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

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 middle-income 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 low-income 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 low-income, 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

Comparative studies of the dough raising capacity of local yeast strains isolated from different sources

Background: Fermentation by yeast is of primary importance for its leavening function and its possible contribution to the production of desirable flavoured compounds.&nbsp;Objectives: This study focused on the isolation of local yeast strains from different sources: fresh pineapple juice, palm wine and orange juices and Burukutu.&nbsp;Methods: &nbsp;Fresh pineapple juice, palm wine and orange juices and Burukutu were kept on a sterile workbench to be fermented at ambient temperature for 72 hours. Aliquots of the fermented samples were introduced into conical flasks containing yeast extract glucose peptone broth compounded for isolation and characterization. Yeast isolated from pineapple, burukutu, orange and palm wine were characterized. The morphological, cultural and biochemical characteristics of the yeasts were identified by using API20C AUX Kit (Bio Meriux), tested for markers characteristics such as sugars fermentation ability and starch hydrolysis. Biomass of each isolate tested was used to ferment flour dough to determine their fermentative abilities. Five out of the seven yeast isolates were compared with the commercial baker yeast (control) in terms of their dough raising capacity to confirm their baking potentials. Sensory evaluation of the baked fermented dough was carried out using these parameters: texture, aroma, taste and appearance.&nbsp;Results: The yeasts were identified to be Saccharomyces cerevisiae,&nbsp; Saccharomyces exiguus, Saccharomyces kluyveri and Saccharomyces ludwigii. Catalase and Urease were found to be identical with the baker’s yeast (Control). The results revealed that Saccharomyces cerevisiae, Saccharomyces exiguus and Saccharomyces ludwigii yeast isolates produced loaves that have sensory properties significant (p≤0.05) when comparable with baker’s yeasts commonly used in many of the bakeries.&nbsp;Conclusion: The findings in this study showed that it is possible to isolate a pure culture of Saccharomyces species from fermented fruits and local beverages for use in baking instead of importing the commercial baker’s yeast that is expensive. These local isolates if used will economize our foreign reserve. Keywords: Local yeast, Baker’s yeast, Saccharomyces species, Dough raisin

Shelf Stability, Microbiological and Physicochemical Studies of ‘Zobo’ Drink Pasteurized and Treated with Preservative

Background: The combined effect of pasteurization, improved hygiene and varied concentrations of sodium benzoate on the shelf stability and physicochemical attributes of ‘Zobo’ drink, a nutritious non-alcoholic indigenous beverage was evaluated.&nbsp;Objectives: To evaluate the combined effects of pasteurization, improved hygiene and food preservatives on the shelf stability of ‘Zobo’ drink.&nbsp;Methods: Freshly prepared ‘Zobo’ samples were aseptically dispensed in 100 mL capacity Polyethylene terephthalate (PET) bottles containing various concentrations of sodium benzoate (0.05%, 0.25%, 0.50%, 0.75% and 1.00%). Six ‘Zobo’ samples were produced from the fresh ‘Zobo’ using a modified method that combined Hurdle Technology and Hazard Analysis and Critical Control Points (HACCP) for preservation and stored for eight weeks on the shelf. Analyses were carried out weekly on loss in vitamin C content, microbial quality and physicochemical properties of the beverage for eight weeks.&nbsp;Results: Parameters analysed significantly (p&lt;0.05) changed considering the methods of treatment and storage period. Pasteurization at 68oC for 20 minutes eliminated successfully all pathogenic organisms and coliforms as none was isolated from the drink throughout the eight weeks of shelf study. Saccharomyces cerevisiae and Lactobacillus fermentum isolated from the samples during storage were responsible for the deterioration and spoilage of the beverage.&nbsp;Conclusion: Although the five different concentrations of the preservative used in combination with pasteurization were effective in extending the shelf life of the beverage, sample Bz 0.05% preserved better than all others without impacting negatively on the vitamin C content and other physicochemical properties of the drink. Keywords:&nbsp;Zobo, Hibiscus sabdariffa, Sodium Benzoate, Pasteurization, shelf lif