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Ameh EA, Seyi-Olajide JO. Retention of locally trained specialist surgeons in sub-Saharan Africa. World J Surg 2024; 48:843-844. [PMID: 38453166 DOI: 10.1002/wjs.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
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Fitzgerald TN, Zambeli-Ljepović A, Olatunji BT, Saleh A, Ameh EA. Gaps and priorities in innovation for children's surgery. Semin Pediatr Surg 2023; 32:151352. [PMID: 37976896 DOI: 10.1016/j.sempedsurg.2023.151352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Lack of access to pediatric medical devices and innovative technology contributes to global disparities in children's surgical care. There are currently many barriers that prevent access to these technologies in low- and middle-income countries (LMICs). Technologies that were designed for the needs of high-income countries (HICs) may not fit the resources available in LMICs. Likewise, obtaining these devices are costly and require supply chain infrastructure. Once these technologies have reached the LMIC, there are many issues with sustainability and maintenance of the devices. Ideally, devices would be created for the needs and resources of LMICs, but there are many obstacles to innovation that are imposed by institutions in both HICs and LMICs. Fortunately, there is a growing interest for development of this space, and there are many examples of current technologies that are paving the way for future innovations. Innovations in simulation-based training with incorporated learner self-assessment are needed to fast-track skills acquisition for both specialist trainees and non-specialist children's surgery providers, to scale up access for the larger population of children. Pediatric laparoscopy and imaging are some of the innovations that could make a major impact in children's surgery worldwide.
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Affiliation(s)
- Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Alan Zambeli-Ljepović
- Philip R. Lee Institute for Health Policy Studies, University of California San Fransisco, USA
| | | | | | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
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Bekele A, Alayande BT, Powell BL, Obi N, Seyi-Olajide JO, Riviello RR, Ntirenganya F, Ameh EA, Makasa EM. National Surgical Healthcare Policy Development and Implementation: Where do We Stand in Africa? World J Surg 2023; 47:3020-3029. [PMID: 37550548 DOI: 10.1007/s00268-023-07131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational learning. METHODS Through a desk review of available African national surgical healthcare plans and written contributions from a committee comprising six African surgical policy development experts, a few key lessons from five healthcare plans were outlined and iteratively reviewed. RESULTS The current state of national surgical healthcare policies across Africa was visually mapped, and lessons from a few compelling examples are highlighted. These include the power of initiative from Senegal; regional leadership from Zambia; contextualization, and renewal of commitment from Ethiopia; multidisciplinary focus and creation of multiple implementation entry points from Nigeria; partnerships and involvement of multiple stakeholders from Rwanda; and the challenge of surgical policy financing from Tanzania. The availability of global expertise, the power of global partnerships, and the critical role of health ministries and Ministers of Health in planning and implementation have also been highlighted. CONCLUSIONS Strategic planning for surgical healthcare improvement is at various stages across the continent, with potential for countries to learn from one another. Convenings of stakeholders and Ministers of Health from countries at various stages of strategic surgical plan development, execution, and evaluation can enhance African surgical policy development through the exchange of ideas, lessons, and experiences.
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Affiliation(s)
- Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
| | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Britany L Powell
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Central Business District, Abuja, Nigeria
| | - Emmanuel M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, University of the Witwatersrand, Johannesburg, South Africa
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Abbas A, Laverde R, Yap A, Stephens CQ, Samad L, Seyi-Olajide JO, Ameh EA, Ozgediz D, Lakhoo K, Bickler SW, Meara JG, Bundy D, Jamison DT, Klazura G, Sykes A, Philipo GS. Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life-A Narrative Review. World J Surg 2023; 47:3419-3428. [PMID: 37341797 PMCID: PMC10694096 DOI: 10.1007/s00268-023-07097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. METHODS A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. RESULTS Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These "neglected" conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. CONCLUSIONS Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.
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Affiliation(s)
- Alizeh Abbas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ruth Laverde
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ava Yap
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Caroline Q Stephens
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Lubna Samad
- Global Surgery Programs, Interactive Research & Development, Karachi, Pakistan
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kokila Lakhoo
- Department of Pediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Alicia Sykes
- Naval Medical Center San Diego, San Diego, CA, USA
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Ameh EA. Aligning Global Surgical Research Collaborations with Local Priorities in Low- and Middle-Income Countries. World J Surg 2023; 47:2328-2329. [PMID: 37493830 DOI: 10.1007/s00268-023-07119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
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Yap A, Olatunji BT, Negash S, Mweru D, Kisembo S, Masumbuko F, Ameh EA, Lebbie A, Bvulani B, Hansen E, Philipo GS, Carroll M, Hsu PJ, Bryce E, Cheung M, Fedatto M, Laverde R, Ozgediz D. Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa. Surgery 2023; 174:567-573. [PMID: 37385869 DOI: 10.1016/j.surg.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. METHODS A prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child's surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. RESULTS In all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308-2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26-174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child's surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). CONCLUSION A full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.
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Affiliation(s)
- Ava Yap
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA.
| | | | - Samuel Negash
- Department of Paediatric Surgery, Menelik II Hospital, Addis Ababa, Ethiopia
| | - Dilon Mweru
- Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo
| | - Steve Kisembo
- Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo
| | - Franck Masumbuko
- Department of Surgery, Hôpital Provincial Général de Reférence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Emmanuel A Ameh
- Department of Paediatric Surgery, National Hospital Abuja, Abuja, Nigeria
| | - Aiah Lebbie
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Bruce Bvulani
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Eric Hansen
- Department of Surgery, Kijabe Hospital, Kijabe, Kenya
| | | | - Madeleine Carroll
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Phillip J Hsu
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Emma Bryce
- Kids Operating Room, Edinburgh, Scotland, United Kingdom; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Maira Fedatto
- Kids Operating Room, Edinburgh, Scotland, United Kingdom
| | - Ruth Laverde
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA
| | - Doruk Ozgediz
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA
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Seyi-Olajide JO, Faboya O, Williams O, Lakhoo K, Ameh EA. Advocating for children's surgery within country health plans: lessons from Nigeria and the global stage. Front Public Health 2023; 11:1209902. [PMID: 37614450 PMCID: PMC10442532 DOI: 10.3389/fpubh.2023.1209902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Despite the growing emphasis on provision of quality safe and affordable surgical care in low- and middle-income countries, and the World Health Assembly resolution 68. 15 on strengthening emergency and essential surgical care and anesthesia as components of universal health coverage, a review of published surgical plans of various countries, revealed a lack of emphasis on children's surgery. Due to the peculiarities of the human resource, infrastructure and equipment required for children's surgery, a lack of deliberate actions and policies targeted at strengthening surgical care for children implies that achieving universal health coverage for children may not be a reality in this setting. Methods A baseline assessment of children's surgical capacity was conducted in Nigeria as a part of the National Surgical Obstetrics Anesthesia and Nursing Plan (NSOANP) process. The assessment was done using the World Health Organization (WHO) hospital assessment tool modified for children's surgery (Children Surgical Assessment Tool). Results Significant infrastructural gaps were found, with an abysmally low density of pediatric surgeons and anaesthesiologists, poor emergency preparedness, lack of reliable surgical data and non-inclusion of children's surgery in the national strategic health plan. Using the Global Initiative for Children's Surgery's (GICS) Optimal Resources for Children's Surgical Care (OReCS) document and focusing on the strategic goals and priorities, children's surgery was incorporated into the NSOANP. Implementation of the plan is currently ongoing. Conclusion From Nigeria's experience, appropriate advocacy and inclusion of children surgery providers in policy making will promote prioritization of children's surgery in country health and surgical plans.
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Affiliation(s)
| | - Omolara Faboya
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Omolara Williams
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Kokila Lakhoo
- Department of Surgery, University of Oxford, Oxford University Hospitals, Oxford, United Kingdom
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M'pele P, Seyi-Olajide JO, Elongo T, Lemvik J, Dovlo D, Ameh EA. From research to a political commitment to strengthen access to surgical, obstetric, and anesthesia care in Africa by 2030. Front Public Health 2023; 11:1168805. [PMID: 37261243 PMCID: PMC10228736 DOI: 10.3389/fpubh.2023.1168805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
Objective This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by 2030 in Africa. Methods From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan 2022-2030 to improve access to surgical care by 2030 in Africa, endorsed by Heads of State. Results The International Symposium was composed of two meetings that gathered (i) 85 scientific experts and (ii) 28 ministers of health or representatives from 28 sub-Saharan African countries. The 28 African countries represent (i) 51% of the continent's total population, (ii) 68% of the 47 African countries of the WHO Africa Region, (iii) 58% of all African Union countries, and (vi) 79% (3,371) of the WHO Africa Region's total (4,271) health districts. The International Symposium and the Heads of State Summit successfully produced the Dakar Declaration on access to equitable, affordable, and quality Surgical, Obstetric, and Anesthesia Care by 2030 in Africa and its Regional Actions Plan 2022-2030 which prioritizes 12 urgent actions needed to be implemented, six strategic priorities, 16 key indicators, and an annual dashboard to monitor progress. Conclusion The Dakar Declaration and its Regional Action Plan 2022-2030 are a commitment to establish quality and sustainable surgical, obstetric, and anesthesia care in each African country within the ambitious framework of "The Africa we want" Agenda 2063.
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Affiliation(s)
- Pierre M'pele
- Scientific Secretariat of the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa, Mercy Ships Africa Office, Cotonou, Benin
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Ameh EA. Realigning Global Health Realities Towards Children's Surgery: Progress and Possibilities. J Pediatr Surg 2023; 58:1039-1047. [PMID: 36907771 DOI: 10.1016/j.jpedsurg.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023]
Abstract
Despite the high population of children, increasing surgical disease burden and shortage of pediatric surgeons, as well as limited infrastructure, children's surgical care in low- and middle-income countries (LMICs) has been neglected for decades. This has contributed to unacceptably high morbidity and mortality, long term disabilities and economic loss to families. The work of the global initiative for children's surgery (GICS) has raised the profile and visibility of children's surgery in the global health space. This has been achieved a philosophy of inclusiveness, LMIC participation, focus on LMIC needs and high income country (HIC) support, and driven by implementation to change on the ground situations. Children's operating rooms are being installed to strengthen infrastructure and children's surgery is being gradually included in national surgical plans to provide the policy framework to support children's surgical care. In Nigeria, pediatric surgery workforce has increased from 35 in 2003 to 127 in 2002, but the density remains low at 0.14 per 100,000 population <15 years. Education and training have been strengthened with the publication of a pediatric surgery textbook for Africa and creation of a Pan Africa pediatric surgery e-learning platform. However, financing children's surgery in LMICs remains a barrier as many families are at risk of catastrophic healthcare expenditure. The success of these efforts provides encouraging examples of what can be collectively achieve by appropriate and mutually beneficial global north-south collaborations. Pediatric surgeons need to commit their time, knowledge and skills, as well as experience and voices to strengthen children's surgery globally to impact more lives, for the overall good of more.
