Les malformations de Dandy-Walker : Aspects diagnostiques et apport de l’endoscopie : A propos de 77 cas

ObjectifDécrire les malformations kystiques de la fosse postérieure chez l’enfant et évaluer les indications et résultats thérapeutiques.MéthodeIl s’agit d’une étude prospective en série continue réalisée dans le service de neurochirurgie de l’hôpital national de Niamey (Niger) entre janvier 2007 et février 2012. Etaient inclus, les enfants de 0 à 5ans admis pour macrocranie ou retard psychomoteur sans antécédents de méningite chez qui un kyste malformatif de la fosse postérieure a été découvert au scanner. Une évaluation clinique et une classification scannographique a été réalisée pour chaque patient. L’indication opératoire a été retenue en présence de syndrome de la fosse postérieure associé ou non à une hydrocéphalie. En présence d’une hydrocéphalie le traitement était endoscopique de première intention (VCS + fenestration du kyste dans le ventricule latérale (VL) + cautérisation plexuelle partielle). Certains patients ont été classés selon les critères prédictifs des résultats de la VCS selon Warf. Une fontanelle non affaissée et tendue à 1mois post opératoire était considérée comme un échec. Seuls les patients suivis pendant au moins 6 mois ont été inclus dans l’étude.RésultatsLa série comportait 144 patients porteurs de kyste de la fosse postérieure soit 11,076% des enfants de 0 à 5 ans ayant réalisé un scanner en 5ans. La moyenne d’âge était de 8,7 mois (7 jours - 5 ans) avec un sexe ratio de 1,4. Il s’agissait de 67 cas de malformation de Dandy Walker (46,52%), de 21 cas de Dandy Walker variant (14,58%) et de 56 cas de kyste de la fosse postérieure considérés comme megacisterna magna ou kyste de la valecula ou Dandy Walker complex (38,88%). Sur les 144 patients porteurs de malformation kystique de la fosse postérieure l’hydrocéphalie était associée dans 128 cas soit dans 88,88% des cas. L’indication opératoire était retenue chez 77 patients suivis pendant au moins 6 mois (53,47%) dont 8 n’avaient pas d’hydrocéphalie (5,55%). Il s’agissait de 49 cas/ 67 de malformation de Dandy Walker, de 7 cas/21 de Dandy Walker variant, et de 21 cas/56 retenus comme des megacisterna magna ou de kyste de la valecula ou Dandy Walker complex. Le suivi moyen était de 16,4 mois (6 mois- 59 mois) avec au moins un scanner de contrôle à 6 mois post- opératoire. Le taux de succès du traitement endoscopique seul était de 57% à 6 mois.ConclusionLorsque l’indication opératoire est retenue pour une malformation kystique de la fosse postérieure associée à une hydrocéphalie, le traitement endoscopique peut être de première intention

Prise En Charge Des Victimes Du Conflit Armé Du Nord Mali Dans Les Hôpitaux De Niamey

Objectives: The aims of this study was to evaluate the management of lesions in victims of the malian conflict patients admitted to Niamey hospitals. Methods: A retrospective study was conducted in Niamey hospitals from January 1st, 2012 to December, 31th, 2013. Data collected included âge, sex, means of transport, topography of trauma, treatment and outcome. Results: The sample included fifty one (51) patients. All patients were male; the mean age was 29,5 years ± 9 years, ranging from 17-71 years. The age between 26 and 35 were most affected in 47% of cases (24 patients), soldiers represented 72.54% (37 patients); and civils 27.45% (14 patients). 74.50% of our patients (38) were been transported in Niamey by aircraft. The trauma concerned the members in 54.90% (28 cases), canio facial in 17.60% (9 cases), abdomen in 11.80% (6 cases). We observed only one polytrauma. 66.66% (34) of patients were injured by firearms, 29.41% (15) by accidents of roads, 3,93% by burn (2 patients). The lesions found were bone in 41.17% (21 patients), skin-muscle in 35.29% (18 patients), visceral in 9.80% (5 patients). Five patients died (9.80%). Conclusion: the internationalization of conflicts requires a reorganization of the care by involving all the nearness health structures in order to ensure adequate care and neutrality

