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

Household food access and coping strategies adopted during Covid-19 pandemic lockdown among people residing in Odeda Local Government Area of Ogun State, Nigeria

Background: Confinement to flatten curves as a protective measure against the novel corona-virus had made it very difficult for the citizens to have sufficient food to sustain themselves. Objective: This study assessed household's food accessibility and coping strategies adopted during COVID-19 pandemic lockdown in Odeda Local Government Area of Ogun State. Methods: The study was cross-sectional design and 300 households were randomly selected in the Local Government. Data such as socio-demographic, household food insecurity status, and coping strategies were obtained using a semi-structured questionnaire, Household food insecurity experience scale, and coping strategies index scale questionnaire. Data were analysed and presented using descriptive and Results: The age of the respondents was between 20-59 years and 60.3% were traders. Food security status showed that 15.7%,50%,14.3% and 20.0% of the respondents were food secure, severely, mildly, and moderately food insecure respectively. The major coping strategies adopted were relied on less preferred and less expensive foods(35%), limited portion size at mealtimes(31.3%), and reduced number of meals eaten in a day(34.3%). A significant association exists between Coping Strategy categories and food security status (P = 0.00). The result on the nutritional status of the respondents revealed that 51.3%, 11.3%, 25.3%, 12%, 59.7%, 14.3% and 32.4% had normal BMI, underweight, overweight, obese, stunted, wasted, and underweight respectively. Conclusion: The prevalence of food insecurity was high and most households adopted coping strategies that leads to higher levels of food insecurity

Nutritional status and micronutrients adequacy of food consumed by adolescents in school in Abeokuta

Background: Micronutrient and nutritional deficiencies remain a serious nutritional problem of significant importance in low-income countries especially Nigeria. Adolescents are vulnerable because they are at a stage of biological and psychological growth and nutrition inadequacy at this stage will have serious nutritional and health consequences. Objectives: The study assessed the nutritional status and micronutrients adequacy of food consumed by adolescents in school in Abeokuta, Ogun state. Materials and Methods: The study design was descriptive and cross-sectional involving multistage sampling for the selection of 200 respondents from public secondary schools in Abeokuta North and South. Data were obtained on socio-demographic, socioeconomic characteristics, nutritional knowledge, nutrients intake and anthropometry of the respondents using a structured self-administered questionnaire, repeated 24-hour dietary recall and standard procedures. Data were analyzed and presented using descriptive and inferential statistics. Statistical significance was established at p≤0.05 Result and Discussion: Result revealed that majority (94%) of the respondents were within the age range of 14-19years, 42% of the respondents consumed breakfast in school, 57.5%, 37.5% and 5% had good, fair, and poor nutritional knowledge respectively. The nutritional status estimation revealed that 31% of the total respondents were stunted, while 50% were thin. There was significant micronutrient inadequacy of vitamin A, carotene, Vitamin B1, Vitamin B2, folate, vitamin C, potassium, calcium, iron, and zinc.&nbsp; Conclusion: This study established substantial micronutrients inadequacy and increased prevalence of undernutrition among the study respondents

Nutritional status and adequacy of selected micronutrients of civil servants in Ogun state, Nigeria

Background: Inadequate micronutrient intake can have a negative impact on physical and mental health causing several health consequences. People who are overweight or obese also fails to meet the majority of micronutrient recommendations Objective: This study assessed the nutritional status and adequacy of selected micronutrients of civil servants in Ogun State, Nigeria. Methods: The study design was cross-sectional in design. The sample consisted of 250 civil servants. A semi-structured questionnaire was used to determine the socio-demographic characteristics, family medical history and nutrition knowledge of the respondents. Nutrient intakes were estimated from 24-hour dietary recall and analyzed using Nutri-Survey software. Anthropometric measurements were carried out to determine nutritional status. Data was analyzed using descriptive and inferential statistics using SPSS version 20. Statistical significance was established at p≤0.05. Results: Prevalence of overweight and obesity was 39.2% and 11.6% respectively. One-third (32.8%) of the population were at risk of cardiovascular diseases. Nutrient adequacy of micronutrients assessed were low except phosphorus (89.6%), zinc (86.8%), iron (68.8%) and sodium (50.0%) which were in excess. Macronutrients were above the recommended dietary allowances. A significance association (p&lt;0.05) was observed between some micronutrient adequacy ratio (folic acid, Vitamin A and Vitamin E) and nutritional status assessed by Body Mass Index of the respondents.Conclusion: Micronutrient intake was inadequate and prevalence of overweight and obesity were higher than reported in previous studies. There is a need for nutrition education that emphasizes on the consumption of micronutrient dense foods

Prevalence of hypertension and obesity among non-academic staff in a Nigerian University : Hypertension and Obesity among Nigerian Staff

Background: The aim of achieving a healthy society has motivated and led many researchers to understand the prevalence of diseases to create awareness and assess interventions’ effectiveness. Objective: This study determines the prevalence of hypertension and obesity among the non-academic staff of the Federal University of Agriculture, Abeokuta. Methods: The study design was descriptive and cross-sectional. 300 Non-academic staff of the institution were randomly selected and data were obtained on their sociodemographic and socioeconomic characteristics, predisposing risk factors of hypertension, anthropometry, and blood pressure measurements using a structured self-administered questionnaire and standard procedures. Data were analyzed and presented using descriptive and inferential statistics. Statistical significance was established at p&lt;0.05. Results: The mean age was 42±8.0years, there were more female respondents (56.0%) than male respondents (44.0%) and 76.0% of the respondents were married. Results further revealed a high prevalence of overweight and obesity (52%), pre-hypertension and hypertension (40%), and risk of abdominal obesity (84%). Conclusion: Non-academic staff are an essential component of the workforce and workplace intervention is essential to reduce the work nature risk factor of Obesity and Hypertension to prolong lives, and boost productivity and economic growth

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)