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

Modelling the potential impacts of climate change on the hydrology of the Aipe river basin in Huila, Colombia

[EN] The dynamics of a global world, and humans performing as a new geological force, require that an effort is undertaken to make robust decisions in order to devise strategies for the management and adaptation to climate change. This study aims to investigate the potential impact of climate change on the hydrology of the Aipe river basin in Huila, Colombia. The abcd Thomas model (four parameters) was calibrated and validated for the stream flows of the Aipe catchment (1992¿2012). The sensitivity and identifiability of the parameters were evaluated using the Monte Carlo Analysis Toolbox (MCAT). The results show the ability of the model to simulate the monthly stream flow (Nash¿Sutcliffe efficiency coefficient of 0,89). The most influential parameters are: a (water storage in the soil) and c (contribution to the aquifer). From the simulated scenarios, the baseline (1992¿2012) was estimated to be an average flow of 15,44 m3s¿1; the trend extrapolation scenario estimated a rate 13,79 m3s¿1 (¿10,64%); while for the multi-model assembly scenario it was 9,34 m3s¿1 (¿39,47%) and for the A2 scenario it was 5,74 m3s¿1 (¿62,60%). Lastly, we propose a set of strategies for adaptation to climate change that are committed to the integral management of water resources.[ES] La dinámica de un mundo global y el hombre como nueva fuerza geológica plantean la necesidad de tomar decisiones robustas, diseñar estrategias de manejo y de adaptarse al cambio climático. Este estudio investiga la respuesta hidrológica de la cuenca hidrográfica del río Aipe (688.9 km2 ), en Huila, Colombia, en acorde con los escenarios de cambio climático desde 2011 a 2040. El modelo hidrológico abcd de Thomas (4 parámetros) fue calibrado y validado comparando el caudal simulado y lo observado en el punto de cierre de la cuenca (en la estación Puente Carretera), usando series históricas mensuales (1992¿2012). Realizamos la evaluación de la sensibilidad e identificabilidad de los parámetros con la herramienta `Monte Carlo Analysis Toolbox¿ (MCAT). Los resultados muestran que el modelo es capaz de representar adecuadamente los caudales mensuales observados en el punto de desagüe de la cuenca, al encontrarse un índice de eficiencia de Nash¿Sutcliffe (NSE) de 0,89. Los parámetros más influyentes son a (almacenamiento del agua en el suelo) y c (aporte al acuífero). Con respecto a la simulación de los escenarios, la línea base (1992¿2012) estimó un caudal medio de 15,44 m3 s ¿1 ; el escenario de extrapolación de tendencias estimó un caudal de 13,79 m3 s ¿1 (¿10,64%); el escenario de ensamble multi-modelo de 9,34 m3 s ¿1 (¿39,47%) y el escenario A2 de 5,74 m3 s ¿1 (¿62,60%). Proponemos una batería de medidas de adaptación al cambio climático que buscan la gestión integral del recurso hídrico.Romero-Cuellar, J.; Buitrago-Vargas, A.; Quintero-Ruiz, T.; Francés, F. (2018). Simulación hidrológica de los impactos potenciales del cambio climático en la cuenca hidrográfica del río Aipe, en Huila, Colombia. RIBAGUA - Revista Iberoamericana del Agua. 5(1):63-78. https://doi.org/10.1080/23863781.2018.1454574S63785

A review of zoonotic infection risks associated with the wild meat trade in Malaysia.

The overhunting of wildlife for food and commercial gain presents a major threat to biodiversity in tropical forests and poses health risks to humans from contact with wild animals. Using a recent survey of wildlife offered at wild meat markets in Malaysia as a basis, we review the literature to determine the potential zoonotic infection risks from hunting, butchering and consuming the species offered. We also determine which taxa potentially host the highest number of pathogens and discuss the significant disease risks from traded wildlife, considering how cultural practices influence zoonotic transmission. We identify 51 zoonotic pathogens (16 viruses, 19 bacteria and 16 parasites) potentially hosted by wildlife and describe the human health risks. The Suidae and the Cervidae families potentially host the highest number of pathogens. We conclude that there are substantial gaps in our knowledge of zoonotic pathogens and recommend performing microbial food safety risk assessments to assess the hazards of wild meat consumption. Overall, there may be considerable zoonotic risks to people involved in the hunting, butchering or consumption of wild meat in Southeast Asia, and these should be considered in public health strategies

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

Contamination des eaux de puits traditionnels par les nitrates sur le bassin versant de la Lobo (Buyo, sudouest de la Côte d’Ivoire)

Objective: Contamination of groundwater by nitrates is a real public health concern that is currently being paid a particular attention worldwide. This study investigates the spatial distribution of nitrates in traditional water supply wells in the Lobo's watershed, in order to derive appropriate measures to protect groundwater resources in this region. Methodology and Results: the origin of nitrate water from traditional wells of Lobo’s watershed was determined through the analysis of nitrate concentrations. The samples were collected in March (dry season) and June (wet season) 2007 on the waters of traditional wells in two villages Gbili and Logbozoa and camps on the lobo’s watershed. The results show that nitrate concentrations vary on the watershed. In general, concentrations range from 0 mg.L-1 to 71,26 mg L-1. Wells with a concentration above the guideline value of WHO (50 mg.L-1) are found in Buyo and both villages Gbili and Logbozoa. On the other hand, wells of Tchemasso, Buyo Provisoire and camps have nitrate levels complying with the standard. Conclusion and application of results: Well waters of Buyo and two villages Gbili and Logbozoa with higher population densities are richer in nitrate. On the contrary, wells of Tchemasso, Buyo Provisoire and camps, with lower population density and sometimes with wells in plantations have low levels. Thus, the high population density, coupled with the lack of sanitation and incorrectly installed latrines, is the main cause of high nitrate levels in traditional water supply wells in the Lobo’s Watershed. Water wells located in plantations with low nitrate levels show that agriculture is not responsible for the contamination of water in this area. In the short term, an appropriately designed awareness campaign on sanitation and public health directed to the populations should be initiated to allow improving and protecting well water quality in the Lobo’s watershed.Keywords: anthropogenic activity; groundwater; pollution; physico-chemical quality

Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years′ experience

Background: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. Materials and Methods: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. Results: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. Conclusion: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay