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

Analisis Faktor Motivasi yang Mempengaruhi Prestasi Belajar Siswa pada Bidang Studi Matematika di Sekolah Menengah Pertama Negeri 1 Namlea

This study aims to determine the effect of motivation on mathematics learning achievement of students at Namlea 1 Middle School. This research is a form of research "Ex Post Facto" which is a research model that aims to examine the events that have occurred. The subjects in this study were all students of class VIIa of Middle School 1 Namlea, totaling 30 people. Data collection techniques using observation techniques, questionnaires and study documentation. Quantitative data analysis was carried out using statistical tests through three stages, namely the stage of data description, the prerequisite test phase of analysis and the stage of testing the hypothesis. Based on the results of the study note that the level of motivation and learning achievement of eighth grade students at Namlea Middle School 1 is categorized high. Associatively, the motivating factor has a positive and significant effect on mathematics learning achievement in class VIIa State Middle High School 1 Namlea

Pemanafaatan Aplikasi Geogebra sebagai Pembelajaran Matematika di SMA Kabupaten Buru

Fakta komunikasi matematis di Indonesia secara khusus di Maluku kabupaten Buru untuk peserta didik ditingkat sekolah menegah atas (SMA) masih tergolong rendah hal ini dipengaruhi oleh beberapa faktor diantaranya penerapan metode dan pengaplikasian alat bantu mengajar. Dan alat bantu dalam proses belajar mengajar menjadi tolak ukur keberhasilan pembelajaran di sekolah khususnya pembelajaran matematika. Pembelajaran dengan bantuan komputer sudah banyak dikembangkan oleh peneliti luar negeri maupun dalam negeri sebagai acuan untuk penggunaan aplikasi dalam menunjang pembelajaran metematika salah satunya adalah aplikasi GeoGebra. Geogebra adalah perangkat lunak yang dapat diterapkan pada komputer untuk digunakan sebagai alat pembelajaran disekolah. Pada aplikasi ini peserta didik dapat menggambar grafik dan menetukkan titik uji penyelesaian, serta dapat menguji fungsi optimum pada titik tersebut. Tujuan penelitian ini memanfaatkan aplikasi GeoGebra sebagai media dalam proses belajar mengajar di SMA 1 Buru. Penelitian ini termasuk penelitian deskriptif dengan menggunakan pendekatan kualitatif. Lokasi penelitian di sekolah SMA Negeri 1 Buru di desa Namlea. Instrumen yang dipakai pada penelitin ini yakni, hasil belajar siswa, dan respon siswa serta keterlaksanaan penggunaan media, untuk itu penggunaan instrumen yang tepat adalah tes angket atau kusioner serta lembar observasi. Hasil peneltian ditemukan bahwa penggunaan media pemebelajaran aplikasi GeoGebra yang diterapkan pada peserta didik dalam proses pembelajaran matematika sangat berbeda dengan penerapan yang tidak memakai aplikasi GeoGebra. hal ini dapat dilihat melalui hasil skor postes yang diperoleh sebesar 31,6% sedangkan untuk peningkatan kemampuan matematis antara skor pretest yakni sebesar 11,6%. Untuk itu dapat disimpulkan bahwa penggunaan media pembelajaran dalam mata pelajaran matematika sangat efektif