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

Socio-Demographic Profile, Asymptomatic Malaria Parasitaemia and Glycemic Control among Midled-Aged and Elderly Type 2 Diabetes Mellitus Patients in Rural Southwestern Nigeria: A Cross Sectional Study

The main therapeutic goal for all type 2 diabetes mellitus (T2DM) patients is to maintain good control so as to prevent the risk of complications associated with poor control. This study determined the prevalence of poor control and its association with socio-demographics and malaria parasitaemia among middle aged and elderly T2DM patients at a tertiary hospital in rural Southwestern Nigeria. We conducted a retrospective observational study on 250 T2DM using semi-structured interviewer administered questionnaire. Venous blood samples were collected and processed for glycated hemoglobin sugar estimation and malaria parasite detection by microscopy. Data were analyzed using SPSS version 20.0. Multivariate logistic regression identified the association of socio-demographics and asymptomatic malaria parasitaemia with poor control. The prevalence of poor glycemic control was 31.6% (95%CI: 34.4%-45.8%). Old age, (AOR=4.868; 95% CI: 1.258-24.574), female genders (AOR=7.100; 95% CI: 1.875-34.655), no formal education (AOR=3.447; 95% CI: 1.098-21.478), presence of malaria parasitaemia (AOR=48.423; 95% CI: 4.987-411.366), and higher parasite density (AOR=7.102; 95% CI: 1.785-15.002), were significantly associated with poor control. Health facilities should integrate screening of malaria parasitaemia into the management of T2DM patients while also exploring other barriers of poor control

Relationship between the Level of Spirituality and Blood Pressure Control among Adult Hypertensive Patients in a Southwestern Community in Nigeria

Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control.Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p &le; 0.05.Results: The mean age of the respondents was 61.1 &plusmn; 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p &lt; 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality.&nbsp;Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients&rsquo; holistic care with the aim of achieving better blood pressure control among hypertensive patients

Prevalence, Risk Factors and Treatment Outcomes of Acute Asthma Exacerbations in Rural South-Western Nigeria: A Three-year Retrospective Observational Study

There is increasing evidence that asthma-related morbidity and mortality may be greater in older population due to greater risk of coexisting co-morbidities. The study ascertained the prevalence, risk factors, and treatment outcomes of asthma exacerbation admissions at a tertiary hospital in rural southwestern Nigeria. A retrospective observational survey using data form and predetermined questionnaire was used to review the patients admitted for asthma exacerbation between January 2019 and December 2021. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. A p-value of <0.05 was used to determine the significant of association. A total of 102 asthma patients were studied. The prevalence of asthma exacerbation was 5.1%, and its risk factors were family history (p = 0.032 ), tobacco smoking (p = 0.040), keeping pets (p = 0.028), co-morbidity (p=0.001), numbers of co-morbidities (p<0.001), hypertension (p<0.001), obesity (p<0.001), obstructive sleep apnea (p=0.004), COPD (P<0.001), Diabetes mellitus (p<0.001), and gastro-esophageal reflux disease (p=0.037).The treatment outcomes showed that 85.3% of the patients were discharged, 11.8% DAMA, and 2.9% died on admission. The study strengthens the argument that asthma exacerbation morbidity and mortality are higher in older age population. The results may provide an impetus for asthma preventive intervention, control strategies, and future research in the study area

Crude and adjusted odd ratios for the factors significantly associated with malaria parasitaemia (N = 180).

Crude and adjusted odd ratios for the factors significantly associated with malaria parasitaemia (N = 180).</p