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Affiliation(s)
- Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, PO Box 187, Garki, Abuja, 900001, Nigeria.
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Laverde R, Majekodunmi O, Park P, Udeigwe-Okeke CR, Yap A, Klazura G, Ukwu N, Bryce E, Ozgediz D, Ameh EA. Impact of new dedicated pediatric operating rooms on surgical volume in Africa: Evidence from Nigeria. J Pediatr Surg 2023; 58:161-166. [PMID: 36289035 DOI: 10.1016/j.jpedsurg.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a large unmet children's surgical need in low- and middle-income countries (LMICs). This study examines the impact of installing dedicated pediatric operating rooms (ORs) on surgical volume at National Hospital Abuja, a hospital in Abuja, Nigeria. METHODS A Non-Governmental Organization installed two pediatric ORs in August 2019. We assessed changes in volume from July 2018 to September 2021 using interrupted time series analysis. RESULTS Total surgical volume increased by 13 cases (p = 0.01) in 1-month post-installation, with elective operations making up 85% (p = 0.02) of cases. There was an increase in elective volume by about 1 case per month (p = 0.01) post-installation and the difference between pre-and post-trends was 1.23 cases per month (p = 0.009). The baseline volume of neonatal surgeries increased by 9 cases per month (p < 0.001) post-installation and this difference between pre- and post-trends was statistically significant (p = 0.001). Similarly, one-month post-installation, the cases classified as ASA class >2 increased by 14 (p < 0.001). There was no significant difference between pre-and post-installation mortality rate at about 2% per month. CONCLUSIONS There were significant changes in surgical volume after OR installation, primarily composed of elective operations, reflecting an increased capacity to address surgical backlogs and/or perform more specialized surgeries. Despite a significant increase in volume and higher ASA class, there was no significant difference in mortality. This study supports the installation of surgical infrastructure in LMICs to strengthen capacity without increasing postoperative mortality.
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Affiliation(s)
- Ruth Laverde
- School of Medicine, University of California, 513 Parnassus Ave, Suite S-224, San Francisco, CA 94143, USA; Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA.
| | - Olubumni Majekodunmi
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Paul Park
- School of Medicine, University of California, 513 Parnassus Ave, Suite S-224, San Francisco, CA 94143, USA; Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA
| | - Chisom R Udeigwe-Okeke
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Ava Yap
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Department of Surgery, University of California, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA
| | - Greg Klazura
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nancy Ukwu
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Emma Bryce
- Kids Operating Room, Edinburgh, Scotland, United Kingdom
| | - Doruk Ozgediz
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
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Sykes AG, Seyi-Olajide J, Ameh EA, Ozgediz D, Abbas A, Abib S, Ademuyiwa A, Ali A, Aziz TT, Chowdhury TK, Abdelhafeez H, Ignacio RC, Keller B, Klazura G, Kling K, Martin B, Philipo GS, Thangarajah H, Yap A, Meara JG, Bundy DAP, Jamison DT, Mock CN, Bickler SW. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries. World J Surg 2022; 46:2114-2122. [PMID: 35771254 PMCID: PMC9334432 DOI: 10.1007/s00268-022-06622-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.
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Affiliation(s)
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Simone Abib
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Keller
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Karen Kling
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Hariharan Thangarajah
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald A P Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA.
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12
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Wild H, Reavley P, Mayhew E, Ameh EA, Celikkaya ME, Stewart B. Strengthening the emergency health response to children wounded by explosive weapons in conflict. World Jnl Ped Surgery 2022; 5:e000443. [DOI: 10.1136/wjps-2022-000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022] Open
Abstract
The 2022 war in Ukraine has highlighted the unacceptable consequences wrought on civilians and health infrastructure by conflict. Children are among the most vulnerable of those affected and constitute an increasing percentage of non-combatants injured in conflicts globally. A disproportionate number of these injuries are caused by blast mechanisms from munitions including ‘conventional’ landmines and indiscriminate explosive weapons such as barrel bombs and improvised explosive devices. In 21st century conflict, children are no longer only accidental casualties of war, but are increasingly targeted by parties through acts such as bombing of school buses and playgrounds, conscription as child soldiers, and use as human shields. In the present viewpoint article, we review the state of pediatric blast injury studies, synthesizing current understandings of injury epidemiology and identifying gaps in research to advance the field towards a concrete agenda to improve care for this vulnerable population.
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13
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Velin L, Lantz A, Ameh EA, Roy N, Jumbam DT, Williams O, Elobu A, Seyi-Olajide J, Hagander L. Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries. BMJ Glob Health 2022; 7:e008791. [PMID: 35483711 PMCID: PMC9052057 DOI: 10.1136/bmjgh-2022-008791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders' perceptions of visiting surgical teams from high-income countries. METHOD We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach. RESULTS Out of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers. CONCLUSION Surgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
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Affiliation(s)
- Lotta Velin
- Department of Biomedical and Clinical Sciences, Linköping University, Centre for Teaching and Research in Disaster Medicine and Traumatology, Linkoping, Sweden
| | - Adam Lantz
- Department of Clinical Sciences in Lund, Orthopedic Surgery, Helsingborg Hospital, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Mumbai, India
- The George Institute for Global Health, New Delhi, India
| | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Omolara Williams
- Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Alex Elobu
- Gastrointestinal Surgery, Mulago Hospital, Kampala, Uganda
- Institute of Digestive Diseases, Kampala, Uganda
| | - Justina Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
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14
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Angell B, Sanuade O, Adetifa IMO, Okeke IN, Adamu AL, Aliyu MH, Ameh EA, Kyari F, Gadanya MA, Mabayoje DA, Yinka-Ogunleye A, Oni T, Jalo RI, Tsiga-Ahmed FI, Dalglish SL, Abimbola S, Colbourn T, Onwujekwe O, Owoaje ET, Aliyu G, Aliyu SH, Archibong B, Ezeh A, Ihekweazu C, Iliyasu Z, Obaro S, Obadare EB, Okonofua F, Pate M, Salako BL, Zanna FH, Glenn S, Walker A, Ezalarab M, Naghavi M, Abubakar I. Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study. Lancet 2022; 399:1117-1129. [PMID: 35303469 PMCID: PMC8943279 DOI: 10.1016/s0140-6736(21)02722-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries. METHODS In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository. FINDINGS Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians. INTERPRETATION Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Blake Angell
- UCL Institute for Global Health, University College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, Sydney, NSW, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, University College London, London, UK; Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Aishatu Lawal Adamu
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Fatima Kyari
- College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Diana A Mabayoje
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Adesola Yinka-Ogunleye
- UCL Institute for Global Health, University College London, London, UK; Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rabiu Ibrahim Jalo
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sarah L Dalglish
- UCL Institute for Global Health, University College London, London, UK
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme Theodora Owoaje
- Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Sani H Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Muhammed Pate
- Health, Nutrition, and Population Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington, DC, USA; Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | | | | | - Scott Glenn
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Ally Walker
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Maha Ezalarab
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA
| | - Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London, UK.
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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16
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Jayaram A, Pawlak N, Kahanu A, Fallah P, Chung H, Valencia-Rojas N, Rodas EB, Abbaslou A, Alseidi A, Ameh EA, Bekele A, Casey K, Chu K, Dempsey R, Dodgion C, Jawa R, Jimenez MF, Johnson W, Krishnaswami S, Kwakye G, Lane R, Lakhoo K, Long K, Madani K, Nwariaku F, Nwomeh B, Price R, Roser S, Rees AB, Roy N, Ruzgar NM, Sacoto H, Sifri Z, Starr N, Swaroop M, Tarpley M, Tarpley J, Terfera G, Weiser T, Lipnick M, Nabukenya M, Ozgediz D, Jayaraman S. Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach. J Surg Res 2021; 267:732-744. [PMID: 34905823 DOI: 10.1016/j.jss.2021.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery. METHODS We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies. RESULTS Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access. CONCLUSION Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.
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Affiliation(s)
| | | | - Alexis Kahanu
- Hackensack University Medical Center, Edison, NJ, USA
| | - Parisa Fallah
- Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Haniee Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edgar B Rodas
- Virginia Commonwealth University Department of Surgery, Richmond VA, USA
| | | | - Adnan Alseidi
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Emmanuel A Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda
| | | | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Robert Dempsey
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Chris Dodgion
- Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA
| | - Randeep Jawa
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Maria F Jimenez
- Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia
| | | | | | - Gifty Kwakye
- University of Michigan Department of Surgery, Ann Arbor, MI, USA
| | - Robert Lane
- International Federation of Surgical Colleges
| | - Kokila Lakhoo
- University of Oxford, Oxford University Hospitals, UK
| | - Kristin Long
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Katayoun Madani
- Northwestern University Department of Surgery, Chicago, IL, USA
| | | | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Raymond Price
- University of Utah Dept of Surgery, Salt Lake City, UT, USA
| | - Steven Roser
- Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew B Rees
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nobhojit Roy
- BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India
| | | | | | - Ziad Sifri
- Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA
| | - Nichole Starr
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Mamta Swaroop
- Northwestern University Department of Surgery, Chicago, IL, USA
| | - Margaret Tarpley
- University of Botswana Department of Medical Education, Gaborone, Botswana
| | - John Tarpley
- University of Botswana Department of Surgery, Gaborone, Botswana
| | - Girma Terfera
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Thomas Weiser
- Stanford University Medical Center Department of Surgery, Stanford, CA, USA
| | - Michael Lipnick
- University of California San Francisco Department of Anesthesia, San Francisco, CA, USA
| | - Mary Nabukenya
- Makerere University Department of Anesthesia, Kampala, Uganda
| | - Doruk Ozgediz
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sudha Jayaraman
- University of Utah Dept of Surgery, Salt Lake City, UT, USA.
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17
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Seyi-Olajide JO, Anderson JE, Williams OM, Faboya O, Amedu JO, Anyanwu SN, Bethuel-Kasimu A, Lawal OA, da Lilly-Tariah OB, Onajin-Obembe B, Farmer DL, Ameh EA. National surgical, obstetric, anaesthesia and nursing plan, Nigeria. Bull World Health Organ 2021; 99:883-891. [PMID: 34866684 PMCID: PMC8640693 DOI: 10.2471/blt.20.280297] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 09/04/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022] Open
Abstract
Recent evidence suggests that strengthening surgical care within existing health systems will strengthen the overall health-care system. However, Nigeria's national strategic health development plan 2018-2022 placed little emphasis on surgical care. To address the gap, we worked with professional societies and other partners to develop the national surgical, obstetric, anaesthesia and nursing plan 2019-2023. The aim was to foster actions to prioritize surgical care for the achievement of universal health coverage. In addition to creating a costed strategy to strengthen surgical care, the plan included children's surgery and nursing: two key aspects that have been neglected in other national surgical plans. Pilot implementation of the plan began in 2020, supported by a nongovernmental organization with experience in surgical care in the region. We have created specific entry points to facilitate the pilot implementation. In the pilot, an electronic surgery registry has been created; personnel are being trained in life support; nurses are being trained in safe perioperative care; biomedical technicians and sterile supplies nurses are being trained in surgical instrument repair and maintenance; and research capacity is being strengthened. In addition, the mainstream media are being mobilized to improve awareness about the plan among policy-makers and the general population. Another development partner is interested in providing support for paediatric surgery, and a children's hospital is being planned. As funding is a key challenge to full implementation, we need innovative domestic funding strategies to support and sustain implementation.
