Management of Guillain–Barré syndrome in Bangladesh: Clinical practice, limitations and recommendations for low- and middle-income countries
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Considerable variation in clinical practice for management of Guillain-Barré syndrome (GBS) has been observed worldwide. Diagnosis and treatment are challenging in low- and middle-income countries (LMIC) due to lack of facilities and treatment availability. We aimed to evaluate current clinical practice and limitations and to provide recommendation for GBS management in low-resource settings.
Methods
We conducted an explanatory-sequential mixed-methods survey among neurologists and internists working in tertiary and secondary government hospitals in Bangladesh. There were two phases: (1) quantitative (cross-sectional survey to evaluate clinical practice and limitations); (2) qualitative (key informant interview to explain certain clinical practice and provide recommendations for GBS management in LMIC). Data were analyzed by frequencies, χ2 test and thematic analysis.
Results
Among 159 physicians (65 neurologists and 94 internists), 11% and 8% physicians used Brighton and NINDS criteria respectively to diagnose GBS. Specific treatment protocols of GBS were used by 12% physicians. Overcrowding of patients, inadequate diagnostic facilities, high costs of standard therapy, and inadequate logistics and trained personnel for intensive care unit and rehabilitation services were considered major challenges for GBS management. In qualitative part, respondents recommended regular training for the physicians, development of cost-effective treatment strategies and appropriate patients' referral and management guideline considering existing limitations in health service delivery and socio-economic status of the country.
Interpretation
Current study design and recommendations might be applied for other LMIC. Such data can assist policymakers to identify areas requiring urgent attention and take required action to improve GBS management in LMIC.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of the Peripheral Nervous System |
| Vol/bind | 28 |
| Udgave nummer | 4 |
| Sider (fra-til) | 564-577 |
| ISSN | 1085-9489 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
icddr,b is grateful to its core donors including the Governments of Bangladesh and Canada for providing core/unrestricted support for its operations and research. N.P. received honoraria from Incepta Pharmaceuticals, Bangladesh, for training and data analysis of the current study. Z.I. received restricted grant (number 1K43TW011447‐01) support from Fogarty International Center and the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Annexon Biosciences for activities unrelated to the subject matter of this manuscript. H.P.E. received unrestrictive support from EU Horizon 2020, the Bill and Melinda Gates Foundation and Fondation Mérieux, for activities unrelated to the current manuscript. B.C.J. received unrestricted support for research from GBS‐CIDP Foundation International, Prinses Beatrix Spierfonds, EU Horizon 2020, Annexon Biosciences, CSL‐Behring, Griffols, Roche, and Hansa Biopharma for activities unrelated to the subject matter of this manuscript. Q.D.M. received consulting honoraria from Annexon Biosciences for activities unrelated to this manuscript. We are indebted to the internists and neurologists who participated in the study and provided their valuable time and opinion.
Publisher Copyright:
© 2023 Peripheral Nerve Society.
ID: 370481136