Sociodemographic factors in anaemia in pregnancy in south-western Nigeria

Background: Anaemia in pregnancy persists, especially in third world countries where poor diet, low levels of literacy, infections, infestations and cultural practices predispose pregnant women to being anaemic. The aim of this study was to determine the prevalence of anaemia in pregnancy and to identify the possible associations between socio-economic status and anaemia in pregnancy among antenatal care seekers at Baptist Medical Centre, Ogbomoso, Oyo State, Nigeria.Method: A total of 350 pregnant women were recruited at booking from the antenatal clinic of the hospital. A standardised questionnaire was administered to collect sociodemographic data. The subjects were stratified into upper, middle and lower socio-economic groups according to a scoring system designed by Olusanya et al. for Nigeria and other African countries.Anaemia is defined as a haemoglobin level of less than 11 g/dl by the World Health Organization.Results: The prevalence of anaemia in pregnancy was 58.0% in the study population. Anaemia prevalence was significantly higher among the subjects in the middle and lower socio-economic classes: 78.3% and 80.3% respectively (P < 0.05). The majority of the severely anaemic subjects (80.0%) were from the lower social class.Conclusion: The prevalence of anaemia in pregnancy was found to be high in this population. Low socio-economic status is significantly associated with increased prevalence and severity of anaemia. It is recommended that the socio-economic situation of women be improved. This no doubt will help to reduce anaemia in pregnancy

Gastric Outlet Obstruction at Bugando Medical Centre in Northwestern Tanzania: A Prospective Review of 184 Cases.

Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. There is a paucity of published data on this subject in our setting. This study was undertaken to highlight the etiological spectrum and treatment outcome of gastric outlet obstruction in our setting and to identify prognostic factors for morbidity and mortality. This was a descriptive prospective study which was conducted at Bugando Medical Centre between March 2009 and February 2013. All patients with a clinical diagnosis of gastric outlet obstruction were, after informed consent for the study, consecutively enrolled into the study. Statistical data analysis was done using SPSS computer software version 17.0. A total of 184 patients were studied. More than two-third of patients were males. Patients with malignant gastric outlet obstruction were older than those of benign type. This difference was statistically significant (p < 0.001). Gastric cancer was the commonest malignant cause of gastric outlet obstruction where as peptic ulcer disease was the commonest benign cause. In children, the commonest cause of gastric outlet obstruction was congenital pyloric stenosis (13.0%). Non-bilious vomiting (100%) and weight loss (93.5%) were the most frequent symptoms. Eighteen (9.8%) patients were HIV positive with the median CD 4+ count of 282 cells/μl. A total of 168 (91.3%) patients underwent surgery. Of these, gastro-jejunostomy (61.9%) was the most common surgical procedure performed. The complication rate was 32.1 % mainly surgical site infections (38.2%). The median hospital stay and mortality rate were 14 days and 18.5% respectively. The presence of postoperative complication was the main predictor of hospital stay (p = 0.002), whereas the age > 60 years, co-existing medical illness, malignant cause, HIV positivity, low CD 4 count (<200 cells/μl), high ASA class and presence of surgical site infection significantly predicted mortality ( p< 0.001). The follow up of patients was generally poor as more than 60% of patients were lost to follow up. Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant. The majority of patients present late with poor general condition. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Lipid profile of adult Nigerians attending medical outpatient clinic of Baptist medical center Ogbomoso

