Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Sub-Saharan Africa

Abstract Background/Purpose Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients in eastern Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children <18 years at Eastern Regional Hospital (ERH) in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study and secondary analysis was performed. Results We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Major procedures, gastrointestinal surgery, surgical trauma, surgical infection and having insurance were significantly associated with prolonged LOS. Age and male gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant and actionable risk factor for readmission in the pediatric surgical population in sub-Saharan Africa. Preventing readmission in patients with malaria could reduce readmission rates by 74%, leading to potential cost-savings and reductions in morbidity.

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Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

10.21203/rs.2.22737/v3 ◽

2020 ◽

Author(s):

Sarah Peiffer ◽

Anna E. Ssentongo ◽

Laura Keeney ◽

Forster Amponsah-Manu ◽

Richard Yeboako ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Univariate Analysis ◽

Gastrointestinal Surgery ◽

Significant Risk ◽

Morbidity And Mortality ◽

Surgical Trauma ◽

Rural Ghana ◽

Laparoscopic Equipment ◽

Hospital Stays

Abstract Background/Purpose: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods: This is a retrospective review of perioperative morbidity and mortality in children <18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.Results: We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.

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Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

10.21203/rs.2.22737/v2 ◽

2020 ◽

Author(s):

Sarah Peiffer ◽

Anna E. Ssentongo ◽

Laura Keeney ◽

Forster Amponsah-Manu ◽

Richard Yeboako ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Univariate Analysis ◽

Gastrointestinal Surgery ◽

Significant Risk ◽

Morbidity And Mortality ◽

Surgical Trauma ◽

Rural Ghana ◽

Laparoscopic Equipment ◽

Hospital Stays

Abstract Background/Purpose: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods: This is a retrospective review of perioperative morbidity and mortality in children <18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study . Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.Results: We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.

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Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

BMC Surgery ◽

10.1186/s12893-020-00867-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sarah Peiffer ◽

Anna E. Ssentongo ◽

Laura Keeney ◽

Forster Amponsah-Manu ◽

Richard Yeboako ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Univariate Analysis ◽

Gastrointestinal Surgery ◽

Significant Risk ◽

Morbidity And Mortality ◽

Surgical Trauma ◽

Rural Ghana ◽

Laparoscopic Equipment ◽

Hospital Stays

Abstract Background/Purpose Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender. Results We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population. Level of Evidence Retrospective comparative study.

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The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa

Clinical Medicine ◽

10.7861/clinmedicine.18-2-123 ◽

2018 ◽

Vol 18 (2) ◽

pp. 123-127 ◽

Cited By ~ 4

Author(s):

Martin Otyek Opio ◽

Teopista Namujwiga ◽

Imaculate Nakitende ◽

John Kellett ◽

Mikkel Brabrand

Keyword(s):

Observational Study ◽

Hospital Mortality ◽

Prospective Observational Study ◽

Sub Saharan Africa ◽

Medical Patients ◽

Upper Arm ◽

Arm Circumference ◽

Resource Poor ◽

Sub Saharan ◽

Mid Upper Arm Circumference

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The toll of COVID-19 on African children: A descriptive analysis on the COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa

10.1101/2021.07.02.21259857 ◽

2021 ◽

Author(s):

Sabina Rodriguez Velasquez ◽

Lea Jacques ◽

Jyoti Dalal ◽

Paolo Sestito ◽

Zahra Habibi ◽

...

Keyword(s):

Cumulative Incidence ◽

Pediatric Population ◽

Adult Population ◽

Age Groups ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

African Countries ◽

Regional Office ◽

Sub Saharan ◽

Epidemiological Characteristics

Introduction: Since the beginning of the COVID-19 pandemic, very little data on the epidemiological characteristics among the pediatric population in Africa has been published. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population within 15 Sub-Saharan African countries. Methods: A merge line listing dataset using a reverse engineering model shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March 2020 and 1 September 2020 with confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases including its medians and 95% confidence intervals were calculated. Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. COVID-19 cases in males and females under the age of 18 were evenly distributed. Among adults, a higher case incidence per 100,000 people was observed compared to children. Conclusion: The cases and deaths within the children population was smaller than the adult population. These differences can reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.

