Factors Involved in Selection of a Career in Surgery and Orthopedics for Medical Students in Malawi

AimsThere is a critical shortage of Orthopedic Surgeons in Malawi as well as all countries in sub-Saharan Africa. To date, there is no published literature that has investigated surgical or Orthopedic career selection amongst African medical trainees. With the goal of facilitating recruitmentinto Surgery and Orthopedics in Malawi, we explored the key aspects of Malawian Medical Students’ choice of careers in surgical disciplines.MethodsAn on-line survey of all students in clinical years at the College of Medicine in Blantyre, Malawi was performed. The survey was anonymous and constructed de novo by a stringent process including Item Generation, Item reduction, Survey composition, Pre-testing, Assessment of Validity by a recognized survey expert, Pilot testing in on-line format byseveral Malawian Medical Students, and then formal survey testing.ResultsSurgery was the most popular specialty choice among the medical trainees (46%). General Surgery was the popular surgical specialty (27%), followed by Neurosurgery (22%) and Orthopedics (19%). The majority of students (67%) feared occupational exposure to HIV but this did not appearto be a factor in specialty choice (p=0.9). Students with Orthopedic mentors were significantly more likely to choose Orthopedics as their first choice surgical specialty (p = 0.01). Despite limited resources and surgeons in sub-Saharan Africa, surgical specialties are desirable career choices.ConclusionsThis is the first evaluation of factors involved in surgical or Orthopedic career selection in any African context. Future initiatives to improve exposure and mentorship in Orthopedics are fundamental to recruitment into the specialty

Paediatric road traffic injuries in Lilongwe, Malawi: an analysis of 4776 consecutive cases

This was a retrospective review of all children aged ≤16 who were treated in the casualty department at the central hospital in Lilongwe, Malawi, between 1 January 2009 and 31 December 2015. A total of 4776 children were treated for road traffic injuries (RTIs) in the study period. There was an increase in incidence from 428 RTIs in 2009 to a maximum of 834 in 2014. Child pedestrians represented 53.8% of the injuries, but 78% of deaths and 71% of those with moderate to severe head injuries. Pedestrians were mostly injured by cars (36%) and by large trucks, buses and lorries (36%). Eighty-four (1.8%) children were brought in dead, while 40 (0.8%) children died in the casualty department or during their hospital stay. There has been a drastic increase of RTIs in children in Lilongwe, Malawi. Child pedestrians were most affected, both in terms of incidence and severity

Effects of drought ? altered seasonality and low rainfall ? in net ecosystem carbon exchange of three contrasting Mediterranean ecosystems

International audienceDroughts cause reductions in gross primary production (GPP) and also in net ecosystem exchange (NEE), contributing to most of the inter-annual variability in terrestrial carbon sequestration. In seasonally dry climates (Mediterranean) droughts result from reductions in annual rainfall and from changes in rain seasonality. In western Iberia, the hydrological-year (i.e., from October to September) of 2004?2005 was extremely dry, with precipitation 50% below the long-term mean (691 mm in 1961?1990), but 2005?2006 was normal. We compared the carbon fluxes measured by the eddy covariance technique from three contrasting ecosystems in southern Portugal: an evergreen oak woodland (savannah-like) with ca. 21% tree cover; a Mediterranean C3/C4 grassland; and a coppiced eucalyptus plantation. During the dry hydrological-year of 2004?2005, NEE was lowest, the highest sink strength was in the eucalypt plantation (NEE = ?399 g C m ?2 year?1) as compared to the oak woodland (NEE = ?88 g C m ?2 year?1), and the grassland (NEE = +49 g C m ?2 year ?1). The latter was a source of carbon dioxide. The NEE values of the dry year were, however, much lower than those for wetter years, e.g. NEE = ?861 g C m?2 year ?1 in 2002?2003 in the eucalypt plantation. The NEE of the grassland and the oak savannah in the 2005?2006 hydrological-year, with annual precipitation above the long term mean, were ?190 and ?120 g C m ?2 year?1, respectively. All ecosystems studied increased their rain-use efficiency (GPP per unit of rain volume) increased in dry years. In the case of annual vegetation ? grassland and low tree density woodland, however &ndash, rain-use efficiency decreased with severe drought. However, this was more pronounced in the eucalypt plantation due to greater GPP and the use of deep soil water resources. Although both calendar years of 2004 and 2005 had equally low rainfall, the effect of drought on the eucalypt plantation was delayed until the second dry year. This suggests that the effects of water deficits on Mediterranean forests are exacerbated by prolonged droughts when long-term soil water reserves are depleted. The grassland, however, was more vulnerable and responded faster to water deficits. This effect of drought was less pronounced in the oak woodland due to the sparse tree cover

