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Entrance surface dose from pediatric diagonostic x-ray examinations in a developing world setting: are we 'ALARA principle' compliant?
Published 2013
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Integrated sustainable childhood Pneumonia and infectious disease reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a clust...
Published 2022
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Background: Child mortality remains unacceptably high, with Northern Nigeria reporting some of the highest rates globally (e.g. 192/1000 live births in Jigawa State). Coverage of key protect and prevent interventions, such as vaccination and clean cooking fuel use, is low. Additionally, knowledge, care-seeking and health system factors are poor. Therefore, a whole systems approach is needed for sustainable reductions in child mortality. Methods: This is a cluster randomised controlled trial, with integrated process and economic evaluations, conducted from January 2021 to September 2022. The trial will be conducted in Kiyawa Local Government Area, Jigawa State, Nigeria, with an estimated population of 230,000. Clusters are defined as primary government health facility catchment areas (n = 33). The 33 clusters will be randomly allocated (1:1) in a public ceremony, and 32 clusters included in the impact evaluation. The trial will evaluate a locally adapted ‘whole systems strengthening’ package of three evidence-based methods: community men’s and women’s groups, Partnership Defined Quality Scorecard and healthcare worker training, mentorship and provision of basic essential equipment and commodities. The primary outcome is mortality of children aged 7 days to 59 months. Mortality will be recorded prospectively using a cohort design, and secondary outcomes measured through baseline and endline cross-sectional surveys. Assuming the following, we will have a minimum detectable effect size of 30%: (a) baseline mortality of 100 per 1000 livebirths, (b) 4480 compounds with 3 eligible children per compound, (c) 80% power, (d) 5% significance, (e) intra-cluster correlation of 0.007 and (f) coefficient of variance of cluster size of 0.74. Analysis will be by intention-totreat, comparing intervention and control clusters, adjusting for compound and trial clustering. Discussion: This study will provide robust evidence of the effectiveness and cost-effectiveness of community-based participatory learning and action, with integrated health system strengthening and accountability mechanisms, to reduce child mortality. The ethnographic process evaluation will allow for a rich understanding of how the intervention works in this context. However, we encountered a key challenge in calculating the sample size, given the lack of timely and reliable mortality data and the uncertain impacts of the COVID-19 pandemic.
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Background: Rediation protection in paediatric radiology requires special attention than in adult because children are more sensitive to radiation and at higher risk. This risk is explained by the longer life expectancy in children which allows for harmful effect of radiation to manifest and thier developing organs and tissues being more sensitive to radiation. Hence, the need for determination of appropraite radiation dose for paediatric patients. Aims:to estimate entrance skin dose (ESD) recieved by paediatric patients during diagnostic x-ray examinations. Material and Methods: A total of 253 paediatric patients undergoing various x-rays examinations between June 2011 and December, 2012. In a teaching hospital in the south west Nigeria were considered in this study. This hospital has no dedicated x-ray unit for paediatric radiology. The ESD recieved during x-ray examination was calculated using mathematical formular that incorporated the use of x-ray beam output and exposure parameters selected for examination. Correlation coefficient (r) analysis was used to test the relationship between ESD, patient size (age and weight) and exposure parameters(KVp, mAs). Results: The ESD and ED recieved by paediatric patients from all the x-ray examinations considered in this study ranged from 10.29+3.80-880.04+89.44 µGy 0.01 level of significant showed that there is a correlation between patient does and exposure factors but there is no correlation between ESD, age and weight of patients. Conclusion: The ESD recieved by paediatric patients is higher that the internationally recommended reference dose. This is attributed to lack of dedicated x-ray unit and personnel for paediatric radiology.
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Child mortality
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Cluster randomised controlled trial
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Community
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Nigeria
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Participatory learning and action
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Pneumonia
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