Assessing the impact of anaesthetic and surgical task-shifting globally:A systematic literature review

The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practiced to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, Embase, CINAHL, and Global Health) in all languages between 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesised narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in Sub-Saharan Africa and the United States. Seventy-five percent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs, and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions, and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in high-income countries and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomised study designs and include long-term outcome measures to generate high quality evidence

Impacts of Caregivers’ Nutrition Knowledge and Food Market Accessibility on Preschool Children’s Dietary Diversity in Remote Communities in Southeast Nigeria

Empirical evidence is scanty on the nexus between caregivers’ nutrition knowledge, market accessibility, and preschool children’s dietary diversity in remote communities of Africa’s most populous country, Nigeria. To fill this gap, this study evaluated the effects of caregivers’ nutrition knowledge and access to food market on dietary diversity of preschool children. We used cross-sectional data from four hundred households selected from twenty remote communities in Southeast Nigeria. The study adopted instrumental variable regression to estimate the impacts of nutrition knowledge and food market access on preschool children’s dietary diversity. The findings show that in remote communities, caregivers’ nutrition knowledge and households’ closeness to the market improved preschool children’s dietary diversity. The study demonstrates the potential of improving preschool children’s nutrition outcomes through enhancing access to food market and the nutrition knowledge of the caregivers

Enquêtes sur les pratiques de prise en charge des fièvres dans les formations sanitaires du "Réseau paludisme OCEAC" : présentation méthodologique

Dans le cadre de la mise en place du "Réseau Paludisme OCEAC" et de la standardisation des actions, une "enquête type" visant à évaluer la prise en charge de fièvres dans les formations sanitaires des pays de l'OCEAC a été élaborée. Deux questionnaires permettent de recueillir des informations sur la structure et l'organisation de la formation sanitaire, ainsi que sur la performance des personnels de santé face aux accès fébriles. (Résumé d'auteur

Surveillance in vivo de la sensibilité de Plasmodium falciparum aux antimalariques dans les états du "réseau paludisme OCEAC" : résultats des enquêtes effectuées à Yaoundé (Cameroun), Malabo (Guinée Equatoriale) et Brazzaville (Congo)

Le test in vivo simplifié et standardisé du Réseau Paludisme OCEAC a été réalisé en mai et juin 1996 dans des groupes scolaires de la périphérie de Yaoundé, Malabo et Brazzaville. Après administration, sur trois jours, de chloroquine à la dose de 25 mg/kg ou d'amodiaquine à 30 ou 35 mg/kg, on note des taux de résistance in vivo de 19 à 25% pour la chloroquine et de 13 à 43% pour l'amodiaquine. Dans chaque pays, les taux de résistance in vivo observés dans l'échantillon ne sont pas significativement différents l'un de l'autre pour ces deux médicaments. Globalement, ces taux sont comparables à ceux observés lors d'études antérieures dans des populations similaires. (Résumé d'auteur

COVID-19, bubonic and meningitis in Democratic Republic of Congo: the confluence of three plagues at a challenging time

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