Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Gastrointestinal helminths of local chickens slaughtered in live bird markets in Makurdi Metropolis, Benue State, Nigeria

The local chicken constitutes a major part of our poultry population providing eggs and meat for domestic and commercial purposes. They however get very little or no medical attention making them vulnerable to parasitic infection. This study was conducted to determine the prevalence of gastrointestinal (GI) helminths of local chickens slaughtered in four Live Bird Markets (LBMs) in Makurdi between September and December, 2016. A total of 200 gastrointestinal samples were collected from male and female chickens and were examined for GI helminths using the flotation method. A total of 110 chickens were infected with an overall prevalence of 55.0% with 69(34.5%) having single infection, 32(16.0%) double infection, 8(4.0%) triple infection and 1(0.50%) had quadruple infection. Ten species of GI helminths were encountered, three cestodes and seven nematodes. Rallietina species with 73(36.5%) was the most prevalent followed by Ascaridia galli 36(18.0%), Amidostomum anseris 1(0.5%) and Davainea proglottina 1(0.5%) as the least prevalent. There was no statistical significant difference between the four different LBMs (p = 0.058) but there was statistical significant difference in the infection rate based on sex (P= 0.041) and site of preference by the parasite (p = 0.00). Based on location of parasites in the GIT 60.5% of the species were restricted to the small intestine, with the large intestine having 19.5%. This study confirms the presence of GI parasites in the local chickens slaughtered in Makurdi. There is need to institute proper measures in the control of GI helminthes which will further improve the productivity of our local chicken.Keywords: Local chickens; gastrointestinal helminthes; live bird markets; Makurd

Prevalence of Trichomonas vaginalis infection among students in some tertiary institutions in Edo State, Nigeria

Trichomoniasis is a sexually transmitted parasitic disease of which sexually active single female students of higher institution of learning are at risk of infection. A total of 946 female students and 656 male students from University of Benin, Ambrose Alli University, Auchi Polytechnic, and College of Eduation, Igueben in Edo State, were examined for the presence of Trichomonas vaginalis from vaginal swab and urine samples using the light microscope. Overall, the prevalence of infection was 2% as no positive case was recorded for male students. Among positives, students from Auchi Polytechnic had the highest prevalence of infection (2.92%) and indicated the highest number that do not use condom during sex. These results clearly reaffirm the need to regularly engage in protected sex so as to reduce the risk of infection.Keywords: Trichomonas vaginalis; students; Edo State; Nigeria

A survey of haematophagous flies and cattle trypanosomiasis in Ikara and Kubau Local Government Areas, Kaduna State, Nigeria

A survey of species composition and distribution of haematophagous flies as well as occurrence of Trypanosoma species of cattle was conducted between March and August, 2015, at Ikara and Kubau Local Government Areas, Kaduna State, using Biconical and Nzi traps. Twelve traps were placed for 48hrs along four districts in each of the local government areas and harvested every 24hrs. Blood samples from cattle were analyzed for the presence of Trpanosomes using thick, thin Blood smear and Hematocrit centrifugation method. A total of 232 haematophagous and non-haematophagous flies were caught during the study period. Ikara Local Government had a higher occurrence of flies 127(54.7%) than Kubau Local Government 105(45.3%). The occurrence of the haematophagous flies, Stomoxys calcitrans 107(85.3%) had the highest occurrence than Tabanus 9(7.1%) while Glossina had 0(0.0%). The rainy season had 212 flies trapped compared to the dry season with fewer flies. There was a significant association (p<0.05) between flies occurrence and seasons. The cattle sampled were positive for T. vivax and T. brucei. There was no significant association (p>0.05) between the occurrence of Trypanosoma infection in the study area. It is very important to mention that plans should be put in place for the total eradication of these flies and parasite as they could act as vector for the transmission of pathogens that can cause significant health crises in human and animals.Keywords: Haematophagous; flies; trypanosome; Nzi, biconical; Ikara; Kubau; Kaduna State

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran