Author: "Bernard Mbwele" / Language: undetermined - Searchworks@Jio Institute Digital Library Search Results

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16 results on '"Bernard Mbwele"'

1. Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

Author: Nicola Vickery, Timothy Stephens, Leon du Toit, Dawid van Straaten, Rupert Pearse, Alexandra Torborg, Lucy Rolt, Mariechen Puchert, Graham Martin, Bruce Biccard, Bruce M. Biccard, Maia Lesosky, Tim Stephens, Landon Myer, Agya BA. Prempeh, Hyla-Louise Kluyts, Akinyinka Omigbodun, Adesoji Ademuyiwa, Muhammed Elhadi, Mohamed Elfagieh, Bernard Mbwele, Mpoki Ulisubisya, Lazaro Mboma, Daniel Z. Ashebir, Mahlet Tesfaye Bahta, Mohammed Hassen, Mikiyas Teferi, Yakob Seman, Eugene Zoumenou, Adam Hewitt-Smith, Janat Tumukunde, Dolly Munlemvo, Atilio Morais, Apollo Basenero, Pisirai Ndarukwa, Nazinigouba Ouerdraogo, Maman Sani Chaibou, Mohyeddine Zarouf, Ahmed Rhassane El Adib, Veekash Gobin, Zimogo Sanogo, Youssouf Coulibaly, Zipporah Ngumi, Tarig Fadalla, Cynthia Iradukunda, Vénérand Barendegere, Isaac O. Smalle, Mustapha Bittaye, Ahmadou Lamin Samateh, Mahmoud Elfiky, Maher Fawzy, Wakisa Mulwafu, Vanessa Msosa, Lygia Lopes, Akwasi Antwi-Kusi, Hamza D. Sama, Patrice Forget, Rupert M. Pearse, Marichen Puchert, Kris Schwebler, Freddy Kabambi, Tebogo Mabotja, Leandys Cobas, Albino Freitas, Maria Antunes, Bartolomeu Cabo, Domingos Paulo, Carlos Camongua, Yvette Avognon, Osseni Marcos, Raymond Kintomonho, Onesime Demahou, Gisèle Hounsa, Hugues Chobli, Elie Fassinou, Aurore Zoglobossou, Blaise Tchaou, Charles Tchegnonsi, Fifame Amadji, Francine Bossa, Ernest Ahounou, Djima Alao, Roushdane Odérémi, Afissatou Montairou, Oswald Gbehade, Romaric Tobome, Adam Boukari, Patrick Bakantieba, Arouna Sambo, Fanou Lionelle, Nounagnon Gilbert, Julien Attinon, Roger Klikpezo, Aumar Dadjo, Dénis Fanou, Gilberte Hounkpe, Bachabi Fafana, Néné Nguilu, Bodourin Dossou-Yovo, Chantal Segla, Mohamed Toko, Evelyne Gnele-Dedewanou, Michel Noukounwoui, Ethienne Yado, Timothé Gouroubéra, Valéry Adjignon, Serge Mewanou, Aïcha Tchomgang, Urielle Agossou, Fernand Soton, Charbel Azanlin, Lidwine Zomahoun, Rawéléguinbasba Armel Flavien Kabore, Salam Savadogo, Fatou Fleur Rosine Sanou, Farid Belém, Victoria Hien, Cheik Tidiane Hafid W. Bougouma, Sie Ahmed Ouattara, Mariam Bambara Kabore, Ouedraogo Nazinigouba, Papougnezambo Bonkoungou, Martin Lankoandé, Mireille Traoré, Patrick Sawadogo, Inès Wenmenga, Boureima Kinda, André Simporé, Christian Sapo, Salah Idriss Traore, Haoua Dipama, Lydie WR. Kaboré, Salifou Napon, Télesphore G. Kaboré, Arouna Louré, Pélagie PP. Tondé, Christian Zoundi, Martin Lankoande, Harouna Sanou, Remy Ndikumana, Carlos Nsengiyumva, Gregory Sund, Alliance Niyukuri, Axel Kwizera, Jean-Claude Niyondiko, Adolphe Manzanza Kilembe, Jean Pierre Mwema Ilunga, Nehema Hailemariam Sarah, Gabriel Mubobo Makeya, Idesbald Mwebe Mwepu, Ted Botawaosenge Likongo, Richard Kapela Mvwala, Raphael Nzau Kapend Mubunda, Noellie Kanka Mukuna, Julie Djondo Pembe, Nicolas Lumuanga Ndaye, Eric Bibonge Amisi, Mike Ilunga Madika, Joe Kembo Lungela, Didier Ndonda Mayemba, Philomene Mamba Diyoyo, Alex Mbo Ngalala, Martin Mamba Mukenga, Patricia Tito Kabuni, Dany Bolimo Mpoto, Herve Inesnku Mole, Louise Keby, Oria Andavo Buti, Anselme Phaka, Belinda Mayenge, Jean Jeacques Kabuley Kalongo, Timothe Kemfuni Mawisa, Rodrigue Tondo Ngwizani, Kuyala Leya, Dieudonne Kisile Sanduku, Timothe Nkemfuni Mawisa, Coco Nseke Mfumu, Mbuta Bolenge, Desire Kinzenzengu Kabuce, Patrick Kintieti, Amelia Mbuluku, Vicky Mahuwa, Tharcice Khonde Mabiala, Guilain Ngoy, Patrick Boloko, Nono Mazangama Mvwama, Jose Kengbanda, Pitchou Mushimbonga, Blaise Kuhapala, Nzosani Marcel, Kienze Guylain, Gerard Mboma, Sandra Zalambo Sagboze, Michel Muteya Manika, Jean Pierre Mumbere Kigayi, Roger Mukanire Cishugi, Placide Buhendwa Mugisho, Roger Baguma, Moïse Kongolo, Michel Mandungu Mbayabu, Crispin Mukendi Muamba, Edmond Banema Kapinga, Vasco Ngolela Kapinga, Guylain Tshimanga Nsumpi, Patrick Kanda Odia, Salomon Bingidimi, Gilbert Kpengbemale, Desire Hubert Bofunga Bosonga Imposo, Patricia Matondo, Servet Lelo, Jeremie Kalambayi, Mohamed Abdel-Ghaffar, Abdelrahman Soliman, Mostafa Abdelrahman, Sameh Shehata, Alia Rabee, Mohamed Abou Heba, Mohamed Rabei Abdelfattah, Tamer Ahmed Maher Ghoniem, Sherif M.K. Shehata, Mohamed Lotfy, Ahmed ElHaddad, Bereket Gebremeskel, Girmay Fisseha, Mebrahtu Abay, Degena Bahrey, Assefa Hika, Abdurezak Ali, Kindie Moges, Jemal Ahmed, Desalegn Abdisa, Abebe Megersa, Wendwosen Abayne, Haftom Berhane, Reiye Esayas, Fitsum Kifle, Kokeb Desita, Abebe Addise, Dagim Shimelash, Shitalem Tadesse, Bezaye Zemedkun, Peniel Kenna, Ayenew Yirdie, Abinet Sisay, Tebikew Gashu, Fassil Mihretu, Yesuf Ahmed, Bekele Debebe, Abdureuf Misgea, Amare Agmas, Rahel Assefa, Abdurahman Gelmo, Seifu Alemu, Brook Damtachew, Merid Mersha, Yaekob Chemere, Samuel Fekadu, Sintayehu Regasa, Bonsa Sileshi, Desalegn Wosen, Rebira Adamu, Gersam Mulugeta, Teshome Bacha, Zewude Gudisa, Kebebe Bekele, Alelign Tasew, Habtamu Gezahegn, Daniel Atlaw, Damtew Solomon, Habtemariam Gebresillasie, Girmaye Tesfaye, Negussie Sarbecha, Biniyam Sahiledengle, Kenbon Seyoum, Gemechu Ganfure, Yohannes Tekalegn, Gosa Tesfaye, Temesgen Ayichew, Shibiru Sendaba, Musefa Redwan, Eyasu Muse, Girma Nina, Bizuneh Sime, Addisalem Tadege, Anbesse Jima, Nugusu Ayalew, Dagmawi Workneh, Daniel Teferi, Momodou T. Nyassi, Landing N. Sanyang, Omar Jallow, Abdoulie Keita, Kitabu Jammeh, Charles Roberts, Patrick Idoko, Kebba Marenah, Masirending Njie, Musa Marena, Karamba Suwareh, Simon Boissey, Fatoumatta Jarjusey, Awa Jah, Awa Sanyang, Dado Jabbi, Kajali Camara, Armando Correa, John Jabang, Lamin Jaiteh, Lamin Dampha, Aminata Manneh, Baboucarr Sowe, Abdoulie Bah, Edrisa Jawo, Victoria Okoje, Momodou Baro, Yaya Bah, Mustapha Njie, Sainabou Mbowe, Ebrima Kanteh, Sarjo Ceesay, Alagie Manneh, Evans Atito-Narh, Adwoa Wilson, Romeo Hussey, Emmanuel Okine, Jemima Kwarteng, Ridge Ntiamoah, Samuel Dadzie, Mark Aseti, Naa Sowah, Akosua Appiah, Charles Bankah, Patrick Mburugu, Thomas Chokwe, Patrick Olang, Vernon Gacii, Susane Nabulindo, Antony Gatheru, Timothy Mwiti, Caroline Mwangi, Julius Muriithi, Daniel Ojuka, Omondi Ogutu, Evans Masitara, Mohamed Chaudhry, Reuben Kamundi, Annmarie Kangangi, Thomas Massaquoi, Stephen Takow, Felister Moraa, Aziz Munubi, Moses Kimani, Adili Wobenjo, Linda Nguu, Vincent Omeddo, Rose Malaba, Ambrose Nabwana, Anita Mwancha, Alexandria Mugaa, John Wamwaki, Joyce Chege, Seymour Sinari, Andrew Ndonga, Rose Shitsinzi, Walter Akello, Winfred Kimani, Elisha Kirwa, Seno Saruni, Andrew Wainaina, Ernest Nshom, Aidah Kenseko, Kizito Shisanya, Purity Wanjiru, Julliah Cherotich, Judy Kimutai, Benson Wahome, Grace Wangui, Dennis Wamalwa, Stephen Mwangi, John Chege, Tabitha Wanjiku, Carolyne Njoki, Wachira Waititu, Conrad Ambani, Samuel Murimi, Sharon Waithira, Nilson Mouti, Collins Kibet, John Kibet, Virginia Sokobe, Beatrice Jeymah, Antony Kamadi, Faith Gichuri, Steve Moses, David Wasike, Favours Adeya, Caesar Bitta, Stephen Ogendo, Killian Kariuki, Hdaya BenAbdalla, Taha Suliaman, Fatima Ali Abokhzam, Mohaned Isa, Mohammed Huwaysh, Asma Bourawi, Kais Alzubaidy, Mohammed Albaraesi, Sumayyah Bahroun, Abdulmueti Alhadi, Ahmed Msherghi, Amira Mohamed, Ala Khaled, Nouran Aljadi, Elham Bareig, Khaled Elgazwi, Adel Elgazwi, Ibrahim El-busife, Safa Owhida, Almahdi Eltwati, Samah Elakeili, Taha Abubaker, Fatima Elkhfeefi, Soha Younis Hasan, Amal Alttaira, Imbarkah Elmraied, Rim Wishah, Omar Abugassa, Hazem Ahmed, Amera Ellafi, Shoukrie Shoukrie, Nawal Aldokali, Aws ElGammudi, Akram Alkaseek, Hoda Elhaddad, Ayyah Alqaarh, Ahlam Brish, Malek Abudsnnuga, Salsabil Albuaishi, Mohammed Albashri, Marwa Morgom, Mohammed Alawami, Eman Shawesh, Abdullah Almabrouk, Moaz Alwarfalli, Nagia Abeid, Anis Buzreg, Ans Malek, Ameerah Abayu, Butaina Abdulhafith, Wedad Abouruwes, Marim Albakuri, Sabria Almuammari, Esam Alsaghair, Fatheia Alreshi, Hassan Badi, Rabiee Alfetoey, Naji Zubia, Bushray Almiqlash, Abdulsalam Alshuhoumi, Rayet Al-islam Ben Jouira, Amaal Dier, Essra Gebril, Mohammed Abdelkabir, Sana Moussa, Marwa Alfitori, Mabroukah Azbeda, Hajar Alamin, Ejmeya Barka, Omlsaad Mosbah, Rema Abdasalam, Miftah Hiyoum, Maryam Abd allateef, Ibrahim Altomi, Mahdi Alsakloul, Ekhlas Karami, Munyah Alriqeeq, Mabruka Omar, Ashraf Samer, Aml Aemeesh, Ahmad Bouhuwaish, Ahmed Elusta, Sultan Ahmeed, Wesal AlFighi Hassan, Mouadah Ali Altayr, Mohamed Addalla, Abrar Geddeda, Kheria Khoja, Doaa Alhaj, Muaad Etturki, Ahmed Elhadi, Ibrahim Ellojli, Anshirah Shuwayyah, Ahmed Elfaghih, Malak Alduwayb, Mohamed Aleiyan, Wedad Aboubreeq, Soliman Alkassem, Sami Ashour, Hayat Ben Hasan, Najat Ben Hasan, Ali Yahya, Palesa Chisala, Edward Kommwa, Lusayo Simwinga, Agness Chalira, Precious Kachitsa, Onias Mtalimanja, Drissa Traoré, Moussa Sissoko, Moussa Camara, Adama Koita, Sekou Koumaré, Omar Sacko, Mahamadou Coulibaly, Lamine Soumaré, Soumaïla Keita, Sidiki Keita, Hamadoun Dicko, Boubacar Diallo, Boureima Bengaly, Mohamed Keita, Siaka Diallo, Drissa Ouattara, Nouhoun Ongoiba, Seydina Beye, Honoré Berthe, Mamadou Diakite, Mamadou Sima, Adégné Togo, Bakary Dembele, Djibo Diango, Moussa Samake, Youssouf Traoré, Louis Traoré, Ongoïba Oumar, Sogoba Gaoussou, Issaga Traoré, Sidy Sangaré, Doua Kanté, Lassana Cissé, Thiam Souleymane, Keita Koniba, Sundaresan Maiyalagan, Julien Chong, Adil Mohit, Khushyant Mungar, Shankaran Vinayagam, Kevin Ramlochun, Jamie Sim, Desai Sneha, Vishaal Kissoon, Yan Tseung, Mohamed Aboobakar, Nitish Fokeerah, Ravi Ramsewak, Jayprakash Gopall, Meetheelesh Abeeluck, Varun Seewoo, Divyanand Jankee, Ashveen Puryag, Senthil Beemadoo, Yashraj Deenoo, Abhisek Goureah, Munawwara Makoon, Hemanshu Rambojan, Beeharry Shanjugsingh, Kevin Viraswami, Shehzaad Joomye, Ashwant Bhugwandass, Bibi Deelawar, Vakil Leelodharry, Luckshmanraj Mungur, Sajid Aungraheeta, Sirsingh Bhajoo, Manpreet Rajcoomar, Rishi Seetaram, Subha Gaya, Gini Batra, Yoshvin Sunnassee, Shailendra Petkar, Sbai Hicham, Labib Smail, Ait Laalim Said, Motaai Youssef, Mouhssine Doumiri, Mustapha Alilou, Nora Farnaoui, Mustapha Bensghir, Abdelghafour Elkoundi, Abdelhamid Jaafari, Abderhmann Elwali, Mohammed Meziane, Walid Atmani, Houssam Rebahi, Hajar Chichou, Safae Zarouf, Abderraouf Soummani, Abou Elhassan Taoufik, Meryem Essafti, Aminata Oumou Traoré, Hamzaoui Hamza, Adnane Berdai, El allani Linda, Salhi Oussama, Nelson Mucopo, Machado Banze, Mouzinho Saide, Tomas Sitoi, Artur Machava, Antonio Carlos, Amilton Guidione, Antonio Saide de Carvalho, Natacha Gemo, Samiro Sema Camal, Arsénio Cuna, Ornelos Madeira, Ladino Assuade, Dercio Amde Fernandes, Dulce Alexandre Machavae Fernandes, Mandua Sebastião, Bernard Sikombe, Matti Kandjimi, Ayoub Shekimweri, Diana Shilomboleni, Mbaundju Kandjii, Leonard Kabongo, Cholastic Hangero, Ike Ndjoze, Ruben Nailonga, Immanuel Uukonga, Uutoni Nakanyala, Lavinia Johannes, Adrian Haruzuvi, Chris Terblanche, Natangwe Shimenda, Delwina Katjipu, Hilma Shalimba, Juliah Kaweendwa, Ali Mbuyi, John Oyedele, Mapumba Mulolo, Peter Njuki, Mutombo Ndaie, Akutu Munyika, Hilma Katangolo, David Tjiyokola, Tawanda Mhene, Archbald Masiambiri, Paidamoyo Mandudzo, Sandra Kapepiso, Haziel Mavesere, Cedia Tjihoto, Daylight Manyere, Charlotte Kauraisa, Learnmore Garanowako, Michael Tune, William DeKlerk, Benvenue Ndolo, Maria Angula, Ndapewoshali Hishekwa, Elizabeth Nandjendja, Elsabe Tsauses, Eunice Mouton, Kudzai Katandawa, Sophia Bruwer, Jaydee Van Staden, Beata Siteketa, Beata Kaholongo, Martha Ntinda, Pueya Nashidengo, Johanna Kandjumbwa, Lahia Lipumbu, Moussa Sirfi, Fouma Djibo, Moutari Mahaman, Abdoulaye Mahaman Bachir, Maikassoua Mamane, Adakal Ousseini, Maman Noury Hamissou Souley, Rabo Oumarou, Rekia Idrissa, Moussa Ichaou, Amina Saley, Abdoulay Seyni, Sahabi Amadou, Mahamane Sani Mahamane Laminou, Issoufou Moustapha Camara, Moussa Gagara, Hadjara Rabiou Daddy, Harissou Adamou, Ibrahim Amadou Magagi, Oumarou Habou, Sabo Ramatou, Saidu Kadas, Rabiu Mohammed, Abubakar Ballah, Tella Olalekan, Kefas Bwala, Mohammed Adamu, Adamu Isa, Ademola Adeyeye, Samuel Fayose, Akinola Akinmade, Taiwo Ajayi, Elizabeth Nwasor, Saidu Yakubu, Euphemia Ugwu, George Mukoro, Muhammed Ahmed, Gideon Akafa, Ahmad Lawal, Daniel Nwoye, Michael Odigbo, Zulaihatu Sarkin-Pawa, Tunde Sholadoye, Benjamin Fomete, Hamisu Yakubu, Abdulkadir Kabiru, Samaila Timothy, Ali Yusuf, Tasiu Saadu, Babangida Mohammed, Abdulghaffar Yunus, Ganiyat Olagunju, Muhammad Aminu, Mohammad Idris, Musliu Tolani, Nasiru Dalhat, Samuel Gana, Talent Adike, Lofty-John Anyanwu, Abdurrahman Sheshe, Sani Aji, Mamuda Atiku, Raphael Attah, Abubakar Muhammed, Rasaki Oseni, Halima Salisu-Kabara, Benjamin Nkemjika, Omotayo Salami, Adekunle Akadri, Bukola Olayinka, Clement Onuoha, Umar Usman Jamaare, Auwalu Saminu Jibrin, Sani Giade Abdullahi, Ibrahim Ishaku, Adenike Odewabi, John Bamigboye, Oladapo Kuforiji, Chidiebere Ogo, Stella Ogunmuyiwa, Abdussemee Abdurrazzaaq, Adebayo Tanimola, Michael Adeyanju, Oluwatimilehin Andero, Temitope Ojo, Olusi Adedotun, Gbadamosi Kehinde, Jimoh Buraimoh, Kabiru Muhammad, Sophia Baidoo, Patrick Okoli, Azeez Adigun, Ekene Ezeonye, Kabir Isa, Yetunde Aremu-Kasumu, Kamil Shoretire, Peter Enesi, Amechi Ezike, Olatunde Olawoye, Emmanuel Ugwu, Christopher Ukah, Abolade Olugbenga, Nwachukwu Chidiebere, Nasiru Abdulraman, Adebiyi Olusegun, Alisa Halisa, Semiat Yusuf, Jamila Salisu, Chidiebube Okoro, Abdul Suleiman, Fabian Onowighose, Aliyu Farinyaro, Suleiman Baba, Umar Abdulmajid, Aisha Abdurrahman, Ogochukwu Obi, Olatunde Alabi, William Adeyemi, Jelili Salau, Jones Taiwo, Nnaemeka Nwafulume, Taiye Ibiyeye, Edith Agu, Ayodeji Danboy, James Abdulazeez, Christopher Ekwunife, Chimaobi Nnaji, Chigozirim Onyekpere, Amara Arunsi, Jude Egwim, Obianuju Nwana, Nnabuike Ojiegbe, Charles Mbamba, Paul Ngwu, Frank Imahigbe, Emmanuel Okoroji, Iloh Ikenna, Abdulrahman Mohammed, Adebayo Adeniyi, Toluwalope Ariyo, Olajide Gabriel, Tesleem Orewole, Salawu Idris, Idowu Adebara, Abiodun Okunlola, Akinwale Akinbade, Oluwasesan Afolabi, Adewumi Bakare, Olabisi Adeyemo, Benjamin Ugwu, Samuel Nuhu, Henry Embu, Erdoo Isamade, Chinedu Obikili, Amaka Ocheke, Solomon Peter, Donald Orshio, Peter Onuminya, Jack Okopi, Olufemi Bankole, Bosede Afolabi, Dapo Osinowo, Ayodeji Oluwole, Muyiwa Rotimi, Ibironke Desalu, Rufus Ojewola, Bolaji Mofikoya, Kola Owonikoko, Adeolu Adeoye, Temidayo Bobo, Taiwo Akinloye, David Ama, Ebere Okoronkwo, Muhammad Mahmud, Jamiu Adebiyi, Temitope Babalola, Mansur Muhammad, Afeez Aruna, Maryrose Osazuwa, Ayodeji Yusuf, Isiaka Lawal, Bitrus Fidelis, Rephath Pius, Cyril Jomosu, Adebayo Adedayo, Abubakar Aliyu, Adaora Agholor, Abdullateef Abdulazeez, Chabiya Bala, Eziamaka Eze, Elizabeth Ani, Uchenna Okeke, Dominica Adebayo, Okechukwu Ekwunife, Victor Modekwe, Chuka Ugwunne, Chukwuemeka Okoro, Chisom Uche, Simeon Olateju, Fred Ige-Orhionkpaibima, Adedapo Adetoye, Olurotimi Aaron, Jeremiah Abimbola, Folayemi Faponle, Olumuyiwa Ajayeoba, Olusoji Jagun, Oluwabunmi Fatungase, Adeniyi Akiseku, Chigbundu Nwokoro, Ramotalai Shoyemi, Ibukunolu Ogundele, Nankat Joseph, Salihu Bura, Chukwuka Nwezoku, Manu Bwala, Meshach Philips, Abubakar Usman, Emmanuel Filibus, Zara Umate, Nwabuoke Chukwuka, Ahmed Nuhu, Watakiri Ibrahim, James Nggada, Ali Izge, Musa Ismail, Olayinka Eyelade, Tinuola Adigun, Babatunde Osinaike, Olayinka Ogunbode, Olusola Idowu, Taiwo Lawal, Temidayo Ogundiran, Olayiwola Shittu, Omobolaji Ayandipo, Stephen Edino, Zumnan Songden, Olumide Akitoye, Bissallah Ekele, Godwin Akaba, Terkaa Atim, Akitoye Adeleke, Owoicho Okochi, Sunday Akeju, Ernest Ukpoju, Osayomwanbo Osaheni, Ifunanya Obaseki, Lateef Kehinde, Osawemwenze Monday, Stanley Nte, Adesuwa Agboifo, Omajuwa Dawodu, Precious Orhiere, David Atiti, Queeneth Kalu, Felix Effiom, Israel Kolawole, Olawale Ojo, Afusat Olabinjo, Olufemi Ige, Beatrice Ogunyemi, Olusola Oladosu, Kikelomo Adesina, Sulaiman Agodirin, Asimiyu Shittu, Audu Idrisa, Sadiq Adamu, Nuhu Ali, Olayinka Adewunmi, Stephen Nwankwor, Akinwumi Olakanmi, Oluseye Ajayi, Ayotolu Ajayi, Victor Ogunmola, Oluwafunke Olakanmi, Adam Kuranga, Enoch Uche, Chukwuemeka Osuagwu, Chukwudi Ilo, Mesi Matthew, Uko Uko, Ngozi Mba, Olubusola Alagbe-Briggs, Amabra Dodiyi-Manuel, Bisola Onajin-Obembe, Bright Obasuyi, Richard Echem, Ihuoma Mike-Elechi, Job Otokwala, Mark Edubio, Catherine Eyo, Isaac Udo, Aliyu Abdulrahman, A.A. Abdullahi, Ibrahim Galadima Bello, Usman Adinoyin Mohammed, Abidemi Oyaromade, Mohammed Bello, Usman Muhammad, Emeri Mbah, Hyacinth Okereke, Almustapha Aminu, Anthony Ahmadu, Abu Rogers, Peter Samai, Sao Amara, Margaret Yankuba, Mary Josayah, Jayah Swarray Jnr, Alusine Dawo, Peter George, Mustapha Kabba, Mohamed Bah, Charles Mondeh, Ibrahim Kapuwa, Mohamed Sheku, Philip Mattia, Brima Sesay, Jones O.A. Omoshoro-Jones, Motselisi Mbeki, Estie Cloete, Philip Anderson, Busi Mrara, Annemarie Steyn, Tsakani Mhlari, Nic Proctor, Caroline Robertson, Gillian Lamacroft, Usha Singh, Sebenzile Sikhakhane, Kelly Gate, Shepherd Nzenza, John Tshimbalanga Kasonga, Sibongile Ndebele, Patrick Lufuta Kande, Jody Davids, Tino-vito Orlandi, Marischka de Jong, Hugo Stark, Francois Roodt, Jonathan Hall, Ian Nortje, Akanimo Akpakan, Vishendran Govindasamy, Ronisha Sathiram, Mohammad Kathrada, Zane Farina, Lucio Frittella, Charles Kohler, Sibuyiselwe Lubelwana, Sarwat Ikram-Hameed, Adriaan Smit, Muneerah Cassiem, Yvonne Freeman, Saaliha Goga, Larissa Cronje, Constantin Buzdugan, Subash Chirkut, Priyadeshni Singh, Sandhya Jithoo, Vivesh Rughubar, John Arnold, Rishan Bipath, Suman Mewa Kinoo, Ncumisa Khanyisa Msolo, Fleur Ackermans-Deijnen, Tshegofatso Mmasello Emma Boka, Martyn Biccard Greenwood, Shakthi Anand Jayrajh, Devarani Naidoo, Syndrini Reddy, Devandiran Harriraman Rungan, Kylene Subrayen, John Roos, Nina Tredoux, Pascal Plumacher, Anthony Reed, Harald Steinhaus, Mariesa Nock, Paul Ryan Herselman, Gareth Davies, Talitha Harvey, Franklin Muller, Willem Naude, Tania Pretorius, Johan Jochemus Swart, Merryn Walls, Prashant Gokal, Nicolette Rorke, Farzaana Dhoodhat, Precious Dzanibe, Mohammed Yusuf Hussain, Ashmita Junpath, Ameela Maharaj, Hylda Makanisi, Khalid Moosa, Ting Ting Wong, Sean Mould, Trisha Ramsamy, Roel Matos-Puig, Hayley Morgan, Nadeem Nabeebuccas, Ria Devi Naidoo, Viantha Pather, Vasheel Vasheel Bahadur, Renilda Pillay, Zahnne Fullerton, Nicole Bell, Bongisa Grey, Vincent Lorenzo Visentin, Hendrik Adriaan Van Zyl, Terri Anne Killingbeck, Emile Maneveldt, Gerhard Thiart, Magdelena May Venter, Oostewalt Swart, Mariette Grobelaar, Carel Cairns, David Bishop, Christien Steenkamp, Thandekile Khumalo, Noel Naidoo, Ross Murray, Martin Kopieniak, Melusi Sishange, Mxolisi Brian Ndimande, Megan Jaworska, Sarwat Ikram, Bence Rainier, Renier J. Liebenberg, Helena D. Zwiegers, Philip M. Nortje, Kamal Bhagwan, Margot Flint, Robert Dyer, Simone Adams, Yoshua Bwambale, Danny Ngomo, Patrice Kanku, Nivashen Pillay, Alexa de Castro, Atisha Maharaj, Janine Carim, Jenna Leigh Taylor, Karl M. Köhne, Leanne W. Drummond, Leanne Temlett, Lieze Geldenhuys, Yvonne Seilbea, Kathryn Naidoo, Nicola A. Kalafatis, Stefné