Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Knowledge of malaria and practice of home management of malaria among mothers of under fives

Background: Malaria is a preventable and treatable disease associated with high morbidity and mortality. It is the 3rd leading cause of death for children under five years worldwide. Home-based management of malaria may go a long way in reducing the attending morbidity and mortality associated with malaria in this group of subjects.Methods: A cross sectional study was conducted among 66 mothers of under five children accessing services in under five clinic in a tertiary health institution to determine the knowledge of malaria and practice of Home Management of Malaria (HMM).Result: The respondents in the study were within the age range of 16 – 45 years with mean age of 25 ± 5 years. Majority (95.5%) of the mothers of under-fives were aware of malaria while only 34.8% had heard of HMM. Less than half (42.4%) of the respondent had practiced management of malaria at home within 24 hours of onset of fever and only 25% used the recommended drug. Age and level of education of the mothers of under fives were significantly associated with the practice of HMM (P < 0.05).Conclusion: The study demonstrates the low level of practice of HMM among mothers of under-fives.Keywords: Knowledge, Practice, Home Management of Malaria, Under-five

Knowledge and utilization of long lasting insecticide treated nets among pregnant women

Background: Long Lasting Insecticide Treated Nets (LLITNs) are a form of personal protection that have been shown to reduce malaria illness in endemic regions. They form a protective barrier around people sleeping under them particularly the vulnerable group such as pregnant women and under - fives.Methods: A cross sectional study carried out among 310 pregnant women attending ANC in a tertiary health institution to assess the knowledge and utilization of Long Lasting Insecticide Treated Nets LLITNs.Results: The mean age of the pregnant women in the study was 27 ± 4 years with 264 (85.2%) of them residing in urban areas. Most (73.9%) of the respondents had good knowledge of LLITNs and consistent utilization of LLITNs was found to be 78.3%.Age of the respondents was found to have statistically significant relationship with consistency of use of LLINs.Conclusion: This study has revealed good knowledge and utilization of LLITNs among pregnant women.Keywords: Knowledge, Utilization, Insecticide Treated Nets, Pregnant Wome