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, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Seventeen Sustainable Development Goals (SDGs) were adopted by the global community to provide benchmark targets for global development between 2015 and 2030 and to reframe the Millennium Development Goals (MDGs) to achieve sustainable global development. This report presents data on maternal mortality in 195 countries from 1990 to 2015. Maternal mortality data were categorized in 3 formats, namely, number of deaths, cause-specific mortality rate per capita, and cause fraction. The overall maternal mortality was modeled using cause-of-death ensemble modeling (CODEm). The number of deaths, maternal mortality ratios (MMRs), and 95% uncertainty intervals were reported for all estimates. The results indicate that the overall decline in global maternal deaths from 1990 to 2015 was approximately 29% (390,185 in 1990; 374,321 in 2000; and 275,288 in 2015), and the reduction in MMR was 30% (282 in 1990, 288 in 2000, and 196 in 2015). In 1990, it was found that 60 countries had an MMR of more than 200, 40 countries had an MMR of more than 400, 15 countries had an MMR of more than 600, and 1 country had an MMR of more than 1000. By 2015, 122 countries had an MMR of less than 70, and 49 countries had an MMR of less than 15. Although MMR and Sociodemographic Index improved between 1990 and 2015 in almost all regions, it was observed that MMR did not universally track with Sociodemographic Index over the whole time period in any single region. The observed minus expected (O - E) MMR ratio was consistently found to be 1.25 or more in many regions; however, MMR reductions slowed considerably, and the O - E MMR ratio was 1.41 in 2015. The risk of maternal mortality increased greatly with age, but decreased greatly in almost all age groups from 1990 to 2015. It was observed that MMR in 10- to 14-year-old girls in 2015 was 278; it then decreased and was lowest in women aged 15 to 29 years before increasing significantly to 1832 in 50- to 54-year-old women. Direct obstetric causes accounted for 86% of all maternal deaths in 2015 due to maternal hemorrhage, maternal hypertensive disorders, and other maternal disorders in comparison to 1990 when direct complications accounted for 87% of all maternal deaths. Other maternal disorders caused approximately 74,299 deaths in 1990 and decreased to 32,734 deaths in 2015. The study authors conclude that although there is global progress in reducing maternal mortality in the past 15 years, more and better data collection systems should be put in place to devise better health care policies and to educate women about reproductive care options available to them

Global, regional, and national levels of maternal mortality, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.Peer reviewe

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

Ingestion volontaire et digestibilité apparente d'une ration à base de la farine de graines de Mucuna pruriens var. utilis complétée de fourrages chez les lapins

Volontary Ingestion and Apparent Digestibility of a Ration Based on Mucuna pruriens var. utilis Seeds Flour Completed with Forage on Rabbits. Mucuna pruriens var. utilis (mucuna) detoxified seeds flour is used as a vegetable protein source, in a basal diet of fifteen growing rabbits divided in five groups of tree. Each rabbit received per day a fixed quantity of basal diet (130.5 g DM), but as only feed (RP) for control group; plus 40.5 g DM of Panicum maximum forage and, 60 g DM of one of the four experimental legumes of Aeschynomene histrix (RH), Mucuna pruriens (RFM), Stylosanthes scabra Secca (RS) and Tridax procumbens (RT) for the others groups. The experiment conducted in Benin has lasted 26 days, split in 19 days for diet adaptability and 7 days for data collection. Voluntary daily feed intake varied from 28 to 42 g/kg of dry mater (DM) of live weight (LW) for basal diet and from 10.5 to 18 g DM/kg of LW for Panicum maximum. Green forage consumption of Aeschynomene histrix, Mucuna pruriens and Stylosanthes scabra were higher compared to the one of Tridax procumbens (P&lt; 0.01). The supply of green forage to basal diet has increased the total daily feed intake that is about 67 to 89 g DM/kg of LW and 26 to 39 g DM/day for dung production.Water intake is higher for rabbit fed with RP diet. Feed resource RFM but also RS and RH have been digestible with 70%, 61% and 54% DM. They gave high weight gain of 30-22 g/day

Place des anemies dans la pathologie hospitaliere en pediatrie a l’hopital du district N°III, hopital de be Lome (Togo)

Introduction : L’anémie est une affection très répandue dans le monde particulièrement dans les pays en voie de développement responsable de décès de nombreux enfants en particulier en Afrique au sud du Sahara. Elle demeure une grande préoccupation à cause de la persistance des circonstances étiologiques notamment les pathologies infectieuses et les maladies liées aux anomalies de l’hémoglobine.Objectifs : Evaluer l’importance et la prise en charge des anémies dans les pathologies hospitalières dans l’hôpital du District sanitaire N° 3 de Lomé Commune.Méthodologie : Nous avons analysé les dossiers médicaux des enfants hospitalisés du 1er novembre 2007 au 30 avril 2008 dans le service de pédiatrie de l’hôpital du district N°III, hôpital de BE. Etait inclus dans l’étude tout enfant de moins de 15 ans hospitalisé et ayant un taux d’hémoglobine inférieur à 10g/dl quelque la pathologie sous-jacente.Résultats : Au total 1029 enfants étaient hospitalisés pendant la période de l’étude parmi lesquels 549 pour anémie sévère qui ont fait l’objet de cette étude soit 53,35%. Environ huit enfants sur dix a moins de 5 ans (76%) dont 42,3% avaient moins d’un an âge moyen 4ans extrême 8 jours et 14 ans. Une prédominance masculine a été observée avec une sex ratio de 2,03. Les cas ont été enregistrés tous les mois avec des pics en novembre, décembre janvier et mars correspondant à la saison pluvieuse. Les principaux signes ayant motivé les d’hospitalisations ont été Fièvre (59,6 %), pâleur cutanéo-muqueuse (43,9 %), troubles digestifs (18,76 %), asthénie (13,8 %). Le paludisme était l’étiologie la plus prédominante (82 %, suivi des hémoglobinopathies (12 %), les infections respiratoires aiguës (6,2 %), les parasitoses digestives (3,6 %), les infections néonatales (2,9 %), souffrances néonatales (2,2 %). La plupart des enfants avaient un taux d’hémoglobine inférieur à 08 g/ dl (68,27 %), il varie de 02g/dl à 09,93 g/dl avec un taux d’hémoglobine moyen de 6,4g/dl. La transfusion sanguine (49,18 %) et le traitement martial (75,18 %) ont été réalisés associées à un traitement antipalustre systématique (100 %) à base d’Artéméther (65,57 %) et de sels de quinine (34,43 %). Le taux de guérison était de 81,2 % contre 10,9 % de décès dont 71,6 % avaient moins de 1an 71,6 % et 33,3 % ayant un taux d’hémoglobine &lt; 5 g/ dl.Conclusion : L’anémie sévère demeure une cause importante de décès de nourrisson même nourris au sein. Les résultats de cette sont importants à prendre en compte dans les stratégies de lutte contre l’anémie du jeune enfant notamment dans les communications en faveur de l’alimentation du nourrisson, la prévention du paludisme et des maladies héréditaires de l’hémoglobine ainsi que les mise à disposition et l’usage des moyens de prise en charge simples et efficaces de l’anémie dans les régions.Mots clés : Anémie, enfant, épidémiologie, traitement, Togo