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13 results on '"S Njoroge"'

1. Vector Error Correction Model: Prediction of Bi-Directional Causality between Gross Domestic Product and Wage Growth in Kenya

Author

Mburu S. Njoroge, Gladys G. Njoroge, and Adolphus Wagala

Abstract

Economic growth and wage growth are very prominent macroeconomic variables in all countries in the World. These two variables are the main signposts signaling the current trends in an economy. To determine the recent behavior of the economy, the government must study and analyze these major variables. The increase in aggregate production in the Kenyan economy has been deteriorating due to the steady rise in the wage bill, especially since the year 2012, in conjunction with the devolved government. An increase in wage rate motivates workers and, in turn, increases the production capacity of a country hence economic growth. An increase in recurrent expenditure implies that the development expenditure will be condensed, which will alter the growth of the economy. The primary goal of this research was to fit vector error correction model on gross domestic product and wage growth data so as to identify the bidirectional causality effects between the two variables. VEC model is superior since it distinguishes between long run and short run relationship among underlying variables in a large sample size. The linear Granger causality test was used to evaluate the causal relationship between the system's variables; hence a causal research design was adopted in this study. This research employed secondary data, which was analyzed using Eviews and STATA statistical software. Data on these target variables was acquired from the World Bank and Central Bank of Kenya. Lastly, this study used yearly time series data for the period 1979 to 2019. It was found that wage growth and GDP granger causes each other and also have a long run relationship since their respective p values were less than 5% significance level. VECM1 (effects of wage growth on GDP) had AIC of -0.2953, RMSE of 1.0039 while the R-squared was 0.7241. Subsequently, effects of GDP on wage growth (VECM2) was found to have an R-squared of 0.7452, AIC of -8.2270 and RMSE of 0.08363. Based on the foregoing findings, it was determined that GDP has more influence on wage growth both in the short and long run. This study thus recommends that the government should keep inflation under control, increase development expenditure to finance projects and fostering a favorable business environment for Small and Medium-sized Enterprises (SMEs) to upsurge total output (productivity) which will in turn, lead to a rise in wage growth, thus a high standard of living for the millions of unemployed Kenyans. Finally, the findings of the current study are expected to be of significance to academicians and also provide appropriate policy options that will help in harmonizing the wage rates, thus managing recurrent expenditure in Kenya.

Published
2022

2. Progress in research on site-specific nutrient management for smallholder farmers in sub-Saharan Africa

Author

P, Chivenge, S, Zingore, K S, Ezui, S, Njoroge, M A, Bunquin, A, Dobermann, and K, Saito

Subjects
Soil Science, Agronomy and Crop Science
Abstract

Increasing fertilizer access and use is an essential component for improving crop production and food security in sub-Saharan Africa (SSA). However, given the heterogeneous nature of smallholder farms, fertilizer application needs to be tailored to specific farming conditions to increase yield, profitability, and nutrient use efficiency. The site-specific nutrient management (SSNM) approach initially developed in the 1990 s for generating field-specific fertilizer recommendations for rice in Asia, has also been introduced to rice, maize and cassava cropping systems in SSA. The SSNM approach has been shown to increase yield, profitability, and nutrient use efficiency. Yield gains of rice and maize with SSNM in SSA were on average 24% and 69% when compared to the farmer practice, respectively, or 11% and 4% when compared to local blanket fertilizer recommendations. However, there is need for more extensive field evaluation to quantify the broader benefits of the SSNM approach in diverse farming systems and environments. Especially for rice, the SSNM approach should be expanded to rainfed systems, which are dominant in SSA and further developed to take into account soil texture and soil water availability. Digital decision support tools such as RiceAdvice and Nutrient Expert can enable wider dissemination of locally relevant SSNM recommendations to reach large numbers of farmers at scale. One of the major limitations of the currently available SSNM decision support tools is the requirement of acquiring a significant amount of farm-specific information needed to formulate SSNM recommendations. The scaling potential of SSNM will be greatly enhanced by integration with other agronomic advisory platforms and seamless integration of digital soil, climate and crop information to improve predictions of SSNM recommendations with reduced need for on-farm data collection. Uncertainty should also be included in future solutions, primarily to also better account for varying prices and economic outcomes.

Published
2022

3. Feed the crop, not the soil! : Explaining variability in maize yield responses to nutrient applications in smallholder farms of western Kenya

Author

S. Njoroge Kinyanjui, Wageningen University, K.E. Giller, A.G.T. Schut, and S. Zingore

Subjects
Soil test, Nutrient management, Crop yield, Soil organic matter, Soil carbon, engineering.material, PE&RC, Manure, Agronomy, Plant Production Systems, Plantaardige Productiesystemen, engineering, Life Science, Environmental science, Fertilizer, Soil fertility
Abstract

Crop productivity intensification in smallholder farming systems of sub-Saharan Africa (SSA) is urgently required to improve food self-sufficiency. Increased fertilizer use can address nutrient deficiencies that limit crop productivity in SSA. There is however large uncertainty in crop yield responses to fertilizer applications on farmer fields. This uncertainty has been linked to strong heterogeneity in soil fertility between and within farms. Fertilizer recommendations that account for this spatial heterogeneity are therefore required to better advise farmers, reduce investment and environmental risks for sustainable crop productivity intensification. The main objective of this study was to better understand and explain patterns of maize yield and yield responses to fertilizer applications under heterogenous fertility conditions in smallholder farming systems. This would allow for improved targeting of fertilizer applications, and enable better prediction of expected crop yield response to fertilizer use. A series of on-farm experiments assessing maize yield response to fertilizer application under variable soil fertility conditions were established on 23 farmers’ fields in Siaya, western Kenya across multiple seasons. Prior to experiment establishment, farmers were extensively interviewed to obtain information on past crop and nutrient management practices in selected fields. The experiment used was comprised of nutrient omission trials (NOTs) on farmer fields in Siaya to assess patterns of maize yield response to fertilizer applications of 150 kg ha-1 nitrogen (N), 40 kg ha-1 phosphorus (P) and 60 kg ha-1 potassium (K). In Phase 1, plots with treatments including control, PK, NK, NP and NPK were repeated for 7 consecutive seasons in the same plots. In Phase 2 of the experiment, a second set of NOTs including PK, NK, NP and NPK were established in every plot on 6 fields that were previously part of Phase 1. On 13 other fields from Phase 1, all plots received NPK in Phase 2. Yields and above ground biomass were measured every year, soil samples were taken in 2013, 2014, 2016 and 2018 and plant samples were taken in 2016 and 2018. Spatial-temporal patterns in yield and yield responses were studied and compared with soil and farmer characteristics. Yield response to soil nutrient supply was studied with the QUEFTS model, and the RC-P model was used to study fate of fertilizer P. Nutrient balances were calculated. The frequency and magnitude of maize yield response to fertilizer N, P and K varied strongly over space and time, yet observed patterns were not adequately explained by soil chemical parameters or texture. Fertilizing with N, P, and K substantially reduced observed spatial-temporal variability in maize yield response, and resulted in consistently enhanced maize yields. All fields were responsive to N, most fields to P and only 7 to K. On average, NPK yields were about 5 to 5.5 tons ha-1 in the short- and long rainy seasons respectively. Application of only NP or NK resulted in strongly declining yields within a few seasons, with large differences between farms in resilience of soil P and K stocks. Based on observed spatial-temporal patterns, we concluded that blanket fertilizer recommendations in such farming systems result in low fertilizer use efficiencies. We further concluded that current methods for soil analysis do not adequately explain the observed variation in maize yield response to application of N, P and K fertilizers under the highly variable soil fertility conditions encountered in smallholder farming systems. Accounting for past manure application in Phase 1 of the experiment improved our ability to explain the variation in maize yield response to fertilizer application. Mean maize yield response to N, P and K application was 2.8, 1.1 and 0.6 t ha-1 in fields with animal manure previously applied, and 2.3, 3.0 and 1.6 t ha-1 in farms without past manure applications over 7 cropping seasons. Differences in maize yield response in fields with and without past manure applications were mainly related to enhanced soil phosphorus (P) and potassium (K) supply, and larger recovery of applied nitrogen (N) in fields with manure previously applied. Based on these findings, we concluded that the strong influence of past animal manure application on yield response to fertilizer applications merits the inclusion of past manure application as a co-variate in analysis of yield response data from smallholder cropping systems of SSA. The Quantitative Evaluation of the Fertility of Tropical Soils (QUEFTS) model did not adequately estimate crop yield responses to fertilizer applications under variable soil fertility conditions. This was linked to poor estimation of soil N, P and K supply based on current relationships for potential soil nutrient supply in the QUEFTS model. In particular, soil organic carbon (SOC) and P-Olsen were poor indicators of crop N and P uptake from the soil. Maize grain yield in unfertilized control treatment plots provided better estimates of potential soil N, P and K supply, resulting in improved predictions of maize yield response to fertilizer applications. These findings suggest that the standard soil parameters analysed do not accurately inform on the soil fertility status of the field and are of little use for smallholder farmers. Improved relations for estimation of potential soil nutrient in QUEFTS are required for better prediction of expected maize yield response to fertilizer application under variable soil fertility conditions. Maize crops in strongly nutrient-depleted soils responded strongly to balanced NPK fertilization, with yields comparative to long-term means within three seasons. Placement of P fertilizer strongly improved recovery, reducing the need for larger soil P stocks on soils that will typically develop a large insoluble P pool under P fertilization. The RC-P model provided insights in long-term recovery of P and could describe the observed P uptake patterns reasonably well. We concluded that strongly nutrient depleted tropical soils such as those in Siaya with high clay contents that are typical for western Kenya, do not require prior investments to rebuild nutrient stocks and soil organic matter to substantially increase crop yields to 5-5.5 t ha-1. This has important implications for crop productivity intensification in SSA as a large proportion of soils under cultivation are strongly nutrient depleted, and earlier approaches have suggested the need for costly and capital intensive soil fertility replenishment. Results in this thesis clearly demonstrate that sustainable intensification of crop productivity on smallholder farms of SSA is very well possible on all fields under good management, even when soils are strongly nutrient depleted. However, the need for P and K fertilizers and amounts applied should be tailored to specific field conditions to reduce farmer costs in the short term. Accounting for past farm management and assessment of current yields under minimal or no fertilizer applications provides a means for improved targeting of fertilizer applications at the farm level. In the long term, farmers should aim for balanced fertilization to prevent mining of soil stocks. Simplified decision support tools that use field level information to develop improved estimates of fertilizer N, P and K requirements based on refined relationships between soil nutrient supply, nutrient uptake and yield, are required to derive fertilizer recommendations in future.

Published
2019

4. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study

Author

David Bishop, Robert A Dyer, Salome Maswime, Reitze N Rodseth, Dominique van Dyk, Hyla-Louise Kluyts, Janat T Tumukunde, Farai D Madzimbamuto, Abdulaziz M Elkhogia, Andrew K N Ndonga, Zipporah W W Ngumi, Akinyinka O Omigbodun, Simbo D Amanor-Boadu, Eugene Zoumenou, Apollo Basenero, Dolly M Munlemvo, Coulibaly Youssouf, Gabriel Ndayisaba, Akwasi Antwi-Kusi, Veekash Gobin, Patrice Forget, Bernard Mbwele, Henry Ndasi, Sylvia R Rakotoarison, Ahmadou L Samateh, Ryad Mehyaoui, Ushmaben Patel-Mujajati, Chaibou M Sani, Tonya M Esterhuizen, Thandinkosi E Madiba, Rupert M Pearse, Bruce M Biccard, Hippolyte Abadagan, N Abbas, A Ibrahim Abdelatif, Traoré Abdoulaye, A Abd-rouf, A Abduljalil, A Abdulrahman, S Abdurazig, A Abokris, W Abozaid, SOA Abugassa, F Abuhdema, SA Abujanah, R Abusamra, A Abushnaf, SA Abusnina, TS Abuzalout, HM Ackermann, YB Adamu, A Addanfour, DM Adeleke, TA Adigun, AO Adisa, Sèhivè Valéry Adjignon, NA Adu-Aryee, BB Afolabi, AFX Agaba, PKA Agaba, K Aghadi, H Agilla, B Ahmed, El-Z Ahmed, Al-J Ahmed, M Ahmed, Rene Ahossi, SA Aji, S Akanyun, I Akhideno, M Akhter, OA Akinyemi, M Akkari, Joseph Akodjenou, AL AL Samateh, ES al Shams, OT Alagbe-Briggs, EA Alakkari, RB Alalem, M Alashhab, OI Alatise, A Alatresh, MSI Alayeb Alayeb, BA Albakosh, F Albert, ANJD Alberts, AD Aldarrat, A Alfari, A Alfetore, M Algbali, A Algddar, HA Algedar, IA Alghafoud, A Alghazali, M Alhajj, A Alhendery Alhendery, FFH Alhoty, A Ali, YA Ali, Beye Seïdina Alioune, MA Alkassem, MA Alkchr, TS Alkesa, A Alkilani, F Alkobty Alkobty, Thomas Allaye, SBM Alleesaib, A Alli, K Allopi, NL Allorto, A Almajbery, R Almesmary, SHA Almisslati, F Almoraid, H Alobeidi, MA Alomami, Christella S Alphonsus, OA Alqawi, AA Alraheem, SA Alsabri, A Alsayed, B Alsellabi, M Al-Serksi, MSA Alshareef, AA Altagazi, JS Aluvale, HW Alwahedi, EA Alzahra, MA Alzarouk, K Al-Zubaidy, M Amadou, Maiga Amadou, Al-A Amer, BT Amisi, MA Amuthenu, TWA Anabah, Felix Anani, PGR Anderson, AGB Andriamampionona, L Andrianina, A Anele, R Angelin, N Anjar, O Antùnez, LJC Anyanwu, AA Aribi, OA Arowolo, O Arrey, Daniel Zemenfes Ashebir, SB Assefa, Guy Assoum, V Athanse, JS Athombo, M Atiku, E Atito-Narh, Anatole Atomabe, A Attia, M Aungraheeta, DMA Aurélia, OO Ayandipo, AET Ayebale, HMZ Azzaidey, NB Babajee, HB Badi, EK Badianga, RB Baghni, MT Bahta, M Bai, Y Baitchu, AM Baloyi, KA Bamuza, MI Bamuza, L Bangure, OB Bankole, ML Barongo, MM Barow, L Bashiya, CH Basson, Sudha Bechan, S Belhaj, MM Ben Mansour, D Benali, ASB Benamour, A Berhe, JD Bertie, JJA Bester, M Bester, JD Bezuidenhout, K Bhagwan, DR Bhagwandass, KAP Bhat, MMZU Bhuiyan, F Bigirimana, CJ Bikuelo, BE Bilby, SS Bingidimi, KE Bischof, David G Bishop, C Bitta, M Bittaye, Thuli Biyase, CA Blake, E Blignaut, F Blignaut, BN BN Tanjong, A Bogoslovskiy, PM Boloko, SKB Boodhun, I Bori, F Boufas, M Brand, Nicholas T Brouckaert, JD Bruwer, I Buccimazza, IM Bula Bula, Fred Bulamba, BC Businge, YB Bwambale, SRC Cacala, MA Cadersa, Chris Cairns, F Carlos, ME Casey, AC Castro, ND Chabayanzara, MS Chaibou, TNO Chaibva, NK Chakafa, C Chalo, C Changfoot, MC Chari, L Chelbi, JT Chibanda, HN Chifamba, N Chikh, E Chikumba, P Chimberengwa, J Chirengwa, FM Chitungo, MC Chiwanga, MM Chokoe, TM Chokwe, B Chrirangi, M Christian, B Church, JC Cisekedi, JN Clegg-Lamptey, Estie Cloete, Megan Coltman, W Conradie, N Constance, Youssouf Coulibaly, L Cronje, MA Da Silva, H Daddy, L Dahim, D Daliri, MS Dambaki, A Dasrath, JG Davids, Gareth L Davies, JT De Lange, JB de Wet, B Dedekind, MA Degaulle, V Dehal, PD Deka, S Delinikaytis, IS Desalu, Hubert Dewanou, MB Moussa Deye, C Dhege, BSG Diale, DF Dibwe, BJS Diedericks, JM Dippenaar, L Dippenaar, MP Diyoyo, Edith Djessouho, SN Dlamini, A Dodiyi-Manuel, BA Dokolwana, DP Domoyyeri, Leanne W Drummond, DE du Plessis, WM du Plessis, LJ du Preez, K Dube, NZ Dube, KD Dullab, R Duvenhage, RC Echem, SA Edaigbini, AK Egote, A Ehouni, G Ekwen, NC Ekwunife, M El Hensheri, IE Elfaghi, MA Elfagieh, S Elfallah, Mahmoud Elfiky, S Elgelany, AM Elghallal, MG Elghandouri, ZS Elghazal, AM Elghobashy, FT Elharati, RM Elkhwildi, S Ellis, L Elmadani, HB Elmadany, H Elmehdawi, A Elmgadmi, H Eloi, D Elrafifi, G Elsaadi, RB Elsaity, A Elshikhy, M Eltaguri, A Elwerfelli, IE Elyasir, AZ Elzoway, AM Elzufri, EO Enendu, BC Enicker, EO Enwerem, R Esayas, M Eshtiwi, AA Eshwehdi, JL Esterhuizen, EB Etuk, O Eurayet, OR Eyelade, RF Fanjandrainy, Lionelle Fanou, Z Farina, Maher Fawzy, A Feituri, NL Fernandes, LM Ford, T François, T Freeman, YBM Freeman, VM Gacii, B Gadi, M Gagara, A Gakenia, PD Gallou, GGN Gama, MG Gamal, YG Gandy, A Ganesh, Diallo Gangaly, M Garcia, AP Gatheru, SSD Gaya, Oswald Gbéhadé, G Gerbel, A Ghnain, R Gigabhoy, DG Giles, GT Girmaye, S Gitau, B Githae, Said Gitta, Riaz Goga, AAG Gomati, ME Gonzalez, J Gopall, Christina Salmina Gordon, O Gorelyk, M Gova, K Govender, P Govender, S Govender, V Govindasamy, JTK Green-Harris, MB Greenwood, SV Grey-Johnson, Mariette Grobbelaar, MA Groenewald, KK Grünewald, Ambroise Guegni, M Guenane, S Gueye, Marius Guezo, T Gunguwo, MG Gweder, M Gwila, L Habimana, Rodrigue Hadecon, E Hadia, L Hamadi, M Hammouda, MI Hampton, R Hanta, Tim C Hardcastle, JA Hariniaina, S Hariparsad, AH Harissou, R Harrichandparsad, SHA Hasan, HB Hashmi, MP Hayes, A Hdud, SH Hebli, HMSN Heerah, S Hersi, AH Hery, Adam Hewitt-Smith, TC Hlako, SCH Hodges, Richard Eric Hodgson, M Hokoma, H Holder, EB Holford, E Horugavye, C Houston, M Hove, D Hugo, CM Human, H Hurri, O Huwidi, AI Ibrahim, Traoré Ibrahim, OK Idowu, IE Igaga, John Igenge, O Ihezie, K Ikandi, IAR Ike, JJN Ikuku, MN Ilbarasi, IBB Ilunga, JPM Ilunga, NAV Imbangu, Z Imessaoudene, DH Imposo, AM Iraya, M Isaacs, M Isiguzo, A Issoufou, P Izquirdo, A Jaber, UV Jaganath, CS Jallow, S Jamabo, ZS Jamal, L Janneh, MJ Jannetjies, I Jasim, Megan AJ Jaworska, S Jay Narain, K Jermi, R Jimoh, S Jithoo, M Johnson, S Joomye, RM Judicael, M Judicaël, A Juwid, LP Jwambi, R Kabango, JK Kabangu, DK Kabatoro, AN Kabongo, K Kabongo, LT Kabongo, MD Kabongo, N Kady, S Kafu, M Kaggya, BNK Kaholongo, PCK Kairuki, SI Kakololo, K Kakudji, Amina Kalisa, R Kalisa, MR Kalufwelu, S Kalume, RJ Kamanda, MK Kangili, H Kanoun, null Kapesa, P Kapp, JK Karanja, M Karar, K Kariuki, K Kaseke, PNK Kashuupulwa, KJP Kasongo, SK Kassa, GK Kateregga, MIS Kathrada, PM Katompwa, L Katsukunya, KAM Kavuma, null Khalfallah, A Khamajeet, SB Khetrish, null Kibandwa, W Kibochi, AM Kilembe, AK Kintu, B Kipng'etich, B Kiprop, VMK Kissoon, Theroshnie K Kisten, JK Kiwanuka, MEK Knox, AK Koledale, VL Koller, MA Kolotsi, M Kongolo, ND Konwuoh, WJ Koperski, MYK Koraz, AA Kornilov, M Zach Koto, Samantha Kransingh, D Krick, S Kruger, C Kruse, W Kuhn, WP Kuhn, AM Kukembila, KL Kule, M Kumar, Belinda S Kusel, VK Kusweje, KJ Kuteesa, YY Kutor, MA Labib, M Laksari, F Lanos, TA Lawal, Yannick Le Manach, C Lee, RM Lekoloane, SN Lelo, B Lerutla, MT Lerutla, AI Levin, TB Likongo, ML Limbajee, DM Linyama, C Lionnet, MM Liwani, E Loots, A Garrido Lopez, CLC Lubamba, KF Lumbala, AJM Lumbamba, John Lumona, RF Lushima, L Luthuli, HL Luweesi, TSK Lyimo, HM Maakamedi, BM Mabaso, M Mabina, ME Maboya, I Macharia, AM Macheka, AZ Machowski, ASM Madsen, Farai Madzimbamuto, LJ Madzivhe, SC Mafafo, M Maghrabi, Diango Djibo Mahamane, A Maharaj, AD Maharaj, MR Mahmud, M Mahoko, NA Mahomedy, O Mahomva, TM Mahureva, RK Maila, DM Maimane, M Maimbo, SN Maina, Dela A Maiwald, MD Maiyalagan, N Majola, N Makgofa, V Makhanya, WP Makhaye, NM Makhlouf, S Makhoba, EK Makopa, O Makori, Alex M Makupe, MA Makwela, ME Malefo, SM Malongwe, DM Maluleke, MR Maluleke, K Touré Mamadou, MP Mamaleka, Y Mampangula, RM Mamy, MNR Mananjara, MTM Mandarry, DM Mangoo, C Manirimbere, A Manneh, A Mansour, I Mansour, M Manvinder, DV Manyere, VT Manzini, JK Manzombi, PM Mapanda, LC Marais, O Maranga, JPB Maritz, FK Mariwa, RS Masela, MM Mashamba, Doreen M Mashava, MV Mashile, E Mashoko, OR Masia, JN Masipa, ATM Masiyambiri, MW Matenchi, W Mathangani, RC Mathe, Christopher Y Matola, PM Matondo, R Matos-Puig, FFH Matoug, JT Matubatuba, HP Mavesere, R Mavhungu, S Maweni, CJM Mawire, T Mawisa, S Mayeza, R Mbadi, M Mbayabu, N Mbewe, WD Mbombo, T Mbuyi, WMS Mbuyi, MW Mbuyisa, RM Mehyaoui, ID Menkiti, LVM Mesarieki, A Metali, Serge Mewanou, L Mgonja, N Mgoqo, S Mhatu, TM Mhlari, S Miima, IM Milod, P Minani, F Mitema, A Mlotshwa, JE Mmasi, T Mniki, BO Mofikoya, JO Mogale, A Mohamed, S Mohamed, TS Mohamed, AM Mohamed, P Mohamed, I Mohammed, FAM Mohammed, M Mohammed, NM Mohammed, MP Mohlala, R Mokretar, FM Molokoane, KN Mongwe, L Montenegro, OD Montwedi, QK Moodie, M Moopanar, M Morapedi, TG Morulana, VL Moses, P Mossy, H Mostafa, SR Motilall, SP Motloutsi, Kanté Moussa, M Moutari, OM Moyo, PE Mphephu, Busi Mrara, C Msadabwe, VM Mtongwe, FK Mubeya, K Muchiri, J Mugambi, GIM Muguti, AB Muhammad, IF Mukama, MM Mukenga, FK Mukinda, PM Mukuna, ARW Mungherera, TW Munyaradzi, AA Munyika, JM Muriithi, MP Muroonga, R Murray, VK Mushangwe, M Mushaninga, VEM Musiba, JM Musowoya, S Mutahi, MGH Mutasiigwa, G Mutizira, A Muturi, T Muzenda, KR Mvwala, NM Mvwama, A Mwale, CN Mwaluka, JD Mwamba, HAM Mwanga, CM Mwangi, S Mwansa, V Mwenda, IM Mwepu, TM Mwiti, SZ Mzezewa, L Nabela, MTN Nabukenya, SM Nabulindo, K Naicker, D Naidoo, L Naidoo, LC Naidoo, N Naidoo, R Naidoo, RD Naidoo, S Naidoo, TD Naidoo, TK Naidu, NZ Najat, Y Najm, F Nakandungile, P Nakangombe, CN Namata, ES Namegabe, A Nansook, NP Nansubuga, C Nantulu, Rodrigue Nascimento, GT Naude, H Nchimunya, MA Ndaie, PN Ndarukwa, D Ndegwa, R Ndikumana, Andrew KN Ndonga, C Ndung'u, MC Neil, MS Nel, EV Neluheni, DS Nesengani, NT Nesengani, LE Netshimboni, AM Ngalala, BM Ngari, NBM Ngari, E Ngatia, GK Ngcobo, TS Ngcobo, D Ngorora, D Ngouane, K Ngugi, Zipporah WW Ngumi, Z Nibe, E Ninise, JC Niyondiko, PW Njenga, MN Njenga, M Njoroge, S Njoroge, W Njuguna, PN Njuki, T Nkesha, TN Nkuebe, NP Nkuliyingoma, M Nkunjana, Ernest Nkwabi, RN Nkwine, C Nnaji, I Notoane, Shaaban Nsalamba, LM Ntlhe, C Ntoto, B Ntueba, MT Nyassi, Z Nyatela-Akinrinmade, HO Nyawanda, NN Nyokabi, VN Nziene, S Obadiah, OJP Ochieng, PK Odia, OEO Oduor, EO Ogboli-Nwasor, SWO Ogendo, O Ogunbode, TO Ogundiran, O Ogutu, RW Ojewola, M Ojujo, DO Ojuka, OS Okelo, S Okiya, N Okonu, PR Olang, S Omoding, J Omoshoro-Jones, R Onyango, A Onyegbule, O Orjiako, MO Osazuwa, Kpatinvo Oscar, BB Osinaike, AO Osinowo, OM Othin, FFH Otman, J Otokwala, F Ouanes, Ongoïba Oumar, AO Ousseini, S Padayachee, SM Pahlana, J Pansegrouw, FP Paruk, MB Patel, AP Patience, JD Pembe, GN Pengemale, N Perez, MF Aguilera Perez, A Mallier Peter, M Phaff, RM Pheeha, BH Pienaar, V Pillay, KA Pilusa, MP Pochana, O Polishchuk, Owen S Porrill, EF Post, A Prosper, M Pupyshev, A Rabemazava, MS Rabiou, L Rademan, M Rademeyer, RAR Raherison, FR Rajah, MSR Rajcoomar, Z Rakhda, AHR Rakotoarijaona, AHN Rakotoarisoa, RR Rakotoarison, François Rakotoniaina, L Ramadan, MLR Ramananasoa, M Rambau, TPR Ramchurn, HE Ramilson, Rajesh J Ramjee, H Ramnarain, R Ramos, TJ Rampai, SR Ramphal, T Ramsamy, R Ramuntshi, R Randolph, DMA Randriambololona, WAP Ras, RAF Rasolondraibe, JDLC Rasolonjatovo, RM Rautenbach, S Ray, Sarah R Rayne, FAR Razanakoto, SR Reddy, Anthony R Reed, JR Rian, FR Rija, B Rink, AT Robelie, CA Roberts, AGL Rocher, S Rocher, I Rois, W Rois, S Rokhsi, J Roos, Nicolette F Rorke, H Roura, FJ Rousseau, N Rousseau, L Royas, D Roytowski, Devan Rungan, SSR Rwehumbiza, BB Ryabchiy, V Ryndine, CR Saaiman, HK Sabwa, S Sadat, SS Saed, E Salaheddin, H Salaou, M Saleh, HM Salisu-Kabara, Hamza Doles Sama, W Sam-Awortwi (Jnr), N Samuel, DK Sanduku, LN Sanyang, HN Sarah, A Sarkin-Pawa, R Sathiram, T Saurombe, H Schutte, MP Sebei, MD Sedekounou, MP Segooa, EM Semenya, BO Semo, CS Sendagire, SA Senoga, FS Senusi, T Serdyn, MD Seshibe, GB Shah, R Shamamba, CS Shambare, TN Shangase, SH Shanin, IE Shefren, AA Sheshe, OB Shittu, AS Shkirban, T Sholadoye, A Shubba, N Sigcu, SE Sihope, DS Sikazwe, BS Sikombe, K Simaga Abdoul, WAG Simo, K Singata, AS Singh, S Singh, Usha Singh, V Sinoamadi, N Sipuka, NLM Sithole, S Sitima, David Lee Skinner, GC Skinner, OI Smith, CAG Smits, MSI Sofia, Gaoussou Sogoba, A Sohoub, SS Sookun, O Sosinska, Rosalie Souhe, G Souley, Thiam Souleymane, JM Spicer, Sandra Spijkerman, H Steinhaus, A Steyn, G Steyn, HC Steyn, Heidi L Stoltenkamp, S Stroyer, A Swaleh, E Swayeb, AJ Szpytko, NA Taiwo, A Tarhuni, D Tarloff, Blaise Tchaou, Charles Tchegnonsi, M Tchoupa, MO Teeka, B Thakoor, MM Theunissen, BP Thomas, MB Thomas, A Thotharam, O Tobiko, AM Torborg, SM Tshisekedi, SK Tshisola, R Tshitangano, F Tshivhula, HT Tshuma, Janat Tumukunde, M Tun, IA Udo, DI Uhuebor, KU Umeh, AO Usenbo, JdD Uwiteyimbabazi, DJ Van der Merwe, FH van der Merwe, JE van der Walt, JG Van Dyk, JJS van Niekerk, S van Wyk, HA van Zyl, B Veerasamy, PJ Venter, AJ Vermeulen, R Villarreal, J Visser, L Visser, M Voigt, Richard P von Rahden, A Wafa, A Wafula, PK Wambugu, P Waryoba, EN Waweru, M Weideman, Robert D Wise, EE Wynne, AI Yahya, AA Yahya, R Yahya, Y Yakubu, JJ Yanga, YM Yangazov, O Yousef, G Yousef, AA Yunus, AS Yusuf, AZ Zeiton, HZ Zentuti, Henry Zepharine, AB Zerihun, S Zhou, A Zidan, Sanogo Zimogo Zié, CZ Zinyemba, A Zo, Lidwine Zomahoun, NZ Zoobei, NZ Zubia, Supporting clinical sciences, and Anesthesiology

