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

Análisis regional de frecuencia de precipitación anual para la determinación de mapas de sequías

Determinar la probabilidad de ocurrencia y frecuencia de sequías es de relevante importancia para la gestión de los recursos hídricos sobre todo en zonas áridas como es la vertiente del Pacífico en el Perú. Las principales características de las series hidrometeorológicas son su corto periodo, discontinua y baja densidad espacial. En este contexto, la metodología utilizada en este estudio (L-momentos) permite cuantificar y mapear el periodo de retorno de una sequía meteorológica desde una perspectiva regional adaptándose a las limitantes de información hidrometeorológica. El área estudiada abarca once unidades hidrográficas (Olmos, Motupe, La Leche, Chancay Lambayeque, Zaña, Chaman, Jequetepeque, Chicama, Moche, Virú y Huamansaña), localizadas en la región hidrográfica del Pacífico, ubicada en la zona norte del Perú, con una extensión de 32 029 km2 . Entre los resultados del estudio se ha determinado 4 regiones homogéneas de precipitación clasificadas por elevación y por rango de tasa de precipitación (por ejemplo en la Región 1 las precipitaciones varían de 16 a 175 mm .año–1 , conformada por 10 estaciones y localizadas entre los 27 y 147 msnm y en la Región 4 varía de 609 a 1560 mm.año–1 , conformada por 5 estaciones y localizada entre 2744 y 3500 msnm). Cada una de estas regiones ha presentado como distribución de frecuencia regional de mejor ajuste el modelo Logístico Generalizado. Sobre la base de esta información se ha mapeado los L-momentos regionales y el período de retorno de una sequía teórica equivalente al 40% de la precipitación normal o histórica. De estos mapas se concluye que en el área de estudio los episodios de sequías en la zona baja (áreas emplazadas de 0 a 1500 msnm) son más recurrentes y más severos con periodos de retorno en el orden de 2 a 10 años, en la zona media (áreas entre 1500 a 3000 msnm) con períodos de retorno de 15 a 25 años y en la zona alta (áreas sobre los 3000 msnm) con periodos de retorno de 25 a 30 años.Determine the probability of drought occurrence and its frequency is so important for the water resources management, especially in arid areas such as the Pacific drainage basin in Peru. Hydrometeorological time series in Peru are mostly of short length, discontinuous and spatially sparse. In this context, the methodology used in this study (L-moments) allows quantifying and mapping the return period of a drought from a regional perspective, adaptable to restrictions of hydrometeorological information. The study covers eleven basins (Olmos, Motupe, La Leche, Lambayeque Chancay, Zaña, Chaman, Jequetepeque, Chicama, Moche, Viru and Huamansaña) corresponding to the Pacific drainage basin located in the northern region of Peru over a surface of 32 029 km2 . This study allowed to determine 4 regions of homogeneous precipitation classified according to their altitude and rainfall rate (e.g. in the Region 1 rainfall varies from 16 to 175 mm.year–1 , and consists of 10 stations located between 27 and 147 masl and the region 4 varies from 609 to 1560 mm.year–1 , and consists of 5 stations located between 2744 and 3500 masl). Each one of these regions has presented as regional frequency distribution of best fitting, the Generalized Logistic model. Based on this information it was mapped the regional L-moments and the Return Period of a theoretical drought equivalent to 40% of the normal or historic rainfall. From these maps, it can be concluded that in the study area drought episodes in the lower area (areas located from 0 to 1500 masl) are more recurrent and more severe, with return periods in the order of 2 to 10 years; in the middle zone (areas between 1500 and 3000 masl) with return periods of 15 to 25 years and in the upper area (areas above 3000 masl) with return periods of 25 to 30 years

Manual de hidrometría. Documento Técnico N° 001 SENAMHI-DHI-2018

El SENAMHI, desde aproximadamente hace medio siglo, en el ámbito de sus actividades como servicio meteorológico e hidrológico del país busca generar y proveer información de manera oportuna y confiable. Para este propósito realiza actividades de medición en los ríos del país, tarea en ocasiones un poco difícil de cumplir ante una serie de factores y condiciones a veces extremas. En el marco de la Hidrometría, actividades como la medición, registro, cálculo y análisis de los volúmenes de agua de una fuente natural nos permite conocer la cantidad de agua que fluye por un río y/o riachuelo. Además es posible determinar los caudales máximos durante los periodos lluviosos para alertar la población frente a una posible amenaza de inundación, al verse influenciado por condiciones meteorológicas. Actualmente, existen diversas teorías y técnicas de medición de flujos de agua; y la disponibilidad de información y los avances tecnológicos han permitido agilizar algunos procesos. Por ello, se hace necesario dejar un rastro para seguir el dinámico camino de la hidrología basada en la experiencia de los profesionales de la Dirección de Hidrología en coordinación con las Direcciones Zonales del SENAMHI y aportes de expertos extranjeros que siempre han visto fascinante la hidrografía nacional, que a través de observaciones y mediciones nos han ayudado a explicar la hidrología del país

Lineamientos para el diseño de sistemas integrados de vigilancia y pronóstico hidrometeorológico con fines de alerta temprana. Nota Técnica

La Nota Técnica presenta los lineamientos para el diseño del sistema integrado de sistemas de vigilancia y pronóstico hidrometeorológico con fines de alerta temprana, principalmente ante inundaciones, y movimientos en masa asociados a lluvias, en ríos y quebradas con enfoque multi-peligros, multi-regional y en múltiples escalas temporales a fin de brindar información oportuna para la toma de decisiones, siendo de aplicación en las cuencas priorizadas por la Reconstrucción con Cambios en los departamentos de Tumbes, Piura, Lambayeque, La Libertad, Ancash, Lima e Ica

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN