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- Ademuyiwa, Adesoji O., et al.
(author)
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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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In: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Journal article (peer-reviewed)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. |
- O'Dowd, Mina, et al.
(author)
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The Sami People in Scandinavia: Government Policies for Indigenous Language Recognition and Support in the Formal Education System
- 2015
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In: Indigenous Education: Language, Culture and Identity. - 9789401793544 - 9789401793551 ; 1, s. 187-205
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Book chapter (peer-reviewed)abstract
- The Sámi people in Scandinavia have experienced a long history of discrimination, oppression, neglect, ridicule, and theft. Some scholars compare the history of the Sámi with that of the American Indian population. Today the Sámi who live in Sweden, Norway and Finland, together with the Sámi in Russia have managed to improve their situation through concerted efforts, collaboration with one another, and cooperation with the international movement for the rights of indigenous peoples. More recently, the Sami have received support from both the European Union and the United Nations. Despite international support, the right of the Sámi people for self-determination has not been acknowledged by the Swedish, Norwegian or Finnish governments. The Sami’s right to instruction and education in their own mother tongue has not been adequately addressed. Rather government policies in the Scandinavian countries can at best be described as policies for language maintenance, while what is sorely needed are policies that re-vitalize language use among all Sámi and provide support for endangered or nearly-extinct Sámi languages. Much remains to be done for this indigenous people, not the least of which is acknowledgement of right to their land, their hunting and fishing rights and their right to determine if and how their land is to be exploited.
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