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

Risky Sexual Behaviours among Adolescents in Owerri Municipal: Predictors of Unmet Family Health Needs

This study examined the risky sexual behaviours (RSBs) of adolescents in Owerri Municipal in Imo State. Adopting the descriptive Survey research design, a stratified sampling technique was used to enroll 1008 adolescents aged 10 – 19 from 4 secondary schools into the study. A structured questionnaire was used for data collection. Result shown that majority of the adolescent (47.4%) have had sex and many have engaged in one form of RSBs or another. Peer group seem to be major source of the sexuality information (55.6%) and influencing factor (52.3%) .Significant association was found to exist between adolescents RSBs and age at first sexual experience or adolescent perception of parental rearing pattern (

Yellow fever vectors’ surveillance in three satellite communities of Enugu Municipality, Nigeria

Outbreaks of yellow fever have continued to occur in various parts of Nigeria. Between 1985 and 2000, sporadic outbreaks have plagued some parts of Oyo, Ekiti, Delta, Imo, Anambra, Cross River, Lagos and Benue States of Nigeria. In addition to favourable environmental factors encouraging the development and spread of the viraemia, there is preponderance of Aedes mosquito vector populations, animal reservoir hosts and high number of non-immune human populations, which do not easily render themselves to vector and environmental management strategies. Regular vector surveillance to detect warning signs posed by vector activities and regular immunization of non-immune human populations have remained a reliable method of abating yellow fever outbreaks. In consequence, yellow fever vectors surveillance has been undertaken in three satellite villages (Obe, Nkalagu and Uwani-Uboji) of Enugu Municipality. Four immunized volunteers were used to collect adultvectors, while locally adapted CDC (Centre for Disease Control) ovitraps were used to collect their eggs. Also, house inspection to detect the breeding index of vector populations in and around the houses was undertaken. Results of house inspections in the three communities showed that out of sixty (60) houses visited, 385 containers were found with water, 221 (57.6%) water containers had Aedes larvae with Uwani-Uboji and Obe communities having 83.5% and 53.8% of their water containers withAedes larvae. For the ovitraps, Nkalagu had an average of 22 eggs per trap. There were high numbers of Aedes africanus adults in the human bait collections at Obe and Uwani-Uboji communities. Aedes albopictus was amongst other mosquito species collected

Organ Transplantation: Legal, Ethical and Islamic Perspective in Nigeria

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searchingthe PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholarsand researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissuedonation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/ legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.Keywords: Ethical, Islamic perspective, legal, Nigeria,organ transplantatio

Direct Anti-Human Globulin Test in Negative in Patients on Routine Unfractionated Heparin Anticoagulation Maintenance Haemodialysis

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Perceptions sur l’emploi des moustiquaires imprégnés d’insecticide dans la région du bassin du fleuve Imo, Nigeria: Implications pour la prévention de la malaria pendant la grossesse

This study aimed at assessing perceptions on use of ITNs in parts of the Imo River Basin, Nigeria and its implications in preventing malaria in pregnancy. Data was collected using focus group discussions, key informant interviews and structured questionnaires. Results showed high awareness on the benefits of ITNs. Factors affecting use of ITNs included its high cost, perceptions of chemicals used to treat them as having dangerous effects on pregnancy, low utilization of antenatal care, husband’s lack of interest in malaria prevention and perceptions that adolescent girls are at low risk of getting malaria. The implications of these findings include demystifying the negative perceptions on the chemicals used for net treatment and subsidizing the cost of ITNs to increase access. These findings provide important lessons for malaria programmes that aim at increasing access to ITNs by pregnant women in developing countries (Afr J Reprod Health 2010; 14[1]:117-128).Cette étude avait pour but d’évaluer les perceptions sur l’emploi des MIIs dans des régions du bassin du fleuve Imo, Nigeria et ses implications dans la prévention de la malaria dans la grossesse. Les données ont été collectées à l’aide des discussions à groupe cible, des interviews auprès des informateurs et des questionnaires structurés. Les résultats ont montré une conscience élevée des avantages des MIIs. Parmi les facteurs qui affectent l’emploi des MIIs sont le coût élevé, la perception des produits chimiques utilisés pour les traiter comme ayant des effets dangereux sur la grossesse, la faible utilisation des soins prénatals, le manque d’intérêt chez le mari dans la prévention de la malaria et des perceptions selon lesquelles les filles adolescentes courent un faible risque d’attraper la malaria. Les implications des ces résultats comprennent la démystification des perceptions négatives sur les produits chimiques qu’on a utilisés pour le traitement du moustiquaire et la subvention du coût des MIIs pour augmenter l’accès. Ces résultats donnent des leçons importantes pour des programmes de la malaria qui visent l’augmentation d’accès aux MIIs par les femmes enceintes dans les pays en voie de développement (Afr J Reprod Health 2010; 14[1]:117-128)

Perceptions on the use of insecticide treated nets in parts of the Imo River Basin, Nigeria: Implications for preventing malaria in pregnancy

This study aimed at assessing perceptions on use of ITNs in parts of the Imo River Basin, Nigeria and its implications in preventing malaria in pregnancy. Data was collected using focus group discussions, key informant interviews and structured questionnaires. Results showed high awareness on the benefits of ITNs. Factors affecting use of ITNs included its high cost, perceptions of chemicals used to treat them as having dangerous effects on pregnancy, low utilization of antenatal care, husband’s lack of interest in malaria prevention and perceptions that adolescent girls are at low risk of getting malaria. The implications of these findings include demystifying the negative perceptions on the chemicals used for net treatment and subsidizing the cost of ITNs to increase access.These findings provide important lessons for malaria programmes that aim at increasing access to ITNs by pregnant women in developing countries(Afr J Reprod Health 2010; 14[1]:117-128)