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

Summary 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 middleincome 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 lowincome 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 lowincome, 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

Technology development for sustainable use of stormwater using numerical modelling

Runoff estimation is very important for adequate management of stormwater; however runoff assessment is not simple for those catchments where there is a lack of data. Australian Rainfall and Runoff recommended several methods for estimating runoff which are explicitly suitable for particular regions of Australia. Unfortunately there is no regional equation available specifically for Queensland. Moreover, stream gauges in Australian catchments are relatively sparse, and many catchments are crisscrossed by numerous rivers. This study attracted the author’s attention because it was viewed as essential in the Australian context to have a reliable methodology for estimating runoff from ungauged catchments. The main aim of this study is to develop a technology for reusing stormwater for irrigation purposes, especially in an ungauged catchment. This study presents a new approach for stormwater runoff quantification from an ungauged catchment where there is no regional equation available, through developing a hydrologic-hydraulic integrated model, applying Geographical Information Systems (GIS) and numerical modelling techniques. Using the simulated stormwater runoff, the necessary stormwater pond volume is calculated and a typical design of pond is suggested to reuse the stored stormwater for irrigation purposes of a case study area

Technology development for sustainable use of stormwater using numerical modelling

Runoff estimation is very important for adequate management of stormwater; however runoff assessment is not simple for those catchments where there is a lack of data. Australian Rainfall and Runoff recommended several methods for estimating runoff which are explicitly suitable for particular regions of Australia. Unfortunately there is no regional equation available specifically for Queensland. Moreover, stream gauges in Australian catchments are relatively sparse, and many catchments are crisscrossed by numerous rivers. This study attracted the author’s attention because it was viewed as essential in the Australian context to have a reliable methodology for estimating runoff from ungauged catchments. The main aim of this study is to develop a technology for reusing stormwater for irrigation purposes, especially in an ungauged catchment. This study presents a new approach for stormwater runoff quantification from an ungauged catchment where there is no regional equation available, through developing a hydrologic-hydraulic integrated model, applying Geographical Information Systems (GIS) and numerical modelling techniques. Using the simulated stormwater runoff, the necessary stormwater pond volume is calculated and a typical design of pond is suggested to reuse the stored stormwater for irrigation purposes of a case study area

A review on stormwater harvesting and reuse

Australia is a country of some 7,700 million square kilometers with a population of about 22.6 million. At present water security is a major challenge for Australia. In some areas the use of water resources is approaching and in some parts it is exceeding the limits of sustainability. A focal point of proposed national water conservation programs is the recycling of both urban stormwater and treated wastewater. But till now it is not widely practiced in Australia, and particularly stormwater is neglected. In Australia, only 4% of stormwater and rainwater is recycled, whereas less than 1% of reclaimed wastewater is reused within urban areas. Therefore, accurately monitoring, assessing and predicting the availability, quality and use of this precious resource are required for better management. As stormwater is usually of better quality than untreated sewage or industrial discharge, it has better public acceptance for recycling and reuse, particularly for non-potable usesuch as irrigation, watering lawns, gardens, etc. Existing stormwater recycling practice is far behind of research and no robust technologies developed for this purpose. Therefore, there is a clear need for using modern technologies for assessing feasibility of stormwater harvesting and reuse. Numerical modeling has, in recent times, become a popular tool for doing this job. It includes complex hydrological and hydraulic processes of the study area. The hydrologic model computes stormwater quantity to design the system components, and the hydraulic model helps to route the flow through stormwater infrastructures. Nowadays water quality module is incorporated with these models. Integration of Geographic Information System (GIS) with these models provides extra advantage of managing spatial information. However for the overall management of a stormwater harvesting project, Decision Support System (DSS) plays an important role incorporating database with model and GIS for the proper management of temporal information. Additionally DSS includes evaluation tools and Graphical user interface. This research aims to critically review and discuss all the aspects of stormwater harvesting and reuse such as available guidelines of stormwater harvesting and reuse, public acceptance of water reuse, the scopes and recommendation for future studies. In addition to these, this paper identifies, understand and address the importance of modern technologies capable of proper management of stormwater harvesting and reuse

Stormwater pond design for Rockhampton (Queensland) golf course premises

In recent times, pond has become the most common management practice for the controlling, treating and storing of stormwater runoff. Golf courses provide a unique setting for ponds that provide both an environmental benefit and an aesthetic amenity of golf course premises. A significant body of technical literatures concerning the design and performance of ponds indicates favourable performance of ponds, when they are designed, constructed, and maintained properly. To calculate the volume of pond, careful watershed wide analysis is needed to estimate the peak design runoff. A great deal of consideration is needed to design a safe, cost effective and legal pond. In this study peak design runoff for a delineated subcatchment was calculated from a rainfall runoff model developed by ‘xpstrom’modelling software. Using the runoff coefficient (C) from this model, volume of a golf course pond was calculated using rational method. Intensities corresponding to different rainfall durations were found from Intensity Duration Frequency (IDF)curve, developed by Bureau of Meteorology (BOM) for the study area. Pond volume was calculated considering adequate management of stormwater runoff as well as ensuring availability of enough water for irrigating turf. A typical design of the stormwater pond along with important design aspects of ponds are provided in this paper. However the information contained in this paper does not replace the need to understand the sitespecific design needs, nor does it supersede other requirements, such as applicable regulatory requirements

Comparison of different hydrograph routing techniques in XPSTORM modelling software a case study /

A variety of routing techniques are available to develop surface runoff hydrographs from rainfall. The selection of runoff routing method is very vital as it is directly related to the type of watershed and the required degree of accuracy. There are different modelling softwares available to explore the rainfall-runoff process in urban areas. XPSTORM, a link-node based, integrated stormwater modelling software, has been used in this study for developing surface runoff hydrograph for a Golf course area located in Rockhampton in Central Queensland in Australia. Four commonlyused methods, namely SWMM runoff, Kinematic wave, Laurenson,and Time-Area are employed to generate runoff hydrograph fordesign storm of this study area. In runoff mode of XPSTORM, therainfall, infiltration, evaporation and depression storage for subcatchments were simulated and the runoff from the subcatchment to collection node was calculated. The simulation results are presented, discussed and compared. The total surface runoff generated by SWMM runoff, Kinematic wave and Time-Areamethods are found to be reasonably close, which indicates any ofthese methods can be used for developing runoff hydrograph of thestudy area. Laurenson method produces a comparatively less amount of surface runoff, however, it creates highest peak of surface runoff among all which may be suitable for hilly region. Although the Laurenson hydrograph technique is widely acceptable surface runoff routing technique in Queensland (Australia), extensive investigation is recommended with detailed topographic and hydrologic data in order to assess its suitability for use in the case study area

A comparative view of groundwater flow simulation using two modelling software - MODFLOW and MIKE SHE

The sustainable use and management of groundwater resources is now a great challenge for many countries of the world. Recently groundwater modelling has been an effective way to address this challenge. There are a number of modelling software exist to simulate groundwater flow. Among them two modelling software - MIKE SHE and MODFLOW were used to develop two individual groundwater models and a comparison of these model’s output is presented in this paper. The main difference between these two modelling software is that MIKE SHE includes unsaturated zone whereas MODFLOW deals with saturated zone only. Using existing hydro-geological and meteorological data, two models were developed and calibrated for the high Barind area of Bangladesh in layers of five distinct vertical deposits, namely Clay Top, Upper Aquifer, Clay Middle, Lower Aquifer and Clay Bottom). The difference of groundwater flow hydrographs from two models and the probable reasons behind the difference are discussed. The important calibration parameters are being depicted in this paper

Automatic delineation of drainage networks and catchments using DEM data and GIS capabilities : a case study

Catchment and drainage network delineation is an important step of hydrologic model development that represents hydrologic boundary. Due to spatial and temporal variations of the characteristics of a watershed, it is often necessary to delineate a watershed into smaller-sized model areas where variables can be considered homogeneous. Catchments are scale independent delineations to capture surface water in an area of interest. Generally there are two types of delineation; manual and automatic. The traditional manual catchment delineation method for large-scale watersheds is time consuming. Using an elevation raster or digital elevation model (DEM) as input, it is possible to automatically delineate a drainage system and quantify the characteristics of the system. With the development of computer and information technology, automatic catchment delineation becomes widely popular. For accurate delineation, the quality of grid based DEM is vital. The DEM quality depends on two important aspects i.e. horizontal resolution and vertical accuracy. In this paper catchment and drainage network have been delineated for a case study area ‘Rockhampton Golf Course’. A rainfall runoff model was needed to develop in the study area and catchment delineation is a prerequisite to get the model boundary. In this study 3sec DEM data and 1sec DEM data were used for automatic delineation along with hydrologic analysis tools in ArcGIS Spatial Analyst. The hydrologic analysis tools described the physical components of a surface through some major functions like flow direction, flow accumulation and determining watersheds from a given source. Moreover the channel shape file generated by Geoscience Australia was also used as reference data of delineation to fix up the flow accumulation threshold area value. The delineated catchment and drainage networks using the two DEM data and their comparison are plotted and discussed in this paper. Besides consideration regarding automatic catchment or drainage network delineation found in this study are discussed here

Stormwater pond design for Rockhampton (Queensland) golf course premises

In recent times, pond has become the most common management practice for the controlling, treating and storing of stormwater runoff. Golf courses provide a unique setting for ponds that provide both an environmental benefit and an aesthetic amenity of golf course premises. A significant body of technical literatures concerning the design and performance of ponds indicates favourable performance of ponds, when they are designed, constructed, and maintained properly. To calculate the volume of pond, careful watershed wide analysis is needed to estimate the peak design runoff. A great deal of consideration is needed to design a safe, cost effective and legal pond. In this study peak design runoff for a delineated subcatchment was calculated from a rainfall runoff model developed by ‘xpstrom’modelling software. Using the runoff coefficient (C) from this model, volume of a golf course pond was calculated using rational method. Intensities corresponding to different rainfall durations were found from Intensity Duration Frequency (IDF)curve, developed by Bureau of Meteorology (BOM) for the study area. Pond volume was calculated considering adequate management of stormwater runoff as well as ensuring availability of enough water for irrigating turf. A typical design of the stormwater pond along with important design aspects of ponds are provided in this paper. However the information contained in this paper does not replace the need to understand the sitespecific design needs, nor does it supersede other requirements, such as applicable regulatory requirements