Water quality awareness and barriers to safe water provisioning in informal communities: A case study from Ndola, Zambia

Local water providers in developing nations typically view shallow hand-dug wells as traditional and backward sources of water supply. It has long been assumed that the urban poor do not have the ability to develop these in a way that allows them to be classified as ‘improved’ in terms of the Millennium Development Goal for water, believing that users do not understand the factors that constitute safe water and the threats to these sources. Our assessment of the level of environmental knowledge held by local water-users in Ndola in Zambia demonstrates a coherent understanding of the safety of their water sources, the quality of these, the threats to them, and the fundamentals of how their local hydrology works, all of which is contrary to the perspective of key informants who are involved in water supply. Despite their environmental awareness, the majority of users did not generally protect their wells from contamination nor treat their water. The apparent paradox between awareness of risks to water and implementing protection of that water source is a function of the complex suite of socially manifested attitudes, habits and behaviours when it comes to water protection and treatment, which is exacerbated by vulnerable community and family structures and entrenched poverty. For meaningful outcomes in improved access to safe water to be realised providers need to increase their engagement with the informal communities, moving deeper into community-based participatory planning and recognise the societal and cultural factors that are entrained into these communities water supply practices. A key part of this involves the need for providers to move away from simple knowledge-based education to the more holistic form of skill-based health education

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

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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 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

Die invloed wat agtergrondmusiek in advertensies en tipe en vlak van betrokkenheid uitoefen op verbruikers se houding teenoor advertensie, houding teenoor handelsmerk en koopintensie

Tesis (MComm)--Stellenbosch University, 1991.ENGLISH ABSTRACT: This study examines the effect of involvement and background music in television commercials on consumers' attitudes toward the commercial, their attitude toward the brand and their intension to buy that spesific brand. Involvement refers to type of involvement (cognitive vs affective) and the level of involvement (high vs low). The planning of the experiment had been done according to research projects in the past. A commercial with different soundtracks was viewed by different subjects. Thereafter they completed a questionniare. The members of the different groups were subjected to different manipulations. The results indicated that background music in commercials have a significant influence on consumers' attitudes towards the commercial. (cognitive vs affective) had a on consumers' attitudes towards the a significant relationship between commercial , attitude toward the brand Type of involvement significant influence brand. There was attitude toward the and intension to buy.AFRIKAANSE OPSOMMING: In hierdie navorsing is die gesamentlike invloed wat agtergrondmusiek en betrokkenheid in advertensies uitoefen op die kyker se houding teenoor die advertensie, houding teenoor die handelsmerk en koopintensie ondersoek. Betrokkenheid verwys na tipe betrokkenheid (kognitief vs affektief) en vlak van betrokkenheid (hoog vs laag). Daar is gebruik gemaak van In laboratorium eksperiment om hierdie invloede te bepaal. Die beplanning van die eksperiment is gedoen na aanleiding van verskillende navorsingsprojekte wat in die verlede gedoen is. In Advertensie met verskillende klankbane is aan groepe proefpersone vertoon waarna hulle In vraelys voltooi het. Elkeen van die groepe (12) was aan verskillende eksperimentele manipulasies onderworpe. Hierna is die vraelyste gekodeer en die data statisties verwerk. Dit is gevind dat agtergrondmusiek In beduidende invloed op verbruikers se houding teenoor In advertensie uitoefen. Tipe betrokkenheid het ook In beduidende invloed op verbruikers se houding teenoor die handelsmerk uitgeoefen. Verder is In beduidende positiewe verband tussen houding teenoor advertensie, houding teenoor handelsmerk en koopintensie gevind

Population change in the Karoo

In common with arid and semi-arid areas worldwide, South Africa’s Karoo has experienced significant population shifts over the last 100 years. These have been caused by a range of considerations related to advances in farming technology and changing labour needs, transport improvements, environmental considerations and contextual economic variables. This paper pays attention to how, in the twentieth century, these factors catalysed net population loss in the Karoo’s rural areas but population gain in all categories of urban settlement, particularly the larger centres. An exception to this was the phenomenon of ‘shrinking towns’, which became discernible in the late twentieth century. In the twenty-first century the process has become more complex, as small towns’ decline has now been reversed and all towns are now attracting rural and inter-regional migrants in the post-apartheid years. We comment on the potential causes, nature and effects of these variations in the Karoo, and discuss the key role of these towns as they reflect the dynamic socio-economic and environmental shifts witnessed in the region.Keywords: Karoo, population, urba