Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary 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 middleincome 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 lowincome 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 lowincome, 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

Replication Package: Social Competition Drives Collective Action to Reduce Informal Waste Burning in Uganda

This directory contains the code and data needed to reproduce all analytical figures and tables in the main manuscript and Supporting Information of the following article: Buntaine, Mark T., Komakech, Polycarp, and Shen, Shiran Victoria. 2024. Social Competition Drives Collective Action to Reduce Informal Waste Burning in Uganda. Proceedings of the National Academy of Sciences. https://doi.org/10.1073/pnas.231971212

The Challenges of Using Citizen Reporting to Improve Public Services: A Field Experiment on Solid Waste Services in Uganda

Abstract Governments around the world are investing in technologies that allow citizens to participate in the coproduction of public services by providing monitoring and feedback, but there is little evidence about how these initiatives affect the quality of public services. We implemented a large-scale field experiment that involved organizing 50 citizen reporters in each of 100 neighborhoods across Kampala, Uganda, to provide weekly reports to the municipal government about the delivery of solid waste services via an SMS-messaging platform, resulting in 23,856 reports during the 9-month study period. Citizen reporting did not reduce informal waste accumulation as targeted, which would indicate improvements to formal services. Using our observations as participants in the development and deployment of the reporting platform and interviews with staff at the government agency receiving the citizen reports, we show how the public generated inconsistent information that did not fit existing decision-making processes. We generalize lessons from this field experiment by explaining how coproduction involving information sharing through information and communication technologies is likely to affect public services based on the alignment of citizen-produced data with the information problems managers face; the search costs of detecting public services failures; the quality of citizen-produced data; and the operating costs of citizen-reporting platforms

The Challenges of Using Citizen Reporting to Improve Public Services: A Field Experiment on Solid Waste Services in Uganda

Abstract Governments around the world are investing in technologies that allow citizens to participate in the coproduction of public services by providing monitoring and feedback, but there is little evidence about how these initiatives affect the quality of public services. We implemented a large-scale field experiment that involved organizing 50 citizen reporters in each of 100 neighborhoods across Kampala, Uganda, to provide weekly reports to the municipal government about the delivery of solid waste services via an SMS-messaging platform, resulting in 23,856 reports during the 9-month study period. Citizen reporting did not reduce informal waste accumulation as targeted, which would indicate improvements to formal services. Using our observations as participants in the development and deployment of the reporting platform and interviews with staff at the government agency receiving the citizen reports, we show how the public generated inconsistent information that did not fit existing decision-making processes. We generalize lessons from this field experiment by explaining how coproduction involving information sharing through information and communication technologies is likely to affect public services based on the alignment of citizen-produced data with the information problems managers face; the search costs of detecting public services failures; the quality of citizen-produced data; and the operating costs of citizen-reporting platforms

Reducing Air Pollution and Waste Burning through Social Competition

Improving urban air quality is a pressing challenge in the Global South. A key source of air pollution is the informal burning of household waste. Reducing informal burning requires governments to develop formal systems for waste disposal and for residents to adopt new disposal behaviors. Using a randomized experiment, we show that social competitions between pairs of neighborhoods in Nansana municipality, Uganda, galvanized leadership and inspired collective action to reduce informal burning. All 44 neighborhoods in the study received a public health campaign, while 22 treated neighborhoods were paired and competed to reduce waste burning over an 8-month period. Treated neighborhoods showed a 24 percent reduction (95\% CI: 11-35 percent) in waste burning relative to control neighborhoods at the end of the competition period. There is no evidence that treated neighborhoods experienced a rebound in waste burning several months after the competitions. Community leaders reported greater effort in coordinating residents and more pride in their neighborhood when assigned to the competition treatment. These results suggest that creating focal points for leadership and collective action can be an effective and low-cost strategy to address policy problems that require broad participation and costly behavior change

Profitability of rice production in different production systems in Ebonyi State, Nigeria

Profitability of rice production in different production systems in Ebonyi State, Nigeria was evaluated. Rice is critical for food security in Nigeria, hence, farmers need to make appropriate choices of rice production systems to optimize production and ensure an adequate domestic supply. This study used 2015 survey data from rice farming households. Rice farmers in swamp, lowland and upland rice production systems showed variability in profit. Swamp production systems had the highest return per hectare (29.37%) followed by lowland production systems (20.10%) and upland production systems (13.03%). Poor access to production credit and climate change were constraints to rice production in the area. Rice production using the swamp production system is profitable and would ensure increased production and higher returns to the farmers. It is recommended that farmers should form cooperative groups to enable them to pool resources together to boost their production

Analysis of Rural Farm Households’ Access to Formal Agricultural Credit in Yola South Local Government Area, Adamawa State, Nigeria

The purpose of this study was to analyse rural farm households’ access to formal agricultural credit in Yola South Local Government Area of Adamawa state, Nigeria. Descriptive and inferential statistics were used to analyse the primary data collected using structured questionnaire (from 140 rural farming households). Findings from the study have shown that, 90 % of the respondents were male, mostly educated (70 %) and married (89 %) engaging in farming as their primary livelihood activity (about 81 %) with an average farm size of 2.47 hectares. The result of the binary logit regression has shown that level of education and income do influence access to credit positively, while age and distance to access point negatively influence respondents’ access to formal credit. The study further revealed that, lack of acceptable collateral / security, high interest rates, low financial literacy, and complex banking procedures were the main factors that limits the respondents’ access to credit facility from formal sources. In order for farmers to have an improved access to formal credits, the formation of strong groups that are viable to provide the needed capital is encouraged, banking operations should be simplified to suite farmers’ needs / convenience and financial literacy among farmers should be improved through awareness campaigns (in agricultural extension packages)

A National Survey On The Professional Role Conceptions Of Journalists In Kenya

A research paper by Dr. Kioko Ireri, an Assistant Professor of Journalism and Mass CommunicationThe professional role conceptions of journalists have for many years remained a central strand in journalism studies. The present research investigates the professional role conceptions that Kenyan journalists perceive to be the most important in their work. Similarly, the professional role they consider the most important is further analyzed in relation to demographics (age, gender, education, contract type, media type, and media ownership). Findings from a national survey of 504 Kenyan journalists indicate that “providing citizens with information” is the most important role (61.3 percent), followed by “advocate for social change” (51.7 percent). The other major roles include to “support official policies” (46.9 percent), “motivate people to participate in civic activities” (45.6 percent), and “act as watchdog of government” (35.3 percent). The most important role—providing citizens with information—is backed across all demographics with a strong mean of 4.4 on a five-point scale ranging from 1 (“not important at all”) to 5 (“extremely important”). However, the difference of means across all the analyzed demographics are not statistically significant

Ethics

We provide information about the ethics application and certificates obtained for the MLA stud