Evaluation of the antimicrobial susceptibility testing process in clinical microbiology laboratories at Niamey, Niger

Background: Risk assessment is the means of identifying and evaluating potential errors or problems that may occur in testing process. The aim of this study was to perform risk assessment of antimicrobial susceptibility testing (AST) process in clinical microbiology laboratories of Niamey, Niger Republic.Methodology: We conducted a descriptive cross-sectional study from October 1 to December 31, 2019, to evaluate AST performance in seven clinical microbiology laboratories at Niamey, the capital city of Niger republic. The evaluation focused on the determination of the criticality index (CI) of each critical point (frequency of occurrence of anomalies, severity of the process anomaly, and detectability of the anomaly during the process) in the AST process and the performance of the AST through an observation sheet using two reference strains; Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213.Results: The criticality index (CI) was greater than 6 for most of the critical points related to material, medium, equipment, method and labour for the AST process in all the laboratories. A range of 18-100% errors on the inhibition zone diameters of the reference strains were observed. Major and/or minor categorization (Sensitive S, Intermediate I and Resistance R) discrepancies were found at all the laboratories for either one or both reference strains. The antibiotics most affected by the S/I/R discrepancies were trimethoprim (100%), vancomycin (100%), amoxicillin (80%) and amoxicillin + clavulanic acid (70%).Conclusion: This study showed a deficiency in the control of critical control points that impacts the performance of the AST reported by the laboratories in Niger. Corrective actions are needed to improve the performance of AST in clinical microbiology laboratories in Niger.   French title: Evaluation du processus de réalisation de l’antibiogramme dans les laboratoires d’analyses de biologie médicale de la ville de Niamey, Niger Contexte: L'évaluation des risques est le moyen d'identifier et d'évaluer les erreurs ou les problèmes potentiels qui peuvent survenir dans le processus de test. L'objectif de cette étude était de réaliser une évaluation des risques du processus d'antibiogramme (ABG) dans les laboratoires de microbiologie clinique de Niamey, en République du Niger.Méthodologie: Nous avons mené une étude transversale descriptive du 1er octobre au 31 décembre 2019 pour évaluer la performance des ABG dans sept laboratoires de microbiologie clinique à Niamey, capitale de la république du Niger. L'évaluation a porté sur la détermination de l'indice de criticité (IC) de chaque point critique (fréquence d'apparition des anomalies, gravité de l'anomalie du processus et détectabilité de l'anomalie au cours du processus) dans le processus et la performance des AGB à travers une fiche d'observation en utilisant deux souches de référence; Escherichia coli ATCC 25922 et Staphylococcus aureus ATCC 29213.Résultats: L'indice de criticité était supérieur à 6 pour la plupart des points critiques liés au matériel, au milieu, à l'équipement, à la méthode et à la main-d'oeuvre pour le processus AST dans tous les laboratoires. Une fourchette d'erreurs de 18 à 100% sur les diamètres des zones d'inhibition des souches de référence a été observée. Des écarts de catégorisation majeurs et/ou mineurs (Sensible: S, Intermédiaire: I et Résistance: R) ont été constatés dans tous les laboratoires pour l'une ou les deux souches de référence. Les  antibiotiques les plus touchés par les écarts S/I/R étaient la triméthoprime (100%), la vancomycine (100%), l'amoxicilline (80%) et l'amoxicilline + acide clavulanique (70%).Conclusion: Cette étude a montré une déficience dans le contrôle des points de contrôle critiques qui a un impact sur la performance de l'antibiogramme rapportée par les laboratoires au Niger. Des actions correctives sont nécessaires pour améliorer la performance des ABG dans les laboratoires de microbiologie clinique au Niger

