32 research outputs found
Estudio de factibilidad para la creación de una empresa de producción y comercialización de gerberas, "Gerberas del Café" en la ciudad de Pereira
El estudio de factibilidad realizado para analizar la creación de GERBERAS DEL CAFE, Cultivo de flores ornamentales, permitió definir ciertos criterios.
- El estudio de mercados infiere sobre la población objetivo de GERBERAS DEL CAFE, obteniendo como resultado demandas potenciales favorables, respaldadas por una penetración de mercado progresiva, lo que le da vía libre a las proyecciones de ventas realizadas y muestra factibilidad comercial.
- La factibilidad técnica, comprendida por los estudios de tamaño, localización e ingeniería, muestra que la capacidad de la empresa cumple con las necesidades de producción, además de ajustarse al diseño requerido por las condiciones del cultivo y al lugar elegido para su implementación.
- El estudio administrativo y legal, garantiza el correcto funcionamiento de la empresa a partir de direccionamientos estratégicos claramente definidos, manuales e instructivos de trabajo óptimo, y trámites legales y de reglamentación identificados, dando como resultado una empresa factible desde el punto de vista organizacional, reflejado en el excelente servicio al cliente que se presta.
- El estudio de factibilidad financiera arroja resultados positivos que determinan la viabilidad de la creación de esta nueva unidad de negocio; los ingresos son suficientes para cubrir sus costos de inversión y sostenimiento.
- El análisis de sensibilidad evaluado con el VPN, TIR y B/C refleja que se debe aceptar la inversión ya que todos los valores obtenidos son positivos
- Como se establece en las políticas ambientales de GERBERAS DEL CAFE, el impacto al medio ambiente es positivo en todo momento a partir de procesos más limpios y campañas de protección ambiental implementadas en el proceso de producción y comercialización, respaldando las iniciativas de responsabilidad social y ambiental generadas alrededor de todo el planeta.
- Finalmente, es importante resaltar la necesidad de creación de empresa con sentido social y de impacto positivo; se recomienda buscar la disminución al máximo de costos operativos para mejorar las expectativas en el proyectoThe feasibility study undertaken to examine the creation of GERBERAS Coffee Cultivation of ornamental flowers, possible to define certain criteria. - Market research on the target population inferred Gerbera COFFEE, resulting in favorable potential claims, backed by a progressive market penetration, which gives free rein to sales projections and shows commercial feasibility. - Technical feasibility, including studies by size, location and engineering, shows that the ability of the company meets the needs of production, and fit the design required by the conditions of cultivation and the site chosen for implementation. - The administrative and legal study, the proper functioning of the company from clearly defined strategic direction, manuals and work instructions optimum, and legal and regulatory procedures identified, resulting in an enterprise feasible organizational standpoint, reflected in the excellent customer service that is provided. - The financial feasibility study shows positive results to determine the feasibility of creating this new business unit, revenue sufficient to cover its investment costs and maintenance. - The sensitivity analysis evaluated the NPV, IRR and B / C shows that investment should be accepted and that all values obtained are positive. - As stated in the environmental policies of gerbera CAFE, the environmental impact is positive at all times from cleaner processes and environmental protection campaigns implemented in the production and marketing process, supporting social responsibility initiatives and generated environment around the planet. - Finally, it is important to highlight the need for setting up a business with a social and positive impact, they should get the maximum reduction of operating costs to improve the prospects in the project
Knowledge networks in public health and the capacity for building up through collaborative strategies
ABSTRACT: This paper presents the experience of a thematic network on
public health in Colombia, which focuses its development
and contributions to the field of research in policy and health
systems. It is recognized in the work of this network the
revival of knowledge from the interactions of social actors
who share experiences, data, information, approaches, state
of art and research methodologies and intervention as well
as possibilities of systematization and measures generating
political and public opinion in order to advance social
transformation processes. The reflection on the construction
of this type of endogenous capacities in the field leads to the
necessary dimension of the challenges of increased national
and global interaction. It builds networks of knowledge must
advance and mature in the development of different forms of
cooperation that allow them to experience greater international
integration to improve performance and territorial impact.
We conclude by interpreting how the internationalization
of academic and scientific relations is the foundation of
a perspective for the work of knowledge networks in a
globalized world.RESUMEN: Este ensayo presenta la experiencia de una red temática en
salud pública para Colombia que orienta sus desarrollos y
aportes hacia el campo de la investigación en políticas y sistemas
de salud. Se reconoce en el trabajo de esta red el surgimiento
de relaciones de conocimiento a partir de las interacciones
de actores sociales que comparten experiencias, datos,
información, enfoques, estados del arte y metodologías de
investigación e intervención, así como posibilidades de sistematización
y medidas de política y generación de opinión
pública, con el objeto de avanzar en procesos de transformación
social. La reflexión en torno a la construcción de
este tipo de capacidades en el ámbito endógeno lleva a la
necesaria dimensión de los retos de una mayor interacción
nacional y global. Se sustenta que las redes de conocimiento
deben avanzar y madurar en el desarrollo de diferentes
modalidades de cooperación que les permitan experimentar
una mayor inserción internacional para mejorar la actuación
e incidencia territorial. Se concluye interpretando cómo la
internacionalización de las relaciones académicas y científicas
es la base de una perspectiva para el trabajo de redes de
conocimiento en un mundo globalizado
Reflexiones para la construcción de política pública con impacto en el componente bucal de la salud
ABSTRACT: The workshop on Oral Health by the interinstitutional cooperation “Management of Public Policies and Health” has the objective of promoting a reflection conducive to the formulation of public health proposals that have a positive effect on the general health and its oral component. There are precedents of such policies and the local and international levels that have gone unrecognized by the reform to the social security system in health; this has produced, in the specific case of Medellin, the dismantling of public health programs that have proven their efficiency and efficacy in previous years. Some examples that show this statement are presented and some basic enunciates are proposed which should be part of a public policy with impact on the oral component of health. It concluded that the political, economic and demographic changes experienced by our country in the past recent years have given place to a determined profile of health disease which should be attended by the organized management of society. The oral component of health has also been affected and the dental practice called to respond to the new or old needs that the population has in this field.RESUMEN: La Mesa de trabajo por la Salud Bucal del proyecto interinstitucional de cooperación “Gestión de Políticas Públicas y Salud”, tiene como propósito promover una reflexión que conduzca a la formulación de propuestas de política pública que afecten positivamente la salud general y su componente bucal. Existen en el ámbito mundial y nacional antecedentes de dicha política que han sido desconocidos por la reforma al sistema de seguridad social en salud, lo que ha provocado en el caso específico de Medellín el desmonte de programas de salud pública que en otros tiempos mostraron ser eficaces y eficientes. Se exponen algunos ejemplos que ilustran esta afirmación y se proponen algunos enunciados básicos que deben hacer parte de una política pública con impacto en el componente bucal de la salud. Se concluye que los cambios políticos, económicos y demográficos que el país ha experimentado en los últimos años, han dado lugar a un determinado perfil de salud enfermedad que debe ser atendido mediante la gestión organizada de la sociedad; el componente bucal de la salud también se ha visto afectado y la práctica odontológica convocada a responder a las necesidades nuevas o antiguas que en este campo tiene la población
“Diseño de una estrategia pedagógica comunicativa, para una estudiante de 21 años con discapacidad neuromotora y discapacidad intelectual moderada asociada”
En su célebre frase Yadiar Julián “La mentalidad fuerte del ser humano, debe enfocarse en sus logros, no es sus limitaciones” Yadiar (2000), hace referencia a los provechos que los profesionales de la Educación Especial pueden alcanzar cuando en su actuar hacen énfasis en la búsqueda y potenciación de las capacidades de la persona con discapacidad, para un mejor desarrollo y provecho de las mismas en su vida cotidiana, con el fin de enfocar la labor docente no en el “mejoramiento” de sus déficits sino en el desarrollo de sus habilidades, permitiendo así que su discapacidad pase a ser vista desde la concepción de talentos diversos.
De otra parte, la discapacidad como condición presente en nuestra sociedad, es una realidad a la que cualquier familia puede enfrentarse tras diversas situaciones tales como: el cambio brusco de las condiciones biológico-ambientales de un individuo por nacer, o en cualquier etapa de la vida posterior al nacimiento, adicionalmente la discapacidad de un miembro de la familia trae consigo situaciones nuevas, extrañas y difíciles de llevar, como el sentimiento de culpa y la inseguridad, ante las cuales ninguna familia o persona estará lo suficientemente preparada y consciente para asumir, aceptar y enfrentar las dificultades emocionales y físicas que trae consigo el día a día de un familiar con discapacidad. Lo anterior, genera inquietudes que al ir experimentando situaciones impensadas, confrontan directamente lo emocional, lo que puede afectar o no, el desarrollo de la familia y de la persona en condición de discapacidad, donde la discapacidad es entendida, como un “término general que abarca las deficiencias, las limitaciones de la actividad y las restricciones de la participación” (2000, OMS). Sin embargo, actualmente Brand y Pope proponen de manera asertiva que “la discapacidad puede ser mayor o menor en la medida que el entorno le ofrezca las herramientas, adaptaciones y recursos que la persona necesite, de tal 12
manera que pueda interactuar cómodamente con su ambiente y tener una calidad de vida”, lo cual en relación con el rol de la familia y la influencia de la sociedad, permite reconocer la importancia de las acciones de las mismas en el desarrollo del individuo, de forma que éstas lo beneficien o perjudiquen.In his famous phrase Yadiar Julián "The strong mentality of the human being, must focus on his achievements, not his limitations" Yadiar (2000), refers to the benefits that Special Education professionals can achieve when they emphasize in the search and empowerment of the person with disabilities, for a better development and benefit from them in their daily lives, in order to focus the teaching work not on the "improvement" of their deficits but on the development of their abilities, thus allowing their disability to be seen from the conception of diverse talents.
On the other hand, disability as a present condition in our society, is a reality that any family can face after various situations such as: the abrupt change of the biological-environmental conditions of an unborn individual, or at any stage of the life after birth, additionally the disability of a family member brings with it new, strange and difficult situations, such as feelings of guilt and insecurity, before which no family or person will be sufficiently prepared and conscious to assume, Accept and face the emotional and physical difficulties that the daily life of a family member with disabilities brings. This generates concerns that, when experiencing unthinkable situations, directly confront the emotional, which may or may not affect the development of the family and the person with a disability, where the disability is understood as a “general term that it covers deficiencies, activity limitations and participation restrictions ”(2000, WHO). However, Brand and Pope are now assertively proposing that “the disability may be greater or less as the environment offers the tools, adaptations and resources that the person needs, in such a way
12
so that it can interact comfortably with its environment and have a quality of life ”, which in relation to the role of the family and the influence of society, allows us to recognize the importance of their actions in the development of the individual, of so that they benefit or harm you
Physicochemical and functional characterization of trupillo flour (Prosopis juliflora (Sw.) DC) and its inclusion in a food matrix
Introduction: The high protein content has made legumes a raw material of interest in the formulation of different agro-industrial products; the trupillo (Prosopis juliflora) tree is an easily accessible, multipurpose, wild legume that can be used in all its composition, has a high protein value and little commercial level, which is currently being wasted as it is mistakenly considered a weed and that It could be seen as a new alternative that helps in the potentialization of the food sector.
Objective: This research aims to functionally characterize trupillo flour (Prosopis juliflora), obtained from leaves and seeds, to include it in a food matrix as a protein extender.
Methodology: The experimental design for this research required three phases, i) obtaining, bromatological and functional characterization of leaf flour and trupillo seeds, ii) standardization of formulations for artisan sausages using trupillo flour as a protein source, and iii) bromatological and sensory characterization of the processed sausages.
Results: It was found that the flours obtained preserved the characteristic odor and color of each raw material. Particularly, the seed flour presented bromatologically and functionally better protein contents (27.7%), ash (8.04%), swelling capacity (16.7 ml water / g sample), water absorption (7.89 g water / g sample) and water retention capacity (27.9 g water/g sample), for which it was selected to be included in the sausages. In the three formulations made (C, CT and T), there were variations in the color and texture of the sausages, with Formulation T standing out for presenting higher protein content (13.7%). However, consumers preferred Formulation C.
Conclusions: These results allow to propose the inclusion of sausage with trupillo flour in the human diet as an alternative to traditional products.Introduction: The high protein content has made legumes a raw material of interest in the formulation of different agro-industrial products; the trupillo (Prosopis juliflora) tree is an easily accessible, multipurpose, wild legume that can be used in all its composition, has a high protein value and little commercial level, which is currently being wasted as it is mistakenly considered a weed and that It could be seen as a new alternative that helps in the potentialization of the food sector.
Objective: This research aims to functionally characterize trupillo flour (Prosopis juliflora), obtained from leaves and seeds, to include it in a food matrix as a protein extender.
Methodology: The experimental design for this research required three phases, i) obtaining, bromatological and functional characterization of leaf flour and trupillo seeds, ii) standardization of formulations for artisan sausages using trupillo flour as a protein source, and iii) bromatological and sensory characterization of the processed sausages.
Results: It was found that the flours obtained preserved the characteristic odor and color of each raw material. Particularly, the seed flour presented bromatologically and functionally better protein contents (27.7%), ash (8.04%), swelling capacity (16.7 ml water / g sample), water absorption (7.89 g water / g sample) and water retention capacity (27.9 g water/g sample), for which it was selected to be included in the sausages. In the three formulations made (C, CT and T), there were variations in the color and texture of the sausages, with Formulation T standing out for presenting higher protein content (13.7%). However, consumers preferred Formulation C.
Conclusions: These results allow to propose the inclusion of sausage with trupillo flour in the human diet as an alternative to traditional products. 
Epidemiología y la relación salud-ambiente : reflexiones sobre el cambio ambiental, desarrollo sustentable y salud poblacional
ABSTRACT: This essay presents a discussion on current environmental
problems and their relationship to the health of populations.
The limitations of the model of economic and social
development are analyzed focusing on the augmentation
of the capital and the industrial production and its negative
impact on natural resources, the balance of ecosystems and
human vulnerability. The methodological basics and the
developments in environmental epidemiological approach
are exposed analyzing their main potential application.
Finally, options for solutions are formulated linking them to
the premises of sustainable development and environmental
justice. The responsibility of the academic environment is
pointed out in the training of human and scientific resources
in the field of environmental epidemiology, as well as the role
of the community in terms of environmental awareness and
active participation from a point of view that becomes critical,
responsible and capable of defining proposals to make part of
the solution.RESUMEN: Ensayo que presenta una discusión sobre la problemática ambiental
actual y su relación con la salud de las poblaciones. Se
analizan las limitaciones del modelo de desarrollo económico
y social, centrado en el incremento del capital y la producción
industrial, y su impacto negativo sobre los recursos naturales,
el equilibrio de los ecosistemas y la vulnerabilidad humana. Se
exponen los fundamentos metodológicos y los desarrollos del
enfoque epidemiológico ambiental, analizando sus principales
potenciales de aplicación. Por último, se formulan opciones de
solución articuladas a las premisas del desarrollo sustentable y
de la justicia ambiental, y se destaca la responsabilidad de la
academia en la formación del recurso humano y científico en
el área de epidemiología ambiental, así como el papel protagónico
de la comunidad en la toma de conciencia ambiental y
la participación activa desde una postura crítica, responsable y
propositiva para hacer parte de la solución del problema
The Research Journey as a Challenge Towards New Trends
The academic community of the department of Risaralda, in its permanent interest in evidencing the results of the research processes that are carried out from the Higher Education Institutions and as a product of the VI meeting of researchers of the department of Risaralda held in November 2021 presents its work: “The journey of research as a challenge towards new trends”, which reflects the result of the latest research and advances in different lines of knowledge in Agricultural Sciences, Health Sciences, Social Sciences and Technology and Information Sciences, which seek to solve and meet the demands of the different sectors.
This work would not have been possible without the help of each of the teachers, researchers and authors who presented their articles that make up each of the chapters of the book, to them our gratitude for their commitment, dedication and commitment, since their sole purpose is to contribute from the academy and science to scientific and technological development in the search for the solution of problems and thus contribute to transform the reality of our society and communities. We also wish to extend our
gratitude to the institutions of the Network that made this publication possible: UTP, UCP, UNAD, UNIREMINGTON; UNISARC, CIAF, Universidad Libre, Uniclaretiana, Fundación Universitaria Comfamiliar and UNIMINUTO, institutions that in one way or another allowed this work to become a reality, which we hope will be of interest to you.Preface............................................................................................................................7
Chapter 1. Technologies and Engineering
Towards a humanization in Engineering using soft skills in training
in Engineers.............................................................................................................11
Omar Iván Trejos Buriticá1, Luis Eduardo Muñoz Guerrero
Innovative materials in construction: review from a bibliometric
analysis....................................................................................................................27
Cristian Osorio Gómez, Daniel Aristizábal Torres, Alejandro Alzate Buitrago,
Cristhian Camilo Amariles López
Bibliometric review of disaster risk management: progress, trends,
and challenges.........................................................................................................51
Alejandro Alzate Buitrago, Gloria Milena Molina Vinasco.