Background: Economic development and urbanization in many developing countries has led to a nutritional transition characterized by a shift to a higher caloric content of diet and/or to the reduction of physical activity, and whose consequences are changes in the body composition of the individuals and elevated blood lipid levels. This study's aim was to determine the lipid profile and to determine if there is any association between lipid profile and abdominal obesity among adults attending the outpatient clinic at the Baptist Medical Centre, Ogbomoso, a semi urban environment. Methods: A cross-sectional descriptive study of 400 adults aged 18 years and above was carried out. Participants were administered a standardized questionnaire and had measurements of waist circumference and serum lipids taken. Results: Four hundred subjects were randomly selected (221 females and 179 males) with a mean age of 48.65 ± 16.56 years. The mean total cholesterol, LDL- cholesterol, Triglycerides and HDL-cholesterol were 3.78 ± 1.07 mmol/L, 1.18 ± 1.02 mmol/L, 0.97 ± 0.58 mmol/L and 2.15 ± 0.86 mmol/L respectively. The prevalence of abdominal obesity among the study population was 33.75%. The subjects who had abdominal obesity had the highest mean values for total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol. The mean values of total cholesterol, HDL-cholesterol, triglycerides and LDL-cholesterol obtained among the physically inactive subjects were higher than those of the subjects who were physically active. Conclusion: Higher mean values for total cholesterol, triglycerides and LDLcholesterol were found among the subjects who had abdominal obesity and those who were physically inactive in Ogbomoso. Keywords: Lipid profile, abdominal obesity, physical activity, Nigeria

Body size and abnormal lipids among adult patients at the Baptist Medical centre, Ogbomoso, Nigeria

Background: In many developing countries overweight, obesity and obesity-related morbidity are becoming a problem of increasing importance. Obese individuals are more likely to have elevated total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol and decreased high density lipoprotein (HDL) cholesterol.Objective: To determine the prevalence of obesity using the measure of body mass index (BMI) and abnormal lipid level and the association between obesity and abnormal lipid level among adults in Ogbomoso, Nigeria.Methods: A cross-sectional descriptive study of 400 adults aged 18 years and above was carried out at the Baptist Medical Centre, Ogbomoso, Nigeria. Participants were administered a standardized questionnaire and had measurements of weight, height and blood lipids taken.Results: Four hundred subjects were randomly selected (221 females and 179 males) with a mean age of 48.65 ± 16.56 years. The overall prevalence of obesity was 14.75% (8.9% for males and 19.5% for females p&lt;0.05). The female subjects were significantly more sedentary than the males (50.8% for males, 62.4% for females, p&lt;0.05). Most of the subjects who were obese (88.1%) preferred high calorie food. The overall prevalence of abnormal lipid levels was 28.5% (26.8% for males and29.9% for females). The prevalence of abnormal lipid levels among the subjects who were obese was 40.7%.Conclusion: Obesity in this environment is particularly significant among females and is associated with abnormal lipid level.Key words: Obesity, blood lipid level, body mass index

Body size and abnormal lipids among adult patients at the Baptist Medical centre, Ogbomoso, Nigeria

Background: In many developing countries overweight, obesity and obesity-related morbidity are becoming a problem of increasing importance. Obese individuals are more likely to have elevated total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol and decreased high density lipoprotein (HDL) cholesterol. Objective: To determine the prevalence of obesity using the measure of body mass index (BMI) and abnormal lipid level and the association between obesity and abnormal lipid level among adults in Ogbomoso, Nigeria. Methods: A cross-sectional descriptive study of 400 adults aged 18 years and above was carried out at the Baptist Medical Centre, Ogbomoso, Nigeria. Participants were administered a standardized questionnaire and had measurements of weight, height and blood lipids taken. Results: Four hundred subjects were randomly selected (221 females and 179 males) with a mean age of 48.65 ± 16.56 years. The overall prevalence of obesity was 14.75% (8.9% for males and 19.5% for females p<0.05). The female subjects were significantly more sedentary than the males (50.8% for males, 62.4% for females, p<0.05). Most of the subjects who were obese (88.1%) preferred high calorie food. The overall prevalence of abnormal lipid levels was 28.5% (26.8% for males and 29.9% for females). The prevalence of abnormal lipid levels among the subjects who were obese was 40.7%. Conclusions:Obesity in this environment is particularly significant among females and is associated with abnormal lipid level