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Affiliation(s)
| | - Jamie E Anderson
- Department of Surgery, University of Washington, Seattle, United States of America (USA)
| | - Omolara M Williams
- Department of Surgery, Lagos State University College of Medicine, Lagos, Nigeria
| | - Omolara Faboya
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | | | | | | | | | - Diana L Farmer
- Department of Surgery, University of California, Davis, USA
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Central Business District, Abuja, 900001, Nigeria
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18
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El Vilaly MAS, Jones MA, Stankey MC, Seyi-Olajide J, Onajin-Obembe B, Dasogot A, Klug SJ, Meara J, Ameh EA, Osagie OO, Juran S. Access to paediatric surgery: the geography of inequality in Nigeria. BMJ Glob Health 2021; 6:bmjgh-2021-006025. [PMID: 34697085 PMCID: PMC8547353 DOI: 10.1136/bmjgh-2021-006025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background About 96.3 million children and adolescents aged 0–19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population’s unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study’s aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level. Methods The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access. Results Across Nigeria’s 36 states and Federal Capital Territory, the percentage of Nigeria’s 0–19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%–30.5%. In 3 states, only 2.1%–4.8% of the population can access a facility within 2 hours, 12 have 4.9%–13.8%, and 8 have 13.9%–22.6%. Conclusion There is significant variation across Nigerian states regarding access to surgical care, with 69.5%–98% of Nigeria’s 0–19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria’s 0–19 population and reducing Nigeria’s burden of surgical disease, in line with Nigeria’s National Surgical, Obstetrics, Anaesthesia and Nursing Plan.
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Affiliation(s)
- Mohamed Abd Salam El Vilaly
- Technical Division, Population and Development Branch, United Nations Population Fund, New York, New York, USA
| | - Maureen A Jones
- Technical Division, Population and Development Branch, United Nations Population Fund, New York, New York, USA
| | - Makela Cordero Stankey
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bisola Onajin-Obembe
- Department of Anaesthesiology, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
| | - Andat Dasogot
- Nigeria Country Office, United Nations Fund for Population Activities, Abuja, Nigeria
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Germany and Munich Data Science Institute (MDSI), Technical University of Munich, Germany, Munich, Germany
| | - John Meara
- Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emmanuel A Ameh
- National Hospital, Abuja, Nigeria.,Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Olabisi O Osagie
- Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Sabrina Juran
- Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Germany and Munich Data Science Institute (MDSI), Technical University of Munich, Germany, Munich, Germany .,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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19
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Abbas A, Samad L, Ozgediz D, Ademuyiwa A, Ameh EA, Banu T, Botelho F, Espineda B, Gathuya Z, Lakhoo K, Olubunmi LA, Madhuri V, Millano L, Nabulindo S, Shehata S, Wong K, Butler MW. Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care. Pediatr Surg Int 2021; 37:1221-1233. [PMID: 33880597 PMCID: PMC8057944 DOI: 10.1007/s00383-021-04903-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE We aimed to understand the challenges facing children's surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children's surgery. METHODS Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children's Surgery (GICS) with a geographically diverse panel representing four children's surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes. RESULTS The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs. CONCLUSION Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children's surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.
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Affiliation(s)
- Alizeh Abbas
- Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, Woodcraft Building, Plot 3 and 3A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, Woodcraft Building, Plot 3 and 3A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Doruk Ozgediz
- University of California, San Francisco, San Francisco, CA USA
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Fabio Botelho
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Beda Espineda
- Philippines Children’s Medical Center, Quezon City, The Philippines
| | | | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College and Hospital, Vellore, India
| | - Leecarlo Millano
- Pediatric Surgery Division, Tarakan General Hospital, Jakarta, Indonesia
| | - Susane Nabulindo
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
| | - Sameh Shehata
- Department of Pediatric Surgery, University of Alexandria, Alexandria, Egypt
| | - Kenneth Wong
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Marilyn W. Butler
- Division of Pediatric Surgery, Oregon Health and Science University, 501 N. Graham Street, Suite 300, Portland, OR 97227 USA
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20
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Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med 2021; 18:e1003749. [PMID: 34415914 PMCID: PMC8415575 DOI: 10.1371/journal.pmed.1003749] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
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Affiliation(s)
- Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Public Health, Wits University, Johannesburg, South Africa
- * E-mail:
| | - Adrian W. Gelb
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia & Perioperative Care, University of California San Francisco, California, United States of America
| | - Julian Gore-Booth
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
| | - Christina Åkerman
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States of America
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, United States of America
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, The National Hospital, Abuja, Nigeria
- National Surgical, Obstetric and Anaesthesia Planning Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Bruce M. Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Western Cape, South Africa
| | - Geir Sverre Braut
- Research Department of Community Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | | | - Lars Hagander
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Haylock-Loor
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care Medicine, Interventional Pain Unit, Hospital Del Valle, San Pedro Sula, Honduras
| | - Hampus Holmer
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States of America
| | - Sabrina Juran
- Population and Development, United Nations Population Fund, New York, New York, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicolas J. Kassebaum
- Anesthesiology and Pain Medicine, Health Metrics Sciences, Global Health, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Michael S. Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, United States of America
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel M. Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare (WitSSurg), Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Mark W. Newton
- Department of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Tennessee, United States of America
- AIC Kijabe Hospital, Kenya
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, The University of Copenhagen, Copenhagen, Denmark
| | - Teri Reynolds
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Lauri J. Romanzi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anaesthesia and Perioperative Care, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Emi Suzuki
- The World Bank, Washington, DC, United States of America
| | - John E. Varallo
- Department of Safe Surgery, Jhpiego, Baltimore, Maryland, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - David Watters
- University Hospital Geelong, Victoria, Australia
- Faculty of Health, School of Medicine, Deakin University, Victoria, Australia
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Thomas G. Weiser
- Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care Stanford University, Stanford, United States of America
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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21
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Jin J, Akau Ola S, Yip CH, Nthumba P, Ameh EA, de Jonge S, Mehes M, Waiqanabete HI, Henry J, Hill A. The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. World J Surg 2021; 45:2993-3006. [PMID: 34218314 DOI: 10.1007/s00268-021-06208-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes. METHODS A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542. RESULT Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93). CONCLUSION There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.
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Affiliation(s)
- James Jin
- Department of Surgery, The University of Auckland, Auckland, 1010, New Zealand
| | - Salesi Akau Ola
- Surgery, Fiji National University, samabula fiji Lakeba Street Samabula, Suva, Fiji
| | - Cheng-Har Yip
- Surgery, University of Malaya, Subang Jaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Peter Nthumba
- AIC Kijabe Hospital Surgery, Kijabe Road Kijabe Lari Kiambu KE, Kijabe, Kenya
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Northcentral University, 8667 E Hartford Dr Ste 100, Scottsdale, AZ, 85255, USA
| | - Stijn de Jonge
- Department of Surgery, Amsterdam UMC Locatie AMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | | | | | - Jaymie Henry
- Department of Surgery, Florida Atlantic University, Boca Raton, USA.
| | - Andrew Hill
- Department of Surgery, University of Auckland, Auckland, 1010, New Zealand
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22
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Rao PK, Cunningham AJ, Kenron D, Mshelbwala P, Ameh EA, Krishnaswami S. Applying LEAN Healthcare in Lean Settings: Launching Quality Improvement in Resource-Limited Regions. J Surg Res 2021; 266:398-404. [PMID: 34091087 DOI: 10.1016/j.jss.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lean methodology is frequently utilized in high income settings to maximize capacity and operational efficiency during process improvement (PI) initiatives. To date there has been little published on the application of these techniques in low- and-middle-income countries (LMIC) despite the potential benefits in resource limited settings. We describe a pilot project developed in 2018 to promote sustainable operating theater efficiency at two hospitals in Abuja, Nigeria. This study details the first known attempt to use Lean techniques to improve surgical care systems in LMIC. METHODS Perioperative committees were established at two Nigerian institutions to evaluate current processes, identify problems, and compile a list of priorities. A physician champion and a PI specialist in conjunction with local physician-partners held a workshop to teach practical applications of PI methodology as part of an ongoing collaboration. Pre and post-workshop surveys were administered, and theme coding was used to categorize free responses. Results were compared with a chi-square test. RESULTS In total, 42 individuals attended the PI workshop. After the workshop, 37 respondents reported the workshop as valuable both personally and for the perioperative committee (P < 0.001), and all reported that PI methodology could benefit the institution overall. CONCLUSIONS By identifying stakeholders, holding a workshop to teach tools of PI, and establishing a committee for ongoing improvement, it is possible to implement quality improvement techniques at LMIC hospitals, which may be of future benefit. Sustainability in this project will be facilitated by tele mentoring, and future efforts include expansion beyond the perioperative setting.
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Affiliation(s)
- Pavithra K Rao
- Department of Surgery, Oregon Health & Science University, Portland, OR.
| | | | - Daniel Kenron
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Philip Mshelbwala
- Department of Surgery, University of Abuja, Gwagwalada, FCT, Nigeria
| | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Abuja, FCT, Nigeria
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Amin SM, Nwatah VE, Ameh EA, Oyesegun AR, Oyesakin AB. Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review. Afr Health Sci 2021; 21:54-59. [PMID: 34394281 PMCID: PMC8356580 DOI: 10.4314/ahs.v21i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary. OBJECTIVE The objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria. METHODS A retrospective review of the histopathology register over the period January 2006 to December 2015. RESULTS The total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 - 12 years (mean 6.1 years ± 3.97 SD). The age group 2 - 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%). CONCLUSION Benign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information.
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Affiliation(s)
- Said M Amin
- Department of Histopathology, National Hospital Abuja, Nigeria
| | | | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
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24
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Seyi-Olajide JO, Ameh EA, Anyanwu SN. Expanding access to surgical care toward universal health coverage: Leveraging sustainable financing strategies for Sub-Saharan Africa. Niger J Clin Pract 2021; 24:148-155. [PMID: 33605902 DOI: 10.4103/njcp.njcp_505_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The National Surgical Obstetric and Anaesthesia Plan is an invaluable country resource with the capacity to promote increased access to safe and affordable surgical and anaesthesia care if implemented. Although cost of implementation is only a fraction of Health Sector Strategic Plan cost in the countries with costed plans, it is important that the funding of the plans is based on sustainable financing strategies. This will ensure appropriate and timely implementation and sustainability of the plan itself. The aim of this review was to discuss and make recommendations on innovative and sustainable strategies for financing national surgical plans in sub-Saharan Africa.
