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## Meet the editors

Dr. Jasneth Mullings is a researcher/scientist/lecturer in the Faculty of Medical Sciences, The University of the West Indies (UWI), Mona, Jamaica. Based in the Health Research Resource Unit, Dr. Mullings provides research support to faculty and graduate students. She has a master's degree in Public Health/Health Education and was the first PhD Epidemiology graduate of UWI (2013). She has received academic awards for her work. Her

current research interests are mental health, urban health, community health, and related interventions. Her publication record includes one book, two book chapters, 10 journal articles, 27 abstracts, and 12 technical reports. She has held membership in the International Society for Urban Health and International Society for Environmental Epidemiology.

Dr. Thoms-Rodriguez has a MD in Microbiology. She lectures at the University of the West Indies, Mona, Jamaica, specializing in Medical Microbiology with special interest in infectious diseases, antibiotic resistance, and control of healthcare-associated infections. She has pursued specialist training in infectious diseases, infection control, and epidemiology surveillance. Dr. Thoms-Rodriguez has published articles in peer-reviewed, ref-

ereed journals and has made numerous presentations at international conferences. She recently co-authored a book chapter, "Bacterial Infections in the Oral Cavity: Characterization, Diagnosis, Treatment and Prevention" in *Clinical Microbiology for the General Dentist*. She holds membership in several learned societies and associations, including the American Society for Microbiology and International Society Infectious Diseases, and is currently President of the Caribbean Association of Clinical Microbiologists.

Dr. McCaw-Binns (BA [NYU], MPH [Tulane], PhD [Bristol]) is Professor of Reproductive Health and Epidemiology in the Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica. Her maternal and perinatal health research has generated more than 100 peer-reviewed publications, informing the development of maternal mortality surveillance, clinical guidelines and health promotion tools for

pre-eclampsia, and establishment of high-risk antenatal clinics and other services aimed at ending preventable maternal and perinatal deaths in Jamaica. Her global service includes collaborations with the Pan American Health Organization (PAHO), United Nations Population Fund (UNFPA), and UN women, among others. Since 2006 she has assisted the WHO Special Programme of Research, Development and Research Training in Human Reproduction to improve measurement, surveillance, and strategies to enhance global maternal health and survival.

Dr. Tomlin Paul is Dean of the Faculty of Medical Sciences, University of the West Indies (UWI), Mona, Jamaica. He has MB, BS, and MPH degrees and is a Diplomate of the Faculty of Public Health Medicine, Royal College of Physicians. His research interests include medical education and social accountability. He is a fellow of the Academy of Medical Educators, UK, and has served as a consultant to the Pan American Health Organization and

Contents

**Section 1**

**Section 2**

*by Donnette Wright*

Sub-Saharan Hospital

*Ghislain Somda and Joachim Sanou*

**Preface III**

Reducing Hospital Mortality: Programmatic and Policy Interventions **1**

**Chapter 1 3**

**Chapter 2 11**

Managing Patients in the Hospital Setting **35**

**Chapter 3 37**

**Chapter 4 55** Improving the Quality of Care in Surgery: The Role of Guidelines, Protocols,

**Chapter 5 67**

Introductory Chapter: Mortality and Quality of Care Systems in LMICs *by Jasneth Mullings, Affette McCaw Binns, Camille-Ann Thoms-Rodriguez,* 

Health Literacy: An Intervention to Improve Health Outcomes *by Monique Ann-Marie Lynch and Geovanni Vinceroy Franklin*

Nutrition and Hospital Mortality, Morbidity and Health Outcomes

*by Joseph Martin Plummer, Mark S. Newnham and Timothy Henry*

Inhospital Outcome of Elderly Patients in an Intensive Care Unit in a

*by Martin Lankoande, Papougnezambo Bonkoungou, Oubian Soulemane,* 

*Antoinette Barton-Gooden and Tomlin Paul*

Checklist and the Multidisciplinary Team

medical schools in the region. He has worked in the primary care setting in Jamaica and is an advocate for quality improvement in health and education systems.

## Contents


Preface

In 2019, the World Health Organization (WHO) named the following top ten threats to global health: air pollution and climate change, non-communicable diseases, global influenza pandemic, fragile and vulnerable settings, antimicrobial resistance, Ebola and other high-threat pathogens, weak primary health care, vaccine hesitancy, dengue, and HIV. In 2017, approximately 56 million deaths were recorded worldwide. Many of the deaths from these conditions and exposures on

This book examines the issue of hospital mortality from the perspective of Lowand Middle-Income Countries (LMICs) and presents a mix of strategies in support of strengthening health systems and reducing mortality. The strategies for reducing hospital mortality are shown in this book to lie within a clinical-public health nexus and, as such, are not only the domain of the hospitalist or clinical administrator. Quality of care is an important overarching theme within which a sound argument on hospital mortality reduction can be built. Achieving such quality of care calls for consideration of a structured system for quality management supported by appro-

This book targets academics, clinicians, health administrators, and policy makers, as well as students of public health. It engages these groups in an examination of health conditions, clinical management tools, and other related issues that require policy and programmatic interventions best suited to the population health realm.

The WHO (2011) defined health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make basic health decisions for themselves and their loved ones. Health literacy and its relationship with health outcomes is well placed in the discussion of hospital mortality and appropriate interventions for researchers and healthcare professionals to reduce the negative impact on these outcomes. There is need for research to advance the conceptualization of health literacy in reducing hospital

The discussion around surgical care and applying guidelines and protocols in patient care is much needed for LMICs. It is relevant to overall hospital mortality reduction as such interventions around standardizing care are needed and will bring similar returns in all areas of a hospital where high-volume, complex care takes place. The surgical environment has become more complex with a wider range of procedures and changes in approaches and use of technology. Additionally, patient expectations have grown. This is more important in developing countries where access to resources are limited but access to information globally has improved. There is no doubt that the streamlining of the patient:-treatment: outcome continuum can be made better with the use of various standard operating procedures, such as the use of guidelines, protocols, and checklists with a multidis-

ciplinary team where all stakeholders are actively engaged.

the WHO's watch list occur in hospitals.

mortality and morbidity.

priate epidemiological and management information.
