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

Bronchoscopy for foreign body removal in children: anaesthetic challenges in a tertiary health Centre.

Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment; to review the anaesthetic practice in our centre, and compare them with universally accepted standards.Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body aspiration was diagnosed clinically and radiologically. Data concerning demography, clinical characteristics, anaesthetics and complications were obtained from the hospital records.Result: A total of 45 patients were studied. They were between the ages of 6 months and 11 years, 29 males and 16 females. A total of 64 procedures were carried out, of which 38 (59.4%) were bronchoscopy. Bronchoscopy was done with Stortz ventilating bronchoscope under general anaesthesia. Repeated doses of suxamethonium were used as muscle relaxant in 92.1% of cases.Conclussion: Rigid bronchoscopy for aspirated foreign body is a safe, effective and often life saving procedure in the hands of experienced anaesthetist and bronchoscopist. A close rapour between the two teams is necessary for a desired outcome.Key words: Foreign body aspiration, Bronchoscopy, Anaesthesia

Management Of Boy Child School Drop Out In South-East Nigeria: Issues And Challenges

The paper examined the circumstances of boy-child education and school drop-out in the south eastern geo-political zone of Nigeria and used available statistics to show that there is high incidence of male child drop out in the south eastern states of Nigeria. Furthermore, it examined the causes of male-child drop out to include poverty, mercantilism and blind curriculum. The preventive measures suggested to reduce boy child drop out included economic empowerment of families, curriculum review, orientation and sensitization on the importance of education, among others. Some recommendations were made to help reduce boy-child drop out phenomenon, including adequate parental upbringing as well as the introduction of adequate poverty eradication strategies, holding in focus State Economic Empowerment and Development Strategies (SEEDS) and National Economic Empowerment &amp; Development Strategies (NEEDS)

Evaluation Of Sachet Water Samples In Owerri Metropolis

Physical, chemical and microbiological analyses were used to determine the wholesomeness status of water sealed in polyethylene sachets, in Owerri metropolis. Fifteen different brands of sachet water were collected and analyzed. The study revealed that about 4 brands sampled did not meet the recommended WHO standard for taste while the chemical analyses showed that all the brands met the recommended standards. Microbiological analyses revealed that 9 brands had total plate count above 100 cfu/ml of sample. 6 brands were positive for coliforms while 3 brands were positive for E.coli. Other surveys revealed that 12 brands had fake manufactures' address, 2 brands had NAFDAC registration number while 3 brands had genuine manufacturers' address on them. It was discovered that the producers packaged the water from their water source without any form of treatment or analysis on it. Key words: Sachet water, coliforms, E.coli, standard, analyses. Nigerian Food Journal Vol.22 2004: 164-17

Nasalseptal hematoma/abscess: management and outcome in a tertiary hospital of a developing country

Jones N Nwosu, Peter C NnadedeDepartment of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency.Objective: To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution.Method: Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated.Results: Fifty-three patients (37 males and 16 females), age 5&ndash;65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases.Conclusion: Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess.Keywords: septal hematoma, abscess, facial deformit

Postoperative vomiting and fever following tonsillectomy in Enugu, Nigeria

OBJECTIVE: To determine the incidence of postoperative vomiting and fever in patients that had tonsillectomy in our centre over a five year period.METHODS: The hospital records (case files) of patients that had tonsillectomy with or without adenoidectomy under general anaesthesia at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria from January 2004 to December 2008 were retrieved and analyzed. Patients that had an adenoidectomy only were excluded. The patients were of the American Society of Anesthesiologists (ASA) 1 to III status. RESULTS: There were fifty two (52) patients that had tonsillectomy and adenotonsillectomy under general anaesthesia during the period under review. Forty one (41) patients were between the ages of 1-13 years (78%) and eleven (11) patients between the ages of 18 - 62 years (12%). There were 32 males and 20 females. The average age for all the patients was 9.03 years. There were seven (7) patients with post operative vomiting (13.4%). These included four (4) patients in the paediatric population (9.75%) and three (3) in the adult population (27.2%). Twenty one (21) patients (40.3%) developed postoperative fever. There were no deaths. The other significant morbidity was postoperative pain.CONCLUSION: The number of patients that had tonsillectomy in our center was small compared to other studies. The incidence of postoperative vomiting in this study is lower than that reported from Western World, showing possible racial variations, a trend that has been reported in some earlier studies in Black populations.KEYWORDS: Tonsillectomy, postoperative vomiting and fever, Afric

The effect of soaking and roasting on the proximate and functional properties of asparagus bean (Vigna sesquipedalis)

No Abstract. IJOTAFS Vol. 2 (2) 2008: pp. 191-19

Effects of cold storage and storage over fireplace on the rheological functions of “Ogbono” (Irvingia gabonensis)

The rheological functions of flour of the two varieties (Irvingia gabonensis and Irvingia wombolu) kernels were studied. The kernels were stored under cold storage and over fireplace and analysed fortnightly for a period of three months. The result showed that cold storage significantly (

Effects of processing on the proximate and sensory quality of ‘oze\' (Bosqueia angolensis) seeds

No Abstract.International Journal of Tropical Agriculture and Food Systems Vol. 2 (1) 2008: pp. 77-8

Proximate, Functional and Anti-Nutritional Properties of Boiled Ukpo Seed (Mucuna flagellipes) Flour

gUkpoh (&lt;i&gt;Mucuna flagellipes&lt;/i&gt;) seed flour is one of the soup thickeners used in most rural Igbo-speaking communities of Southern Nigeria. Its preparation is usually associated with long cooking time which is required to soften the cotyledon before grinding as well as reduce the anti-nutritional components of the seed. This work was therefore aimed at determining the effect of boiling time on some functional properties and antinutritional properties of the ukpo seed flour. The result obtained showed that there were slight reductions in the protein, fat and ash content as boiling time increased probably due to leaching. All the functional properties analysed increased significantly (p .0.05) with increasing boiling time. The water absorption, oil absorption and emulsion capacities increased from values of 1.60 ml/g, 1.23 ml/g and 9.3 ml/g respectively at 0 minutes to 3.2 ml/g, 2.8 ml/g and 17.66 ml/g respectively at 60 minutes. The bulk density and swelling index also increased from 0.72 g/ml to 1.17cm3/cm3 and from 1.02 g/ml to 1.36 cm3/cm3 respectively. The oxalate, tannin, saponin, phenol and phytate contents decreased significantly (p .0.05) with increasing boiling time. The values at 60 minutes boiling time were 0.14%, 0.182%, 0.434%, 0.146% and 0.719% respectively. These results suggest that heat treatment improves the performance of the Ukpo flour in soup thickening while reducing to a large extent the anti-nutritional properties.Keywords: Thickners, anti-nutritional, functional properties