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Affiliation(s)
- J O Seyi-Olajide
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - E A Ameh
- Division of Paediatric Surgery, National hospital, Abuja, Nigeria
| | - S N Anyanwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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25
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Nasir AA, Ameh EA, Ojo EO. A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa. World J Surg 2021; 44:2542-2549. [PMID: 32318791 DOI: 10.1007/s00268-020-05535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa. METHODS Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback. RESULTS The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship. CONCLUSIONS This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Pediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, PMB 1459, Ilorin, Nigeria.
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
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Truche P, Botelho F, Bowder A, Levis A, Corlew DS, Rice HE, Ameh EA, Meara JG, Poenaru D, Mooney DP. Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-Up in Low- and Middle-Income Countries: A Global Study. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mehtar S, Wanyoro A, Ogunsola F, Ameh EA, Nthumba P, Kilpatrick C, Revathi G, Antoniadou A, Giamarelou H, Apisarnthanarak A, Ramatowski JW, Rosenthal VD, Storr J, Osman TS, Solomkin JS. Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases. Int J Infect Dis 2020; 100:123-131. [PMID: 32712427 PMCID: PMC7378004 DOI: 10.1016/j.ijid.2020.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/26/2022] Open
Abstract
Surgical site infection (SSI) rates in low- and middle-income countries (LMICs) range from 8 to 30% of procedures, making them the most frequent healthcare-acquired infection (HAI) with substantial morbidity, mortality, and economic impacts. Presented here is an approach to surgical site infection prevention based on surveillance and focused on five critical areas identified by international experts. These five areas include 1. Collecting valid, high-quality data; 2. Linking HAIs to economic incapacity, underscoring the need to prioritize infection prevention activities; 3. Implementing SSI surveillance within infection prevention and control (IPC) programs to enact structural changes, develop procedural skills, and alter healthcare worker behaviors; 4. Prioritizing IPC training for healthcare workers in LMICs to conduct broad-based surveillance and to develop and implement locally applicable IPC programs; and 5. Developing a highly accurate and objective international system for defining SSIs, which can be translated globally in a straightforward manner. Finally, we present a clear, unambiguous framework for successful SSI guideline implementation that supports developing sustainable IPC programs in LMICs. This entails 1. Identifying index operations for targeted surveillance; 2. Identifying IPC “champions” and empowering healthcare workers; 3. Using multimodal improvement measures; 4. Positioning hand hygiene programs as the basis for IPC initiatives; 5. Use of telecommunication devices for surveillance and healthcare outcome follow-ups. Additionally, special considerations for pediatric SSIs, antimicrobial resistance development, and antibiotic stewardship programs are addressed.
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Affiliation(s)
- Shaheen Mehtar
- Infection Control Africa Network, Cape Town, South Africa
| | - Anthony Wanyoro
- Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya
| | - Folasade Ogunsola
- Infection Control African Network, College of Medicine, University of Lagos, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery National Hospital, Abuja, Nigeria
| | - Peter Nthumba
- Clinical Epidemiologist and Plastic Surgeon, AIC Kijabe Hospital, and GCB, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | | | - Gunturu Revathi
- Microbiology Laboratory, Aga Khan University Hospital, Nairobi, Kenya
| | | | | | | | - John W Ramatowski
- International Federation for Infectious Diseases, Boston, United States
| | | | - Julie Storr
- Consultant with S2 Incorporated, Geneva, Switzerland
| | - Tamer Saied Osman
- Global Disease Detection, US Naval Medical Research Unit 3, Cairo, Egypt
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Seyi-Olajide JO, Anderson J, Enivwaene AO, Ibrahim SH, Farmer D, Ameh EA. Catastrophic Healthcare Expenditure from Typhoid Perforation in Children in Nigeria. Surg Infect (Larchmt) 2020; 21:586-591. [PMID: 32423308 DOI: 10.1089/sur.2020.134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Out-of-pocket payments and catastrophic healthcare expenditures (CHE) are important barriers to achieving equity and access to emergency and essential surgical care in low- and middle-income countries (LMICs), with important implications for universal health coverage (UHC). However, data on CHE for surgical care in these settings are limited, especially with regard to infections. Methods: We performed a retrospective review of 32 children receiving laparotomy for typhoid intestinal perforation in a four-year period. Data on medical costs were reviewed. Because of the lack of reliable data on household incomes and average national incomes for Nigeria, gross domestic product per capita was used to calculate CHE. The GDP per capita for the country during the study period was $2,028.182. Expenditure >10% GDP per capita (or > $202.82) was considered CHE. Results: There were 15 boys and 17 girls aged 2-15 years (mean 7.72 years). Seventeen patients (53%) were referred from district/general hospitals or mission hospitals. After surgical treatment, 16 patients (50%) developed complications (intra-abdominal abscesses and incision complications), and nine (28.1%) required re-operation. Seven patients (21.9%) required intensive care (ICU) treatment and three (9.4%) died from overwhelming infection. The hospital stay was 3-93 days (mean 23 days). The average total medical cost was $452 (range $236-$1,700). The total medical costs exceeded 10% of GDP ($202.82) for all patients. Total expenditure for four patients requiring intensive care exceeded $202.82 for the ICU care alone. Conclusion: Surgical treatment of typhoid intestinal perforation in children is associated with a high rate of CHE if care is provided at tertiary hospitals. Investments in prevention and control of this and other surgical infections as well as scale up of capacity at district hospitals to provide such care are important in preventing CHE.
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Affiliation(s)
- Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Jamie Anderson
- Department of Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Augustine O Enivwaene
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Salamatu Halid Ibrahim
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Diana Farmer
- Department of Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
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Abstract
Background: In past decades, surgical site infections (SSIs) were neglected and not given much global attention in low- and middle-income countries (LMICs). The risk and incidence of SSIs in LMICs continue to increase. Methods: We reviewed the limited quality data on SSIs and complicated intra-abdominal infections in these settings that have hampered advocacy and infection prevention and control efforts. Results: This review identifies the rising profile of global surgery that has resulted in efforts to scale up access to surgical care as well as increase surgical volumes to address unmet needs. The fallout of these efforts would be increasing SSI rates and a rising volume of laparotomies for intra-abdominal infections. Conclusion: Surgical infections are an emerging frontier in global health and surgery. There is an urgent need for global advocacy and investments in their prevention and control.
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Affiliation(s)
- Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
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Abstract
Abstract
Background
Congenital abnormalities of the vas deferens are very uncommon. Duplicate vas deferens is a rare abnormality. It is the presence of two separate vasa deferentia within one spermatic cord. It has been encountered during inguinal hernia repair, orchidopexy, varicocoelectomy, vasectomy and radical prostatectomy. Identification of the vas deferens is mandatory during surgeries involving manipulation of the spermatic cord because if duplication exists and is not detected, there is increased chance of iatrogenic injury.
Case presentation
We present a 3-year-old boy with duplicate vas deferens identified during herniotomy for a right hydrocele. A postoperative abdominopelvic ultrasound scan revealed no abnormalities.
Conclusion
The risk of iatrogenic injury to the vas is increased in the presence of a duplication. A deliberate identification of the vas during procedures involving manipulation of the spermatic cord reduces this risk.
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Seyi-Olajide JO, Ameh EA. Investing in Pediatric Surgical Research to Advance Universal Health Coverage for Children in Nigeria. Niger J Surg 2020; 26:1-8. [PMID: 32165829 PMCID: PMC7041358 DOI: 10.4103/njs.njs_43_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022] Open
Abstract
About 1.7 billion children and adolescents most of whom are in low- and middle-income countries lack access to safe and affordable surgical and anesthesia care when needed. 43% of Nigeria's population of 199 million are below the age of 15 years. In 2015, Nigeria had a pediatric surgeon workforce deficit of 693 for children <15 years. While threats and constraints to achieving universal health coverage in Nigeria have been highlighted, the role of research is often not included. Over the years, there has been a slow but progressive increase in pediatric surgical workforce and research output, both locally and with international collaborations, and in trainee involvement in research as lead authors. There has unfortunately been a challenge with translation of research findings, outcomes, and recommendations into actions. Despite the various challenges mitigating against pediatric surgery research, efforts must be committed to developing and implementing innovative approaches to address the problems and challenges, as well as implementing quality improvement programs and deploying technology to advance children's care. It is hoped that inclusion of children's surgery in the National Surgical, Obstetrics, Anaesthesia, and Nursing Plan would strengthen pediatric surgical research in Nigeria.
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Affiliation(s)
- Justina O Seyi-Olajide
- Department of Surgery, Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emmanuel A Ameh
- Department of Surgery, Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
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Truché P, Shoman H, Reddy CL, Jumbam DT, Ashby J, Mazhiqi A, Wurdeman T, Ameh EA, Smith M, Lugazia E, Makasa E, Park KB, Meara JG. Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery. Global Health 2020; 16:1. [PMID: 31898532 PMCID: PMC6941290 DOI: 10.1186/s12992-019-0531-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022] Open
Abstract
Efforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners - individuals and institutions - help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.
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Affiliation(s)
- Paul Truché
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Haitham Shoman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ché L. Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Desmond T. Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
| | - Joanna Ashby
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | | | - Martin Smith
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Edwin Lugazia
- Department of Anaesthesiology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Emmanuel Makasa
- PSMD-Cabinet Office, Office of the President, Lusaka, Zambia
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Kee B. Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
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Ogundele IO, Alakaloko FM, Nwokoro CC, Ameh EA. Early impact of COVID-19 pandemic on paediatric surgical practice in Nigeria: a national survey of paediatric surgeons. BMJ Paediatr Open 2020; 4:e000732. [PMID: 32923694 PMCID: PMC7467520 DOI: 10.1136/bmjpo-2020-000732] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The novel coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known and mortality is increasing. We assessed its initial impact on paediatric surgical practice in Nigeria, creating a benchmark for recommendations and future reference. METHODS Survey of 120 paediatric surgeons from 50 centres to assess sociodemographics and specific domains of impact of COVID-19 on their services and training in Nigeria. Valid responses were represented as categorical data and presented in percentages. Duplicate submissions for centres were excluded by combining and taking the mean of responses from centres with multiple respondents. RESULTS Response rate was 74 (61%). Forty-six (92%) centres had suspended elective surgeries. All centres continued emergency surgeries but volume reduced in March by 31%. Eleven (22%) centres reported 13 suspended elective cases presenting as emergencies in March, accounting for 3% of total emergency surgeries. Twelve (24%) centres adopted new modalities for managing selected surgical conditions: non-operative reduction of intussusception in 1 (2%), antibiotic management of uncomplicated acute appendicitis in 5 (10%) and more conservative management of trauma and replacement of laparoscopic appendectomy with open surgery in 3 (6%), respectively. Low perception of adequacy of personal protective equipment (PPE) was reported in 35 (70%) centres. Forty (80%) centres did not offer telemedicine for patients' follow-up. Twenty-nine (58%) centres had suspended academic training. Perception of safety to operate was low in 37 (50%) respondents, indifferent in 24% and high in 26%. CONCLUSION Majority of paediatric surgical centres reported cessation of elective surgeries while continuing emergencies. There was, however, an acute decline in the volume of emergency surgeries. Adequate PPE needs to be provided and preparations towards handling backlog of elective surgeries once the pandemic recedes. Further study is planned to more conclusively understand the full impact of this pandemic on children's surgery.