Incidence of land coverage and geology, in the unstability of lands
of the micro-basin of the Combia creek, Pereira, Risaralda....................................73
Alejandro Alzate Buitrago, Daniel Aristizábal Torres.
Chapter 2. Arts, Humanities, and Social Sciences
Training experience with teachers teaching mathematics using the
inquiry methodology ...............................................................................................95
Vivian Libeth Uzuriaga López, Héctor Gerardo Sánchez Bedoya.
Interpretation of the multiple representations of the fears associated
to the boarding of limited visual patients in the elective I students’ written
productions and low vision ...................................................................................113
Eliana Bermúdez Cardona, Ana María Agudelo Guevara, Caterine Villamarín Acosta.
The relevance of local knowledge in social sciences............................................131
Alberto Antonio Berón Ospina, Isabel Cristina Castillo Quintero.
Basic education students’ conceptions of conflict a view from the peace
for the education....................................................................................................143
Astrid Milena Calderón Cárdenas,Carolina Aguirre Arias, Carolina Franco Ossa,
Martha Cecilia Gutiérrez Giraldo, Orfa Buitrago.
Comprehensive risk prevention in educational settings: an interdisciplinary
and socio-educational approach ............................................................................163
Olga María Henao Trujillo, Claudia María López Ortiz.
Chapter 3. Natural and Agricultural Sciences
Physicochemical characterization of three substrates used in the deep
bedding system in swine .......................................................................................175
Juan Manuel Sánchez Rubio, Andrés Felipe Arias Roldan, Jesús Arturo Rincón Sanz,
Jaime Andrés Betancourt Vásquez.
Periodic solutions in AFM models........................................................................187
Daniel Cortés Zapata, Alexander Gutiérrez Gutiérrez.
Phenology in flower and fruit of Rubus glaucus benth. Cv. Thornless
in Risaralda: elements for phytosanitary management .........................................199
Shirley Palacios Castro, Andrés Alfonso Patiño Martínez, James Montoya Lerma,
Ricardo Flórez, Harry Josué Pérez.
Socio-economic and technical characterization of the cultivation of
avocado (Persea americana) in Risaralda..............................................................217
Andrés Alfonso Patiño Martínez, Kelly Saudith Castañez Poveda, Eliana Gómez Correa.
Biosecurity management in backyard systems in Santa Rosa de Cabal,
Risaralda................................................................................................................227
Julia Victoria Arredondo Botero, Jaiver Estiben Ocampo Jaramillo, Juan Sebastián Mera Vallejo,
Álvaro de Jesús Aranzazu Hernández.
CONTENTS
Physical-chemical diagnosis of soils in hillside areas with predominance
of Lulo CV. La Selva production system in the department of Risaralda.............241
Adriana Patricia Restrepo Gallón, María Paula Landinez Montes, Jimena Tobón López.
Digestibility of three concentrates used in canine feeding....................................271
María Fernanda Mejía Silva, Valentina Noreña Sánchez, Gastón Adolfo Castaño Jiménez.
Chapter 4. Economic, Administrative, and Accounting Sciences
Financial inclusion in households from socioeconomic strata 1 and 2 in
the city of Pereira ..................................................................................................285
Lindy Neth Perea Mosquera, Marlen Isabel Redondo Ramírez, Angélica Viviana Morales.
Internal marketing strategies as a competitive advantage for the company
Mobilautos SAS de Dosquebradas........................................................................303
Inés Montoya Sánchez, Sandra Patricia Viana Bolaños, Ana María Barrera Rodríguez.
Uses of tourist marketing in the tourist sector of the municipality of Belén
de Umbría, Risaralda.............................................................................................319
Ana María Barrera Rodríguez, Paola Andrea Echeverri Gutiérrez, María Camila Parra Buitrago,
Paola Andrea Martín Muñoz, Angy Paola Ángel Vélez, Luisa Natalia Trejos Ospina.
