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

The effect of oral care interventions in stroke survivors

Session A. Clinical Physical and Rehabilitation Medicine Sciences: Neurological and Mental Health Conditions - Stroke 2: poster presentation no. ISPR7-0822Background and aims: Despite the importance of good oral health, oral health is often neglected among stroke survivors. As a result, periodontal diseases are commonly reported among stroke survivors due to poor oral hygiene and increase in dental plaque . In addition, poor oral health increase carriage of oral pathogens and the risk for opportunistic infection such as aspiration pneumonia . Thus maintenance of good oral health is of key importance to reduce the risk of infection following stroke. Objective: This study aimed to evaluate the effectiveness of an oral health care intervention in improving the oral hygiene and decreasing oral opportunistic pathogens in post stroke patients. Methods: A multi-centre randomized controlled trial was conducted among 86 hospitalised stroke survivors. The inclusion criteria were patients with Modified Barthel Index (MBI) score of less than 70, who were medically stable and able to follow simple instructions. In addition, patients who were not on any antibiotic or antimicrobial agents and of having dentition of not less than five were included into the study. Written informed consent were obtained from all participants before the study commenced. Patients were then randomized into either the i) Test group - who were given a powered toothbrush and antimicrobial gel [1% chlorhexidine gluconate], or ii) Control group - who were given a manual toothbrush and a commercial toothpaste. Oral health assessments and oral microbial sampling using oral rinsing methods were conducted on each patients at three-time points; baseline (before the intervention), 3months and 6-months following interventions. Results: A total of 54 (response rate of 62.7%) patients were assessed at the three-time points. More than half of the participants were male (n=52, 60.5%) and at the age of above 40 (n=73, 84.9%). More than three-quaters of them did not have a denture (n=68, 79.1%), did not take alcohol (n=73, 84.9%) and did not smoke (n=66, 76.7%). For most, it was their first-stroke (n=75, 89.5%) and was of the ischemic type (n=77, 89.5%). Most (n=61, 70.9%) had a MBI scores of less than 50 (total and severe dependency level). Dental plaque scores were significantly lower at 6-months for both groups compared to baseline (P<0.001). Based on microorganism limit of detection (LOD), all participants showed the presence of yeasts, and 88.4% of them haboured S.aureus at baseline. There was a significant difference in yeast prevalence between the control and test group at 6-months (P=0.032), but was not significant within groups changes. A significant difference in S.aureus prevalence within the test group (P=0.024) was observed, however the prevalence was not significantly different between the control and test group at 6-months. Conclusion: The oral care interventions were effective in reducing dental plaque scores among stroke survivors over 6-months. Futhermore, changes in S.aureus over time were apparent and between group differences in yeast prevalence existed at 6-months. The effectiveness of the oral care interventions were comparable for both groups; i) a powered toothbrush and 1% Chlorhexidine gel or ii) a manual toothbrush and commercial toothpaste. The findings have implications for incorporation oral hygiene regimes within stroke rehabilitation

Students’ perceptions of Education for Sustainable Development (ESD) to Achieve SDG 4 in Indonesia: a case study of Universitas Islam Riau

Sustainable development at higher education level plays an important role in achieving the Sustainable Development Goals (SDGs). Higher education holds a great responsibility to increase the awareness and knowledge of students who will manage and develop resources. For the purpose of the sustainability of resources, awareness and knowledge of sustainable development are needed. This knowledge can be conveyed through Education for Sustainable Development (ESD) to achieve high education quality and equal access to education for women and men. Perception ofESDmust be studied to gather information about the facts, problems and challenges faced by Universitas Islam Riau (UIR) to achieve SDGs, especially SDG 4 (Quality Education). This study aims to identify the perception students of both genders at Universitas Islam Riau (UIR) hold about Education for Sustainable Development (ESD). This research is a descriptive survey research conducted using a quantitative approach. There were 99 respondents in this study, Consisting of 43 men and 56 women. Data was collected by distributing questionnaires containing 70 statements, while processing of questionnaire data was done through the frequency analysis formula. Generally, the results of social, environmental and economic aspects in the ‘Good’ category are between 71.08 and 78.75%. Based on gender, both female and male students scored a higher percentage in economic aspect than other aspects, whereby female students scored 77.76%, whereas it was 76.50% for male students. Based on this study, it can be concluded that the students of Universitas Islam Riau have a good perception of Education for Sustainable Development. Therefore, the University must begin to apply the concept of sustainable development in every aspect in order to contribute to achieving SDG 4