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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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- Lucian, Charles
(författare)
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Geotechnical Aspects of Buildings on Expansive Soils in Kibaha, Tanzania : Preliminary Study
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this study is on potential problems resulting from construction on expansive soils in Kibaha region, Tanzania. For the fact that most of the affected structures are founded on expansive soils, a clear understanding of the soil behaviour and their interaction with structures, specifically as they relate to shallow foundations, has been of more interest to the study in order to evaluate properly the source of the problem. The geotechnical behaviour of expansive clay soils is investigated by looking into the geomorphologic, geological and climatic conditions and mineralogical composition of the soils in the study area. The geotechnical results are linked with the performance of the foundation as well as structures. Two sites, representative of known problem-areas in Kibaha were selected for geotechnical tests. Geotechnical site investigation consisted of open trial pits, profile description and the collection of both disturbed and undisturbed samples. The collected samples were submitted to soil laboratories at KTH and DIT for mineralogical composition tests, natural water content, density, Atterberg limits and swell tests (free swell and swelling pressure). The results of this investigation indicate that soil in Kibaha contains clay (31%), have high liquid limit (59%) and plastic limit (37%) which indicate high potential swell. Since swell potential and swell pressure are key properties of expansive soils, the swell parameters were measured by free swell tests and one-dimensional oedometer swell tests respectively. The free swell ranged from 100% to 150% and the swell pressure was in the region of 45 kPa. The properties of expansive soils were confirmed by the x-ray diffraction test which showed the presence of montmorillonite in the soil. It is from this fact that the source of the problem is in the expansive soils coupled with poor building materials. Physical conditions of the surveyed properties in the area confirmed the hypothesis of building damages due to poor building materials triggered by expansive soils. In support of the obtained data, the actual behaviour of the foundations is supplemented with prototypes of strip foundations whose performances are to be monitored over a long period. Finally, suggested are the ways forward to solve the problem of foundation on expansive soil.
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- Lucian, Charles, 1963-
(författare)
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Geotechnical Aspects of Buildings on Expansive Soils in Kibaha, Tanzania
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus of this study is on potential damages to buildings resulting from expansive soils in Tanzania, particularly clay soils in Kibaha. For the fact that most of the affected structures are founded on expansive soils, a clear understanding of the behaviour of soils and their interaction with structures has been of interest to the study in order to evaluate properly the source of the problem.The geotechnical behaviour of expansive clay soils is investigated by looking into the geomorphologic, geological and climatic conditions and mineralogical composition of the soils in the study area.Two sites, representative of known problem-areas in Kibaha were selected for geotechnical tests. Geotechnical site investigation consisted of open trial pits, profile description and the collection of both disturbed and undisturbed samples. To extend and amplify the findings, supplementary samples were collected from the environs of the two sites.The collected samples were submitted to soil laboratories at KTH, ARU, SEAMIC and DIT for mineralogical composition tests, natural water content, density, Atterberg limits and swell tests. The results of this investigation indicate that soils in Kibaha contains clay (31%), have high liquid limit (59%) and plastic limit (37%) which indicate high potential swell.Since swell pressure, free swell and swell percent are key properties of expansive soils, the swell properties were measured by free swell tests and one-dimensional oedometer swell tests. The free swell ranged from 100% to 150% and the swell pressure was in the region of 45 kPa. The coefficient of linear extensibility (COLE) was determined for characterizing expansive clays. For all tested samples, COLE ranged from 0.09 to 0.14 indicating that soils fall in the region of high to very high expansion potential rating. The properties of expansive soils were confirmed by the x-ray diffraction test which showed the presence of smectite in the soil. Furthermore, total suction measurement technique using filter paper method indicated that the soils have high suction values, signifying that they have a tendency to swell upon wetting depending on plasticity of particular soil.The depth of the active zone was measured as a function of moisture variations in the profiles during two extreme weather conditions. The active zone depth was found to be between 1.0 and 2.0 m deep. Procedures to assess models to predict swell in the case study were outlined together with their validity.Vertical and horizontal spatial variability in selected soil properties was defined using geostatistical techniques through the fitting of variogram. The indicator semivariograms of both clay contents and free swell gave a range of 20 m horizontally and 1.0 m vertically, with the horizontal variograms exhibiting greater ranges than the dipping variograms.Physical conditions of the surveyed properties in the area confirmed that building damages are associated with poor building materials triggered by expansive soils. In support of the obtained data, the actual behaviour of the foundations was supplemented with prototypes of strip foundations whose performances were monitored over a period of four months. Finally, suggested are the ways forward to solve the problem of foundation on expansive soil
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