DIABETES RISK SCORE OF STAFF OF AN URBAN MISSION HOSPITAL IN NIGERIA

Background: Diabetes mellitus is a major global health problem which in hospital staff poses a major stress and can lead to migration away from health related posts. Certain features of health work e.g. long hours, shifts and uncertain break times increase the risk for hospital staff. It is critical to predict chronic conditions like diabetes mellitus that have a definable onset in adults so that morbidity and mortality can be mitigated through early recognition and treatment. Aims: To determine the diabetes risk score of health workers in an urban hospital and the associated risk factors. Methods and Materials: A correlational cross sectional survey of staff was conducted and diabetes risk was determined using a modified form of the Finnish Diabetes Risk Score questionnaire. Results and Conclusions: A total of 220 staff representing a response rate of 69.8% completed the study. The mean age was 41.6±9.88, Median duration of employment was 7.2years with a range of (0-37). Majority (66.4%) were in the 25-44 years age group, and most were female (66.4%) and married (70.5%). Mean BMI was 26.62±4.85. The mean Diabetes Risk score for the entire study group was 7.43±4.46 with a median score of 7 and a range of 0-19. About 40.5% had slightly elevated risk, 14.5% had moderate risk, and 5% had high risk. Female gender (AOR 0.17, 95% CI 0.09-0.33), and duration of employment (AOR 2.27, 95% CI 1.18-4.37) were significant predictors of higher diabetic risk score category. KEYWORDS: Type 2 Diabetes mellitus; Diabetes risk; Risk score; Health workforce

DIABETES RISK SCORE OF STAFF OF AN URBAN MISSION HOSPITAL IN NIGERIA

Background: Diabetes mellitus is a major global health problem which in hospital staff poses a major stress and can lead to migration away from health related posts. Certain features of health work e.g. long hours, shifts and uncertain break times increase the risk for hospital staff. It is critical to predict chronic conditions like diabetes mellitus that have a definable onset in adults so that morbidity and mortality can be mitigated through early recognition and treatment. Aims: To determine the diabetes risk score of health workers in an urban hospital and the associated risk factors. Methods and Materials: A correlational cross sectional survey of staff was conducted and diabetes risk was determined using a modified form of the Finnish Diabetes Risk Score questionnaire. Results and Conclusions: A total of 220 staff representing a response rate of 69.8% completed the study. The mean age was 41.6±9.88, Median duration of employment was 7.2years with a range of (0-37). Majority (66.4%) were in the 25-44 years age group, and most were female (66.4%) and married (70.5%). Mean BMI was 26.62±4.85. The mean Diabetes Risk score for the entire study group was 7.43±4.46 with a median score of 7 and a range of 0-19. About 40.5% had slightly elevated risk, 14.5% had moderate risk, and 5% had high risk. Female gender (AOR 0.17, 95% CI 0.09-0.33), and duration of employment (AOR 2.27, 95% CI 1.18-4.37) were significant predictors of higher diabetic risk score category. KEYWORDS: Type 2 Diabetes mellitus; Diabetes risk; Risk score; Health workforce

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030