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

Modeling the Colombian Swine Supply Chain from a Knowledge Management Perspective

The Colombian swine supply chain (CSSC) has a low level of national competitiveness compared to other supply chains such as coffee and fruit. While consumption of pork has raised in Colombia, most dealers are importing it from The United States and Canada, since farmers in those countries have received agricultural incentives to breed and commercialize pigs. Additionally, agribusiness have received technological developments to share information and develop the swine sector. This article aims to state theoretical Knowledge Management (KM) dimensions for CSSC that were built under authors’ assumptions on the literature. These were proposed to identify the competitiveness level in CSSC, because only two different kinds of measuring for swine competitiveness were found, but on the other hand, no model about Swine Supply Chain (SSC) was found. Perspectives of researching KM in CSSC would integrate stakeholders using a technological web platform which allows interchange of information among them.La cadena de suministro porcina colombiana (CSSC) tiene un bajo nivel de competitividad nacional en comparación con otras cadenas de suministro como café y frutas. Si bien el consumo de carne de cerdo ha aumentado en Colombia, la mayoría de los comerciantes la importan de Estados Unidos y Canadá, ya que los ganaderos de esos países han recibido incentivos agrícolas para criar y comercializar cerdos. Adicionalmente, la agroindustria ha recibido desarrollos tecnológicos para compartir información y desarrollar el sector porcino. Este artículo tiene como objetivo establecer las dimensiones teóricas de la Gestión del conocimiento (KM) para CSSC que se construyeron bajo los supuestos de los autores en la literatura. Estos fueron propuestos para identificar el nivel de competitividad en CSSC, debido a que solo se encontraron dos tipos diferentes de medición para la competitividad porcina, pero por otro lado, no se encontró un modelo sobre Cadena de suministro porcina (SSC). Las perspectivas de investigar KM en CSSC integrarían a las partes interesadas utilizando una plataforma web tecnológica que permita el intercambio de información entre ellos