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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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| 2. |
- Habtezion, Senay, et al.
(författare)
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Earth System Governance in Africa: knowledge and capacity needs
- 2015
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Ingår i: Current Opinion in Environmental Sustainability. - : Elsevier BV. - 1877-3443 .- 1877-3435. ; 14, s. 198-205
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Tidskriftsartikel (refereegranskat)abstract
- Traditional approaches for understanding environmental governance - such as environmental policy analysis or natural resources management - do not adequately address the gamut of human-natural system interactions within the context of the complex biogeophysical cycles and processes of the planet. This is perhaps more so in the African regional context where the complex relationships between modern and traditional governance systems and global change dynamics are arguably more pronounced. The Earth System Governance (ESG) Analytical Framework encompasses diverse systems and actors involved in the regulation of societal activities and behaviors vis-a-vis earth system dynamics. The concept encompasses a myriad of public and private actors and actor networks at all levels of policy and decision-making. The existence of, and interaction among, these diverse actors and systems, however, is under-researched in the African context. Various research approaches taken to address crucial global environmental change (GEC) challenges in Africa have proven to be inadequate because they tend to overlook the complex interactions among the various local actors, players, and indigenous conditions and practices vis-a-vis GEC system drivers and teleconnections. Similarly, the regional peculiarities in terms of governance typologies and sociocultural diversity highlight the need for nuanced understanding of the complex interactions and nexuses among multiple actors and interests and Earth system processes. However, this diversity and complexity has often been lost in generalized enquiries. We argue that examination of the governance-GEC nexus through the aid of the ESG Framework would provide a much broader and more helpful insight.
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