Influence of Sex and Management System on Seroprevalence of Newcastle Disease Antibodies in Indigenous Chicken in Ashanti Region, Ghana

This study sought to provide data on influence of sex and management system on seroprevalence of Newcastle disease (ND) in unvaccinated indigenous chicken in Ashanti Region, Ghana. A total of seventy-one (71) local chickens were screened for ND virus antibodies using haemagglutination inhibition (HI) test. The overall seroprevalence of 69.0% was obtained. A higher ND antibodies seroprevalence of 60.56% was recorded in local chicken at Aboaso (kept under extensive system) than those from Amakom (kept under intensive system) with 8.45%. More female birds from extensive system (11 (69.1%) tested positive for the ND antibodies also a higher mean titer of 6.4 were obtained in positive male birds also the same system. The differences in seroprevalence with respect to management systems and the mean titre values with respect to sex of birds were statistically significant (p<0.05). The findings indicate that ND is endemic in Ashanti region particularly at Aboaso where extensive system is practised. It is imperative to conclude that the extensive system of management of indigenous chicken play a role in the spread of ND in Ghana

An Open Label Clinical Study Evaluating the Effectiveness of a Cryptolepis sanguinolenta based Herbal Antimalarial Agent

Medicinal plants are key in the treatment of malaria in many developing countries. This study reports on the effectiveness of Mist Nibima, a Ghanaian herbal product from the Centre for Plant Medicine Research, Mampong-Akuapem. The product is a proprietary remedy prepared from the roots of Cryptolepis sanguinolenta. A non-comparative open label study was undertaken involving 33 subjects diagnosed with uncomplicated malaria. Mean parasitaemia at baseline was 3454 (± 2507) declining to 64.11 (± 66.16) after 7 days. In terms of the achievement of the primary outcome, 24 (72.72%) subjects had total parasite clearance with the other 9 (27.27%) attaining partial clearance by Day 7. No treatment failure and parasite recrudescence was also observed among the study subjects. The product Mist Nibima was also well tolerated and shown to safe as biochemical and haematological indices were normal post treatment. Cryptolepis sanguinolenta and herbal products formulated from the plant may therefore hold some potential for use as a first-line antimalarial agents

Storage rot of seed yam resulting from speargrass injuries

Postharvest rot due to injury is a major contributing factor to the declining quality of stored seed yams ( Dioscorea spp.). Among the several known injuries, the piercing effect of speargrass rhizomes has become a serious constraint for yam production in Ghana. The objective of this study was to assess injuries on seed yams resulting from piercing of speargrass rhizomes and their effects on postharvest rots in Ghana. Eighty farmer fields from Mem, Watro, Asanteboa and Abour in the Atebubu-Amantin Municipal in the Bono East Region of Ghana were screened for speargrass incidence and injury on harvested tubers, for laboratory analysis of pathogens in 2016 and 2017. The tubers were sorted into four categories of seed yam based on weight. Thirty seed yams each of two selected white yam cultivars (Dente and Kpamyo) with visible speargrass rhizome-pierced-tubers (VSRPT) and non-speargrass rhizome pierced healthy tubers (NSRPHT) were randomly selected and stored in a ban for weekly assessment of rot. The rotten tissues from the localised area of VPSRT were subjected to pathological investigations in the laboratory. The incidence of injury seemingly increased with increasing tuber weight. It was 0% for < 100 g samples and averagely 14% for > 1 kg samples, irrespective of cultivars and locations. Incidence of rot from NSRPHT sample was observed 5 weeks after storage (WAS) for both cultivars; and 2 WAS from the VSRPT sample and 40% higher than NSRPHT at 8 WAS. Eight and six known rot pathogens were isolated from the rotten tissues of VSRPT of Dente and Kpamyo, respectively. Injury from the piercing of speargrass rhizome significantly contributed to hastening of tuber rots; while tuber injury increased with increasing speargrass density. Appropriate management of speargrass is essential for commercial seed yam growers to reduce tuber damage which affects yam quality, storage and marketing.La pourriture post-r\ue9colte due \ue0 une d\ue9chirure est un facteur majeur contribuant \ue0 la baisse de la qualit\ue9 des ignames des semences stock\ue9es ( Dioscorea spp.). Parmi les nombreuses d\ue9chirures connues, l\u2019effet per\ue7ant des rhizomes de la gerbe d\u2019herbe est devenu une contrainte s\ue9rieuse pour la production d\u2019igname au Ghana. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer les d\ue9chirures sur les ignames de semence r\ue9sultant du per\ue7age des rhizomes de gerbe d\u2019herbe et leurs effets sur les pourritures post-r\ue9colte au Ghana. Quatre-vingts champs d\u2019agriculteurs de Mem, Watro, Asanteboa et Abour dans la municipalit\ue9 d\u2019Atebubu-Amantin dans la region de l\u2018 Est de Bono au Ghana ont \ue9t\ue9 examin\ue9s pour d\ue9terminer l\u2019incidence et les dommages de la gerbe d\u2019herbe sur les tubercules r\ue9colt\ue9s, pour une analyse en laboratoire des agents pathog\ue8nes en 2016 et 2017. Les tubercules ont \ue9t\ue9 tri\ue9s en quatre cat\ue9gories d\u2019igname de semence en fonction du poids. Trente ignames de semence de chacun des deux cultivars s\ue9lectionn\ue9s d\u2019igname blanche (Dente et Kpamyo) avec des tubercules perc\ue9s de rhizome de gerbe d\u2019herbe (VSRPT) et des tubercules sains perc\ue9s de rhizome non- gerbe d\u2019herbe (NSRPHT) ont \ue9t\ue9 s\ue9lectionn\ue9s au hasard et stock\ue9s dans une interdiction pour une \ue9valuation hebdomadaire de la pourriture . Les tissus pourris de la zone localis\ue9e de VPSRT ont \ue9t\ue9 soumis \ue0 des investigations pathologiques en laboratoire. L\u2019incidence des d\ue9chirures a apparemment augment\ue9 avec l\u2019augmentation du poids des tubercules. Il \ue9tait de 0% pour les \ue9chantillons <100 g et de 14% en moyenne pour les \ue9chantillons > 1 kg, quels que soient les cultivars et les emplacements. L\u2019incidence de pourriture de l\u2019\ue9chantillon NSRPHT a \ue9t\ue9 observ\ue9e 5 semaines apr\ue8s stockage (WAS) pour les deux cultivars; et 2 WAS de l\u2019\ue9chantillon VSRPT et 40% plus \ue9lev\ue9s que NSRPHT \ue0 8 WAS. Huit et six agents pathog\ue8nes de la pourriture connus ont \ue9t\ue9 isol\ue9s respectivement dans les tissus pourris du VSRPT de Dente et de Kpamyo. Les d\ue9chirures caus\ue9es par le per\ue7age du rhizome de gerbe d\u2019herbe ont consid\ue9rablement contribu\ue9 \ue0 acc\ue9l\ue9rer la pourriture des tubercules; tandis que les dommages aux tubercules augmentaient avec l\u2019augmentation de la densit\ue9 de la gerbe d\u2019herbe. Une gestion appropri\ue9e de la groseille verte est essentielle pour les producteurs commerciaux d\u2019ignames de semence afin de r\ue9duire les dommages aux tubercules qui affectent la qualit\ue9, le stockage et la commercialisation des ignames

Enhancing productivity of farmer-saved seed yam in Ghana: Positive selection and neem leaf powder factors