Verwey, Thulile Biyase, Theroshnie Kisten, Belinda S. Kusel, Timothy Craig Hardcastle, Richard Magagula, Christian Kampik, Kuzolunga Xulu, Sivuyisiwe Solala, Mia Sayed, Basil Enicker, Anil Madaree, Innocent Mukama, Gladmore Madombwe, Nonhlanhla Zulu, Nompumelelo Gasa, Nokuzula Kanjana, Sebenzile Buthelezi, Thembelihle Buthelezi, Andries Brink, Francois Potgieter, Busisiwe Mrara, Zaynab Alexander, Charles Choto, Paula Ima, Zintle Gxagxisa, Baphethuxolo Ningiza, Gillian Lamacraft, Jerome Mogorosi, Nadia du Plessis, Leonie de Man, Suné Thompson, Gerrit van Heerden, Edwin W. Turton, Pieter M. van der Linde, Josephine K. Teme-Pitse, Reitumetse Tladi, Gillian D. Saffy, Ene-Mari Roscher, Kristel Fortune, George Barnard, Tiisetso Makhasane, Evan Bowen, Akangcha Pal, Rachel Moore, Maria Fourtounas, Mary Augusta Adam, Renessa Arumugan, Gabriella Hyman, Jaclyn Jonosky, Maninginingi Makondo, Heveshan Moodley, Phillip Munda, Mzwandile Nyalungu, Victor Olusola, Sohan Zane Pinto, Tristan Pillay, Lucinda Singh, Paul Mwindekuma Wondoh, John Devar, Boitumelo Baloyi-Mnisi, Zach Koto, Matlou Ernest Mabitsela, Sibongile Ruth Ndlovu, Branny Mthelebofu, Colin Beck, Matthew Dold, Alice Fan, Shannon MacQueen, Thembani Matabata, Catherine Mpehle, Charné Kulenkampf, Tsakani McCreath Mhlari, Simangele Cecilia Nyoka-Mokgalong, Felix Thumba Masinge, Randhir Ramnath Gunpath, Maropeng Petrus Pat Mothwa, Jo-Anne Asenath Mothwa, Danai Mhlanga, Jamie-Lyn Colly, Aunel Mallier Peter, Khalid Ben Hameda, Pulane Mokae, Stella Josephine Moumakoe, Kelechi Ekeh, Nezingu Lengo, Marnus Booyens, Inge Louise Seale, Pieter Daniel Theron, Nicolaas Abraham Schuman, Amber Carlyn Sonn, Jacobus Lukas Stander, Nadia Cloete, Marius Cloete, Catherine Ann Makepeace, Ronel van der Westhuizen, Leanne Robyn Messiahs, Amy Ruth Visagie, Fatima Vawda, Frans Christiaan Voster, Deepika Dhilraj, Oliver Smith, Stefan Bolon, Daniel Montwedi, Motsilisi Mbeki, Jayde Wyngaard, Mthunzi Ngcelwane, Thomas Kleyenstuber, Phyllis Phukubye, Liesel Schärf, Grace Laker, Elizabeth Semenya, Reinhard Dembskey, Thomas Tarlton, Tapiwa Jiri, Ngoie Hubert Mushid, Nhlanhla Samuel Ngwenya, Hazel Morongoa Mogodi, Carmen Sinevici, Anthony Osarogie Usenbo, Naledi Fodo, Anesu Chimini, Ntetelelo Sikobi, Sinovuyo Nokwange, Mluleki Noqhamza, Qumba Thembisa, Kajake Anantha Padmanabha Bhat, Rabin Mathew, Katrin Middleton, Abdus-sami Adewunmi, Craig Dickson, Humairah Bulbulia, Bianka Bester, Michelle de Klerk, Christia Benade, Francois Viljoen, Monique Fischer, Khalid Alfaki, Abdalmalik Awad, Abdelsalam Algray, Mohammed Elsiddig, Suha Mohamed, Salih Mahmoud, Muhammed Osman, Asia Elgailany, Mazin Suliman, Hanaa Mohammed, Lina Aljeally, Mohammed Dirar, Mohammed Osman, Mazin Mohamed, Mohamed Elhasan, Abrar Widatalla, Abubakr Abubakr, Eman Mohamed, Alshareef Nour, Ntonto Doris Gama, Dolorosa Khetsiwe Shabangu, Cynthia Iradikunda, Samuel Mkoko, Paul Kisanga, Emmanuel Lema, Benson Lyimo, Mohamed Binde, Alphonce Chandika, Salim Salim, Sylvia Jumbe, Abel Makubi, Vihar Kotecha, Felician Kachinde, Museleta Nyakiroto, Emmanuel Jitambi, Venant Geofrey, Johaphes Josiah, Phinius Makubi, Frank Manumbu, Suzan Mlingwa, Ernest Ibenzi, Peter Mbelle, Kato Peleus, Enid Chiwanga, Nillah Richard, Shoo Leonard, Paulo Sanka, Subira Mushi, Bashir Nyangasa, Mohamed Janabi, Naizihijwa Majani, Pedro Palangyo, Evarist Nyawawa, William Ramadhan, Faraj Lydenge, Gileard Gabriel Masenga, Sakina Rashid, Mubashir Jusabani, Ansbert Ndebea, Jenitha Cheru, Margaret Henjewele, Greyson Kilimanjaro, Sarah Sikimata, Deocles Donatus, Hazina Maduhu, Tumaini Mariro, Given Massasi, Moshi Moshi Shabani, Braison Cholela, Marco Mgeleka, Yohatinus Mbilinyi, Faraja Chiwanga, Bilton Exavery, Caspar Haule, Samson Ndile, Sirili Harya, Julieth Magandi, Deogratius Manyama, Redempta Matindi, Adam Moshi, Daudi Kitwana, Merida Makia, Philip Muhochi, Miriam Herman, Clauda Miombo, Furaha Kahindo, Langtone Kishebuka, Elijah Ussiri, Gloria Kinasa, Patrick Adel, Eric Malaba, Vensesla Sakwari, Sadot Lugereka, Mohamed Mungia, George Mocha, Herman Wella, Cecilia Protas, Patrick Karua, Ahmada Kashagama, Faraja Mwasambugu, Suzana Kajeri, Jacquiline Mchilla, Elibariki Lucumay, Robert Maise, Amon Marti, Beatrice Mahundi, Frederika Jager, Charles Majani, Ludovick Rukeha, Tareeq Mohamed, Nabila Fuad, Winifrida Halinga, Elias Chrisant, Gilbert Msoma, Titus Kihwili, Gadiel Temu, Naima Yusuf, Rashid Saleh, Rashid Inoja, Eva Shang'a, Stella Ibrahim, Hussein Msuma, Edwin Edward, Paul Kilamile, Stephen Mwakyolile, Talkana Adja, Edem Gueouguede, Hafoudhoi Oussene Seddoh, Saliou Adam, Pilakimwe Egbohou, Mawunyo Ahomagnon, Olivier Kadjossou, Abdul-Bassiti Boukari, Mary T. Nabukenya, Ruth Muhindo, Peter Waswa, Peter Kaahwa Agaba, Daphne Kabatoro, Joseph Kayongo, Margaret Naggujja, Nabasiige Rehema, Phiona Nansubuga, Daniel Kavuma, Aggrey Lubikire, Hope Bisilikirwa, Godfrey Ssebaggala, Emmanuel Muwema, Humble Joan Agaba, John Kiconco, Nicholas Wataaka, Bonet Chan, Mary Juliet Nampawu, Fred Bulamba, Emmanuel Bua, Christine Mugala, Caroline Nyakato, John Paul Ochieng, Linda Kyomuhendo Jovia, George Kateregga, Rachel Alum, Lazia Najjuma, Gorret Nampiina, Andrew Kintu, Joshua Sempiira, Luzige Simon, Peter Kayima, Jacob Eyul, Erick Odwar, Rita Nkwine, Christine Namata, Elizabeth Nabakka, Denis Kakaire, Velda Mushangwe-Mtisi, Erisha Munhamo, Celestino Dhege, Juliet Hungwa, Hemish Jasi, Crispin Ntoto, Derek Matsika, Brightson Mutseyekwa, Joseph Zimbovoora, Beaulah Gudyanga, Dennis Mazingi, Chenesa Mbanje, Busisiwe Mlambo, Michael Chiwanga, Harunavamwe N. Chifamba, Sarudzai Zhou, Esta Hove, Shamiso Dende, Beauty Manjengwa, Penias Kapisa, null Mashava, Caritas Chiura, Locadia Katsukunya, Godfrey Muguti, Doreen Mashava, Elton Ndhlovu, Zanele Mangwangwa, and Nombulelo Dube
Subjects: medicine.medical_specialty, Interprofessional Relations, media_common.quotation_subject, Psychological intervention, Fidelity, Postoperative Complications, Surveys and Questionnaires, Intervention (counseling), Humans, Medicine, Postoperative Period, Cooperative Behavior, Nursing management, media_common, Response rate (survey), business.industry, Standard of Care, Odds ratio, Hospitals, Confidence interval, Clinical trial, Anesthesiology and Pain Medicine, Population Surveillance, Africa, Physical therapy, business
Abstract: Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.
Published: 2021