Prise En Charge Des Anévrismes Artériels Dans Un Centre Africain Non Spécialisée

Introduction: Arterial aneurysms affect 7 to 8% of people over 65 in the West and are the 2nd leading cause of death in these countries. In Africa this frequency is poorly evaluated. The objective of this work is to report the management of arterial aneurysms at the National Hospital of Niamey (HNN). Patients and methods: This was a retrospective, descriptive study over a period of eight (8) years from January 2009 to December 2016, performed in the surgical departments of the National Hospital of Niamey. Included in the study were patients of both sexes, hospitalized and / or operated for arterial aneurysm. Not included were patients treated for arterial aneurysm with incomplete records or those concerning the neurosurgical sphere. Results: During the study period, 17,748 patients were hospitalized in the general surgery departments, including 16 patients for arterial aneurysm, or 0.09% of surgical pathologies. There were 13 men (81.25%) and 3 women (18.75%), or a sex ratio of 4.33. The average age was 55.75 years with extremes ranging from 25 years old to 90 years old. The circumstances of discovery of the aneurysms were swelling of the antero-internal aspect of the thigh in 7 cases (43.75%), abdominal mass 6 cases (37.50%), then 2 cases (12.50%) of chest pain and incidental discovery in 1cas (6.25%). The most common risk factor was high blood pressure with 43.75% (7 cases). The aneurysm sat on the femoral artery in 43.75% (n = 7), of which 6 on the deep femoral and 1 on the superficial femoral, on the infrarenal aorta in 31.25% (n = 5), on thoracic aorta 12.50% (n = 2), on the iliac artery 12.50% (n = 2). For the diagnosis the angioscanner is realized in all the patients and in addition Doppler ultrasound in 43, 75% of cases. Twelve (12) patients benefited from curative surgical intervention by prosthetic graft by PTFE in 58.33% of cases and by Dacron in 41.66%. The average stay was 29.75 days and the immediate operative followup was complicated by thrombosis in 12.5% and parietal suppurations in 6.25%. We recorded two (2) deaths, ie 12.5% among non-operated patients. Conclusion: Arterial aneurysms are rare diseases at the HNN. Conventional surgery is the treatment performed in our patients. The postoperative course was simple in most cases

Evaluation De L’efficacité De L’analgésie Postopératoire Procurée Par 100 μg De Morphine Versus 25 μg De Néostigmine Après Rachianesthésie Pour Fracture Du Fémur À Propos De 60 Cas