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Affiliation(s)
| | - Felix M Alakaloko
- Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Collins C Nwokoro
- Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Emmanuel A Ameh
- Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
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Adedayo AA, Igashi JB, Mshelbwala PM, Nasir AA, Ameh EA, Adeniran JO. Accuracy of ultrasonography in the evaluation of abdominal masses in children in Nigeria. Afr J Paediatr Surg 2019; 16:1-5. [PMID: 32952131 PMCID: PMC7759082 DOI: 10.4103/ajps.ajps_74_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/05/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Abdominal masses in children constitute a spectrum of lesions of diverse origin, nature and significance. In a low-income setting with limited investigative facilities, accurate diagnosis of abdominal masses can be very challenging. However, ultrasound has been used preferentially as a diagnostic tool in evaluating abdominal masses in children. This study aimed to determine the accuracy of ultrasound evaluation of abdominal masses in children. MATERIALS AND METHODS This was a prospective descriptive study of 135 consecutive children presenting with palpable and/or suspected abdominal masses over a 1-year period at a tertiary hospital. Data analyses were done using SPSS version 17 software and level of significance was set at P < 0.05. RESULTS Abdominal mass was located in the kidney in 40 (32.3%) patients. Definitive diagnoses of abdominal masses were confirmed intraoperatively in 33 (24.4%) and by histopathological examination in 102 (75.6%) cases. Abdominal masses were detected in 124/135 (91.9%) of the participants. Ultrasound (US) correctly identified 109/124 (87.9%) of the pathologies. The sensitivity and specificity of USS were 87.9% and 81.8%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 97.2%-98.2% and 37.5%-45.7%, respectively. The overall US diagnostic accuracy was 87.4%. The predictive value of US for intussusceptions, Wilms' tumour and hydronephrosis was high (sensitivity was 92.0%, 95.8% and 81.1% and PPV was 90.0%, 83.0% and 93.8%, respectively). On the other hand, the sensitivity indices for appendiceal mass/abscess, lymphoma and neuroblastoma were low (28.6%, 66.7% and 57.1%, respectively), while their PPV was low too (66.7%, 42.9% and 77.7%, respectively). The PPV was especially poor for lymphoma. The specificity and NPV indices for these six disease conditions were good. CONCLUSION Ultrasound is a reliable tool in the evaluation of abdominal masses in children in this setting.
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Affiliation(s)
- Adebayo Ayokunle Adedayo
- Department of Surgery, Division of Paediatric Surgery, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Joseph Bako Igashi
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Philip Mari Mshelbwala
- Department of Surgery, Division of Paediatric Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Abdulrashid A. Nasir
- Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel A. Ameh
- Department of Surgery, Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - James O. Adeniran
- Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Nourian MM, Stephens CQ, Mshelbwala P, Li F, Ameh EA, Krishnaswami S. Bridging the Gap: Understanding the Potential of Social Media for Support of Medical Student Education in Resource Limited Settings. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stephens CQ, Ashok A, Ameh EA, Swaroop M, Nwomeh BC, Yang E, Krishnaswami S. Utilizing Technology for Global Surgery: A Survey of the West African College of Surgeons. J Surg Res 2018; 232:202-208. [PMID: 30463719 DOI: 10.1016/j.jss.2018.05.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/07/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Information and communication technology (ICT) has been heralded as a possible mechanism for expanding global surgery collaborations. However, little is known regarding feasibility of ICT use in low- and middle-income countries (LMIC). We sought to determine the appropriate ICT platforms for surgical education initiatives and international collaborations. MATERIALS AND METHODS We conducted a survey of members of the West African College of Surgeons. Topics included computer and internet access/utilization, familiarity with ICT, such as social media (SM), virtual document sharing platforms (VDS), virtual meeting applications (VM), and learning management systems (LM), and interest in ICT adoption. Statistical analyses were done using chi-squared tests, with Bonferroni corrections. RESULTS Survey respondents included 83 individuals from 10 countries, 50% of whom had been in practice >10 y. All had computer access, with most (95%) using SM compared to all other modalities (P < 0.001); 77% used SM for professional reasons and 57% for education. Sixty percent of participants used VDS, 73% of whom used it for education. The utilization of other ICTs was lower (VM 43%, LM 32%). Unreliable Wi-Fi hindered every ICT, less often SM (41%) and VDS (23%), and more commonly VM (64%) and LM (52%). Despite this, VM was most often used in international collaboration (79%, P < 0.01). Most respondents (98%) supported ICT use for international collaboration. CONCLUSIONS ICT platforms can support education initiatives and international collaborations in resource-limited areas. Deployment of similar surveys and ICT workshops across other LMIC regions could maximize ICT utilization, further expanding global surgical collaborations.
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Affiliation(s)
| | - Arjun Ashok
- Oregon Health and Science University, Portland, Oregon
| | - Emmanuel A Ameh
- National Hospital, Abuja, Federal Capital Territory, Nigeria
| | - Mamta Swaroop
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Estin Yang
- Oregon Health and Science University, Portland, Oregon
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Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adedoyin RA, Adetifa IMO, Adetokunboh O, Afshin A, Aggarwal R, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akanda AS, Akinyemiju TF, Akseer N, Al Lami FH, Alabed S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alasfoor D, Aldridge RW, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alizadeh-Navaei R, Aljunid SM, Alkaabi JM, Alkerwi A, Alla F, Allam SD, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Ameh EA, Amini E, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Ansari H, Ansha MG, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Asghar RJ, Assadi R, Assaye AM, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Babalola TK, Bacha U, Badawi A, Balakrishnan K, Balalla S, Barac A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhaumik S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bjerregaard P, Blosser CD, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Breitborde NJK, Brenner H, Brugha TS, Bukhman G, Bulto LNB, Bumgarner BR, Burch M, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Car M, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Castañeda-Orjuela CA, Castro FF, Castro RE, Catalá-López F, Chen H, Chiang PPC, Chibalabala M, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colquhoun SM, Coresh J, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, De Leo D, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dherani MK, Diaz-Torné C, Ding EL, Dixit P, Djalalinia S, Do HP, Doku DT, Donnelly CA, dos Santos KPB, Douwes-Schultz D, Driscoll TR, Duan L, Dubey M, Duncan BB, Dwivedi LK, Ebrahimi H, El Bcheraoui C, Ellingsen CL, Enayati A, Endries AY, Ermakov SP, Eshetie S, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Filip I, Fischer F, Foigt N, Foreman KJ, Frank T, Franklin RC, Fraser M, Friedman J, Frostad JJ, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Gambashidze K, Gamkrelidze A, Gankpé FG, Garcia-Basteiro AL, Gebregergs GB, Gebrehiwot TT, Gebrekidan KG, Gebremichael MW, Gelaye AA, Geleijnse JM, Gemechu BL, Gemechu KS, Genova-Maleras R, Gesesew HA, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Girma BW, Giussani G, Goenka S, Gomez B, Gona PN, Gopalani SV, Goulart AC, Graetz N, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Haagsma JA, Hafezi-Nejad N, Hakuzimana A, Halasa YA, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Harikrishnan S, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, He F, Heredia-Pi IB, Herteliu C, Hilawe EH, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huang H, Iburg KM, Igumbor EU, Ileanu BV, Inoue M, Irenso AA, Irvine CMS, Islam SMS, Islam N, Jacobsen KH, Jaenisch T, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jin Y, John D, John O, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Karthikeyan G, Kasaeian A, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Keiyoro PN, Kelbore SG, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Ketema EB, Khader YS, Khalil IA, Khan EA, Khan G, Khang YH, Khera S, Khoja ATA, Khosravi MH, Kibret GD, Kieling C, Kim YJ, Kim CI, Kim D, Kim P, Kim S, Kimokoti RW, Kinfu Y, Kishawi S, Kissoon N, Kivimaki M, Knudsen AK, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kuate Defo B, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kumar P, Kumsa FA, Kutz M, Lachat C, Lagat AK, Lager ACJ, Lal DK, Lalloo R, Lambert N, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Laxmaiah A, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liao Y, Liben ML, Lim SS, Linn S, Lipshultz SE, Liu S, Lodha R, Logroscino G, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Ma S, Macarayan ER, Machado IE, Mackay MT, Magdy Abd El Razek M, Magis-Rodriguez C, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marczak LB, Marks GB, Martin EA, Martinez-Raga J, Martins-Melo FR, Massano J, Maulik PK, Mayosi BM, Mazidi M, McAlinden C, McGarvey ST, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Mehta KM, Meier T, Mekonnen TC, Meles KG, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mengistu DT, Menon GR, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Mikesell J, Miller TR, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohan MBV, Mohanty SK, Mokdad AH, Mollenkopf SK, Molokhia M, Monasta L, Montañez Hernandez JC, Montico M, Mooney MD, Moore AR, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Morrison SD, Mruts KB, Mueller UO, Mullany E, Muller K, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naidoo KS, Nanda L, Nangia V, Nascimento BR, Natarajan G, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Ningrum DNA, Nisar MI, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyakarahuka L, O'Donnell MJ, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Osgood-Zimmerman A, Ota E, Owolabi MO, Oyekale AS, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Park EK, Parsaeian M, Patel T, Patten SB, Patton GC, Paudel D, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petri WA, Petzold M, Phillips MR, Piel FB, Pigott DM, Pishgar F, Plass D, Polinder S, Popova S, Postma MJ, Poulton RG, Pourmalek F, Prasad N, Purwar M, Qorbani M, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman SU, Rahman M, Rai RK, Rajsic S, Ram U, Rana SM, Ranabhat CL, Rao PV, Rawaf S, Ray SE, Rego MAS, Rehm J, Reiner RC, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rivas JC, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Sahebkar A, Sahraian MA, Salama J, Salamati P, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Sanchez-Niño MD, Santos IS, Santric Milicevic MM, Sarmiento-Suarez R, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Seid AM, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Shen J, Shetty BP, Shi P, Shibuya K, Shifa GT, Shigematsu M, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Sindi S, Singh JA, Singh PK, Singh A, Singh V, Sinha DN, Skarbek KAK, Skiadaresi E, Sligar A, Smith DL, Sobaih BHA, Sobngwi E, Soneji S, Soriano JB, Sreeramareddy CT, Srinivasan V, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stöckl H, Stokes MA, Strong M, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tadese F, Tandon N, Tanne D, Tarajia M, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Temsah MH, Terkawi AS, Tesema CL, Tesssema B, Theis A, Thomas N, Thompson AH, Thomson AJ, Thrift AG, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tortajada M, Tran BX, Truelsen T, Trujillo U, Tsilimparis N, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uthman OA, Uzochukwu BSC, van Boven JFM, Varakin YY, Varughese S, Vasankari T, Vasconcelos AMN, Velasquez IM, Venketasubramanian N, Vidavalur R, Violante FS, Vishnu A, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Waid JL, Wakayo T, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wesana J, Wijeratne T, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Workicho A, Workie SB, Xavier D, Xu G, Yaghoubi M, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yirsaw BD, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zeeb H, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zodpey S, Zuhlke LJ, Lopez AD, Murray CJL. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1084-1150. [PMID: 28919115 PMCID: PMC5605514 DOI: 10.1016/s0140-6736(17)31833-0] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Makama JG, Kache SA, Ajah LJ, Ameh EA. INTESTINAL OBSTRUCTION CAUSED BY APPENDICITIS: A SYSTEMATIC REVIEW. J West Afr Coll Surg 2017; 7:94-115. [PMID: 30525005 PMCID: PMC6237405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The known complications of appendicitis include perforated appendicitis with generalised peritonitis, appendiceal mass, appendiceal abscess, sepsis, adhesion formation and in a few occasions, small bowel intestinal obstruction. AIM To review published cases of intestinal obstruction due to appendicitis with a view to better understand the pathophysiology of this complication. METHODOLOGY A search of the literature in the MEDLINE database, using PubMed and OvidSP, Scopus, Google Scholar and Cochrane Databases with the following MeSH terms: (Appendicitis or appendiceal mass, appendiceal abscess or appendiceal adhesion band) and (intestinal obstruction, intestinal herniation, intestinal strangulation, intestinal knotting and paralytic ileus) was done. Also, these searches were restricted according to the following MeSH limits: (a) January 1, 1950 to July 31, 2016, (b) English articles (c) Human. RESULTS Overall, 27 articles reported 45 patients with intestinal obstruction due to appendicitis. Of the 30 (66.7%) patients that the gender was indicated, 22 (48.9%) were male while 8 (17.8%) were female. In 38 (84.4%) cases the cause was mechanical obstruction resulting from one or a combination of the following: (a) appendix laid across loops of bowel bound down by adhesions, (b) herniation through a ring or gap formed by the appendix tip being attached to its base, (c) appendix tip attached to the bowel causing a torsion, (d) kinking of the bowel, (e) complex knotting. Pre-operative diagnosis was a major challenge and so, none was approached through incision based on the McBurney's point.The outcome of treatment which was mostly achieved by immediate appendectomy followed by adhesiolysis was sufficient and often gave good results. CONCLUSION This study has shown that appendicitis is an important cause of intestinal obstruction. Even though pre-operative diagnosis is still a major challenge, clinical evaluation and a high index of suspicion are key to diagnosis.
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Affiliation(s)
- J G Makama
- Department of Surgery, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria
| | - S A Kache
- Department of Surgery, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria
| | - L J Ajah
- Department of Surgery, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria
| | - E A Ameh
- Department of Surgery, National Hospital, Garki, Abuja, Nigeria
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Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, Rice HE. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One 2016; 11:e0165480. [PMID: 27792792 PMCID: PMC5085034 DOI: 10.1371/journal.pone.0165480] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/12/2016] [Indexed: 12/05/2022] Open
Abstract
Background Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs). Methods We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. Findings We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Interpretation Our findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.
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Affiliation(s)
- Anthony T. Saxton
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Dan Poenaru
- McMaster Paediatric Surgery Research Collaborative, Dept. of Surgery, McMaster University, Hamilton, Canada
| | - Doruk Ozgediz
- Yale-New Haven Hospital, New Haven, CT, United States of America
| | | | - Diana Farmer
- University of California-Davis Health System, Davis, CA, United States of America
| | - Emily R. Smith
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Henry E. Rice
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
- * E-mail:
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Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR, Kutz M, Kyu HH, Larson HJ, Leung J, Liang X, Lim SS, Lind M, Lozano R, Marquez N, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Roth GA, Salomon JA, Sandar L, Silpakit N, Sligar A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Thomas BA, Troeger C, VanderZanden A, Vollset SE, Wanga V, Whiteford HA, Wolock T, Zoeckler L, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abreu DMX, Abu-Raddad LJ, Abyu GY, Achoki T, Adelekan AL, Ademi Z, Adou AK, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Lami FHA, Alabed S, Al-Aly Z, Alam K, Alam NKM, Alasfoor D, Aldhahri SF, Aldridge RW, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Alhabib S, Ali R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amegah AK, Ameh EA, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Aregay AF, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu A, Basu S, Bayou YT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Belay HA, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhalla A, Biadgilign S, Bikbov B, Abdulhak AAB, Biroscak BJ, Biryukov S, Bjertness E, Blore JD, Blosser CD, Bohensky MA, Borschmann R, Bose D, Bourne RRA, Brainin M, Brayne CEG, Brazinova A, Breitborde NJK, Brenner H, Brewer JD, Brown A, Brown J, Brugha TS, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cercy K, Cerda J, Chen W, Chew A, Chiang PPC, Chibalabala M, Chibueze CE, Chimed-Ochir O, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colistro V, Colomar M, Colquhoun SM, Cooper C, Cooper LT, Cortinovis M, Cowie BC, Crump JA, Damsere-Derry J, Danawi H, Dandona R, Daoud F, Darby SC, Dargan PI, das Neves J, Davey G, Davis AC, Davitoiu DV, de Castro EF, de Jager P, Leo DD, Degenhardt L, Dellavalle RP, Deribe K, Deribew A, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Ding EL, dos Santos KPB, Dossou E, Driscoll TR, Duan L, Dubey M, Duncan BB, Ellenbogen RG, Ellingsen CL, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Faghmous IDA, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Flaxman A, Foigt N, Fowkes FGR, Franca EB, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gall SL, Gambashidze K, Gamkrelidze A, Ganguly P, Gankpé FG, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Geleijnse JM, Gessner BD, Ghoshal AG, Gibney KB, Gillum RF, Gilmour S, Giref AZ, Giroud M, Gishu MD, Giussani G, Glaser E, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gosselin RA, Gotay CC, Goto A, Gouda HN, Greaves F, Gugnani HC, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Havmoeller R, Heckbert SR, Heredia-Pi IB, Heydarpour P, Hilderink HBM, Hoek HW, Hogg RS, Horino M, Horita N, Hosgood HD, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Htike MMT, Hu G, Huang C, Huang H, Huiart L, Husseini A, Huybrechts I, Huynh G, Iburg KM, Innos K, Inoue M, Iyer VJ, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jonas JB, Joshi TK, Kabir Z, Kamal R, Kan H, Kant S, Karch A, Karema CK, Karimkhani C, Karletsos D, Karthikeyan G, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Khader YS, Khalil IA, Khan AR, Khan EA, Khang YH, Khera S, Khoja TAM, Kieling C, Kim D, Kim YJ, Kissela BM, Kissoon N, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Krog NH, Defo BK, Bicer BK, Kudom AA, Kuipers EJ, Kulkarni VS, Kumar GA, Kwan GF, Lal A, Lal DK, Lalloo R, Lallukka T, Lam H, Lam JO, Langan SM, Lansingh VC, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leigh J, Levi M, Li Y, Lindsay MP, Lipshultz SE, Liu PY, Liu S, Liu Y, Lo LT, Logroscino G, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Ma S, Machado VMP, Mackay MT, MacLachlan JH, Razek HMAE, Magdy M, Razek AE, Majdan M, Majeed A, Malekzadeh R, Manamo WAA, Mandisarisa J, Mangalam S, Mapoma CC, Marcenes W, Margolis DJ, Martin GR, Martinez-Raga J, Marzan MB, Masiye F, Mason-Jones AJ, Massano J, Matzopoulos R, Mayosi BM, McGarvey ST, McGrath JJ, McKee M, McMahon BJ, Meaney PA, Mehari A, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Micha R, Millear A, Miller TR, Mirarefin M, Misganaw A, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Mohan V, Mola GLD, Monasta L, Hernandez JCM, Montero P, Montico M, Montine TJ, Moradi-Lakeh M, Morawska L, Morgan K, Mori R, Mozaffarian D, Mueller UO, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naidoo KS, Naik N, Naldi L, Nangia V, Nash D, Nejjari C, Neupane S, Newton CR, Newton JN, Ng M, Ngalesoni FN, de Dieu Ngirabega J, Nguyen QL, Nisar MI, Pete PMN, Nomura M, Norheim OF, Norman PE, Norrving B, Nyakarahuka L, Ogbo FA, Ohkubo T, Ojelabi FA, Olivares PR, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osman M, Ota E, Ozdemir R, PA M, Pain A, Pandian JD, Pant PR, Papachristou C, Park EK, Park JH, Parry CD, Parsaeian M, Caicedo AJP, Patten SB, Patton GC, Paul VK, Pearce N, Pedro JM, Stokic LP, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Plass D, Platts-Mills JA, Polinder S, Pope CA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Qorbani M, Quame-Amaglo J, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajavi Z, Rajsic S, Raju M, Rakovac I, Rana SM, Ranabhat CL, Rangaswamy T, Rao P, Rao SR, Refaat AH, Rehm J, Reitsma MB, Remuzzi G, Resnikoff S, Ribeiro AL, Ricci S, Blancas MJR, Roberts B, Roca A, Rojas-Rueda D, Ronfani L, Roshandel G, Rothenbacher D, Roy A, Roy NK, Ruhago GM, Sagar R, Saha S, Sahathevan R, Saleh MM, Sanabria JR, Sanchez-Niño MD, Sanchez-Riera L, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schaub MP, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Sharma R, She J, Sheikhbahaei S, Shen J, Shen Z, Shepard DS, Sheth KN, Shetty BP, Shi P, Shibuya K, Shin MJ, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Singh V, Soneji S, Søreide K, Soriano JB, Sposato LA, Sreeramareddy CT, Stathopoulou V, Stein DJ, Stein MB, Stranges S, Stroumpoulis K, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Takahashi K, Takala JS, Talongwa RT, Tandon N, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tedla BA, Tefera WM, Have MT, Terkawi AS, Tesfay FH, Tessema GA, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tirschwell DL, Tonelli M, Topor-Madry R, Topouzis F, Towbin JA, Traebert J, Tran BX, Truelsen T, Trujillo U, Tura AK, Tuzcu EM, Uchendu US, Ukwaja KN, Undurraga EA, Uthman OA, Dingenen RV, van Donkelaar A, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Vidavalur R, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Wagner JA, Wagner GR, Wallin MT, Wang L, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, White RA, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Wong JQ, Woolf AD, Xavier D, Xiao Q, Xu G, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yebyo HG, Yip P, Yirsaw BD, Yonemoto N, Yonga G, Younis MZ, Yu S, Zaidi Z, Zaki MES, Zannad F, Zavala DE, Zeeb H, Zeleke BM, Zhang H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1459-1544. [PMID: 27733281 PMCID: PMC5388903 DOI: 10.1016/s0140-6736(16)31012-1] [Citation(s) in RCA: 4031] [Impact Index Per Article: 503.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. INTERPRETATION At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. FUNDING Bill & Melinda Gates Foundation.