2. The role of cognitive reserve in mediating cognitive impairment in cART-treated HIV positive older adults in Mbeya, Tanzania

Author: Molly Sadler, K Said, E Chuma, S.M Kaminyoge, B Mussa, E Kuhoga, Richard Walker, Gill Livingston, William Keith Gray, Stella-Maria Paddick, and Bernard Mbwele
Abstract: Introduction: HIV-associated neurocognitive disorders (HAND) are a spectrum of cognitive impairments occurring in chronic HIV infection. HAND are highly prevalent in sub-Saharan Africa (SSA), despite combination antiretroviral therapy (cART). Older people appear to be at increased risk. Cognitive reserve (CR), shown to be protective in neurodegenerative dementias, may also protect against HAND.Aim: To evaluate the association of CR and risk of HAND in an older cART-treated population in SSA.Methods: This was a cross-sectional observational study undertaken at hospital outpatient clinics in Mbeya, Southwest Tanzania. HIV-positive participants aged ≥ 50 years and established on cART underwent diagnostic assessment by operationalised AAN criteria. Assessment included neuropsychological test battery, functional assessment, informant history and depression screen. HIV-negative control participants were attendees of other chronic disease clinics who completed neuropsychological assessments to provide normative scores for HAND diagnosis. CR was measured using the Cognitive Reserve Index (CRI) and other proxy measures including years of formal education.Results: Lower total Cognitive Reserve Index (CRI) score, lack of formal education, unemployment and low-skilled manual work were associated with increased risk of HAND. Lower CRI score and lack of formal education were independent risk factors for HAND but HIV disease severity measures were not.Conclusion: Higher total CRI score and formal education appeared to be protective for HAND, in this cohort. These are potentially modifiable factors, though education may be difficult to modify in later life. Cognitive reserve may be more important than HIV-disease control in risk of HAND in older people with treated HIV.
Published: 2022

3. Epidemiological Linkages of Diarrheagenic Vibrio Species from Sea water, Seafood and Patients and their Antimicrobial Susceptibility Patterns in Zanzibar, Tanzania

Author: Kheir Kheir, Bernard Mbwele, Khadija Omar, Modester Damas, and Lucy A. Namkinga
Abstract: Background Vibrio species are reported to cause diarrhea in developing countries, particularly in Africa. The typical species of Vibrio have an association with seawater, seafood and patient stool which have been rarely studied in Zanzibar. Methods A cross-sectional study was conducted from October, 2019 to February, 2020. Randomly samples were collected to investigate Vibrio species from seawater, seafood to human and vice versa. The samples were cultured using Thiosulphate - citrate - bile salts-sucrose agar and AMS was done by Kirby – Bauer disc diffusion method. Results A total of 303 sample participated in the study (60) 60.0% V. cholerae were identified from seawater, (57) 57.0% from seafood and (20)19.4% from stool. Similarly, 22.0% of V. parahaemolyticus were identified from seawater, 21.0% from seafood and 14.5% from stool. About 12.0% of V. vulnificus were identified from seawater,10.0% from seafood and 4.8% from stool while 6.0% of similar V. alginolyticus from seawater, 5.0% from seafood and 2.9% from stool. All Vibrio spp presented sufficient susceptibility to Chloramphenicol, Ciprofloxacin and Doxycycline with a varying pattern to trimethoprim-sulfamethoxazole. Conclusion Vibrio cholerae and V. parahaemolyticus isolates are common causative agents of diarrhea in Zanzibar with reservoir in seawater and seafood. Both species presents sufficient susceptibility response to chloramphenicol, ciprofloxacin and doxycycline.
Published: 2022

4. Saving lives through voluntary blood donation: learning from medical students in ruvuma, southern Tanzania

Author: Soha Sobhy, Moshi Moshi Shabani, Bernard Mbwele, and Kauke Bakari Zimbwe
Subjects: medicine.medical_specialty, Blood donor, Tanzania, biology, business.industry, Family medicine, medicine, biology.organism_classification, business
Abstract: Background: Medical students present a high merit and potential source of blood in hospitals due to their medical knowledge, physiological potential by age however their use has been rarely described in southern Tanzania. Objectives: The main objective of the study was to assess the knowledge, attitude, willingness for the future blood donation among medical students of southern, Tanzania. Methods: A cross-sectional study to assess awareness, knowledge, attitudes, willingness and factors associated blood donation among medical students in Ruvuma, Southern Tanzania was conducted from March to June 2018. A self- administered questionnaire was used and data was analyzed by IBM Corp, SPSS Version 24.0. Results: A total of 176 students were assessed at an average age of 25.8 ± 3.6 years. Eighty medical students (45.5%) ever donated blood while among them 66 (82.5%) of those being out of volunteering. About 46 (57.5%) students had a repeated experience for blood donation. Majority of students had positive attitude toward blood donation 159 (90.3%), often 135 (77%) identified voluntary blood donation to be useful and 133 (75.6%) were willing to donate in the future. Factors that were significantly associated with blood donation were age above 30 (OR=0.18, p
Published: 2020

5. Postoperative Outcomes Associated With Procedural Sedation Conducted by Physician and Nonphysician Anesthesia Providers: Findings From the Prospective, Observational African Surgical Outcomes Study

Author: Freliza, van der Merwe, Nicola J, Vickery, Hyla-Louise, Kluyts, Dongsheng, Yang, Yanyan, Han, Dolly M, Munlemvo, Daniel Z, Ashebir, Bernard, Mbwele, Patrice, Forget, Apollo, Basenero, Coulibaly, Youssouf, Akwasi, Antwi-Kusi, Andrew K, Ndonga, Zipporah W W, Ngumi, Abdulaziz, Elkhogia, Akinyinka O, Omigbodun, Janat, Tumukunde, Farai D, Madzimbamuto, Veekash, Gobin, Ryad, Mehyaoui, Ahmadou L, Samateh, Leon, du Toit, Thandinkosi E, Madiba, Rupert M, Pearse, and Bruce M, Biccard
Subjects: Adult, Anesthesiology and Pain Medicine, Postoperative Complications, Treatment Outcome, Physicians, Humans, Anesthesia, Prospective Studies
Abstract: There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Nonphysician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by nonphysicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death.A secondary analysis of a prospective cohort of inhospital adult surgical patients representing 25 African countries was performed. The primary outcome was a collapsed composite of inhospital severe postoperative complications and death. We assessed the association between receiving procedural sedation conducted by a nonphysician (versus physician) and the composite outcome using logistic regression. We used the inverse probability of treatment weighting propensity score method to adjust for potential confounding variables including patient age, hemoglobin level, American Society of Anesthesiologists (ASA) physiological status, diabetes mellitus, urgency of surgery, severity of surgery, indication for surgery, surgical discipline, seniority of the surgical team, hospital level of specialization, and hospital funding system using public or private funding. All patients who only received procedural sedation for surgery were included.Three hundred thirty-six patients met the inclusion criteria, of which 98 (29.2%) received sedation from a nonphysician provider. The incidence of severe postoperative complications and death was 10 of 98 (10.2%) in the nonphysician group and 5 of 238 (2.1%) in the physician group. The estimated association between procedural sedation conducted by a nonphysician provider and inhospital outcomes was an 8-fold increase in the odds of severe complications and/or death, with an odds ratio (95% confidence interval [CI]) of 8.3 (2.7-25.6).The modest number of observations in this secondary data analysis suggests that shifting the task of procedural sedation from physicians to nonphysicians to increase access to care may be associated with severe postoperative complications and death in Africa. Research focusing on identifying factors contributing to adverse outcomes associated with procedural sedation is necessary to make this practice safer.
Published: 2021

6. A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers Admitted with Diarrhoea Suffering Children in West Urban Region of Unguja-Zanzibar

Author: Kheir M. Kheir, Bernard Mbwele, Khadija Omary, Modester Damas, and Lucy Nmakinga
Abstract: BackgroundThe knowledge, attitude and health practices of the mothers directly reflect on the health and vitality of the child in most of diarrhoea affected communities. The aim of the study was to determine the knowledge, attitude and practice of mothers and caregivers (house girls) towards diarrhoeal disease among children under-five in Unguja, Zanzibar Tanzania. MethodsA quantitative cross-sectional study using a rapid appraisal technique to assess the knowledge, attitudes and practice of mothers and caregivers admitted with children with diarrhoeal diseases was conducted in 23 hospitals of west urban region of Unguja, Zanzibar. ResultsA total of 102 mothers and caregivers were studied. From the respondents 97 (95%) had satisfactory level of knowledge on diarrhoea while 5 (5%) had unsatisfactory knowledge. A total of 52 (51%) rejected the use of Oral Rehydration Solution (ORS) at home due to taste and smell and 50 (49%) agreed its use. A total of 55 (54%) children were served by caregivers. Collectively mothers and caregivers were asked for their practice of drinking treated or boiling water where 47 (46%) reported not to practice. A total of 48 (47%) respondents reported hand washing after helping children with defecation while only 19 (19%) respondents reported washing hands before preparing food. ConclusionLimited use of water sanitation and hygiene (WASH) practices was observed among mothers and caregivers in the prevention and management of under-five children with diarrhoeal disease.
Published: 2021

7. International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs

Author: Heidi W. Brown, Aparna Hegde, Markus Huebner, Hedwig Neels, Hayley C. Barnes, Gisele Vissoci Marquini, Narmin Mukhtarova, Bernard Mbwele, Visha Tailor, Ervin Kocjancic, Elisa Trowbridge, and Lynsey Hayward
Subjects: Aging, Pregnancy, Urology, Incidence, Prevalence, Obstetrics and Gynecology, Humans, Female, Human medicine, Referral and Consultation, Pelvic Organ Prolapse
Abstract: Introduction and hypothesis This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. Materials and Methods A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. Results The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. Conclusion Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.
Published: 2021

8. Screening for delirium and dementia in older hospitalised adults in Zambia

Author: Grace George, Monty Fricker, Oliver Todd, Dennis Makowa, Chimozi Tembo, Catherine Dotchin, William K. Gray, Richard W. Walker, Bernard Mbwele, and Stella-Maria Paddick
Subjects: Adult, Neurology, Delirium, Humans, Mass Screening, Zambia, Dementia, Neurology (clinical), Tanzania, Aged
Abstract: Delirium prevalence and aetiology in older people in hospital or community settings in sub-Saharan Africa (SSA) is largely unknown. Cognitive screening tools designed for high-income countries (HICs) may be inappropriate due to cultural and educational differences, and delirium-specific measures lack validation in this context. The 'Identification and Intervention for Dementia in Elderly Africans' (IDEA) screen is a low-literacy tool developed and validated for dementia and delirium screening in Tanzania and Nigeria. This study aims to determine the prevalence and aetiology of delirium and dementia in older hospitalised patients in Zambia and to assess the utility of the IDEA screen for identification of major cognitive impairment in this setting. This was a blinded 4-month validation study which took place February-June 2015. Consecutive inpatient admissions of a rural mission hospital aged ≥60 years were administered the IDEA screen onadmission. Individuals were evaluated for dementia or delirium based on clinical examination, notes review and the Confusion Assessment Method. Delirium aetiological factors were recorded and classified (infectious/non-infectious). Of 136 patients recruited, dementia, delirium and major cognitive impairment were identified in 37 (27.2%), 45 (33.1%) and 62 (45.6%) respectively. Diagnostic accuracy of the IDEA screen for dementia and delirium was 0.661-0.795 (AUROC). Of those with delirium, 18 (40%) were classified infectious and 26 (57.8%) were classified non-infectious aetiologies. Dementia and delirium prevalence in older Zambian inpatients is comparable tohigh-income countries. The IDEA screen ispotentially clinically useful in this setting though diagnostic accuracy was lower than in initial validation studies. Non-infectious diseases are more highly represented amongst delirium precipitants than anticipated.
Published: 2021

9. Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment

Author: Mohamed Mohamed, Gideon Kwesigabo, Joseph Hokororo, Erick Kinyenje, Eliudi Eliakimu, Bernard Mbwele, and Talhiya Yahya
Subjects: medicine.medical_specialty, Quality management, Star Rating Assessment, Infection prevention and control, biology, business.industry, Star rating, lcsh:Public aspects of medicine, Psychological intervention, lcsh:RA1-1270, biology.organism_classification, Article, lcsh:Infectious and parasitic diseases, Tanzania, Health facility, Primary healthcare facilities, Health care, Emergency medicine, parasitic diseases, Infection control, Medicine, lcsh:RC109-216, Quality improvement, business, Baseline (configuration management)
Abstract: Summary: Background: The WHO estimates 10–30% of hospital admissions are associated with poor infection prevention and control (IPC). There are no reliable data on IPC status in Tanzanian healthcare facilities; hence the Star Rating Assessment (SRA) was established to address this. This study compared the health facility performances on adherence to IPC principles using baseline and reassessment data of SRA. Methods: A retrospective analysis of data from eight randomly selected regions across Tanzania. Data was gathered from an SRA database in which records of baseline assessments (2015/16) and reassessments (2017/18) were documented. Each healthcare facility's ownership and service level were investigated as independent variables. Results: A total of 2,131 healthcare facilities at baseline and 2,185 at reassessment were analysed. Median adherence to IPC principles increased from 31% (IQR: 20%, 46%) to 57% (IQR: 41.4%, 73.2%) after interventions (p
Published: 2020

10. A Situational Analysis of Home Delivery among Maasai Communities of Orkesumet, Northern Tanzania: The Qualitative Evidences

Author: Bernard Mbwele
Subjects: Geography, Tanzania, biology, Maasai, language, biology.organism_classification, Socioeconomics, language.human_language, Situation analysis
Published: 2019

11. 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

12. 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. 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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. 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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

13. Assessing the quality of the management skills required for lower respiratory tract infections in Kilimanjaro, Tanzania

Author: Bernard Mbwele
Subjects: medicine.medical_specialty, Surveillance, monitoring & evaluation, biology, Respiratory tract infections, business.industry, Q fever, biology.organism_classification, medicine.disease, Skills management, Pneumonia, Tanzania, Atypical pneumonia, Lower respiratory tract infection, Health care, Medicine, business, Intensive care medicine
Abstract: Lower respiratory tract infections (LRTI) are among the leading causes of morbid-ity and mortality. A severe form of atypical pneu- monia, Q fever, has been found in Northern Tan- zania. Assessment of the quality of health care for lower respiratory tract infection from the cli-nicians performance has rarely been performed. A cross sectional descriptive study using the qualitative and quantitative approaches in 11 hospitals of different levels in Kilimanjaro region. Clinicians of the Health facilities and pa- tients files were assessed. Medications for LRTI were highly variable for both the first and second attempts. No file showed attempts for assessing the severity of Pneumonia. No documentation of atypical pneumonia could be found from files. Clinicians are not aware of the causes of atypical pneumonia and how to treat it. Only 6 (11.1%) clinicians could mention causes of atypical pneumonia. Only 7 clinicians (13.0%) clinicians were aware of Q-fever and could men- tion the cause of Q-fever. Clinical records for monitoring the progress were varying signifi- cantly by levels of care. Level of mental state χ2 (4) = 139.4; P value < 0.001, blood pressure χ2 (8) = 75.2; P value < 0.001, temperature χ2 (4) = 78.7; P value < 0.001, pulse rate χ2 (4) = 139.1; P value < 0.001, respiratory rate χ2 (4) = 197.7; P value < 0.001, auscultation χ2 (4) = 92.2; P value < 0.001. Management of LRTI and atypical pneumonia shall be guided by the local audits reflected by the scientific reports.
Published: 2014

14. The Use of Guidelines for Lower Respiratory Tract Infections in Tanzania: A Lesson from Kilimanjaro Clinicians

Author: A Slot, P Kweka, M Msuya, M Hulscher, Bernard Mbwele, and Q. de Mast
Subjects: medicine.medical_specialty, Pediatrics, Clinicians, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Tanzania, 03 medical and health sciences, 0302 clinical medicine, Lower respiratory tract infection, Health care, medicine, pneumonia, 030212 general & internal medicine, Community acquired, Q fever, Atypical pneumonia, Respiratory tract infections, biology, Sub-Saharan Africa, business.industry, Standard treatment, General Medicine, Guideline, medicine.disease, biology.organism_classification, Lower respiratory tract infections, respiratory tract diseases, Pneumonia, Atypical pneumonia, Clinicians, Community acquired, Lower respiratory tract infections, pneumonia, Q fever, Quality of health care, Sub-Saharan Africa, Tanzania, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], 030228 respiratory system, Family medicine, Quality of health care, Original Article, business
Abstract: Background : Evaluations of the guidelines for the management of Lower Respiratory Tract Infections (LRTI) Sub‑Saharan Africa, particularly in Tanzania is scant. Aim : The aim of the study was to assess the usefulness of the current Tanzanian treatment guideline for the management lower respiratory tract infection. Subjects and Methods : A descriptive cross sectional study in 11 hospitals of different levels in the Kilimanjaro region Data were collected from May 2012 to July 2012 by semi‑structured interview for clinicians using 2 dummy cases for practical assessment. Data were analyzed by STATA v11 (StataCorp, TX, USA). Qualitative narratives from the interviews were translated, transcribed then coded by colors into meaningful themes. Results : A variety of principles for diagnosing and managing LRTI were demonstrated by 53 clinicians of Kilimanjaro. For the awareness, 67.9% (36/53) clinicians knew their responsibility to use Standard Treatment Guideline for managing LRTI. The content derived from Standard Treatment Guideline could be cited by 11.3% of clinicians (6/53) however they all showed concern of gaps in the guideline. Previous training in the management of patients with LRTI was reported by 25.9% (14/53), majority were pulmonary TB related. Correct microorganisms causing different forms of LRTI were mentioned by 11.3% (6/53). Exact cause of Atypical pneumonia and Q fever as an example was stated by 13.0% (7/53) from whom the need of developing the guideline for LRTI was explicitly elaborated. Conclusion : The current guidelines have not been used effectively for the management of LRTI in Tanzania.There is a need to review its content for the current practical use. Keywords : Atypical pneumonia, Clinicians, Community acquired, Lower respiratory tract infections, pneumonia, Q fever, Quality of health care, Sub-Saharan Africa, Tanzania
Published: 2016

15. Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

Author: Bernard Mbwele, John G Mrema, Joshua A Melnick, Sarah A P Ward, Rachael Manongi, and Nicole L Ide
Subjects: Asphyxia, medicine.medical_specialty, biology, Referral, business.industry, education, Tertiary referral hospital, biology.organism_classification, Omics, Triage, Tanzania, Neonatal Health, Nursing, Ambulatory care, Family medicine, Health care, Medicine, medicine.symptom, business
Abstract: Neonatal deaths are generally attributed to suboptimal standards of health care. Health care worker motivation and adherence to existing guidelines are rarely studied. To assess the performance of health workers for neonatal health care in the hospitals of Kilimanjaro region. A descriptive study using a semi-structured interview for health care workers at a tertiary referral hospital and peripheral health facilities (regional referral, district hospitals and health centres).was used. Health Care Workers (HCW) were asked to recall a scenario of a critically ill neonate admitted in the wards and the treatment that was provided. The WHO Emergency Triage Assessment and Treatment (ETAT) guidelines were used as a standard reference for knowledge of critical care. Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% of 120 HCW at both peripheral hospitals and by 46.4% of 28 health workers in tertiary referral centres. Half of the HCW commented on their own performance (47.5%, n=140). HCW presented with low to moderate levels of knowledge for critical care were at 92%. Supplementary training was associated with a higher levels of knowledge of neonatal critical care (p value = 0.05). HCW in peripheral hospital had lower levels of knowledge (only 44.7% at peripheral hospitals had sufficient ratings compared to 82.1% at the referral centre). [Pearson χ2 (2) = 12.10, p value = 0.002]. Guided Practical-Competence Diagnostic Specific neonatal health care training is highly needed in the peripheral facilities of rural Kilimanjaro region.
Published: 2013

16. A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania

Author: Bernard Mbwele, Elizabeth A. Reddy, and Hugh Reyburn
Subjects: Postnatal Care, Pediatrics, medicine.medical_specialty, Quality Assurance, Health Care, Population, Documentation, Tanzania, Medical Records, Health care, medicine, Humans, Medication Errors, Pediatrics, Perinatology, and Child Health, education, Quality Indicators, Health Care, education.field_of_study, biology, business.industry, Medical record, Infant, Newborn, lcsh:RJ1-570, Gestational age, lcsh:Pediatrics, Hospitals, District, biology.organism_classification, Infant mortality, Child mortality, Neonatal Health, Pediatrics, Perinatology and Child Health, Intensive Care, Neonatal, Workforce, Health Resources, business, Infant, Premature, Research Article
Abstract: Background While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Methods Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Results Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age Conclusion Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group.
Published: 2012

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16 results on '"Bernard Mbwele"'

1. Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

2. The role of cognitive reserve in mediating cognitive impairment in cART-treated HIV positive older adults in Mbeya, Tanzania

3. Epidemiological Linkages of Diarrheagenic Vibrio Species from Sea water, Seafood and Patients and their Antimicrobial Susceptibility Patterns in Zanzibar, Tanzania

4. Saving lives through voluntary blood donation: learning from medical students in ruvuma, southern Tanzania

5. Postoperative Outcomes Associated With Procedural Sedation Conducted by Physician and Nonphysician Anesthesia Providers: Findings From the Prospective, Observational African Surgical Outcomes Study

6. A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers Admitted with Diarrhoea Suffering Children in West Urban Region of Unguja-Zanzibar

7. International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs

8. Screening for delirium and dementia in older hospitalised adults in Zambia

9. Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment

10. A Situational Analysis of Home Delivery among Maasai Communities of Orkesumet, Northern Tanzania: The Qualitative Evidences

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

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

13. Assessing the quality of the management skills required for lower respiratory tract infections in Kilimanjaro, Tanzania

14. The Use of Guidelines for Lower Respiratory Tract Infections in Tanzania: A Lesson from Kilimanjaro Clinicians

15. Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

16. A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania

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