Les morphiniques par voie intrathécale renforcent l’analgésie peropératoire et participent à celle postopératoire. Des molécules comme la néostigmine ont été testées comme adjuvants aux anesthésiques locaux pour une meilleure analgésie postopératoire. La supériorité de la néostigmine par rapport à la morphine administrée par voie intrathécale n’a pas été prouvée. Nous proposons de comparer l’efficacité de l’analgésie postopératoire que procuraient 100 μg de morphine en intrathécale à celle de 25 μg de néostigmine au cours de rachianesthésie chez des patients proposés pour une chirurgie de fémur. L’objectif était de montrer que la gestion de la douleur postopératoire peut se faire par des adjuvants sans risque. Il s’agissait d’une étude prospective descriptive et analytique portant sur une période de trois mois allant du 1er septembre au 30 novembre 2019 à propos de soixante patients de sexe masculin randomisés en double aveugle repartis en deux groupes : Groupe M : Les patients ont reçu un mélange de 15 mg de bupivacaine 0,5% isobare + 25 μg de fentanyl + 100 μg de morphine. Groupe N : Les patients ont reçu un mélange de 15 mg de bupivacaine 0,5% isobare + 25 μg de fentanyl +25 μg de néostigmine. Les variables étudiées étaient les données démographiques, hémodynamiques, la douleur postopératoire, les effets indésirables (prurit, vomissement, dépression respiratoire) la qualité du bloc sensitif et moteur. L’analyse a été faite à l’aide du logiciel SPSS 10.0. Le test de Ki-2 a été utilisé pour comparer les variables qualitatives et le test t student pour celles quantitatives. Le seuil de signification était fixé à 5%. Durant la période d’étude un total de 401 actes chirurgicaux a été pratiqué dont 63,34 % sous anesthésie générale et 36,50 % sous rachianesthésie. L’étude portait sur soixante patients opérés sous rachianesthésie. L’âge moyen était de 30 ± 6 ans dans le groupe N et 32 ± 4 ans dans celui M. La classe ASA était comparable dans les deux groupes. L’hypertension artérielle était le principal antécédent (13, 3% pour le groupe N contre 20% pour celui M.). La durée moyenne de la chirurgie était de 90 ± 8 minutes. A la sortie du bloc opératoire le score EVA était nul chez tous les patients. A la première heure postopératoire le score EVA était de 08 ± 3 mm dans le groupe N versus 06 ±3 mm dans celui M (p = 0,852). A la quatrième heure postopératoire le score EVA était de 15,6 ± 20 mm dans le groupe N contre 3,3 ± 8 mm dans le M (p = 0,003). Mais à la huitième heure postopératoire dans le groupe N le score EVA était de 33,6 ± 33 mm contre 4 ± 9 mm ; la différence était statistiquement significative (p ˂ 0,001). Par contre dans le groupe M l’acmé de la douleur n’a été observée qu’à la 24ème heure. Dans le groupe N, le recours à un complément d’analgésie par la morphine intraveineuse pendant les 24 premières heures postopératoires était observé chez 16 patients (5,33%) alors qu’aucun complément d’analgésie n’a été jugée nécessaire dans le M. La différence était significative (p ˂ 0,001). La consommation moyenne de morphine intraveineuse dans le groupe N était de 2,6 ±1mg avec des extrêmes de 2 à 4 mg. Le délai moyen de la première demande d’analgésie supplémentaire était de 3 heures avec des extrêmes de 1 à 8 heures. Dans le groupe N, 56,7% des patients avaient présentés des nausées et vomissements contre 16,7% dans le groupe M, la différence était significative (p = 0,0001). Nous avions enregistrés 23,3% des cas de prurit dans le groupe N versus 33,3% dans celui M, la différence était non significative (P= 0,39). La néostigmine en intrathécale à la dose de 25 μg procurait une analgésie postopératoire moins efficace que celle de 100 μg de morphine en intrathécale. La néostigmine par voie intrathécale reste limitée du fait de la forte incidence des nausées vomissements. Intrathecal morphinics reinforce intraoperative analgesia and participate in postoperative analgesia. Other molecules, such as neostigmine, have been tested as adjuvants to local anesthetics for a better postoperative analgesia. The superiority of neostigmine over morphine administered intrathecally has not been proven. We propose to compare the effectiveness of postoperative analgesia provided by100 μg Intrathecal morphine to that of 25 μg of neostigmine during spinal anaesthesia in patients proposed for femur surgery. Show that the management of postoperative pain can be done with safe adjuvants. This was a prospective and analytical study over a three-month period from September 1 to November 30, 2019. There were sixty randomized double-blind male patients divided into two groups: Group M: received a mixture of 15 mg bupivacaine 0.5% isobaric acid + 25 μg fentanyl + 100 μg morphine. Group N: received a mixture of 15 mg bupivacaine 0.5% isobaric acid + 25 μg fentanyl + 25 μg neostigmine. The variables studied were demographic, hemodynamic, postoperative pain, adverse effects, quality of sensory and motor block. The analysis was done using the SPSS 10.0 software. The Ki-2 test was used to compare the qualitative variables and the student t test for the quantitative ones. The significance threshold was set at 5%. During the study period 401 patients were operated on. General anaesthesia was performed in 63.34% of cases and rachianesthesia in 36.50%. The mean age was 30 ± 6 years in the N group and 32 ± 4 years in the M. The ASA class was comparable in both groups. Arterial hypertension was the main antecedent (13.3% for the N group versus 20% for the M.). The average duration of the procedure was 90 ± 8 minutes. At the exit of the operating room the EVA score was nil in all patients. At the first postoperative hour the EVA score was 08 ± 3 mm in the N group versus 06 ± 3 mm in the M group (p = 0.852). At the fourth postoperative hour the EVA score was 15.6 ± 20 mm in the N group versus 3.3 ± 8 mm in the M (p = 0.003). But at the eighth postoperative hour in the N group the EVA score was 33.6 ± 33 mm versus 4 ± 9 mm; the difference was statistically significant (p ˂ 0.001). On the other hand, in group M, the acme of pain was observed only at the 24th hour. In group N, the use of supplemental intravenous morphine analgesia during the first 24 postoperative hours was observed in 16 patients (533%), whereas no additional analgesia was considered necessary in the M. The difference was significant (p ˂ 0.001). The average intravenous morphine consumption in the N group was 2.6 ± 1 mg with extremes of 2 to 4 mg. The average interval of the first request for additional analgesia was 3 hours with extremes of 1 to 8 hours. In group N, 56.7% of patients had nausea and vomiting compared to 16.7% in group M, the difference was significant (p = 0.0001). We recorded 23.3% of the pruritic cases in the N group versus 33.3% in the M group, the difference was not significant (P = 0.39). Intrathecal neostigmine at a dose of 25 μg provides less postoperative analgesia than intrathecal morphine 100 μg. Intrathecal neostigmine remains limited because of the high incidence of nausea and vomiting