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BACKGROUND Primary wound closure following laparotomy for peritonitis is generally believed to be associated with wound complications and long hospital stay. Open wound management has long been the most common practice after laparotomy for peritonitis. Primary closure (PC), however, has recently been advocated to reduce cost and morbidity. This study determined the incidence and severity of wound complications and their impact on hospital stay and overall outcome when PC of abdominal wounds is done following laparotomy for peritonitis. PATIENTS AND METHODS A prospective review of patients who had PC of abdominal wounds following laparotomy for peritonitis over a 6-year period. RESULTS Fifty-six children were analysed (35 boys and 21 girls), aged 11 months to 13 years (median: 8 years). The indication for laparotomy was typhoid intestinal perforation 47 (83.9%), perforated appendicitis 4 (7.1%), complicated cholecystitis 3 (5.3%) and penetrating abdominal injury with bowel perforation and intestinal obstruction with bowel perforation, 1 (1.8%) each, respectively. Postoperatively, 34 patients had wound complications. Nine patients (16.1%) had superficial wound infection alone, 12 (21.4%) had superficial wound infection with partial wound dehiscence, 6 (10.7%) had deep wound infection, 7 (12.5%) had deep wound infection with complete wound dehiscence, whereas 22 (39.3%) had no wound complication. Overall, wound complications in 13 (23.2%) patients were considered to be severe, but none resulted in mortality. Hospital stay in patients who developed wound complications was 8-37 days (median: 25 days) and 6-22 days (median: 10 days) in patients who had no wound complications (P = 0.02). CONCLUSION The rate of wound complications following PC of dirty abdominal wounds remain but PC is safe and gives good healing outcomes.
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Affiliation(s)
- Stephen Akau Kache
- Department of Surgery, Division of Paediatric Surgery, Kaduna State University, Barau Dikko Teaching Hospital, Kaduna, Nigeria
| | - Philip M Mshelbwala
- Department of Surgery, Division of Paediatric Surgery, University of Abuja, Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Emmanuel A Ameh
- Department of Surgery, Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
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Most of the world is in a surgical workforce crisis. While a lack of human resources is only one component of the myriad issues affecting surgical care in resource-poor regions, it is arguably the most consequential. This article examines the current state of the pediatric surgical workforce in low- and middle-income countries (LMICs) and the reasons for the current shortfalls. We also note progress that has been made in capacity building and discuss priorities going forward. The existing literature on this subject has naturally focused on regions with the greatest workforce needs, particularly sub-Saharan Africa (SSA). However, wherever possible we have included workforce data and related literature from LMICs worldwide. The pediatric surgeon is of course critically dependent on multi-disciplinary teams. Surgeons in high-income countries (HICs) often take for granted the ready availability of excellent anesthesia providers, surgically trained nurses, radiologists, pathologists, and neonatologists among many others. While the need exists to examine all of these disciplines and their contribution to the delivery of surgical services for children in LMICs, for the purposes of this review, we will focus primarily on the role of the pediatric surgeon.
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Affiliation(s)
- Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Suite 300, Portland, Oregon 97239.
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University School of Medicine. Columbus, Ohio
| | - Emmanuel A Ameh
- Division of Pediatric Surgery, National Hospital, Abuja, Nigeria
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Greenberg SLM, Ng-Kamstra JS, Ameh EA, Ozgediz DE, Poenaru D, Bickler SW. An investment in knowledge: Research in global pediatric surgery for the 21st century. Semin Pediatr Surg 2016; 25:51-60. [PMID: 26831138 DOI: 10.1053/j.sempedsurg.2015.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The body of literature addressing surgical and anesthesia care for children in low- and middle-income countries (LMICs) is small. This lack of research hinders full understanding of the nature of many surgical conditions in LMICs and compromises potential efforts to alleviate the significant health, welfare and economic burdens surgical conditions impose on children, families and countries. This article will evaluate the need for improved global pediatric surgery research by (1) presenting the current state of surgical research for children in LMICs and (2) discussing methods and opportunities for improvement within the political context of current global health priorities.
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Affiliation(s)
- Sarah L M Greenberg
- Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, Wisconsin 53266; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Joshua S Ng-Kamstra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Doruk E Ozgediz
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Dan Poenaru
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec; Bethany Kids at Myung Sung Christian Medical Center, Addis Ababa, Ethiopia
| | - Stephen W Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, California
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Ameh EA. Peer review report 1 on “The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study”. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.11.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cassidy LD, Olaomi O, Ertl A, Ameh EA. Collaborative Development and Results of a Nigerian Trauma Registry. J Registry Manag 2016; 43:23-28. [PMID: 27195995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND More than 90% of injury-related deaths and disabilities occur in low- and middle-income countries. The development of the Nigerian Trauma Registry (NTR) and the first descriptive data analysis of the patient characteristics, mechanisms of injury, injury severity, and treatments are reported. METHODS Existing data collection tools were modified to capture a minimum data set of variables reflective of the trauma experience in Nigeria. Data are collected using the secure, Web-based application, REDCap (Research Electronic Data Capture). RESULTS Two hospitals entered 564 patients into the registry. Motor vehicle accidents were the most frequently reported trauma (69.2%). Of the 51 fall injuries, 82% were from buildings. There were 229 mass casualties, including bus accidents (41.5%), bombings or blasts (28.8%), multiple vehicle accidents (23.6%), fires (3.1%), and civil conflicts or riots (3.1%). External soft tissue was the most commonly reported injury region followed by extremities, head and neck, face, abdomen, and thorax/spine. Only 18.1% of patients arrived by ambulance. There were 19 recorded in-hospital deaths and 79.0% of these were due to motor vehicle accidents. CONCLUSIONS This is the largest report of injury surveillance in this country. These data are essential to inform policy makers about the increasing trauma burden and provide a strong advocacy tool, prevention opportunities, provisions for unmet capacity needs, and better allocation of limited health care resources. The NTR has demonstrated that development and implementation of an electronic trauma registry is feasible in low- and middle-income countries. The NTR evolved through international collaborations that included a partnership with an American epidemiologist and 2 Nigerian hospitals that contributed their individual and institutional capabilities. Local champions are required to drive the initiation and implementation of registries.
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Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NME, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs ADM, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PGJ, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TKD, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farzadfar F, Fay DFJ, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IAM, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VMP, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega JDD, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS, Pain AW, Pandian JD, Panelo CIA, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SAL, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DAA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJC, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJC, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AMN, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CDA, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, Murray CJ. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:2287-323. [PMID: 26364544 PMCID: PMC4685753 DOI: 10.1016/s0140-6736(15)00128-2] [Citation(s) in RCA: 1719] [Impact Index Per Article: 191.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING Bill & Melinda Gates Foundation.
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Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, Abera SF, Abraham JP, Adofo K, Alsharif U, Ameh EA, Ammar W, Antonio CAT, Barrero LH, Bekele T, Bose D, Brazinova A, Catalá-López F, Dandona L, Dandona R, Dargan PI, De Leo D, Degenhardt L, Derrett S, Dharmaratne SD, Driscoll TR, Duan L, Petrovich Ermakov S, Farzadfar F, Feigin VL, Franklin RC, Gabbe B, Gosselin RA, Hafezi-Nejad N, Hamadeh RR, Hijar M, Hu G, Jayaraman SP, Jiang G, Khader YS, Khan EA, Krishnaswami S, Kulkarni C, Lecky FE, Leung R, Lunevicius R, Lyons RA, Majdan M, Mason-Jones AJ, Matzopoulos R, Meaney PA, Mekonnen W, Miller TR, Mock CN, Norman RE, Orozco R, Polinder S, Pourmalek F, Rahimi-Movaghar V, Refaat A, Rojas-Rueda D, Roy N, Schwebel DC, Shaheen A, Shahraz S, Skirbekk V, Søreide K, Soshnikov S, Stein DJ, Sykes BL, Tabb KM, Temesgen AM, Tenkorang EY, Theadom AM, Tran BX, Vasankari TJ, Vavilala MS, Vlassov VV, Woldeyohannes SM, Yip P, Yonemoto N, Younis MZ, Yu C, Murray CJL, Vos T. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2015; 22:3-18. [PMID: 26635210 PMCID: PMC4752630 DOI: 10.1136/injuryprev-2015-041616] [Citation(s) in RCA: 779] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/30/2015] [Indexed: 12/14/2022]
Abstract
Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.
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Affiliation(s)
- Juanita A Haagsma
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA ErasmusMC, Rotterdam, Netherlands
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Ian Bolliger
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Hideki Higashi
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Semaw Ferede Abera
- Mekelle University, College of Health Sciences, School of Public Health, Mekelle, Tigray, Ethiopia Kilte Awlaelo-Health and Demographic Surveillance Site, Mekelle, Tigray, Ethiopia
| | - Jerry Puthenpurakal Abraham
- University of Southern California (USC) Family Medicine Residency Program at California Hospital, a Dignity Health member, Los Angeles, California, USA Harvard School of Public Health/Harvard Institute for Global Health, Boston, Massachusetts, USA
| | - Koranteng Adofo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | | | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Lope H Barrero
- Department of Industrial Engineering, Pontificia Universidad Javeriana, Bogota, Cundinamarca, Colombia
| | - Tolesa Bekele
- Madawalabu University, Ethiopia, Bale Goba, Oromia, Ethiopia
| | | | - Alexandra Brazinova
- Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Ferrán Catalá-López
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA Public Health Foundation of India, New Delhi, India
| | | | - Paul I Dargan
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Diego De Leo
- Griffith University, Brisbane, Queensland, Australia
| | | | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand School of Public Health, College of Health, Massey University, Palmerston North, New Zealand
| | | | - Tim R Driscoll
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leilei Duan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, China CDC, Beijing, China
| | - Sergey Petrovich Ermakov
- The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia Federal Research Institute for Health Organization and Informatics of Ministry of Health of Russian Federation, Moscow, Russia
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
| | | | | | - Richard A Gosselin
- University of California in San Francisco, San Francisco, California, USA
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Martha Hijar
- Fundacion Entornos AC, Cuernavaca, Morelos, Mexico
| | - Guoqing Hu
- Central South University, School of Public Health, Changsha, Hunan, China
| | | | - Guohong Jiang
- Tianjin Centers for Diseases Control and Prevention, Tianjin, China
| | | | - Ejaz Ahmad Khan
- Health Services Academy, Islamabad, Punjab, Pakistan Expanded Programme on Immunization, Islamabad, Punjab, Pakistan
| | | | - Chanda Kulkarni
- Rajrajeswari Medical College & Hospital, Bangalore, Karnataka, India
| | - Fiona E Lecky
- EMRiS, Health Services Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | | | - Raimundas Lunevicius
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Marek Majdan
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia
| | | | - Richard Matzopoulos
- South African Medical Research Council, Cape Town, South Africa University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Peter A Meaney
- Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Children's Hospital of Philadelphia
| | | | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA Curtin University Centre for Population Health, Perth, Western Australia, Australia
| | | | - Rosana E Norman
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ricardo Orozco
- National Institute of Psychiatry, Mexico City, Distrito Federal, Mexico
| | | | - Farshad Pourmalek
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Rojas-Rueda
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
| | - Nobhojit Roy
- BARC Hospital, HBNI University, Mumbai, Maharashtra, India Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | - Sergey Soshnikov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation was founded in 1999 by the order of Ministry of Health of Russia, Moscow, Russia
| | - Dan J Stein
- University of Cape Town, Cape Town, Western Province, South Africa MRC Unit on Anxiety & Stress Disorders, Cape Town, Western Cape, South Africa
| | | | - Karen M Tabb
- University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | | | | | | | - Bach Xuan Tran
- Johns Hopkins University, Baltimore, Maryland, USA Hanoi Medical University, Hanoi, Vietnam
| | | | | | | | | | - Paul Yip
- The University of Hong Kong, Hong Kong, China
| | - Naohiro Yonemoto
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan, Hubei, China Global Health Institute, Wuhan University, Wuhan, China
| | | | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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Murray CJL, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Ackerman IN, Ademi Z, Adou AK, Adsuar JC, Afshin A, Agardh EE, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allebeck P, Almazroa MA, Alsharif U, Alvarez E, Alvis-Guzman N, Amare AT, Ameh EA, Amini H, Ammar W, Anderson HR, Anderson BO, Antonio CAT, Anwari P, Arnlöv J, Arsic Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Avila MA, Awuah B, Bachman VF, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Basu A, Basu S, Basulaiman MO, Beardsley J, Bedi N, Beghi E, Bekele T, Bell ML, Benjet C, Bennett DA, Bensenor IM, Benzian H, Bernabé E, Bertozzi-Villa A, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bienhoff K, Bikbov B, Biryukov S, Blore JD, Blosser CD, Blyth FM, Bohensky MA, Bolliger IW, Bora Başara B, Bornstein NM, Bose D, Boufous S, Bourne RRA, Boyers LN, Brainin M, Brayne CE, Brazinova A, Breitborde NJK, Brenner H, Briggs AD, Brooks PM, Brown JC, Brugha TS, Buchbinder R, Buckle GC, Budke CM, Bulchis A, Bulloch AG, Campos-Nonato IR, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chiang PP, Chimed-Ochir O, Chowdhury R, Christensen H, Christophi CA, Cirillo M, Coates MM, Coffeng LE, Coggeshall MS, Colistro V, Colquhoun SM, Cooke GS, Cooper C, Cooper LT, Coppola LM, Cortinovis M, Criqui MH, Crump JA, Cuevas-Nasu L, Danawi H, Dandona L, Dandona R, Dansereau E, Dargan PI, Davey G, Davis A, Davitoiu DV, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dherani MK, Diaz-Torné C, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Duber HC, Ebel BE, Edmond KM, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Estep K, Faraon EJA, Farzadfar F, Fay DF, Feigin VL, Felson DT, Fereshtehnejad SM, Fernandes JG, Ferrari AJ, Fitzmaurice C, Flaxman AD, Fleming TD, Foigt N, Forouzanfar MH, Fowkes FGR, Paleo UF, Franklin RC, Fürst T, Gabbe B, Gaffikin L, Gankpé FG, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Giroud M, Giussani G, Gomez Dantes H, Gona P, González-Medina D, Gosselin RA, Gotay CC, Goto A, Gouda HN, Graetz N, Gugnani HC, Gupta R, Gupta R, Gutiérrez RA, Haagsma J, Hafezi-Nejad N, Hagan H, Halasa YA, Hamadeh RR, Hamavid H, Hammami M, Hancock J, Hankey GJ, Hansen GM, Hao Y, Harb HL, Haro JM, Havmoeller R, Hay SI, Hay RJ, Heredia-Pi IB, Heuton KR, Heydarpour P, Higashi H, Hijar M, Hoek HW, Hoffman HJ, Hosgood HD, Hossain M, Hotez PJ, Hoy DG, Hsairi M, Hu G, Huang C, Huang JJ, Husseini A, Huynh C, Iannarone ML, Iburg KM, Innos K, Inoue M, Islami F, Jacobsen KH, Jarvis DL, Jassal SK, Jee SH, Jeemon P, Jensen PN, Jha V, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Karch A, Karema CK, Karimkhani C, Karthikeyan G, Kassebaum NJ, Kaul A, Kawakami N, Kazanjan K, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SEA, Khan EA, Khan G, Khang YH, Kieling C, Kim D, Kim S, Kim Y, Kinfu Y, Kinge JM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kosen S, Krishnaswami S, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kyu HH, Lai T, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larsson A, Lawrynowicz AEB, Leasher JL, Leigh J, Leung R, Levitz CE, Li B, Li Y, Li Y, Lim SS, Lind M, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Lofgren KT, Logroscino G, Looker KJ, Lortet-Tieulent J, Lotufo PA, Lozano R, Lucas RM, Lunevicius R, Lyons RA, Ma S, Macintyre MF, Mackay MT, Majdan M, Malekzadeh R, Marcenes W, Margolis DJ, Margono C, Marzan MB, Masci JR, Mashal MT, Matzopoulos R, Mayosi BM, Mazorodze TT, Mcgill NW, Mcgrath JJ, Mckee M, Mclain A, Meaney PA, Medina C, Mehndiratta MM, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Mitchell PB, Mock CN, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GLD, Monasta L, Montañez Hernandez JC, Montico M, Montine TJ, Mooney MD, Moore AR, Moradi-Lakeh M, Moran AE, Mori R, Moschandreas J, Moturi WN, Moyer ML, Mozaffarian D, Msemburi WT, Mueller UO, Mukaigawara M, Mullany EC, Murdoch ME, Murray J, Murthy KS, Naghavi M, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nejjari C, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Nguyen G, Nisar MI, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Ohno SL, Olusanya BO, Opio JN, Ortblad K, Ortiz A, Pain AW, Pandian JD, Panelo CIA, Papachristou C, Park EK, Park JH, Patten SB, Patton GC, Paul VK, Pavlin BI, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phillips BK, Phillips DE, Piel FB, Plass D, Poenaru D, Polinder S, Pope D, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Pullan RL, Qato DM, Quistberg DA, Rafay A, Rahimi K, Rahman SU, Raju M, Rana SM, Razavi H, Reddy KS, Refaat A, Remuzzi G, Resnikoff S, Ribeiro AL, Richardson L, Richardus JH, Roberts DA, Rojas-Rueda D, Ronfani L, Roth GA, Rothenbacher D, Rothstein DH, Rowley JT, Roy N, Ruhago GM, Saeedi MY, Saha S, Sahraian MA, Sampson UKA, Sanabria JR, Sandar L, Santos IS, Satpathy M, Sawhney M, Scarborough P, Schneider IJ, Schöttker B, Schumacher AE, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serina PT, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shamah Levy T, Shangguan S, She J, Sheikhbahaei S, Shi P, Shibuya K, Shinohara Y, Shiri R, Shishani K, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh JA, Singh L, Skirbekk V, Slepak EL, Sliwa K, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stanaway JD, Stathopoulou V, Stein DJ, Stein MB, Steiner C, Steiner TJ, Stevens A, Stewart A, Stovner LJ, Stroumpoulis K, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Tandon N, Tanne D, Tanner M, Tavakkoli M, Taylor HR, Te Ao BJ, Tediosi F, Temesgen AM, Templin T, Ten Have M, Tenkorang EY, Terkawi AS, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tonelli M, Topouzis F, Toyoshima H, Traebert J, Tran BX, Trillini M, Truelsen T, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Undurraga EA, Uzun SB, Van Brakel WH, Van De Vijver S, van Gool CH, Van Os J, Vasankari TJ, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Wagner J, Waller SG, Wan X, Wang H, Wang J, Wang L, Warouw TS, Weichenthal S, Weiderpass E, Weintraub RG, Wenzhi W, Werdecker A, Westerman R, Whiteford HA, Wilkinson JD, Williams TN, Wolfe CD, Wolock TM, Woolf AD, Wulf S, Wurtz B, Xu G, Yan LL, Yano Y, Ye P, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaki ME, Zhao Y, Zheng Y, Zonies D, Zou X, Salomon JA, Lopez AD, Vos T. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet 2015; 386:2145-91. [PMID: 26321261 PMCID: PMC4673910 DOI: 10.1016/s0140-6736(15)61340-x] [Citation(s) in RCA: 1284] [Impact Index Per Article: 142.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING Bill & Melinda Gates Foundation.
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Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 2015; 25:75-8. [PMID: 26597405 DOI: 10.1016/j.ijoa.2015.09.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Blake C Alkire
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nivaldo Alonso
- Plastic Surgery Department, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A Ameh
- Department of Surgery, Division of Peadiatric Surgery, National Hospital, Abuja, Nigeria
| | - Stephen W Bickler
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
| | - Lesong Conteh
- School of Public Health, Imperial College London, London, UK
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | | | | | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Division of Global Health Equity, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA; Partners in Health, Boston, MA, USA
| | - Atul Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs Boston, MA, USA
| | - Rowan Gillies
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Russell L Gruen
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Thaim Buya Kamara
- Connaught Hospital, Freetown, Sierra Leone; Department of Surgery, University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ganbold Lundeg
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyengo C Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Edgar Rodas
- The Cinterandes Foundation, Universidad del Cuenca, and Universidad del Azuay, Cuenca, Ecuador; Universidad del Azuay, Cuenca, Ecuador
| | - John Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, King's Centre for Global Health, King's College London, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Watters
- Royal Australasian College of Surgeons, East Melbourne and Deakin University, Melbourne, VIC, Australia
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Iain H Wilson
- Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK
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