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Practical approaches for administering nevirapine to newborns in low resource settings

By Elizabeth Glaser | 07 Jul, 2012

Practical approaches for administering nevirapine to newborns in low resource settings - address challenges of adherence and accurate dosing of nevirapine for women who deliver at home.

Replies

 

Elizabeth Glaser Replied at 3:44 PM, 7 Jul 2012

Replying to myself - to add more explanation. In Kisumu and the surrounding rural areas in Nyanza province Kenya, the majority of women deliver in a non-hospital setting, some due to access issues, some by choice. Despite the low use of hospital and standardized medical services for delivery, the majority of women do seek out prenatal care prior to delivery. Nurses at New Nyanza Provincial General Hospital (NNPGH) in Kisumu, Kenya have been working with mothers who either have HIV or are at high risk for HIV, to have nevirapine on hand after delivery in order to prevent transmission of HIV to their child. The 1cc dose is to be drawn up by the mother in a 20cc syringe. The staff realize the difficulty that the mothers may have in accurately drawing up a small volume in such a large syringe and are looking for other, practical, solutions to providing PMTCT for women who deliver at home. While I am in Kisumu working on a different project, I have met with the nurses at NNPGH and find them to be thoughtful and open to trying anything that might help improve this process.
Constraints : the syringes are provided to the mothers still in their plastic seal to prevent contamination , there is no cap for the syringe so the dose cannot be predrawn and capped, marking or taping the syringe to the proper dose has not worked in the past as the mothers wash/rinse the syringe and remove the marks or tape, they are investigating the availability of 1cc PPD /TB syringes to make dosing easier -but in lieu of a 1cc syringe, what else might be effective in your experience?

Dr Shanta Ghatak Replied at 2:38 AM, 8 Jul 2012

This is a kind of universal problem, really. Number of staff has plenty
difficulty in properly executing diluting the injectibles also - for low
weight TB patients/children. Yes tuberculin syringes are a relief but they
seem to cost more when they are to be purchased in hard to reach facilities
as far as my field knowledge goes.
Little else is at hand just now...
Nice that you shared !

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