Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Comparative trial of artesunate and halofantrine in the treatment of uncomplicated malaria in children at a general hospital in Enugu

No Abstract. Nigerian Journal of Paediatrics Vol. 32(1) 2005: 1-

Relationship between Corneal Biomechanical Properties among Pregnant Women in a Tertiary Hospital in Nigeria

Objective: In Nigeria, many pregnant women as well as health‑care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. Materials and Methods: A prospective longitudinal study was used. One hundred and thirty‑four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6‑week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni’s post hoc test. Results: The women were aged 18–48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). Conclusion: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6‑week postpartum.Keywords: Central corneal thickness, cornea sensitivity, intraocular pressure, pregnanc

Causes of visual impairment among commercial motor vehicle drivers in Uyo metropolis, Akwa Ibom State, Nigeria

Background: Commercial motor vehicles are a very important means oftransport in Nigeria where most people do not own personal vehicles and the railway system is not functioning.Aims and Objectives: The aim of the study is to assess the ocular health status of commercial motor vehicle drivers in Uyo metropolis and to determine the causes of visual impairment amongst them.Materials and Methods: Uyo is the capital city of Akwa Ibom State in theSouth-South geo-political zone of Nigeria with a population of 305,961according to 2006 National population census. This is a cross sectional survey of commercial motor vehicle drivers in all the eleven functional motor parks in Uyo as at the time of the study. A total of two hundred and ninety-one (291) drivers who consented to the study were recruited, interviewed with a standardized questionnaire and examined. Examination included distant visual acuity with Snellen’s Chart and near visual acuity with near chart, tonometry using Schiotz’s tonometer; penlight and magnifying loupe were used to examine the anterior segment, color vision test was with Ishihara chart, funduscopy with direct ophthalmoscope and visual field assessment by confrontation amongst other tests. Data were analysed with SPSS10 soft ware package.Results: Mean age of drivers was found to be ±41.5 years. Prevalence of road traffic accident (RTA) in the study was 24.7%. Human factor contributed 27.7% to the cause of accidents. Causes of visual impairment included refractive error, glaucoma and cataract.Conclusion: There was no statistically significant association between RTA and visual impairment but there was statistically significant association between RTA and visual field defect (P=0.037).Recommendation: Visual field assessment at least by confrontation should be made a requirement before issuance of motor vehicle driving licence and proper visual field assessment of suspected drivers be done by an ophthalmologist before issuance of license. A State-wide survey of visual status of commercial motor vehicle drivers is recommended.Keywords: Cataract, drivers, refractive error, road, transportation

Blindness and visual impairment in the Niger Delta: A study of Ahoada East Local Government, Rivers State, Nigeria

Background: According to the WHO and the National Program for Prevention of Blindness (NNPB), the prevalence of blindness for Nigeria averages 1%. For blindness control/prevention programs to be effective, reliable epidemiological data are needed which is seldom available in developing countries where most of the blind live. Aim: To determine the prevalence and common causes of blindness and visual impairment in Ahoada-East Local Government Area of Rivers State. Methods: A community-based, cross-sectional study was carried out between November and December 2002. A multi-stage sampling technique was employed to randomly select 866 individuals from a generated household list in six of the 34 communities in the LGA. Ocular examination included visual acuity, fundoscopy and intra-ocular pressure (IOP) measurement in subjects with cup/disc ratio > 0.5. Data was recorded using the standard WHO/PBL eye examination. Results: Most of the subjects wer

The Nigerian national blindness and visual impairment survey: Rationale, objectives and detailed methodology.

BACKGROUND: Despite having the largest population in Africa, Nigeria has no accurate population based data to plan and evaluate eye care services. A national survey was undertaken to estimate the prevalence and determine the major causes of blindness and low vision. This paper presents the detailed methodology used during the survey. METHODS: A nationally representative sample of persons aged 40 years and above was selected. Children aged 10-15 years and individuals aged <10 or 16-39 years with visual impairment were also included if they lived in households with an eligible adult. All participants had their height, weight, and blood pressure measured followed by assessment of presenting visual acuity, refractokeratomery, A-scan ultrasonography, visual fields and best corrected visual acuity. Anterior and posterior segments of each eye were examined with a torch and direct ophthalmoscope. Participants with visual acuity of < = 6/12 in one or both eyes underwent detailed examination including applanation tonometry, dilated slit lamp biomicroscopy, lens grading and fundus photography. All those who had undergone cataract surgery were refracted and best corrected vision recorded. Causes of visual impairment by eye and for the individual were determined using a clinical algorithm recommended by the World Health Organization. In addition, 1 in 7 adults also underwent a complete work up as described for those with vision < = 6/12 for constructing a normative data base for Nigerians. DISCUSSION: The field work for the study was completed in 30 months over the period 2005-2007 and covered 305 clusters across the entire country. Concurrently persons 40+ years were examined to form a normative data base. Analysis of the data is currently underway. CONCLUSION: The methodology used was robust and adequate to provide estimates on the prevalence and causes of blindness in Nigeria. The survey would also provide information on barriers to accessing services, quality of life of visually impaired individuals and also provide normative data for Nigerian eyes