Management of postoperative pain: experience of the Niamey National Hospital, Niger

Maman Sani Chaibou,1 Samuila Sanoussi,2 Rachid Sani,2 Nouhou A Toudou,1 Hadjara Daddy,1 Moussa Madougou,1 Idrissa Abdou,1 Habibou Abarchi,2 Martin Chobli31Department of Anesthesiology and Intensive Care, 2Department of Surgery, The Niamey National Hospital, Niamey, Republic of Niger; 3Department of Anesthesiology, Hubert K Maga University Teaching Hospital, Cotonou, BeninObjective: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital.Methods: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery.Results: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. Conclusion: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.Keywords: postoperative pain, pain scales, Niamey National Hospita

Anaesthetic Management of Homozygous Sickle Cell Patients at Niamey National Hospital, Niger

Background: Sickle cell disease is a common comorbidity in patient presenting for surgical care in our hospitals. The aim of this study was to evaluate the outcome of anaesthetic management of sickle cell disease patients in our hospital.Patients and method: A prospective audit was conducted for a period of 12 months, from 1st March 2015 to 29th February, 2016. Included were all homozygous sickle cell patients who underwent anaesthesia. The following variables were studied: age, sex, blood transfusion, hemoglobin level, ASA status, type of anaesthesia, pre-, intra- and post-operative management and outcome.Results: Thirty (30) patients with homozygous sickle-cell disease were found among the 3882 patients who were operated on (0.77%). Mean age was 12 ± 8 years, with a range from 9 months to 36 years. More than half of the patients were female (53.3%) with a sex ratio of 1.14. Hemoglobin level was less than 7 g / dl in 23.33%. Only 6.67% of patients had hemoglobin level above 10 g / dl. Of the 30 patients, 93.34% were ASA II, 36.70% had preoperative transfusion, surgery was elective in 93.30% and emergent in 6.70%. The commonest surgical procedures were tonsillectomy in 26.66%. General anaesthesia was performed in 96.70% of patients, spinal anaesthesia in 3.30%. Intraoperative incidents occurred in 23.33%. Intraoperative transfusion was given to 43.30% of patients. Mortality rate was 10%.Conclusion: Anaesthetic management of the sickle cell patient in our hospital is challenging due to lack of transfusion procedures and exchange transfusions.Keywords: Sickle cell disease, anaesthesia, outcome, Niamey, Nige

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study

CITATION: Bishop, D. et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. The Lancet Global Health, 7(2):e513-e522. doi:10.1016/S2214-109X(19)30036-1The original publication is available at https://www.thelancet.com/journals/langlo/issue/vol7no2/PIIS2214-109X(19)X0002-9Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30036-1/fulltextPublisher’s versio

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran