 30, 2014 we conducted active pneumonia surveillance in children &lt;5 years at seven hospitals, 18 health centres, and with 38 community health workers in two districts, central Malawi. Eligible children had clinical pneumonia per Malawi guidelines, defined as fast breathing only, chest indrawing +/- fast breathing, or, ≥1 clinical danger sign. Since pulse oximetry was not in the Malawi guidelines, oxygenation &lt;90% defined hypoxemic pneumonia, a distinct category from clinical pneumonia. We quantified the pneumonia case burden and rates in two ways. We compared the period immediately following vaccine introduction (early) to the period with &gt;75% three-dose PCV13 coverage (post). We also used multivariable time-series regression, adjusting for autocorrelation and exploring seasonal variation and alternative model specifications in sensitivity analyses. The early versus post analysis showed an increase in cases and rates of total, fast breathing, and indrawing pneumonia and a decrease in danger sign and hypoxemic pneumonia, and pneumonia mortality. At 76% three-dose PCV13 coverage, versus 0%, the time-series model showed a non-significant increase in total cases (+47%, 95% CI: -13%, +149%, p = 0.154); fast breathing cases increased 135% (+39%, +297%, p = 0.001), however, hypoxemia fell 47% (-5%, -70%, p = 0.031) and hospital deaths decreased 36% (-1%, -58%, p = 0.047) in children &lt;5 years. We observed a shift towards disease without danger signs, as the proportion of cases with danger signs decreased by 65% (-46%, -77%, p&lt;0.0001). These results were generally robust to plausible alternative model specifications.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSIONS: &lt;/b&gt;Thirty months after PCV13 introduction in Malawi, the health system burden and rates of the severest forms of childhood pneumonia, including hypoxemia and death, have markedly decreased.&lt;/p&gt;</style></abstract><issue><style face="normal" font="default" size="100%">1</style></issue><custom1><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/28052071?dopt=Abstract</style></custom1></record><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Lazzerini, Marzia</style></author><author><style face="normal" font="default" size="100%">Shukurova, Venera</style></author><author><style face="normal" font="default" size="100%">Davletbaeva, Marina</style></author><author><style face="normal" font="default" size="100%">Monolbaev, Kubanychbek</style></author><author><style face="normal" font="default" size="100%">Kulichenko, Tatiana</style></author><author><style face="normal" font="default" size="100%">Akoev, Yuri</style></author><author><style face="normal" font="default" size="100%">Bakradze, Maya</style></author><author><style face="normal" font="default" size="100%">Margieva, Tea</style></author><author><style face="normal" font="default" size="100%">Mityushino, Ilya</style></author><author><style face="normal" font="default" size="100%">Namazova-Baranova, Leyla</style></author><author><style face="normal" font="default" size="100%">Boronbayeva, Elnura</style></author><author><style face="normal" font="default" size="100%">Kuttumuratova, Aigul</style></author><author><style face="normal" font="default" size="100%">Weber, Martin Willy</style></author><author><style face="normal" font="default" size="100%">Tamburlini, Giorgio</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan.</style></title><secondary-title><style face="normal" font="default" size="100%">Bull World Health Organ</style></secondary-title><alt-title><style face="normal" font="default" size="100%">Bull. World Health Organ.</style></alt-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Child</style></keyword><keyword><style  face="normal" font="default" size="100%">Child Care</style></keyword><keyword><style  face="normal" font="default" size="100%">Cluster Analysis</style></keyword><keyword><style  face="normal" font="default" size="100%">Hospitalization</style></keyword><keyword><style  face="normal" font="default" size="100%">Hospitals, Public</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Kyrgyzstan</style></keyword><keyword><style  face="normal" font="default" size="100%">Medical Audit</style></keyword><keyword><style  face="normal" font="default" size="100%">Pediatricians</style></keyword><keyword><style  face="normal" font="default" size="100%">Professional Role</style></keyword><keyword><style  face="normal" font="default" size="100%">Prospective Studies</style></keyword><keyword><style  face="normal" font="default" size="100%">Quality Improvement</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2017</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2017 Jun 01</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">95</style></volume><pages><style face="normal" font="default" size="100%">397-407</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;b&gt;OBJECTIVE: &lt;/b&gt;To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.&lt;/p&gt;&lt;p&gt;&lt;b&gt;METHODS: &lt;/b&gt;In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.&lt;/p&gt;&lt;p&gt;&lt;b&gt;FINDINGS: &lt;/b&gt;We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group ( &lt; 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION: &lt;/b&gt;Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.&lt;/p&gt;</style></abstract><issue><style face="normal" font="default" size="100%">6</style></issue><custom1><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/28603306?dopt=Abstract</style></custom1></record></records></xml>