Recycling of diseased and pests infested seed yam ( Dioscorea spp.) has resulted in drastic yield reductions in yam production. The objective of this study was to determine the effect of positive selection on the quality of farmer-saved seed yam and also evaluate the effect of neem leaf powder in managing plant parasitic nematodes damage to yam. Two farming systems namely; Positive selection (PS) and Farmer practice (FP) and two soil amendment regimes; neem leaf powder at 20 g stand-1 (NA20) and no neem amendment (NA0) were tested on one variety of yam (Dente). A 2 x 2 x 1 factorial study, mounted on a randomised complete block design in a split plot arrangement was conducted in four replications. Positive selection occupied main plots; while Farmer practice occupied sub-plots. The study was conducted in eight communities located in two municipalities of Ghana, during 2015-2017. Parameters evaluated included Yam Mosaic Virus incidence and severity, incidence and severity of nematode cracks and galling on yam tubers, plant establishment and yield of yam. It was observed that Yam Mosaic Virus (YMV) disease incidence decreased from 38% in 2016 to 31% in 2017 in PS plots as a result of using virus-free planting materials. However, in FP plots, it increased from 67% in 2016 to 72% in 2017. Neem leaf powder amendment resulted in significantly (P< 0.05) low tuber galling (7%) compared with 40% in unamended plots. Similarly, PS plots yielded 7.7 t ha-1 compared to 5.9 t ha-1 in FP fields. In conclusion, Positive selection out-yielded FP by 30.5%; while PS-neem leaf powder interaction resulted in 38.5% over and above FP without neem amendment.Le recyclage des semences d\u2019igname ( Dioscorea spp.) contamin\ue9es par des maladies et des parasites a entra\ueen\ue9 une r\ue9duction drastique du rendement de la production d\u2019igname. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9terminer l\u2019effet de la s\ue9lection positive sur la qualit\ue9 des semences d\u2019igname conserv\ue9es par les agriculteurs et \ue9galement d\u2019\ue9valuer l\u2019effet de la poudre de feuilles de neem dans la gestion des dommages caus\ue9s par les n\ue9matodes parasites des plantes. Deux syst\ue8mes agricoles \ue0 savoir; S\ue9lection positive (PS) et pratique paysanne (PF) et deux r\ue9gimes d\u2019amendement du sol; De la poudre de feuille de neem \ue0 20 g du stand-1 (NA20) et aucun amendement de neem (NA0) ont \ue9t\ue9 test\ue9s sur une vari\ue9t\ue9 d\u2019igname (Dente). Une \ue9tude factorielle de 2 x 2 x 1, mont\ue9e sur une dispositif en\ua0blocs al\ue9atoires complets dans un arrangement en parcelles divis\ue9es, a \ue9t\ue9 men\ue9e en quatre r\ue9p\ue9titions. S\ue9lection positive occup\ue9e parcelles principales; tandis que la pratique paysanne occupait des sous-parcelles. L\u2019\ue9tude a \ue9t\ue9 men\ue9e dans huit communaut\ue9s situ\ue9es dans deux municipalit\ue9s du Ghana en 2015-2017. Les param\ue8tres \ue9valu\ue9s comprenaient l\u2019incidence et la gravit\ue9 du virus de la mosa\uefque de l\u2019igname, l\u2019incidence et la gravit\ue9 des fissures de n\ue9matode et le grippage des tubercules de l\u2019igname, l\u2019\ue9tablissement de la plante et le rendement de l\u2019igname. Il a \ue9t\ue9 observ\ue9 que l\u2019incidence de la maladie caus\ue9e par le virus de la mosa\uefque \ue0 l\u2019igname (YMV) avait diminu\ue9 de 38% en 2016 \ue0 31% en 2017 dans les parcelles PS gr\ue2ce \ue0 l\u2019utilisation de mat\ue9riel de plantation d\ue9pourvu de virus. Cependant, dans les parcelles de PF, il est pass\ue9 de 67% en 2016 \ue0 72% en 2017. L\u2019amendement de poudre de feuille de Neem a entra\ueen\ue9 une r\ue9duction significative du galles des tubercules (P <0,05) (7%) par rapport \ue0 40% dans les parcelles non modifi\ue9es. De m\ueame, les parcelles de PS ont produit 7,7 t ha-1, contre 5,9 t ha-1 dans les champs de PF. En conclusion, la s\ue9lection positive a eu un rendement sup\ue9rieur de 30,5% \ue0 celui de la PF; tandis que l\u2019interaction de la poudre de feuille PS-neem a eu pour r\ue9sultat 38,5% de plus que FP sans amendement de nee

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1�70.8) million) to 6.4 (58.3 (47.6�70.7) million), but is predicted to remain above the World Health Organization�s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8�38.5) million) in 2000 to 6.0 (55.5 (44.8�67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)

An amendment to this paper has been published and can be accessed via a link at the top of the paper. © 2020, The Author(s)