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BackgroundThere is increasing evidence suggesting that adolescents are contributing to the populations at risk of malaria. This study determined the prevalence of malaria infection among the adolescents and examined the associated determinants considering socio-demographic, Long Lasting Insecticide Nets (LLINs) usage, and hematological factors in rural Southwestern Nigeria.MethodsA hospital-based cross-sectional study was conducted between July 2021 and September 2022 among 180 adolescents who were recruited at a tertiary health facility in rural Southwestern Nigeria. Interviewer administered questionnaire sought information on their socio-demographics and usage of LLINs. Venous blood samples were collected and processed for malaria parasite detection, ABO blood grouping, hemoglobin genotype, and packed cell volume. Data were analyzed using SPSS version 20. A p-value ResultsThe prevalence of malaria infection was 71.1% (95% CI: 68.2%-73.8%). Lack of formal education (AOR = 2.094; 95% CI: 1.288–3.403), being a rural residence (AOR = 4.821; 95% CI: 2.805–8.287), not using LLINs (AOR = 1.950; 95% CI: 1.525–2.505), genotype AA (AOR = 3.420; 95% CI: 1.003–11.657), genotype AS (AOR = 3.574; 95%CI: 1.040–12.277), rhesus positive (AOR = 1.815; 95% CI:1.121–2.939), and severe anemia (AOR = 1.533; 95% CI: 1.273–1.846) were significantly associated with malaria infection.ConclusionThe study revealed the prevalence of malaria infection among the adolescents in rural Southwestern Nigeria. There may be need to pay greater attention to adolescent populations for malaria intervention and control programs.</div

Prevalence of malaria parasitaemia among the respondents.

Prevalence of malaria parasitaemia among the respondents.</p

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BackgroundThere is increasing evidence suggesting that adolescents are contributing to the populations at risk of malaria. This study determined the prevalence of malaria infection among the adolescents and examined the associated determinants considering socio-demographic, Long Lasting Insecticide Nets (LLINs) usage, and hematological factors in rural Southwestern Nigeria.MethodsA hospital-based cross-sectional study was conducted between July 2021 and September 2022 among 180 adolescents who were recruited at a tertiary health facility in rural Southwestern Nigeria. Interviewer administered questionnaire sought information on their socio-demographics and usage of LLINs. Venous blood samples were collected and processed for malaria parasite detection, ABO blood grouping, hemoglobin genotype, and packed cell volume. Data were analyzed using SPSS version 20. A p-value ResultsThe prevalence of malaria infection was 71.1% (95% CI: 68.2%-73.8%). Lack of formal education (AOR = 2.094; 95% CI: 1.288–3.403), being a rural residence (AOR = 4.821; 95% CI: 2.805–8.287), not using LLINs (AOR = 1.950; 95% CI: 1.525–2.505), genotype AA (AOR = 3.420; 95% CI: 1.003–11.657), genotype AS (AOR = 3.574; 95%CI: 1.040–12.277), rhesus positive (AOR = 1.815; 95% CI:1.121–2.939), and severe anemia (AOR = 1.533; 95% CI: 1.273–1.846) were significantly associated with malaria infection.ConclusionThe study revealed the prevalence of malaria infection among the adolescents in rural Southwestern Nigeria. There may be need to pay greater attention to adolescent populations for malaria intervention and control programs.</div

Socio-demographic characteristics of respondents.

BackgroundThere is increasing evidence suggesting that adolescents are contributing to the populations at risk of malaria. This study determined the prevalence of malaria infection among the adolescents and examined the associated determinants considering socio-demographic, Long Lasting Insecticide Nets (LLINs) usage, and hematological factors in rural Southwestern Nigeria.MethodsA hospital-based cross-sectional study was conducted between July 2021 and September 2022 among 180 adolescents who were recruited at a tertiary health facility in rural Southwestern Nigeria. Interviewer administered questionnaire sought information on their socio-demographics and usage of LLINs. Venous blood samples were collected and processed for malaria parasite detection, ABO blood grouping, hemoglobin genotype, and packed cell volume. Data were analyzed using SPSS version 20. A p-value ResultsThe prevalence of malaria infection was 71.1% (95% CI: 68.2%-73.8%). Lack of formal education (AOR = 2.094; 95% CI: 1.288–3.403), being a rural residence (AOR = 4.821; 95% CI: 2.805–8.287), not using LLINs (AOR = 1.950; 95% CI: 1.525–2.505), genotype AA (AOR = 3.420; 95% CI: 1.003–11.657), genotype AS (AOR = 3.574; 95%CI: 1.040–12.277), rhesus positive (AOR = 1.815; 95% CI:1.121–2.939), and severe anemia (AOR = 1.533; 95% CI: 1.273–1.846) were significantly associated with malaria infection.ConclusionThe study revealed the prevalence of malaria infection among the adolescents in rural Southwestern Nigeria. There may be need to pay greater attention to adolescent populations for malaria intervention and control programs.</div