Evapotranspiration from a Mediterranean evergreen oak savannah: The role of trees and pasture

Mediterranean evergreen oak woodlands of southern Portugal (montados) are savannah-type ecosystems with a widely sparse tree cover, over extensive grassland. Therefore, ecosystem water fluxes derive from two quite differentiated sources: the trees and the pasture. Partitioning of fluxes according to these different sources is necessary to quantify overall ecosystem water losses as well as to improve knowledge on its functional behaviour. In southern Iberia, these woodlands are subjected to recurrent droughts. Therefore, reaction/resilience to water stress becomes an essential feature of vegetation on these ecosystems. Long-term tree transpiration was recorded for 6 years from a sample of holm oak (Quercus ilex ssp. rotundifolia) trees, using the Granier sap flow method. Ecosystem transpiration was measured by the eddy covariance technique for an 11-month period (February to December 2005), partly coincident with a drought year. Pasture transpiration was estimated as the difference between ecosystem (eddy covariance) and tree (sap flow) transpiration. Pasture transpiration stopped during the summer, when the surface soil dried up. In the other seasons, pasture transpiration showed a strong dependence on rainfall occurrence and on top soil water. Conversely, trees were able to maintain transpiration throughout the summer due to the deep root access to groundwater. Q. ilex trees showed a high resilience to both seasonal and annual drought. Tree transpiration represented more than half of ecosystem transpiration, in spite of the low tree density (30 trees ha 1) and crown cover fraction (21%). Tree evapotranspiration was dominated by transpiration (76%), and interception loss represented only 24% of overall tree evaporatio

The Effect of a Surgery Residency Program and Enhanced Educational Activities on Trauma Mortality in Sub-Saharan Africa

Introduction: To address the need for more surgical providers in low-resource settings, a collaboration to create a surgical residency-training program for local Malawian physicians was established in 2009. This study sought to describe the short-term independent effect of a surgical residency program on trauma mortality at a tertiary trauma center in sub-Saharan Africa. Methods: We conducted a retrospective analysis of all patients recorded in the trauma surveillance registry of Kamuzu Central Hospital in Lilongwe, Malawi, from 2009 (three residents) through 2014 (11 residents). Log-binominal regression modeling was used to compare the risk ratio of death compared to the referent year of 2009, when the program was started, after adjusting for relevant covariates. Primary injury type was used as a surrogate for injury severity. Results: In total, 82,534 patients were recorded into the KCH Trauma Registry during the study period. Mean age was 23.1 years (SD 15.7) with a male preponderance (72.1%). Trauma patient volume increased from 8725 patients in 2009 to 15,998 patients in 2014. Each year had a significantly decreased risk of death compared to 2009 when adjusted for primary injury type, age, and gender, with an adjusted risk ratio of 0.73 (95% CI 0.58, 0.90) in 2010 and 0.52 (95% CI 0.43, 0.62) in 2014. Conclusion: The global burden of surgical diseases cannot be attenuated in the presence of an inadequate surgical workforce. After institution of a surgery residency program, adjusted injury-associated mortality decreased each year despite substantial increases in trauma patient volume. In low-resource settings, establishment of a surgical residency program significantly improves trauma-associated outcomes

Net ecosystem carbon exchange in three contrasting Mediterranean ecosystems ? the effect of drought

