Social determinants and child survival in Nigeria in the era of Sustainable Development Goals: Progress, challenges, and opportunities

Introduction: Like in many low- and middle-income settings, childhood mortality remains a big challenge in Nigeria—being the second largest contributor to under-five mortality globally, after India. Currently, there is little local evidence to guide policymakers in Nigeria to tailor appropriate social interventions to make the Sustainable Development Goal (SDG) targets of child survival (SDG-3), gender equality (SDG-5), and social inclusiveness (SDG-10) achievable by 2030. In addition, lack of methodological rigor and theoretical foundations of child survival research in Nigeria limit their use for proper planning of child health services. Aims: The basis of this thesis is to understand the complex issues relating to child survival and recommend new approaches to guide policymakers on interventions that will improve child survival in Nigeria. The overarching goal of this thesis is to address the methodological and theoretical shortcomings identified in the previous studies conducted in Nigeria. Using robust interdisciplinary analytic techniques, this thesis assessed the following specific objectives. Objective 1: (a) Compare predictive abilities of the most used conventional statistical time-series methods—ARIMA and Holt-Winters exponential smoothing models, with artificial intelligence technique such as group method of data handling (GMDH)-type artificial neural network (ANN), and (b) estimate the age- and sex-specific mortality trends in child-related SDG indicators (i.e., neonatal and under-five mortality rates) over the 1960s-2017 period, and estimate the expected annual reduction rates needed to achieve the SDG-3 targets by projecting rates from 2018 to 2030. Objective 2: (a) Identify the social determinants of age-specific childhood (0-59 months) mortalities, which are disaggregated into neonatal mortality (0-27 days), post-neonatal mortality (1-11 months) and child mortality (12-59 months), and (b) estimate the within- and between-community variations of mortality among under-five children in Nigeria. Objective 3: Identify the critical pathways through which social factors (at maternal, household, community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Objective 4: (a) Determine patterns and determinants of geographical clustering of neonatal mortality at the state and regional levels in Nigeria, (b) assess gender inequity for neonatal mortality between urban and rural communities across the regions in Nigeria, and (c) measure gaps in SDG-3 target for neonatal mortality at the state and regional levels in Nigeria. Methods: This thesis is a quantitative study which used two secondary datasets—aggregated historical childhood mortality data from 1960s to 2017 (objective 1), and the latest (2016/2017) Nigeria Multiple Indicator Cluster Survey (MICS) for 36 states and Federal Capital Territory (FCT) in Nigeria (objectives 2-4). To minimize recall bias, analysis was limited to a weighted nationally representative sample of 30,960 live births delivered within five years before the survey. The selection of relevant social determinants of child survival was primarily informed by Mosley-Chen framework. The candidate variables were layered across child, maternal, household, and community-levels. The analytic approaches include artificial intelligence technique (i.e., group method of data handling (GMDH)-type artificial neural network, and multilayer perceptron (MLP) neural network), autoregressive integrated moving average (ARIMA), Holt-Winters exponential smoothing models, spatial cluster analysis, hierarchical path analysis with time-to-event outcome, and multilevel multinomial regression. Results: Progress towards achieving SDG targets – Nigeria is not likely to achieve SDG targets for child survival and, within, gender equity by 2030 at the current annual reduction rates (ARR) under-five mortality rate (U5MR): 1.2%, and neonatal mortality rate (NMR): 2.0%. If the current trend continues, U5MR will begin to increase by 2028. Also, at the end of SDG-era, female deaths will be higher than male deaths (80.9 vs. 62.6 deaths per 1000 live births). To make child-related SDG targets achievable by 2030, Nigeria needs to reduce annual U5MR by 9 times and annual NMR by 4 times the current rate of decrease. Social determinants of childhood mortality – At each stage of early childhood development, there are different factors relating to survival outcomes. Surprisingly, attendance of skilled health providers during delivery was associated with an increased neonatal mortality risk, although its effect disappeared during post-neonatal and toddler/pre-school stages. The observed association requires cautious interpretation because of unavailability of variables on quality of care in MICS dataset to assess how skilled birth delivery impacts child survival in Nigeria. However, there is a possibility of under-reporting under-five mortalities at the community level. Also, it could indicate a functioning referral system that sends the high-risk deliveries to health facilities to a greater extent. There is a large variation (39%) of under-five mortalities across the Nigerian communities, which is accounted for by maternal-level factors (i.e., maternal education, contraceptive use, maternal wealth, parity, death of previous children and quality of perinatal care). Pathways to childhood mortality – Region and area of residence (urban/rural), infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate indirectly on neonatal, infant and under-five survival. Female children, singleton, children whose mothers delivered at least two years apart and aged 20-34 years survived much longer. Specifically, women from Northern areas of Nigeria were less likely to reside in urban cities and towns than those in the Southern areas. This, in turn, limited their access to social infrastructure and acted as a barrier to maternal education. Without adequate education, women were less likely to use contraceptive methods. Women with no history of contraceptive use were more likely to have childbirths closer together (less than two-year gap), which in turn, negatively impacted child survival. Regional inequities in childhood mortality – There was significant state-level clustering of NMR in Nigeria. The states with higher neonatal mortality rates were majorly clustered in the North-West and North-Central regions, and states with lower neonatal mortality rates were clustered in the South-South and South-East regions. Gender inequity was worse in the rural areas of Northern Nigeria, while it was worse in the urban areas of Southern Nigeria. NMR was disproportionately higher among females in urban areas (except North-West and South-West regions). Conversely, male neonates had higher mortality risks in the rural areas for all the regions. Conclusions: This thesis provides more refined age- and sex-specific mortality estimates for Nigeria. At the current rates, Nigeria will not meet SDG targets for child survival. In addition, this thesis identifies the critical intervention pathways to child survival in Nigeria during the SDG-era. The new estimates may be used to improve the design and accelerate the implementation of child health programmes to attain the SDG targets. Also, it is important for stakeholders to implement more impactful policies that promote maternal education and improve living conditions of women (especially in the rural areas). To address gender inequities, gender-sensitive policies, and community mobilization against gender-based discrimination towards girl-child should be implemented. Further research is required to assess the quality of skilled birth attendants in Nigeria