Territorial prospective of Risaralda department (Colombia), based on
the SDGS...............................................................................................................333
Juan Guillermo Gil García, Samanta Londoño Velásquez.
Chapter 5. Health and Sports Sciences
Performance evaluation in times of pandemic. What do medical
students think?.......................................................................................................353
Samuel Eduardo Trujillo Henao, Rodolfo A. Cabrales Vega, Germán Alberto Moreno Gómez.
The relevance of the therapist’s self and self-reference in the training
of psychologists.....................................................................................................371
Maria Paula Marmolejo Lozano, Mireya Ospina Botero.
Habits related to oral health which influence lifestyle of elder people
in a wellness center for the elderly in Pereira 2020. .............................................387
Isadora Blanco Pérez, Olga Patricia Ramírez Rodríguez, Ángela María Rincón Hurtado.
Analysis of the suicide trend in the Coffee Region in Colombia during
the years 2012-2018 ..............................................................................................405
Germán Alberto Moreno Gómez, Jennifer Nessim Salazar, Jairo Franco Londoño,
Juan Carlos Medina Osorio.
Hind limb long bone fractures in canines and felines...........................................419
María Camila Cruz Vélez, Valentina Herrera Morales, Alba Nydia Restrepo Jiménez, Lina
Marcela Palomino, Gabriel Rodolfo Izquierdo Bravo.
Prevalence of overweight and obesity in children in the rural and urban
area of Risaralda....................................................................................................439
Angela María Álvarez López, Angela Liceth Pérez Rendón, Alejandro Gómez Rodas,
Luis Enrique Isaza Velásquez.
Chapter 6. Architecture, Design and Advertising
The artisan crafts of Risaralda, characteristics, importance, and risks
within the Colombian Coffee Cultural Landscape, CCCL....................................457
Yaffa Nahir Ivette Gómez Barrera, Javier Alfonso López Morales
Vocabulario de la sociedad civil, la ruralidad y los movimientos sociales en América Latina
El Vocabulario de la Sociedad Civil, la Ruralidad y los
Movimientos Sociales en América Latina tiene como
objetivo desarrollar vocablos relacionados con temas
de gran trascendencia para la vida colectiva de la
población Latinoamericana; pretende introducir a
estudiantes, personas del ámbito académico y activistas
en la comprensión de estas categorías de análisis.
A través de la mirada de 70 especialistas que
participaron en este vocabulario, es posible comprender
muchos de los términos que se utilizan dentro de
la investigación social y áreas relacionadas con las
ciencias políticas, ambientales y rurales, a partir de
una mayor explicación y detalle. Es por ello que se
inserta este trabajo desde una mirada colectiva y
amplia de los conceptos que se exponen.
En este libro podrá encontrar las ideas de varios autores
y autoras de distintas universidades, con una visión
multi, inter y transdisciplinaria. El esfuerzo que se
realizó para conjuntar varios términos y analizar su
compleja red de interpretaciones, permitirá que este
manuscrito pueda ser consultado por estudiantes,
personas del ámbito científico-académico, y ciudadanía;
porque contiene el estado del arte, la historia del
paulatino avance de múltiples conceptos y su vigencia
en el contexto actual
Anales del III Congreso Internacional de Vivienda y Ciudad "Debate en torno a la nueva agenda urbana"
Acta de congresoEl III Congreso Internacional de Vivienda y Ciudad “Debates en torno a la NUEVa Agenda Urbana”, ha sido una apuesta de alto compromiso por acercar los debates centrales y urgentes que tensionan el pleno ejercicio del derecho a la ciudad. Para ello las instituciones organizadoras (INVIHAB –Instituto de Investigación de Vivienda y Hábitat y MGyDH-Maestría en Gestión y Desarrollo Habitacional-1), hemos convidado un espacio que se concretó con potencia en un debate transdisciplinario. Convocó a intelectuales de prestigio internacional, investigadores, académicos y gestores estatales, y en una metodología de innovación articuló las voces académicas con las de las organizaciones sociales y/o barriales en el Foro de las Organizaciones Sociales que tuvo su espacio propio para dar voz a quienes están trabajando en los desafíos para garantizar los derechos a la vivienda y los bienes urbanos en nuestras ciudades del Siglo XXI
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