Subjects
Adult, medicine.medical_specialty, 030231 tropical medicine, Population, 03 medical and health sciences, South Africa, 0302 clinical medicine, Postoperative Complications, Pregnancy, Risk Factors, Infant Mortality, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, education, Medicine(all), education.field_of_study, Placental abruption, Antepartum haemorrhage, Obstetrics, business.industry, Cesarean Section, lcsh:Public aspects of medicine, Infant, Newborn, Infant, lcsh:RA1-1270, General Medicine, medicine.disease, Infant mortality, Pregnancy Complications, Maternal Mortality, Treatment Outcome, Cohort, Female, business, Cohort study
Abstract

Summary Background Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding Medical Research Council of South Africa.

Published
2018

5. The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Author

H.-L. Kluyts, Y. le Manach, D.M. Munlemvo, F. Madzimbamuto, A. Basenero, Y. Coulibaly, S. Rakotoarison, V. Gobin, A.L. Samateh, M.S. Chaibou, A.O. Omigbodun, S.D. Amanor-Boadu, J. Tumukunde, T.E. Madiba, R.M. Pearse, B.M. Biccard, Hippolyte Abadagan, N. Abbas, A. Ibrahim Abdelatif, Traoré Abdoulaye, A. Abd-rouf, A. Abduljalil, A. Abdulrahman, S. Abdurazig, A. Abokris, W. Abozaid, S.O.A. Abugassa, F. Abuhdema, S.A. Abujanah, R. Abusamra, A. Abushnaf, S.A. Abusnina, T.S. Abuzalout, H.M. Ackermann, Y.B. Adamu, A. Addanfour, D.M. Adeleke, T.A. Adigun, A.O. Adisa, Sèhivè Valéry Adjignon, N.A. Adu-Aryee, B.B. Afolabi, A.F.X. Agaba, P.K.A. Agaba, K. Aghadi, H. Agilla, B. Ahmed, El.-Z. Ahmed, Al.-J. Ahmed, M. Ahmed, Rene Ahossi, S.A. Aji, S. Akanyun, I. Akhideno, M. Akhter, O.A. Akinyemi, M. Akkari, Joseph Akodjenou, A.L. AL Samateh, E.S. al Shams, O.T. Alagbe-Briggs, E.A. Alakkari, R.B. Alalem, M. Alashhab, O.I. Alatise, A. Alatresh, M.S.I. Alayeb Alayeb, B.A. Albakosh, F. Albert, A.N.J.D. Alberts, A.D. Aldarrat, A. Alfari, A. Alfetore, M. Algbali, A. Algddar, H.A. Algedar, I.A. Alghafoud, A. Alghazali, M. Alhajj, A. Alhendery Alhendery, F.F.H. Alhoty, A. Ali, Y.A. Ali, Beye Seïdina Alioune, M.A. Alkassem, M.A. Alkchr, T.S. Alkesa, A. Alkilani, F. Alkobty Alkobty, Thomas Allaye, S.B.M. Alleesaib, A. Alli, K. Allopi, N.L. Allorto, A. Almajbery, R. Almesmary, S.H.A. Almisslati, F. Almoraid, H. Alobeidi, M.A. Alomami, Christella S. Alphonsus, O.A. Alqawi, A.A. Alraheem, S.A. Alsabri, A. Alsayed, B. Alsellabi, M. Al-Serksi, M.S.A. Alshareef, A.A. Altagazi, J.S. Aluvale, H.W. Alwahedi, E.A. Alzahra, M.A. Alzarouk, K. Al-Zubaidy, M. Amadou, Maiga Amadou, Simbo D. Amanor-Boadu, Al.-A. Amer, B.T. Amisi, M.A. Amuthenu, T.W.A. Anabah, Felix Anani, P.G.R. Anderson, A.G.B. Andriamampionona, L. Andrianina, A. Anele, R. Angelin, N. Anjar, O. Antùnez, Akwasi Antwi-Kusi, L.J.C. Anyanwu, A.A. Aribi, O.A. Arowolo, O. Arrey, Daniel Zemenfes Ashebir, S.B. Assefa, Guy Assoum, V. Athanse, J.S. Athombo, M. Atiku, E. Atito-Narh, Anatole Atomabe, A. Attia, M. Aungraheeta, D.M.A. Aurélia, O.O. Ayandipo, A.E.T. Ayebale, H.M.Z. Azzaidey, N.B. Babajee, H.B. Badi, E.K. Badianga, R.B. Baghni, M.T. Bahta, M. Bai, Y. Baitchu, A.M. Baloyi, K.A. Bamuza, M.I. Bamuza, L. Bangure, O.B. Bankole, M.L. Barongo, M.M. Barow, Apollo. Basenero, L. Bashiya, C.H. Basson, Sudha Bechan, S. Belhaj, M.M. Ben Mansour, D. Benali, A.S.B. Benamour, A. Berhe, J.D. Bertie, J.J.A. Bester, M. Bester, J.D. Bezuidenhout, K. Bhagwan, D.R. Bhagwandass, K.A.P. Bhat, M.M.Z.U. Bhuiyan, Bruce M. Biccard, F. Bigirimana, C.J. Bikuelo, B.E. Bilby, S.S. Bingidimi, K.E. Bischof, David G. Bishop, C. Bitta, M. Bittaye, Thuli Biyase, C.A. Blake, E. Blignaut, F. Blignaut, B.N. BN Tanjong, A. Bogoslovskiy, P.M. Boloko, S.K.B. Boodhun, I. Bori, F. Boufas, M. Brand, Nicholas T. Brouckaert, J.D. Bruwer, I. Buccimazza, I.M. Bula Bula, Fred Bulamba, B.C. Businge, Y.B. Bwambale, S.R.C. Cacala, M.A. Cadersa, Chris Cairns, F. Carlos, M.E. Casey, A.C. Castro, N.D. Chabayanzara, T.N.O. Chaibva, N.K. Chakafa, C. Chalo, C. Changfoot, M.C. Chari, L. Chelbi, J.T. Chibanda, H.N. Chifamba, N. Chikh, E. Chikumba, P. Chimberengwa, J. Chirengwa, F.M. Chitungo, M.C. Chiwanga, M.M. Chokoe, T.M. Chokwe, B. Chrirangi, M. Christian, B. Church, J.C. Cisekedi, J.N. Clegg-Lamptey, Estie Cloete, Megan Coltman, W. Conradie, N. Constance, Youssouf Coulibaly, L. Cronje, M.A. Da Silva, H. Daddy, L. Dahim, D. Daliri, M.S. Dambaki, A. Dasrath, J.G. Davids, Gareth L. Davies, J.T. De Lange, J.B. de Wet, B. Dedekind, M.A. Degaulle, V. Dehal, P.D. Deka, S. Delinikaytis, I.S. Desalu, Hubert Dewanou, M.B Moussa Deye, C. Dhege, B.S.G. Diale, D.F. Dibwe, B.J.S. Diedericks, J.M. Dippenaar, L. Dippenaar, M.P. Diyoyo, Edith Djessouho, S.N. Dlamini, A. Dodiyi-Manuel, B.A. Dokolwana, D.P. Domoyyeri, Leanne W. Drummond, D.E. du Plessis, W.M. du Plessis, L.J. du Preez, K. Dube, N.Z. Dube, K.D. Dullab, R. Duvenhage, R.C. Echem, S.A. Edaigbini, A.K. Egote, A. Ehouni, G. Ekwen, N.C. Ekwunife, M. El Hensheri, I.E. Elfaghi, M.A. Elfagieh, S. Elfallah, Mahmoud Elfiky, S. Elgelany, A.M. Elghallal, M.G. Elghandouri, Z.S. Elghazal, A.M. Elghobashy, F.T. Elharati, Abdulaziz M. Elkhogia, R.M. Elkhwildi, S. Ellis, L. Elmadani, H.B. Elmadany, H. Elmehdawi, A. Elmgadmi, H. Eloi, D. Elrafifi, G. Elsaadi, R.B. Elsaity, A. Elshikhy, M. Eltaguri, A. Elwerfelli, I.E. Elyasir, A.Z. Elzoway, A.M. Elzufri, E.O. Enendu, B.C. Enicker, E.O. Enwerem, R. Esayas, M. Eshtiwi, A.A. Eshwehdi, J.L. Esterhuizen, Tonya M. Esterhuizen, E.B. Etuk, O. Eurayet, O.R. Eyelade, R.F. Fanjandrainy, Lionelle Fanou, Z. Farina, Maher Fawzy, A. Feituri, N.L. Fernandes, L.M. Ford, Patrice Forget, T. François, T. Freeman, Y.B.M. Freeman, V.M. Gacii, B. Gadi, M. Gagara, A. Gakenia, P.D. Gallou, G.G.N. Gama, M.G. Gamal, Y.G. Gandy, A. Ganesh, Diallo Gangaly, M. Garcia, A.P. Gatheru, S.S.D. Gaya, Oswald Gbéhadé, G. Gerbel, A. Ghnain, R. Gigabhoy, D.G. Giles, G.T. Girmaye, S. Gitau, B. Githae, Said Gitta, Veekash Gobin, Riaz Goga, A.A.G. Gomati, M.E. Gonzalez, J. Gopall, Christina Salmina Gordon, O. Gorelyk, M. Gova, K. Govender, P. Govender, S. Govender, V. Govindasamy, J.T.K. Green-Harris, M.B. Greenwood, S.V. Grey-Johnson, Mariette Grobbelaar, M.A. Groenewald, K.K. Grünewald, Ambroise Guegni, M. Guenane, S. Gueye, Marius Guezo, T. Gunguwo, M.G. Gweder, M. Gwila, L. Habimana, Rodrigue Hadecon, E. Hadia, L. Hamadi, M. Hammouda, M.I. Hampton, R. Hanta, Tim C. Hardcastle, J.A. Hariniaina, S. Hariparsad, A.H. Harissou, R. Harrichandparsad, S.H.A. Hasan, H.B. Hashmi, M.P. Hayes, A. Hdud, S.H. Hebli, H.M.S.N. Heerah, S. Hersi, A.H. Hery, Adam Hewitt-Smith, T.C. Hlako, S.C.H. Hodges, Richard Eric Hodgson, M. Hokoma, H. Holder, E.B. Holford, E. Horugavye, C. Houston, M. Hove, D. Hugo, C.M. Human, H. Hurri, O. Huwidi, A.I. Ibrahim, Traoré Ibrahim, O.K. Idowu, I.E. Igaga, John Igenge, O. Ihezie, K. Ikandi, I.A.R. Ike, J.J.N. Ikuku, M.N. Ilbarasi, I.B.B. Ilunga, J.P.M. Ilunga, N.A.V. Imbangu, Z. Imessaoudene, D.H. Imposo, A.M. Iraya, M. Isaacs, M. Isiguzo, A. Issoufou, P. Izquirdo, A. Jaber, U.V. Jaganath, C.S. Jallow, S. Jamabo, Z.S. Jamal, L. Janneh, M.J. Jannetjies, I. Jasim, Megan A.J. Jaworska, S. Jay Narain, K. Jermi, R. Jimoh, S. Jithoo, M. Johnson, S. Joomye, R.M. Judicael, M. Judicaël, A. Juwid, L.P. Jwambi, R. Kabango, J.K. Kabangu, D.K. Kabatoro, A.N. Kabongo, K. Kabongo, L.T. Kabongo, M.D. Kabongo, N. Kady, S. Kafu, M. Kaggya, B.N.K. Kaholongo, P.C.K. Kairuki, S.I. Kakololo, K. Kakudji, Amina. Kalisa, R. Kalisa, M.R. Kalufwelu, S. Kalume, R.J. Kamanda, M.K. Kangili, H. Kanoun, null Kapesa, P. Kapp, J.K. Karanja, M. Karar, K. Kariuki, K. Kaseke, P.N.K. Kashuupulwa, K.J.P. Kasongo, S.K. Kassa, G.K. Kateregga, M.I.S. Kathrada, P.M. Katompwa, L. Katsukunya, K.A.M. Kavuma, null Khalfallah, A. Khamajeet, S.B. Khetrish, null Kibandwa, W. Kibochi, A.M. Kilembe, A.K. Kintu, B. Kipng’etich, B. Kiprop, V.M.K. Kissoon, Theroshnie K. Kisten, J.K. Kiwanuka, Hyla-Louise Kluyts, M.E.K. Knox, A.K. Koledale, V.L. Koller, M.A. Kolotsi, M. Kongolo, N.D. Konwuoh, W.V.J. Koperski, M.Y.K. Koraz, A.A. Kornilov, M. Zach Koto, Samantha Kransingh, D. Krick, S. Kruger, C. Kruse, W. Kuhn, W.P. Kuhn, A.M. Kukembila, K.L. Kule, M. Kumar, Belinda S. Kusel, V.K. Kusweje, K.J. Kuteesa, Y.Y. Kutor, M.A. Labib, M. Laksari, F. Lanos, T.A. Lawal, Yannick Le Manach, C. Lee, R.M. Lekoloane, S.N. Lelo, B. Lerutla, M.T. Lerutla, A.I. Levin, T.B. Likongo, M.L. Limbajee, D.M. Linyama, C. Lionnet, M.M. Liwani, E. Loots, A. Garrido Lopez, C.L.C. Lubamba, K.F. Lumbala, A.J.M. Lumbamba, John Lumona, R.F. Lushima, L. Luthuli, H.L. Luweesi, T.S.K. Lyimo, H.M. Maakamedi, B.M. Mabaso, M. Mabina, M.E. Maboya, I. Macharia, A.M. Macheka, A.Z. Machowski, Thandinkosi E. Madiba, A.S.M. Madsen, Farai Madzimbamuto, L.J. Madzivhe, S.C. Mafafo, M. Maghrabi, Diango Djibo Mahamane, A. Maharaj, A.D. Maharaj, M.R. Mahmud, M. Mahoko, N.A. Mahomedy, O. Mahomva, T.M. Mahureva, R.K. Maila, D.M. Maimane, M. Maimbo, S.N. Maina, Dela A. Maiwald, M.D. Maiyalagan, N. Majola, N. Makgofa, V. Makhanya, W.P. Makhaye, N.M. Makhlouf, S. Makhoba, E.K. Makopa, O. Makori, Alex M. Makupe, M.A. Makwela, M.E. Malefo, S.M. Malongwe, D.M. Maluleke, M.R. Maluleke, K. Touré Mamadou, M.P. Mamaleka, Y. Mampangula, R.M. Mamy, M.N.R. Mananjara, M.T.M. Mandarry, D.M. Mangoo, C. Manirimbere, A. Manneh, A. Mansour, I. Mansour, M. Manvinder, D.V. Manyere, V.T. Manzini, J.K. Manzombi, P.M. Mapanda, L.C. Marais, O. Maranga, J.P.B. Maritz, F.K. Mariwa, R.S. Masela, M.M. Mashamba, Doreen M. Mashava, M.V. Mashile, E. Mashoko, O.R. Masia, J.N. Masipa, A.T.M. Masiyambiri, M.W. Matenchi, W. Mathangani, R.C. Mathe, Christopher Y. Matola, P.M. Matondo, R. Matos-Puig, F.F.H. Matoug, J.T. Matubatuba, H.P. Mavesere, R. Mavhungu, S. Maweni, C.J.M. Mawire, T. Mawisa, S. Mayeza, R. Mbadi, M. Mbayabu, N. Mbewe, W.D. Mbombo, T. Mbuyi, W.M.S. Mbuyi, M.W. Mbuyisa, Bernard Mbwele, R.M. Mehyaoui, I.D. Menkiti, L.V.M. Mesarieki, A. Metali, Serge Mewanou, L. Mgonja, N. Mgoqo, S. Mhatu, T.M. Mhlari, S. Miima, I.M. Milod, P. Minani, F. Mitema, A. Mlotshwa, J.E. Mmasi, T. Mniki, B.O. Mofikoya, J.O. Mogale, A. Mohamed, S. Mohamed, T.S. Mohamed, A.M. Mohamed, P. Mohamed, I. Mohammed, F.A.M. Mohammed, M. Mohammed, N.M. Mohammed, M.P. Mohlala, R. Mokretar, F.M. Molokoane, K.N. Mongwe, L. Montenegro, O.D. Montwedi, Q.K. Moodie, M. Moopanar, M. Morapedi, T.G. Morulana, V.L. Moses, P. Mossy, H. Mostafa, S.R. Motilall, S.P. Motloutsi, Kanté Moussa, M. Moutari, O.M. Moyo, P.E. Mphephu, Busi Mrara, C. Msadabwe, V.M. Mtongwe, F.K. Mubeya, K. Muchiri, J. Mugambi, G.I.M. Muguti, A.B. Muhammad, I.F. Mukama, M.M. Mukenga, F.K. Mukinda, P.M. Mukuna, A.R.W. Mungherera, Dolly M. Munlemvo, T.W. Munyaradzi, A.A. Munyika, J.M. Muriithi, M.P. Muroonga, R. Murray, V.K. Mushangwe, M. Mushaninga, V.E.M. Musiba, J.M. Musowoya, S. Mutahi, M.G.H. Mutasiigwa, G. Mutizira, A. Muturi, T. Muzenda, K.R. Mvwala, N.M. Mvwama, A. Mwale, C.N. Mwaluka, J.D. Mwamba, H.A.M. Mwanga, C.M. Mwangi, S. Mwansa, V. Mwenda, I.M. Mwepu, T.M. Mwiti, S.Z. Mzezewa, L. Nabela, M.T.N. Nabukenya, S.M. Nabulindo, K. Naicker, D. Naidoo, L. Naidoo, L.C. Naidoo, N. Naidoo, R. Naidoo, R.D. Naidoo, S. Naidoo, T.D. Naidoo, T.K. Naidu, N.Z. Najat, Y. Najm, F. Nakandungile, P. Nakangombe, C.N. Namata, E.S. Namegabe, A. Nansook, N.P. Nansubuga, C. Nantulu, Rodrigue Nascimento, G.T. Naude, H. Nchimunya, M.A. Ndaie, P.N. Ndarukwa, Henry Ndasi, Gabriel Ndayisaba, D. Ndegwa, R. Ndikumana, Andrew K.N. Ndonga, C. Ndung’u, M.C. Neil, M.S. Nel, E.V. Neluheni, D.S. Nesengani, N.T. Nesengani, L.E. Netshimboni, A.M. Ngalala, B.M. Ngari, N.B.M. Ngari, E. Ngatia, G.K. Ngcobo, T.S. Ngcobo, D. Ngorora, D. Ngouane, K. Ngugi, Zipporah W.W. Ngumi, Z. Nibe, E. Ninise, J.C. Niyondiko, P.W. Njenga, M.N. Njenga, M. Njoroge, S. Njoroge, W. Njuguna, P.N. Njuki, T. Nkesha, T.N. Nkuebe, N.P. Nkuliyingoma, M. Nkunjana, Ernest Nkwabi, R.N. Nkwine, C. Nnaji, I. Notoane, Shaaban Nsalamba, L.M. Ntlhe, C. Ntoto, B. Ntueba, M.T. Nyassi, Z. Nyatela-Akinrinmade, H.O. Nyawanda, N.N. Nyokabi, V.N. Nziene, S. Obadiah, O.J.P. Ochieng, P.K. Odia, O.E.O. Oduor, E.O. Ogboli-Nwasor, S.W.O. Ogendo, O. Ogunbode, T.O. Ogundiran, O. Ogutu, R.W. Ojewola, M. Ojujo, D.O. Ojuka, O.S. Okelo, S. Okiya, N. Okonu, P.R. Olang, Akinyinka O. Omigbodun, S. Omoding, J. Omoshoro-Jones, R. Onyango, A. Onyegbule, O. Orjiako, M.O. Osazuwa, Kpatinvo. Oscar, B.B. Osinaike, A.O. Osinowo, O.M. Othin, F.F.H. Otman, J. Otokwala, F. Ouanes, Ongoïba Oumar, A.O. Ousseini, S. Padayachee, S.M. Pahlana, J. Pansegrouw, F.P. Paruk, M.B. Patel, Ushmaben Patel, A.P. Patience, Rupert M. Pearse, J.D. Pembe, G.N. Pengemale, N. Perez, M.F. Aguilera Perez, A. Mallier Peter, M. Phaff, R.M. Pheeha, B.H. Pienaar, V. Pillay, K.A. Pilusa, M.P. Pochana, O. Polishchuk, Owen S. Porrill, E.F. Post, A. Prosper, M. Pupyshev, A. Rabemazava, M.S. Rabiou, L. Rademan, M. Rademeyer, R.A.R. Raherison, F.R. Rajah, M.S.R. Rajcoomar, Z. Rakhda, A.H.R. Rakotoarijaona, A.H.N. Rakotoarisoa, Sylvia R. Rakotoarison, R.R. Rakotoarison, L. Ramadan, M.L.R. Ramananasoa, M. Rambau, T.P.R. Ramchurn, H.E. Ramilson, Rajesh. J. Ramjee, H. Ramnarain, R. Ramos, T.J. Rampai, S.R. Ramphal, T. Ramsamy, R. Ramuntshi, R. Randolph, D.M.A. Randriambololona, W.A.P. Ras, R.A.F. Rasolondraibe, J.D.L.C. Rasolonjatovo, R.M. Rautenbach, S. Ray, Sarah. R. Rayne, F.A.R. Razanakoto, S.R. Reddy, Anthony R. Reed, J.R. Rian, F.R. Rija, B. Rink, A.T. Robelie, C.A. Roberts, A.G.L. Rocher, S. Rocher, Reitze N. Rodseth, I. Rois, W. Rois, S. Rokhsi, J. Roos, Nicolette F. Rorke, H. Roura, F.J. Rousseau, N. Rousseau, L. Royas, D. Roytowski, Devan. Rungan, S.S.R. Rwehumbiza, B.B. Ryabchiy, V. Ryndine, C.R. Saaiman, H.K. Sabwa, S. Sadat, S.S. Saed, E. Salaheddin, H. Salaou, M. Saleh, H.M. Salisu-Kabara, Hamza. Doles Sama, Ahmadou L. Samateh, W. Sam-Awortwi, N. Samuel, D.K. Sanduku, Chaibou M. Sani, L.N. Sanyang, H.N. Sarah, A. Sarkin-Pawa, R. Sathiram, T. Saurombe, H. Schutte, M.P. Sebei, M.D. Sedekounou, M.P. Segooa, E.M. Semenya, B.O. Semo, C.S. Sendagire, S.A. Senoga, F.S. Senusi, T. Serdyn, M.D. Seshibe, G.B. Shah, R. Shamamba, C.S. Shambare, T.N. Shangase, S.H. Shanin, I.E. Shefren, A.A. Sheshe, O.B. Shittu, A.S. Shkirban, T. Sholadoye, A. Shubba, N. Sigcu, S.E. Sihope, D.S. Sikazwe, B.S. Sikombe, K. Simaga Abdoul, W.A.G. Simo, K. Singata, A.S. Singh, S. Singh, Usha Singh, V. Sinoamadi, N. Sipuka, N.L.M. Sithole, S. Sitima, David Lee Skinner, G.C. Skinner, O.I. Smith, C.A.G. Smits, M.S.I. Sofia, Gaoussou Sogoba, A. Sohoub, S.S. Sookun, O. Sosinska, Rosalie Souhe, G. Souley, Thiam Souleymane, J.M. Spicer, Sandra Spijkerman, H. Steinhaus, A. Steyn, G. Steyn, H.C. Steyn, Heidi L. Stoltenkamp, S. Stroyer, A. Swaleh, E. Swayeb, A.J. Szpytko, N.A. Taiwo, A. Tarhuni, D. Tarloff, Blaise Tchaou, Charles Tchegnonsi, M. Tchoupa, M.O. Teeka, B. Thakoor, M.M. Theunissen, B.P. Thomas, M.B. Thomas, A. Thotharam, O. Tobiko, A.M. Torborg, S.M. Tshisekedi, S.K. Tshisola, R. Tshitangano, F. Tshivhula, H.T. Tshuma, Janat Tumukunde, M. Tun, I.A. Udo, D.I. Uhuebor, K.U. Umeh, A.O. Usenbo, Jd.D. Uwiteyimbabazi, D.J. Van der Merwe, F.H. van der Merwe, J.E. van der Walt, Dominique van Dyk, J.G. Van Dyk, J.J.S. van Niekerk, S. van Wyk, H.A. van Zyl, B. Veerasamy, P.J. Venter, A.J. Vermeulen, R. Villarreal, J. Visser, L. Visser, M. Voigt, Richard P. von Rahden, A. Wafa, A. Wafula, P.K. Wambugu, P. Waryoba, E.N. Waweru, M. Weideman, Robert D. Wise, E.E. Wynne, A.I. Yahya, A.A. Yahya, R. Yahya, Y. Yakubu, J.J. Yanga, Y.M. Yangazov, O. Yousef, G. Yousef, Coulibaly Youssouf, A.A. Yunus, A.S. Yusuf, A.Z. Zeiton, H.Z. Zentuti, Henry Zepharine, A.B. Zerihun, S. Zhou, A. Zidan, Sanogo Zimogo Zié, C.Z. Zinyemba, A. Zo, Lidwine Zomahoun, N.Z. Zoobei, Eugene Zoumenou, and N.Z. Zubia

