Forging Ahead By Land and By Sea: Archaeology and Paleoclimate Reconstruction in Madagascar

Madagascar is an exceptional example of island biogeography. Though a large island, Madagascar’s landmass is small relative to other places in the world with comparable levels of biodiversity, endemicity, and topographic and climatic variation. Moreover, the timing of Madagascar’s human colonization and the social-ecological trajectories that followed human arrival make the island a unique case study for understanding the dynamic relationship between humans, environment, and climate. These changes are most famously illustrated by the mass extinction of the island’s megafauna but also include a range of other developments. Given the chronological confluence of human arrival and dramatic transformations of island ecologies, one of the most important overarching questions for research on Madagascar is how best to understand the interconnections between human communities, the environment, and climate. In this review paper, we contribute to the well-established discussion of this complex question by highlighting the potential for new multidisciplinary research collaborations in the southwest part of the island. Specifically, we promote the comparison of paleoclimate indicators from securely dated archaeological and paleontological contexts with Western Indian Ocean climate records, as a productive way to improve the overall resolution of paleoclimate and paleoenvironmental reconstruction for the island. Given new archaeological findings that more than double the length of Madagascar’s human occupation, models of environmental transformation post-human arrival must be reassessed and allow for the possibility of slower and more varied rates of change. Improving the spatial and temporal resolution of paleoclimate reconstruction is critical in distinguishing anthropogenic and climate drivers of environmental change. It will also increase our capacity to leverage archaeological and paleoclimate research toward resolving modern challenges, such as environmental conservation and poverty alleviation

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa