Cost Characteristics of the African Catfish Culture in Recirculating Production Facilities in Ibadan, Oyo State, Nigeria

Recirculating fish production technology re-­‐uses water more than once by passing it through treatment processes thereby utilizing less water and space required by conventional ponds to produce similar yields of fish. Economic performance of the African catfish in three recirculating fish production facilities in Ibadan metropolis was investigated. Data were obtained using structured questionnaires, physical inspection of facilities, fish sampling and laboratory analysis of water quality parameters were also carried out using standard methods. Facilities sustained African catfish (Clarias gariepinus) loading capacity of 98.1kg/m3 and 176.6kg/m3 of juvenile and adult fish with feeding rates of 2.14kg/m3/day and 1.29kg/m3/day respectively. Stocking densities are 20,000-­‐31,000fish/m3; 6000-­‐9000fish/m3 and 150 – 300fish/m3. SR varies from 75-­‐80% for fingerlings, 75-­‐93% for juveniles and 77-­‐88% for adult fish. Food Conversion Ratio also ranged from 0.60–0.78 for fingerlings, 1.01-­‐ 2.08 for juveniles and 1.15-­‐1.68 for grow out system. In all cases, variable cost accounts for more than 75% of total cost. Within fixed costs input, interest payment on initial investment ranks the highest. While feed cost accounts for the highest among variable costs for fingerlings and growout systems. With 50%, 45% and 40% crude protein feeds, production cost per fish was N5.40, N18.49 and N209.0($0.03,$0.11 and $1.31) for fingerling, juvenile and adult fish of average weight 4.2g, 11.2g and 981.0g reared for 28, 30 and 154 days respectively

Patents and the trans-pacific partnership: How TPP-style intellectual property standards may exacerbate the access to medicines problem in the East African Community

Least developed countries (LDCs) generally enjoy some exemptions under the WTO TRIPS Agreement. Despite these exemptions, patents continue to pose a major challenge to access to affordable medicines in the East African Community (EAC), especially with respect to the HIV/AIDS pandemic. The EAC is a regional economic bloc made up of six states, with five of the member states currently ranked as LDCs by the United Nations. This article argues that the implementation of the patent protection standards following the model adopted in the Trans-Pacific Partnership is likely to further exacerbate the access to medicines conundrum of the EAC

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The impact and morphology of anaemia among Lassa fever patients treated in a dedicated treatment center in South West Nigeria

Background: The haematological indices in Lassa fever infection is not documented in the literature. The clinical relevance of anaemia on the disease course is also largely unknown. Aim: In this study, we aim to determine the impact and morphologic types of anaemia in patients with Lassa fever infection using the red cell indices and to also determine the impact of anaemia on clinical course of the infection. Method: Retrospective observational analytic study of data of confirmed Lassa fever cases managed in the Infection Control and Research Centre of federal Medical Centre Owo Nigeria from November 2018 to June 2019. Results: A total of one hundred and eighty seven (187) confirmed cases were treated at the Infection Control Centre during this period of which we were able to obtain one hundred relevant data for our study (100). The age range was 1-90 years with a mean age range of 33.95±18.80, with 54% male and 46% female. A total of 69% (31 males, 38 females) had anaemia, while 31% had no anaemia, 47% had microcytic hypochromic anaemia, 22% had normocytic normochromic anaemia, 19% had bleeding diathesis, 16% had acute kidney injury, 12% had haemodialysis, 29% with severe anaemia were transfused, 80% had haematinics. The median duration of illness in days was 21vs.16.5 for those with or without anaemia respectively. The median duration in days for ribavirin use was 11 vs. 10 days for those with or without anaemia respectively. Four (4) people each died in both group, the low mortality may have been influenced by the readily availability of blood transfusion services, the other four from the non- anaemic group died from other complications not related to anaemia. All of the patients with anaemia were placed on haematinics as against 31% without anaemia. At discharge, 18(22.5%) patients with anaemia still remained positive with a positive Lassa PCR result after completion of 10days I.V ribavirin while 6(30%) had a negative Lassa PCR result. Conclusion: This study has shown the significant impact of anaemia among Lassa fever patients, classified the morphology of anaemia in these categories of patients and reduced mortality outcome following a readily available blood transfusion service and relevant personnel. The study thus, emphasizes the role of a functional blood transfusion service and clinical haematologist in the management of Lassa fever patients. The recognition of these findings will help in management of Lassa fever patients with timely intervention where necessary

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Nutritional assessment and antioxidant potential of selected meat types consumed in Owhelogbo, Delta State, Nigeria

The present study aims at evaluating the nutritional value and antioxidant potential of various meat types (beef, pork, chicken, catfish and snails) consumed in Owhelogbo, community in Isoko Local Government, Delta State, Nigeria. The different meat samples were analyzed for nutritional composition and antioxidant properties. The results obtained show that the protein content varied from 20.09 to 61.74%, while the fat content varied from 2.00 to 12.08%. The calcium content ranged from 10.30 to 143.73 mg/100 g, while the phosphorous content ranged from 100.85 to 300.11 mg/100g. The linoleic acid content was in a range from 10.91 to 29.54%, while the linolenic acid content ranged from 0.84 to 5.53%. The content of vitamin A and vitamin D varied from 4.61 to 110.69 µg/100g and 2.15 to 18.05 µg/100g, respectively. The DPPH free radical scavenging ability and FRAP inhibitory activities of the different meat types ranged from 50.84 to 65.64% and 0.88 to 1.59%, respectively. The levels of high density lipoprotein and low density lipoprotein were in a range from 13.34 to 21.90 mg/dL and 2.30 to 5.59 mg/dL, respectively. The level of low density lipoprotein was the lowest in snail meat (SN), which suggests that it may be useful in managing obesity and preventing disorders linked to lipids. Consequently, the results conclude that snail meat may be a more valuable and innovative source of animal protein than beef, pork, chicken, and catfish

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

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 &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

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