Subjects
Adult, Male, Risk, medicine.medical_specialty, Adolescent, Population, Risk management tools, Logistic regression, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, law, medicine, Humans, 030212 general & internal medicine, education, Prospective cohort study, Aged, Aged, 80 and over, education.field_of_study, Receiver operating characteristic, business.industry, Middle Aged, Clinical trial, Patient Outcome Assessment, Anesthesiology and Pain Medicine, Calculator, Emergency medicine, Africa, Female, business, Risk assessment
Abstract

Background The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration NCT03044899.

Published
2018

6. Perioperative patient outcomes in the African Surgical Outcomes Study

Author

Bruce M Biccard, Thandinkosi E Madiba, Hyla-Louise Kluyts, Dolly M Munlemvo, Farai D Madzimbamuto, Apollo Basenero, Christina S Gordon, Coulibaly Youssouf, Sylvia R Rakotoarison, Veekash Gobin, Ahmadou L Samateh, Chaibou M Sani, Akinyinka O Omigbodun, Simbo D Amanor-Boadu, Janat T Tumukunde, Tonya M Esterhuizen, Yannick Le Manach, Patrice Forget, Abdulaziz M Elkhogia, Ryad M Mehyaoui, Eugene Zoumeno, Gabriel Ndayisaba, Henry Ndasi, Andrew K N Ndonga, Zipporah W W Ngumi, Ushmah P Patel, Daniel Zemenfes Ashebir, Akwasi A K Antwi-Kusi, Bernard Mbwele, Hamza Doles Sama, Mahmoud Elfiky, Maher A Fawzy, Rupert M Pearse, Hippolyte Abadagan, N Abbas, A Ibrahim Abdelatif, Traoré Abdoulaye, A Abd-rouf, A Abduljalil, A Abdulrahman, S Abdurazig, A Abokris, W Abozaid, SOA Abugassa, F Abuhdema, SA Abujanah, R Abusamra, A Abushnaf, SA Abusnina, TS Abuzalout, HM Ackermann, YB Adamu, A Addanfour, DM Adeleke, TA Adigun, AO Adisa, Sèhivè Valéry Adjignon, NA Adu-Aryee, BB Afolabi, AFX Agaba, PKA Agaba, K Aghadi, H Agilla, B Ahmed, El-Z Ahmed, Al-J Ahmed, M Ahmed, Rene Ahossi, SA Aji, S Akanyun, I Akhideno, M Akhter, OA Akinyemi, M Akkari, Joseph Akodjenou, AL AL Samateh, ES al Shams, OT Alagbe-Briggs, EA Alakkari, RB Alalem, M Alashhab, OI Alatise, A Alatresh, MSI Alayeb Alayeb, BA Albakosh, F Albert, ANJD Alberts, AD Aldarrat, A Alfari, A Alfetore, M Algbali, A Algddar, HA Algedar, IA Alghafoud, A Alghazali, M Alhajj, A Alhendery Alhendery, FFH Alhoty, A Ali, YA Ali, Beye Seïdina Alioune, MA Alkassem, MA Alkchr, TS Alkesa, A Alkilani, F Alkobty Alkobty, Thomas Allaye, SBM Alleesaib, A Alli, K Allopi, NL Allorto, A Almajbery, R Almesmary, SHA Almisslati, F Almoraid, H Alobeidi, MA Alomami, Christella S Alphonsus, OA Alqawi, AA Alraheem, SA Alsabri, A Alsayed, B Alsellabi, M Al-Serksi, MSA Alshareef, AA Altagazi, JS Aluvale, HW Alwahedi, EA Alzahra, MA Alzarouk, K Al-Zubaidy, M Amadou, Maiga Amadou, Al-A Amer, BT Amisi, MA Amuthenu, TWA Anabah, Felix Anani, PGR Anderson, AGB Andriamampionona, L Andrianina, A Anele, R Angelin, N Anjar, O Antùnez, Akwasi Antwi-Kusi, LJC Anyanwu, AA Aribi, OA Arowolo, O Arrey, SB Assefa, Guy Assoum, V Athanse, JS Athombo, M Atiku, E Atito-Narh, Anatole Atomabe, A Attia, M Aungraheeta, DMA Aurélia, OO Ayandipo, AET Ayebale, HMZ Azzaidey, NB Babajee, HB Badi, EK Badianga, RB Baghni, MT Bahta, M Bai, Y Baitchu, AM Baloyi, KA Bamuza, MI Bamuza, L Bangure, OB Bankole, ML Barongo, MM Barow, L Bashiya, CH Basson, Sudha Bechan, S Belhaj, MM Ben Mansour, D Benali, ASB Benamour, A Berhe, JD Bertie, JJA Bester, M Bester, JD Bezuidenhout, K Bhagwan, DR Bhagwandass, KAP Bhat, MMZU Bhuiyan, F Bigirimana, CJ Bikuelo, BE Bilby, SS Bingidimi, KE Bischof, David G Bishop, C Bitta, M Bittaye, Thuli Biyase, CA Blake, E Blignaut, F Blignaut, BN BN Tanjong, A Bogoslovskiy, PM Boloko, SKB Boodhun, I Bori, F Boufas, M Brand, Nicholas T Brouckaert, JD Bruwer, I Buccimazza, IM Bula Bula, Fred Bulamba, BC Businge, YB Bwambale, SRC Cacala, MA Cadersa, Chris Cairns, F Carlos, ME Casey, AC Castro, ND Chabayanzara, MS Chaibou, TNO Chaibva, NK Chakafa, C Chalo, C Changfoot, MC Chari, L Chelbi, JT Chibanda, HN Chifamba, N Chikh, E Chikumba, P Chimberengwa, J Chirengwa, FM Chitungo, MC Chiwanga, MM Chokoe, TM Chokwe, B Chrirangi, M Christian, B Church, JC Cisekedi, JN Clegg-Lamptey, Estie Cloete, Megan Coltman, W Conradie, N Constance, Youssouf Coulibaly, L Cronje, MA Da Silva, H Daddy, L Dahim, D Daliri, MS Dambaki, A Dasrath, JG Davids, Gareth L Davies, JT De Lange, JB de Wet, B Dedekind, MA Degaulle, V Dehal, PD Deka, S Delinikaytis, IS Desalu, Hubert Dewanou, MB Moussa Deye, C Dhege, BSG Diale, DF Dibwe, BJS Diedericks, JM Dippenaar, L Dippenaar, MP Diyoyo, Edith Djessouho, SN Dlamini, A Dodiyi-Manuel, BA Dokolwana, DP Domoyyeri, Leanne W Drummond, DE du Plessis, WM du Plessis, LJ du Preez, K Dube, NZ Dube, KD Dullab, R Duvenhage, RC Echem, SA Edaigbini, AK Egote, A Ehouni, G Ekwen, NC Ekwunife, M El Hensheri, IE Elfaghi, MA Elfagieh, S Elfallah, S Elgelany, AM Elghallal, MG Elghandouri, ZS Elghazal, AM Elghobashy, FT Elharati, RM Elkhwildi, S Ellis, L Elmadani, HB Elmadany, H Elmehdawi, A Elmgadmi, H Eloi, D Elrafifi, G Elsaadi, RB Elsaity, A Elshikhy, M Eltaguri, A Elwerfelli, IE Elyasir, AZ Elzoway, AM Elzufri, EO Enendu, BC Enicker, EO Enwerem, R Esayas, M Eshtiwi, AA Eshwehdi, JL Esterhuizen, EB Etuk, O Eurayet, OR Eyelade, RF Fanjandrainy, Lionelle Fanou, Z Farina, Maher Fawzy, A Feituri, NL Fernandes, LM Ford, T François, T Freeman, YBM Freeman, VM Gacii, B Gadi, M Gagara, A Gakenia, PD Gallou, GGN Gama, MG Gamal, YG Gandy, A Ganesh, Diallo Gangaly, M Garcia, AP Gatheru, SSD Gaya, Oswald Gbéhadé, G Gerbel, A Ghnain, R Gigabhoy, DG Giles, GT Girmaye, S Gitau, B Githae, Said Gitta, Riaz Goga, AAG Gomati, ME Gonzalez, J Gopall, Christina Salmina Gordon, O Gorelyk, M Gova, K Govender, P Govender, S Govender, V Govindasamy, JTK Green-Harris, MB Greenwood, SV Grey-Johnson, Mariette Grobbelaar, MA Groenewald, KK Grünewald, Ambroise Guegni, M Guenane, S Gueye, Marius Guezo, T Gunguwo, MG Gweder, M Gwila, L Habimana, Rodrigue Hadecon, E Hadia, L Hamadi, M Hammouda, MI Hampton, R Hanta, Tim C Hardcastle, JA Hariniaina, S Hariparsad, AH Harissou, R Harrichandparsad, SHA Hasan, HB Hashmi, MP Hayes, A Hdud, SH Hebli, HMSN Heerah, S Hersi, AH Hery, Adam Hewitt-Smith, TC Hlako, SCH Hodges, Richard Eric Hodgson, M Hokoma, H Holder, EB Holford, E Horugavye, C Houston, M Hove, D Hugo, CM Human, H Hurri, O Huwidi, AI Ibrahim, Traoré Ibrahim, OK Idowu, IE Igaga, John Igenge, O Ihezie, K Ikandi, IAR Ike, JJN Ikuku, MN Ilbarasi, IBB Ilunga, JPM Ilunga, NAV Imbangu, Z Imessaoudene, DH Imposo, AM Iraya, M Isaacs, M Isiguzo, A Issoufou, P Izquirdo, A Jaber, UV Jaganath, CS Jallow, S Jamabo, ZS Jamal, L Janneh, MJ Jannetjies, I Jasim, Megan AJ Jaworska, S Jay Narain, K Jermi, R Jimoh, S Jithoo, M Johnson, S Joomye, RM Judicael, M Judicaël, A Juwid, LP Jwambi, R Kabango, JK Kabangu, DK Kabatoro, AN Kabongo, K Kabongo, LT Kabongo, MD Kabongo, N Kady, S Kafu, M Kaggya, BNK Kaholongo, PCK Kairuki, SI Kakololo, K Kakudji, Amina Kalisa, R Kalisa, MR Kalufwelu, S Kalume, RJ Kamanda, MK Kangili, H Kanoun, null Kapesa, P Kapp, JK Karanja, M Karar, K Kariuki, K Kaseke, PNK Kashuupulwa, KJP Kasongo, SK Kassa, GK Kateregga, MIS Kathrada, PM Katompwa, L Katsukunya, KAM Kavuma, null Khalfallah, A Khamajeet, SB Khetrish, null Kibandwa, W Kibochi, AM Kilembe, AK Kintu, B Kipng'etich, B Kiprop, VMK Kissoon, Theroshnie K Kisten, JK Kiwanuka, MEK Knox, AK Koledale, VL Koller, MA Kolotsi, M Kongolo, ND Konwuoh, WJ Koperski, MYK Koraz, AA Kornilov, M Zach Koto, Samantha Kransingh, D Krick, S Kruger, C Kruse, W Kuhn, WP Kuhn, AM Kukembila, KL Kule, M Kumar, Belinda S Kusel, VK Kusweje, KJ Kuteesa, YY Kutor, MA Labib, M Laksari, F Lanos, TA Lawal, C Lee, RM Lekoloane, SN Lelo, B Lerutla, MT Lerutla, AI Levin, TB Likongo, ML Limbajee, DM Linyama, C Lionnet, MM Liwani, E Loots, A Garrido Lopez, CLC Lubamba, KF Lumbala, AJM Lumbamba, John Lumona, RF Lushima, L Luthuli, HL Luweesi, TSK Lyimo, HM Maakamedi, BM Mabaso, M Mabina, ME Maboya, I Macharia, AM Macheka, AZ Machowski, ASM Madsen, Farai Madzimbamuto, LJ Madzivhe, SC Mafafo, M Maghrabi, Diango Djibo Mahamane, A Maharaj, AD Maharaj, MR Mahmud, M Mahoko, NA Mahomedy, O Mahomva, TM Mahureva, RK Maila, DM Maimane, M Maimbo, SN Maina, Dela A Maiwald, MD Maiyalagan, N Majola, N Makgofa, V Makhanya, WP Makhaye, NM Makhlouf, S Makhoba, EK Makopa, O Makori, Alex M Makupe, MA Makwela, ME Malefo, SM Malongwe, DM Maluleke, MR Maluleke, K Touré Mamadou, MP Mamaleka, Y Mampangula, RM Mamy, MNR Mananjara, MTM Mandarry, DM Mangoo, C Manirimbere, A Manneh, A Mansour, I Mansour, M Manvinder, DV Manyere, VT Manzini, JK Manzombi, PM Mapanda, LC Marais, O Maranga, JPB Maritz, FK Mariwa, RS Masela, MM Mashamba, Doreen M Mashava, MV Mashile, E Mashoko, OR Masia, JN Masipa, ATM Masiyambiri, MW Matenchi, W Mathangani, RC Mathe, Christopher Y Matola, PM Matondo, R Matos-Puig, FFH Matoug, JT Matubatuba, HP Mavesere, R Mavhungu, S Maweni, CJM Mawire, T Mawisa, S Mayeza, R Mbadi, M Mbayabu, N Mbewe, WD Mbombo, T Mbuyi, WMS Mbuyi, MW Mbuyisa, RM Mehyaoui, ID Menkiti, LVM Mesarieki, A Metali, Serge Mewanou, L Mgonja, N Mgoqo, S Mhatu, TM Mhlari, S Miima, IM Milod, P Minani, F Mitema, A Mlotshwa, JE Mmasi, T Mniki, BO Mofikoya, JO Mogale, A Mohamed, S Mohamed, TS Mohamed, AM Mohamed, P Mohamed, I Mohammed, FAM Mohammed, M Mohammed, NM Mohammed, MP Mohlala, R Mokretar, FM Molokoane, KN Mongwe, L Montenegro, OD Montwedi, QK Moodie, M Moopanar, M Morapedi, TG Morulana, VL Moses, P Mossy, H Mostafa, SR Motilall, SP Motloutsi, Kanté Moussa, M Moutari, OM Moyo, PE Mphephu, Busi Mrara, C Msadabwe, VM Mtongwe, FK Mubeya, K Muchiri, J Mugambi, GIM Muguti, AB Muhammad, IF Mukama, MM Mukenga, FK Mukinda, PM Mukuna, ARW Mungherera, TW Munyaradzi, AA Munyika, JM Muriithi, MP Muroonga, R Murray, VK Mushangwe, M Mushaninga, VEM Musiba, JM Musowoya, S Mutahi, MGH Mutasiigwa, G Mutizira, A Muturi, T Muzenda, KR Mvwala, NM Mvwama, A Mwale, CN Mwaluka, JD Mwamba, HAM Mwanga, CM Mwangi, S Mwansa, V Mwenda, IM Mwepu, TM Mwiti, SZ Mzezewa, L Nabela, MTN Nabukenya, SM Nabulindo, K Naicker, D Naidoo, L Naidoo, LC Naidoo, N Naidoo, R Naidoo, RD Naidoo, S Naidoo, TD Naidoo, TK Naidu, NZ Najat, Y Najm, F Nakandungile, P Nakangombe, CN Namata, ES Namegabe, A Nansook, NP Nansubuga, C Nantulu, Rodrigue Nascimento, GT Naude, H Nchimunya, MA Ndaie, PN Ndarukwa, D Ndegwa, R Ndikumana, Andrew KN Ndonga, C Ndung'u, MC Neil, MS Nel, EV Neluheni, DS Nesengani, NT Nesengani, LE Netshimboni, AM Ngalala, BM Ngari, NBM Ngari, E Ngatia, GK Ngcobo, TS Ngcobo, D Ngorora, D Ngouane, K Ngugi, Zipporah WW Ngumi, Z Nibe, E Ninise, JC Niyondiko, PW Njenga, MN Njenga, M Njoroge, S Njoroge, W Njuguna, PN Njuki, T Nkesha, TN Nkuebe, NP Nkuliyingoma, M Nkunjana, Ernest Nkwabi, RN Nkwine, C Nnaji, I Notoane, Shaaban Nsalamba, LM Ntlhe, C Ntoto, B Ntueba, MT Nyassi, Z Nyatela-Akinrinmade, HO Nyawanda, NN Nyokabi, VN Nziene, S Obadiah, OJP Ochieng, PK Odia, OEO Oduor, EO Ogboli-Nwasor, SWO Ogendo, O Ogunbode, TO Ogundiran, O Ogutu, RW Ojewola, M Ojujo, DO Ojuka, OS Okelo, S Okiya, N Okonu, PR Olang, S Omoding, J Omoshoro-Jones, R Onyango, A Onyegbule, O Orjiako, MO Osazuwa, Kpatinvo Oscar, BB Osinaike, AO Osinowo, OM Othin, FFH Otman, J Otokwala, F Ouanes, Ongoïba Oumar, AO Ousseini, S Padayachee, SM Pahlana, J Pansegrouw, FP Paruk, MB Patel, Ushmaben Patel, AP Patience, JD Pembe, GN Pengemale, N Perez, MF Aguilera Perez, A Mallier Peter, M Phaff, RM Pheeha, BH Pienaar, V Pillay, KA Pilusa, MP Pochana, O Polishchuk, Owen S Porrill, EF Post, A Prosper, M Pupyshev, A Rabemazava, MS Rabiou, L Rademan, M Rademeyer, RAR Raherison, FR Rajah, MSR Rajcoomar, Z Rakhda, AHR Rakotoarijaona, AHN Rakotoarisoa, RR Rakotoarison, L Ramadan, MLR Ramananasoa, M Rambau, TPR Ramchurn, HE Ramilson, Rajesh J Ramjee, H Ramnarain, R Ramos, TJ Rampai, SR Ramphal, T Ramsamy, R Ramuntshi, R Randolph, DMA Randriambololona, WAP Ras, RAF Rasolondraibe, JDLC Rasolonjatovo, RM Rautenbach, S Ray, Sarah R Rayne, FAR Razanakoto, SR Reddy, Anthony R Reed, JR Rian, FR Rija, B Rink, AT Robelie, CA Roberts, AGL Rocher, S Rocher, Reitze N Rodseth, I Rois, W Rois, S Rokhsi, J Roos, Nicolette F Rorke, H Roura, FJ Rousseau, N Rousseau, L Royas, D Roytowski, Devan Rungan, SSR Rwehumbiza, BB Ryabchiy, V Ryndine, CR Saaiman, HK Sabwa, S Sadat, SS Saed, E Salaheddin, H Salaou, M Saleh, HM Salisu-Kabara, W Sam-Awortwi (Jnr), N Samuel, DK Sanduku, LN Sanyang, HN Sarah, A Sarkin-Pawa, R Sathiram, T Saurombe, H Schutte, MP Sebei, MD Sedekounou, MP Segooa, EM Semenya, BO Semo, CS Sendagire, SA Senoga, FS Senusi, T Serdyn, MD Seshibe, GB Shah, R Shamamba, CS Shambare, TN Shangase, SH Shanin, IE Shefren, AA Sheshe, OB Shittu, AS Shkirban, T Sholadoye, A Shubba, N Sigcu, SE Sihope, DS Sikazwe, BS Sikombe, K Simaga Abdoul, WAG Simo, K Singata, AS Singh, S Singh, Usha Singh, V Sinoamadi, N Sipuka, NLM Sithole, S Sitima, David Lee Skinner, GC Skinner, OI Smith, CAG Smits, MSI Sofia, Gaoussou Sogoba, A Sohoub, SS Sookun, O Sosinska, Rosalie Souhe, G Souley, Thiam Souleymane, JM Spicer, Sandra Spijkerman, H Steinhaus, A Steyn, G Steyn, HC Steyn, Heidi L Stoltenkamp, S Stroyer, A Swaleh, E Swayeb, AJ Szpytko, NA Taiwo, A Tarhuni, D Tarloff, Blaise Tchaou, Charles Tchegnonsi, M Tchoupa, MO Teeka, B Thakoor, MM Theunissen, BP Thomas, MB Thomas, A Thotharam, O Tobiko, AM Torborg, SM Tshisekedi, SK Tshisola, R Tshitangano, F Tshivhula, HT Tshuma, Janat Tumukunde, M Tun, IA Udo, DI Uhuebor, KU Umeh, AO Usenbo, JdD Uwiteyimbabazi, DJ Van der Merwe, FH van der Merwe, JE van der Walt, Dominique van Dyk, JG Van Dyk, JJS van Niekerk, S van Wyk, HA van Zyl, B Veerasamy, PJ Venter, AJ Vermeulen, R Villarreal, J Visser, L Visser, M Voigt, Richard P von Rahden, A Wafa, A Wafula, PK Wambugu, P Waryoba, EN Waweru, M Weideman, Robert D Wise, EE Wynne, AI Yahya, AA Yahya, R Yahya, Y Yakubu, JJ Yanga, YM Yangazov, O Yousef, G Yousef, AA Yunus, AS Yusuf, AZ Zeiton, HZ Zentuti, Henry Zepharine, AB Zerihun, S Zhou, A Zidan, Sanogo Zimogo Zié, CZ Zinyemba, A Zo, Lidwine Zomahoun, NZ Zoobei, Eugene Zoumenou, NZ Zubia, and Supporting clinical sciences

Subjects
Male, Postoperative Complications/epidemiology, 030230 surgery, Global Health, Severity of Illness Index, Neurosurgical Procedures, Postoperative Complications, 0302 clinical medicine, Gynecologic Surgical Procedures, 030202 anesthesiology, Outcome Assessment, Health Care, Medicine, Orthopedic Procedures, Postoperative Period, Prospective Studies, Young adult, Prospective cohort study, Digestive System Surgical Procedures, Surgical Wound Infection/epidemiology, education.field_of_study, General Medicine, Middle Aged, Hospitals, Surgical Procedures, Operative, Cohort studies, Urologic Surgical Procedures, young adult, Female, pregnancy, Vascular Surgical Procedures, Cohort study, Adult, medicine.medical_specialty, Population, Lower risk, 03 medical and health sciences, Outcome Assessment (Health Care), Severity of illness, Surgical Wound Infection, Humans, Cardiac Surgical Procedures, Mortality, education, business.industry, Cesarean Section, Perioperative, Thoracic Surgical Procedures, Logistic Models, Africa/epidemiology, Africa, Emergency medicine, Observational study, business
Abstract

Summary Background There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. Interpretation Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding Medical Research Council of South Africa.

Published
2018

8. Phosphorus agronomic efficiency in maize-based cropping systems: A focus on western Kenya

Author

Job Kihara and S Njoroge

Subjects
Phosphorus, Soil Science, chemistry.chemical_element, engineering.material, Zea mays, N fertilizer, chemistry, Agronomy, Crop production, N application, engineering, Fertilizer, Soil fertility, Agronomy and Crop Science, Cropping, Mathematics
Abstract

Phosphorus (P) is facing a quantity and quality supply issue and increasing its use efficiency is important for its continued use and profitability in crop production. The objective of this study was to determine how agronomic efficiency of P (PAE) in different environments and management systems in western Kenya is affected by N application, inherent soil fertility and organic resources. We used data constituting over 2700 data points from 126 farm fields of 25 different studies conducted from 1996 to 2009. Potassium (K) deficiency is negligible in western Kenya while ommission of P and N result in a 50% and 43% reduction in yield, respectively, relative to a full NPK treatment. In poor fields (low control yields) PAE was low in the absence of fertilizer N. Overall, lack of N application decreased PAE from 29 to 19 kg grain kg−1 P. Boundary analysis indicate that maximum yields are reached at about 50 kg P ha−1. Using a marginal rate of return of 100%, maximum P application rate for western Kenya should be 38 kg P ha−1. Without chemical N fertilizer application, organic resources increased PAE by 60–100% compared to continuous maize system without organic resources. Maximum PAE decreased at increased plant-available soil P and soil coarsiness. Our analysis represents best management practices and PAE may be lower than the reported values under farmer's conditions.

Published
2013

9. MOLECULAR CHARACTERISATION AND ANTIMICROBIAL RESISTANCE PATTERNS OF ESCHERICHIA COLI ISOLATES FROM GOATS SLAUGHTERED IN PARTS OF KENYA

Author

S, Njoroge, A W T, Muigai, P N, Njiruh, and S, Kariuki

Subjects
Meat, Anti-Infective Agents, Goats, Drug Resistance, Bacterial, Escherichia coli, Animals, Humans, Microbial Sensitivity Tests, Hazard Analysis and Critical Control Points, Kenya, Abattoirs, Escherichia coli Infections, Needs Assessment
Abstract

To determine the antibiotic resistance patterns of pathogenic Escherichia coli on goat meat carcass at Huruma and Kiserian abattoirs in Kenya.Laboratory based study.Huruma and Kiserian abattoirs in Kenya,400 slaughtered goats inspected by veterinary health officers and approved for human consumption.A Total of 400 slaughtered goats which were inspected by veterinary health officers and approved for human consumption were sampled from Huruma and Kiserian abattoir. Goat carcass swabs were collected by passing each swab tissue on four parts of the carcass mainly neck, right and left forelimbs, right and left hind limbs, and brisket.A total of 54 E. coli isolates were isolated and confirmed to be pathogenic. The percentage of isolates resistant to various microbial agents was recorded as follows: ampicillin (26 %), amoxycillin-clavulanic acid (17%), tetracycline (15%), chroramphenicol (4%), and ceftrixone (2% each). All Escherichia coli isolates were susceptible to gentamicin sulphamethaxazole-trimethomprin, kanamycin, cetriazididine (CAZ, 30pg), ciproxacin, nalidixic acid and chloramphenicol. Isolates were resistant to one or more of the antibiotics tested. Among the drugs tested, resistance was more frequently observed against ampicillin, amoxycillin-clavulanic acid, tetracycline, ceftrixone and chroramphenicol antibiotics. Among the isolates 26(48%) were positive for the stx1 gene, 19(35%) had the eae gene, 10(19%) possessed est gene,while 8(15%) harboured elt gene. Overall five isolates (10%) possessed aspu gene and two (4%) had aggR gene. No isolate possessed ipah gene.This study demonstrated that there is a significant level of antimicrobial resistance in pathogenic E. coli isolated from goat meat from Huruma and Kiserian abattoir. This indicates that goat meat from abattoirs could pose a risk of transmission of pathogenic antibiotic resistant strains to human. Poor hygienic standards and indiscriminate use of antimicrobials are the two main reasons for the presence of resistant pathogens in goat carcasses.Implemention of appropriate hygiene measures to control contamination of meat with pathogenic E. coli.

Published
2016

10. Crop and Soil Response to Tillage and Crop Residue Application in a Tropical Ferralsol in Sub-humid Western Kenya

Author

Jeremiah M. Okeyo, Fredrick O. Ayuke, John Mukalama, Job Kihara, André Bationo, S Njoroge, Boaz S. Waswa, and Saidou Koala

Subjects
Tillage, Soil management, Crop residue, Geography, Conventional tillage, Mulch-till, biology, Agronomy, Intercropping, Cropping system, Crop rotation, biology.organism_classification
Abstract

Conservation agriculture (CA) offers an opportunity to reverse prevailing land degradation and consequent loss of productivity often occasioned by intensive soil tillage in cropping systems in most parts of sub-Saharan Africa (SSA). A long term experiment was established in Nyabeda Western Kenya in 2003 to evaluate the effect of tillage and crop residue application on maize and soybean yields, and on soil properties. The experiment was set up as a split-split-split plot design with four replicates and involved a factorial combination of tillage system (reduced and conventional tillage), cropping system (continuous cereal, soybean-maize rotation and intercropping), crop residue – maize stover – management (plus and minus crop residue) and nitrogen (N) application. Results showed that tillage influenced performance of maize although significant tillage effects were observed in only 5 out of the 15 seasons analyzed. Overall average maize grain yields were 2.9 ton ha−1 in reduced tillage and 3.6 ton ha−1 in conventional tillage systems. Application of crop residue increased seasonal maize grain yield in reduced tillage (340 kg ha−1) and in conventional tillage (240 kg ha−1), but the only significant crop residue (CR) effect was observed in season 10. Differences in maize yields between the two systems were attributed to phosphorus availability as it was demonstrated that application of crop residue in the reduced tillage resulted in better availability of P than without crop residue application.

Published
2012

11. Utilization of community-based outpatient addiction treatment programmes in Kenya

Author

L Tengia, C Mutua, B Singer, CS Deveau, S Njoroge, and L Dajoh

Subjects
Community based, medicine.medical_specialty, business.industry, media_common.quotation_subject, Addiction, Human immunodeficiency virus (HIV), Abstinence, medicine.disease_cause, Psychiatry and Mental health, medicine, business, Psychiatry, Addiction treatment, media_common
Abstract

This paper examines a number of outpatient addictions treatment programmes developed in various regions of Kenya. The uptake of outpatient services at four sites between 2007 and 2010 has been examined. A field-based follow-up survey was administered to determine abstinence rates among clients who participated in treatment. Factors involved in recovery outcomes are discussed. Utilization of outpatient addictions treatment and retention in services increased over the three-year period, and field-based follow up with clients showed 42% abstinence rates. Key Words: Outpatient treatment, Alcohol, Drug, Addiction recovery, HIV, Kenya

Published
2011

12. Intrinsic viscosities and other solution properties of sugars and their possible relation to sweetness

Author

S. Shamil, S. Njoroge, and Gordon G. Birch

Subjects
Behavioral Neuroscience, Viscosity, Taste, Chromatography, Physiology, Chemistry, Physiology (medical), Organoleptic, Thermodynamics, Sweetness, Sensory Systems
Abstract

Etude, pour 15 glucides, des correlations possibles entre viscosite intrinseque et certaines proprietes moleculaires liees a la conformation d'une part et a la saveur sucree d'autre part

Published
1988

13. An outbreak of arsenic and toxaphene poisoning in Kenyan cattle

Author

D M Gacuhi, J A Kamau, S Njoroge, and C K Maitai

Subjects
inorganic chemicals, Male, Veterinary medicine, Insecticides, chemistry.chemical_element, Arsenic poisoning, Cattle Diseases, Biology, Sodium Chloride, Kidney, Abomasum, TOXAPHENE POISONING, Toxaphene, Arsenic, Disease Outbreaks, chemistry.chemical_compound, Soil, Arsenic Poisoning, medicine, Animals, integumentary system, General Veterinary, Outbreak, Water, General Medicine, medicine.disease, Kenya, chemistry, Liver, Cattle, Female
Abstract

In a case of poisoning involving 70 cattle analysis of specimens obtained during post mortem examination showed that the toxic substances were arsenic and toxaphene. This was consistent with both the clinical and post mortem findings. Arsenic was detected in water from an abandoned cattle dip in the farm. Soil samples collected in the vicinity of the dip contained both arsenic and toxaphene.

Published
1975

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