International audienceDroughts reduce gross primary production (GPP) and ecosystem respiration (Reco), contributing to most of the inter-annual variability in terrestrial carbon sequestration. In seasonally dry climates (Mediterranean), droughts result from reductions in annual rainfall and changes in rain seasonality. We compared carbon fluxes measured by the eddy covariance technique in three contrasting ecosystems in southern Portugal: an evergreen oak woodland (savannah-like) with ca.~21% tree crown cover, a grassland dominated by herbaceous annuals and a coppiced short-rotation eucalyptus plantation. During the experimental period (2003?2006) the eucalyptus plantation was always the strongest sink for carbon: net ecosystem exchange rate (NEE) between ?861 and ?399 g C m?2 year?1. The oak woodland and the grassland were much weaker sinks for carbon: NEE varied in the oak woodland between ?140 and ?28 g C m?2 year?1 and in the grassland between ?190 and +49 g C m?2 year?1. The eucalyptus stand had higher GPP and a lower proportion of GPP spent in respiration than the other systems. The higher GPP resulted from high leaf area duration (LAD), as a surrogate for the photosynthetic photon flux density absorbed by the canopy. The eucalyptus had also higher rain use efficiency (GPP per unit of rain volume) and light use efficiency (the daily GPP per unit incident photosynthetic photon flux density) than the other two ecosystems. The effects of a severe drought could be evaluated during the hydrological-year (i.e., from October to September) of 2004?2005. Between October 2004 and June 2005 the precipitation was only 40% of the long-term average. In 2004?2005 all ecosystems had GPP lower than in wetter years and carbon sequestration was strongly restricted (less negative NEE). The grassland was a net source of carbon dioxide (+49 g C m?2 year?1). In the oak woodland a large proportion of GPP resulted from carbon assimilated by its annual vegetation component, which was strongly affected by the shortage of rain in winter. Overall, severe drought affected more GPP than Reco leading to the deterioration of NEE. Although the rain-use efficiency of the eucalyptus plantation increased in the dry year, this was not the case of evergreen oak woodland, which rain-use efficiency was not influenced by drought. Recovery after drought alleviation, i.e., beginning with heavy rain in October 2005, was fully accomplished in 2006 in the oak woodland and grassland, but slow in the eucalyptus plantation

Etiology of major limb amputations at a tertiary care centre in Malawi

Introduction Amputations in low-and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Methods Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008–2016. Baseline demographic and clinical variables and type of amputation performed were collected. Only major limb amputations, defined as above or below the knee, above or below the elbow, and above the wrist, were included in this study. Results A total of 610 patients underwent 630 major amputations during the study period. Of these, 170 (27%) patients were female, and the median age of the cohort was 39 (interquartile range [IQR] 25–55). Of these patients, 345 (54.8%) had infection or gangrene recorded among the indications for amputation, 203 (32.2%) had trauma, 94 (14.9%) had cancer and 67 (10.6%) had documented diabetes. Women underwent diabetes-related amputations more often than men (37 out of 67, or 56.1%), and were significantly younger when their amputations were due to diabetes (median age 48 vs 53 years old, P=0.004) or trauma (median age 21 vs 30 years old, P=0.02). The commonest operative procedures were below the knee amputations, at 271 (43%), and above the knee amputations, at 213 (33.8%). Conclusion Amputations in Malawi affect primarily the young, in the most economically productive time of their lives, in contrast to amputees in high-income countries. Preventable causes, such as infection and trauma, lead to the majority of amputations. These etiologies represent an important primary prevention target for public health efforts in LMICs

Programme evaluation training for health professionals in francophone Africa: process, competence acquisition and use

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

A large outbreak of Legionnaires’ Disease in an industrial town in Portugal

Background We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10 km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10 km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p < 0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.info:eu-repo/semantics/publishedVersio

Quality Control of CarboEurope Flux Data - Part I: Coupling Footprint Analyses with Flux Data Quality Assessment to Evaluate Sites in Forest Ecosystems

We applied a site evaluation approach combining Lagrangian Stochastic footprint modelling with a quality assessment approach for eddy-covariance data to 25 forested sites of the CarboEurope-IP network. The analysis addresses the spatial representativeness 5 of the flux measurements, instrumental effects on data quality, spatial patterns in the data quality, and the performance of the coordinate rotation method. Our findings demonstrate that application of a footprint filter could strengthen the CarboEurope-IP flux database, since only one third of the sites is situated in truly homogeneous terrain. Almost half of the sites experience a significant reduction in eddy-covariance data 10 quality under certain conditions, though these effects are mostly constricted to a small portion of the dataset. Reductions in data quality of the sensible heat flux are mostly induced by characteristics of the surrounding terrain, while the latent heat flux is subject to instrumentation-related problems. The Planar-Fit coordinate rotation proved to be a reliable tool for the majority of the sites using only a single set of rotation angles. 15 Overall, we found a high average data quality for the CarboEurope-IP network, with good representativeness of the measurement data for the specified target land cover types.JRC.H.2-Air and Climat