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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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- Biswas, AK, et al.
(författare)
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Workshop 3 (synthesis) : water, poverty alleviation and social programs
- 2003
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Ingår i: Water Science and Technology. - 0273-1223 .- 1996-9732. ; 47:6, s. 129-132
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Tidskriftsartikel (refereegranskat)abstract
- Poverty is a complex issue, which must be understood in a holistic manner. Low and variable income is certainly a key element, but it is far from enough to portray poverty. The various characteristics of poverty and their relative strength are determined through contextually specific circumstances, in terms of history, environmental preconditions, socio-cultural traits, etc. Much of this context is made up of local and national circumstances. The consequences of globalisation must, however, increasingly to be taken into account. At a larger scale, it is also relevant to mention that climate change will have a negative, although largely unpredictable, impact for the people in some parts of the world. For those who are already living on marginal lands or who are exposed to water problems, climate change is likely to create considerable adverse effects.
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