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Predictors of three-month mortality among hospitalized older adults in Togo

10.21203/rs.3.rs-38973/v2 ◽

2020 ◽

Author(s):

Fifonsi Adjidossi GBEASOR-KOMLANVI ◽

Martin Kouame TCHANKONI ◽

Akila Wimima BAKOUBAYI ◽

Matthieu Yaovi LOKOSSOU ◽

Arnold SADIO ◽

...

Keyword(s):

Older Adults ◽

Hospital Mortality ◽

Cox Regression ◽

Sub Saharan Africa ◽

Mortality Data ◽

Kaplan Meier ◽

All Cause Mortality ◽

Hospitalized Older Adults ◽

Sub Saharan

Abstract Background: Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.Methods: We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.Results: The median age of the 650 older adults included in the study period was 61 years, IQR: [55-70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4-20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5% and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.Conclusion: Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

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The Need for the Right Socio-Economic and Cultural Fit in the COVID-19 Response in Sub-Saharan Africa: Examining Demographic, Economic Political, Health, and Socio-Cultural Differentials in COVID-19 Morbidity and Mortality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103445 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3445 ◽

Cited By ~ 14

Author(s):

Andre Renzaho

Keyword(s):

Global Economy ◽

Social Protection ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Peace Building ◽

African Countries ◽

Cross Border ◽

Tax Regimes ◽

Sub Saharan ◽

Political Health

The coronavirus disease (COVID-19) has spread quickly across the globe with devastating effects on the global economy as well as the regional and societies’ socio-economic fabrics and the way of life for vast populations. The nonhomogeneous continent faces local contextual complexities that require locally relevant and culturally appropriate COVID-19 interventions. This paper examines demographic, economic, political, health, and socio-cultural differentials in COVID-19 morbidity and mortality. The health systems need to be strengthened through extending the health workforce by mobilizing and engaging the diaspora, and implementing the International Health Regulations (2005) core capacities. In the absence of adequate social protection and welfare programs targeting the poor during the pandemic, sub-Saharan African countries need to put in place flexible but effective policies and legislation approaches that harness and formalise the informal trade and remove supply chain barriers. This could include strengthening cross-border trade facilities such as adequate pro-poor, gender-sensitive, and streamlined cross-border customs, tax regimes, and information flow. The emphasis should be on cross-border infrastructure that not only facilitates trade through efficient border administration but can also effectively manage cross-border health threats. There is an urgent need to strengthen social protection systems to make them responsive to crises, and embed them within human rights-based approaches to better support vulnerable populations and enact health and social security benefits. The COVI-19 response needs to adhere to the well-established ‘do no harm’ principle to prevent further damage or suffering as a result of the pandemic and examined through local lenses to inform peace-building initiatives that may yield long-term gains in the post-COVID-19 recovery efforts.

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Opsonophagocytic Assay To Evaluate Immunogenicity of Nontyphoidal Salmonella Vaccines

Clinical and Vaccine Immunology ◽

10.1128/cvi.00106-16 ◽

2016 ◽

Vol 23 (6) ◽

pp. 520-523 ◽

Cited By ~ 6

Author(s):

Girish Ramachandran ◽

Mary Adetinuke Boyd ◽

Jennifer MacSwords ◽

Ellen E. Higginson ◽

Raphael Simon ◽

...

Keyword(s):

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Content Type ◽

Killing Assay ◽

Invasive Infections ◽

Sub Saharan ◽

Functional Antibodies ◽

Opsonophagocytic Killing ◽

Rabbit Complement

ABSTRACTNontyphoidalSalmonella(NTS) invasive infections are an important cause of morbidity and mortality in sub-Saharan Africa. Several vaccines are in development to prevent these infections. We describe an NTS opsonophagocytic killing assay that uses HL-60 cells and baby rabbit complement to quantify functional antibodies elicited by candidate NTS vaccines.

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