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria

Background: Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria. Methods: Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg. Results: From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant. Conclusions: There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria

Factors Associated with Treatment Success among Pulmonary Tuberculosis and HIV Co-infected Patients in Oyo State, South West-Nigeria

Background The co-existence of Tuberculosis (TB) and Human immunodeficiency Virus (HIV) is  known to increase morbidity and mortality in patients. The determinants of treatment success in TBHIV co-infection are not yet well studied. Such information can help optimise treatment and reduce morbidity and mortality.Objective To determine factors associated with antitubercular treatment success among TB I HIV coinfected patients.Methods A cross sectional study was carried out in fifty  three DOT clinics and treatment centres  using tuberculosis patient's records from January 2009 to December 2010 in Oyo state, Nigeria. The study population consisted of 7905 tuberculosis patients. Information on variables of interest were obtained with the use of data extraction forms. Chi-square and logistic regression were used to test the relationship between TB I HIV coinfection and socio-demographic variables, clinical characteristics and treatment success.Results Prevalence ofTB I HIV co-infection was found to be 14.2%. Patients with TB-HIV co-infection  were younger and more likely to be females. There were statistically significant association between treatment success and gender, marital status and patient point of care. After adjusting for other variables, it was found that patients receiving treatment in private facilities were independently less likely to be successfully treated compared with those receiving care in Public facilities. Female patients were also independently more likely to have better treatment outcome than male.Conclusion In addition to patients' point of care, gender of the patients can adversely impact on their treatment success. Efforts from the government to strengthening the private public mix, health education and media awareness on adherence to treatment to improve treatment success should be intensified in the country.Keywords: Tube rc ulosis; Human immunodeficiency virus, Directly observe therapy short-course;  Treatment success, Coinfection

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

Characterizing Genetic Susceptibility to Breast Cancer in Women of African Ancestry

Background: Genome-wide association studies have identified approximately 100 common genetic variants associated with breast cancer risk, the majority of which were discovered in women of European ancestry. Because of different patterns of linkage disequilibrium, many of these genetic markers may not represent signals in populations of African ancestry. Methods: We tested 74 breast cancer risk variants and conducted fine-mapping of these susceptibility regions in 6,522 breast cancer cases and 7,643 controls of African ancestry from three genetic consortia (AABC, AMBER, and ROOT). Results: Fifty-four of the 74 variants (73%) were found to have ORs that were directionally consistent with those previously reported, of which 12 were nominally statistically significant ( P < 0.05). Through fine-mapping, in six regions ( 3p24, 12p11, 14q13, 16q12/FTO, 16q23, 19p13 ), we observed seven markers that better represent the underlying risk variant for overall breast cancer or breast cancer subtypes, whereas in another two regions ( 11q13, 16q12/TOX3 ), we identified suggestive evidence of signals that are independent of the reported index variant. Overlapping chromatin features and regulatory elements suggest that many of the risk alleles lie in regions with biological functionality. Conclusions: Through fine-mapping of known susceptibility regions, we have revealed alleles that better characterize breast cancer risk in women of African ancestry. Impact: The risk alleles identified represent genetic markers for modeling and stratifying breast cancer risk in women of African ancestry. Cancer Epidemiol Biomarkers Prev; 26(7); 1-11. ©2017 AACR

Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100:a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundAccurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.MethodsTo estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.FindingsDuring the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction.InterpretationFertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.FundingBill &amp; Melinda Gates Foundation

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

SPARC 2019 Fake news & home truths : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2019 SPARC conference. This year we not only celebrate the work of our PGRs but also our first ever Doctoral School Best Supervisor awards, which makes this year’s conference extra special. Once again we have received a tremendous contribution from our postgraduate research community; with over 90 presenters, the conference truly showcases a vibrant, innovative and collaborative PGR community at Salford. These abstracts provide a taster of the inspiring, relevant and impactful research in progress, and provide delegates with a reference point for networking and initiating critical debate. Find an abstract that interests you, and say “Hello” to the author. Who knows what might result from your conversation? With such wide-ranging topics being showcased, we encourage you to take up this great opportunity to engage with researchers working in different subject areas from your own. To meet global challenges, high impact research needs interdisciplinary collaboration. This is recognised and rewarded by all major research funders. Engaging with the work of others and forging collaborations across subject areas is an essential skill for the next generation of researchers. Even better, our free ice cream van means that you can have those conversations while enjoying a refreshing ice lolly

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020