Trends, pattern and outcome of caesarean section at Lagos University Teaching Hospital, Lagos, Nigeria: A ten-year review

Background: Caesarean section (C/S) rate and pattern of indications can be a reflection of maternal health status and quality of medical practice. This study aimed at determining current C/S rate at Lagos University Teaching Hospital (LUTH) and to assess trend, pattern and outcome of C/S in the last ten years. Study design: A cross sectional study of all cases of C/S ≥28 weeks gestational age performed at LUTH from January 1, 2008 to December 31, 2017. Information which included maternal age, parity, gestational age at delivery, booking status, type of C/S and indications was retrieved from Labour Ward register using an electronic database. Data analysis was done with IBM SPSS version 23. Results: A total of 12,811 deliveries that met the inclusion criteria during the study period were reviewed. Overall C/S rate was found to be 51.3% and there has been an increase over the years (p = 0.000). Commonest indications were previous C/S, HIV infection, hypertensive disorders, fetal distress and antepartum haemorrhage. HIV infection ranked topmost in the list of indications in 2008 and 2009, with a change in trend to previous C/S in subsequent years. Maternal death was significantly lower in women who had C/S (0.1%) compared to those who delivered vaginally (0.4%), p = 0.000. Perinatal death rate was also lower in those who had C/S (4.8%) compared to women delivered vaginally (8.5%), p = 0.000. Conclusion: Decision to perform primary C/S should be based on clear cut indications as repeat C/S was found to be a major contributor to rising C/S rate in this study. There is thus a need to conduct regular audits on C/S performed in every health institution using the World Health Organization Robson classification and review policies regarding delivery based on the findings

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Obesity and preeclampsia: Role of fibrinogen andC-reactive protein

Objective: This study aimed at ascertaining the relationship between obesity and preeclampsia and the role of fibrinogen and C-reactive protein (CRP). Study design: This was a case-control study involving 200 pregnant women, 100 of whom were healthy pregnant women, and 100 preeclamptic women, matched for age, parity, and gestational age. Information about their sociodemographic characteristics was obtained and body mass index (BMI) calculated using their height and weight at recruitment. Their plasma fibrinogen and CRP levels were assayed using enzyme-linked immunosorbent assay (ELISA) technique. All data collected were subjected to statistical analysis using Epi Info. Results: The mean (±SD) age of subjects was 31.1 ± 4.51 years. The preeclamptic subjects were found to have higher BMI (30.04 ± 6.06 kg/m2) compared to the normotensive pregnant women (28.08 ± 2.97 kg/m2). However, this was not statistically significant. Using mean arterial blood pressure as an indicator of disease severity, with a cut-off of 125 mmHg, it was found that severe preeclamptics had higher BMI (30.18 ± 6.49 kg/m2) compared to women with mild form of the disease (29.83 ± 5.48 kg/m2) but this difference was not statistically significant (P = 0.2131). There was also statistically significant association between BMI and high-sensitivity C-reactive protein (hsCRP) (P = 0.0000), and between BMI and plasma fibrinogen levels (P = 0.0000). Conclusion: It can thus be inferred from this study that obesity elicits inflammatory response which might predispose to the development of preeclampsia. Lifestyle modifications such as dietary control, exercise, and pre-pregnancy weight reduction may help in reducing the incidence of preeclampsia

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways