| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Drake, TM, et al.
(författare)
-
Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study
- 2020
-
Ingår i: BMJ global health. - : BMJ. - 2059-7908. ; 5:12
-
Tidskriftsartikel (refereegranskat)abstract
- Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings.MethodsA multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI).ResultsOf 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI.ConclusionThe odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
|
|
| 5. |
- Kinyoki, DK, et al.
(författare)
-
Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017
- 2020
-
Ingår i: Nature medicine. - : Springer Science and Business Media LLC. - 1546-170X .- 1078-8956. ; 26:5, s. 750-759
-
Tidskriftsartikel (refereegranskat)abstract
- A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.
|
|
| 6. |
|
|
| 7. |
- Ademuyiwa, Adesoji O., et al.
(författare)
-
Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
-
Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
-
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.
|
|
| 8. |
- Svennerholm, A M, et al.
(författare)
-
Current status of an oral B subunit whole cell cholera vaccine.
- 1983
-
Ingår i: Developments in biological standardization. - 0301-5149. ; 53, s. 73-9
-
Tidskriftsartikel (refereegranskat)abstract
- Purified B subunit of cholera toxin retains membrane-binding capacity and protective immunogenicity and yet has no toxic activity as tested in animals. These properties suggest that B subunit might be a promising immunogen, particularly as an oral vaccine, for stimulating protective antitoxic immunity against cholera in man. A method has been elaborated which allows preparation of +/- 10 grams of pure B subunit per fermentor culture cycle. As tested in both Swedish and Bangladeshi volunteers purified B subunit alone or in combination with conventional whole cell vaccine gives no side-effects at all when given orally and only very mild local reactions after parenteral administration. A single peroral or intramuscular immunization with B subunit has given significant intestinal IgA antitoxin antibody formation in 75-85% of Bangladeshi women tested; however, the duration of the response was longer after the oral route. The preliminary results of a recent study (Svennerholm, A.M., Jertborn, M., Gothefors, L., Karim, A., Sack, D. and Holmgren, J., to be published) have further shown that two peroral immunizations of Bangladeshi volunteers with a combined B subunit--whole cell cholera vaccine give rise to mucosal IgA antitoxin as well as anti-lipopolysaccharide antibody formation which closely resemble these antibody responses in cholera convalescents. The combined vaccine also evoked a local immunologic memory comparable to that induced by clinical disease.
|
|
| 9. |
- Svennerholm, A M, et al.
(författare)
-
Mucosal antitoxic and antibacterial immunity after cholera disease and after immunization with a combined B subunit-whole cell vaccine.
- 1984
-
Ingår i: Journal of Infectious Diseases. - 0022-1899 .- 1537-6613. ; 149:6, s. 884-93
-
Tidskriftsartikel (refereegranskat)abstract
- Mucosal and systemic immune responses to a new oral cholera vaccine, consisting of the B subunit plus killed vibrios, were studied in Bangladeshi volunteers and compared with those to clinical cholera. A single peroral dose of vaccine induced a local IgA antitoxin response in intestinal-lavage fluid of seven of eight vaccinees; the response closely mimicked that of patients convalescing from cholera, and evidence of the induction of local immunologic memory was found as well. Two peroral doses were needed for stimulation of an intestinal IgA immune response to the lipopolysaccharide of Vibrio cholerae that was comparable to the response obtained after clinical cholera. This response to peroral immunization was considerably stronger than that to parenteral vaccination, although the intramuscular route gave rise to the strongest IgG antitoxin and antilipolysaccharide responses in serum. The results suggest that B subunit-whole cell vaccine, when given in at least two oral doses, may be a good candidate for use in cholera prophylaxis.
|
|
| 10. |
|
|
