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1. An International Consensus Survey among Pediatric Surgeons on the Role of Appendectomy in Malrotation

Author

Revathy Menon, Kirtikumar J. Rathod, Arvind Sinha, Ashish Minocha, Carlos Garcia Hernandez, Dapeng Jiang, Enaam Raboei, Jiaoyang Cai, Lily J Saldana Gallo, Milind Chitnis, Purushottam Gera, Samir Pandya, and Zainab Al Balushi

Subjects
appendectomy, ladd’s procedure, malrotation, Pediatrics, RJ1-570, Surgery, RD1-811
Abstract

Introduction: Ladd’s procedure, originally described in 1936 for the treatment of malrotation, does not traditionally include appendectomy as a standard step. We conducted a multinational survey to investigate the current consensus on the role of appendectomy in Ladd’s procedure. Methodology: An anonymous online survey was distributed to pediatric surgeons worldwide. The survey collected demographic data and explored surgical preferences related to the management of malrotation. Open-ended questions were used to assess the opinions regarding the necessity of appendectomy, decision-making factors, and complications associated with appendectomy during Ladd’s procedure. Results: A total of 343 responses were received from 46 countries. Of the respondents, 319 (93%) were consultants and 24 (7%) were residents/trainees. When asked about the choice between open and laparoscopic Ladd’s procedure, 292 (85%) preferred open surgery. Overall, 184 (53%) respondents favored appendectomy in both open and laparoscopic Ladd’s procedure. Furthermore, 172 (50%) surgeons advocated for appendectomy in all malrotation cases, citing concerns about potential future appendicitis. While differences existed between all comparisons, none of them reached statistical significance. The factors influencing the decision to preserve the appendix included the risk of postoperative complications and the potential future use of the appendix as a surgical conduit. The surgical complications following appendectomy included surgical site infections in 14 (33%) patients, adhesive obstruction in 13 (31%) patients, intrabdominal abscesses in 10 (24%) patients, and fecal fistulas in 5 (12%) patients. Conclusion: The majority of surgeons aim to perform appendectomy in all malrotation cases, considering the potential risks and benefits of this approach. These findings offer valuable insights for clinical practice and may inform future guidelines and decision-making algorithms.

Published
2024
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2. Long proximal pouch oesophageal atresia with tracheo-oesophageal fistula, a diagnostic dilemma: case report

Author

Sello Machaea, Vuyo Nogela, and Milind Chitnis

Subjects
Oesophageal atresia, Tracheo-oesophageal fistula, Long proximal pouch, Diagnostic dilemma, Pediatrics, RJ1-570, Surgery, RD1-811
Abstract

Abstract Background Oesophageal atresia is a congenital abnormality commonly encountered in neonates. Classification proposed by Gross is the most frequently used. It divides the oesophageal anomalies into five types. Type C—proximal oesophageal atresia and distal tracheo-oesophageal fistula—is the most common. Dafoe and Ross described a rare subtype with a long proximal pouch. Only 11 cases of a long proximal pouch have been reported in the English literature so far. We describe a neonate with long proximal pouch oesophageal atresia with distal tracheo-oesophageal fistula emphasizing the difficulty in arriving at the diagnosis. Case presentation A 1-week-old neonate presented with feed intolerance and failure to advance orogastric tube into the stomach. Water soluble upper gastrointestinal tract contrast revealed a blind ending proximal oesophagus at the level of the diaphragm. Gastric volvulus was considered as a diagnosis. Patient underwent a laparotomy where a normal stomach was found. Bubbles were seen coming from the fashioned gastrostomy with each inspiration. This prompted us to consider the possibility of a missed oesophageal atresia with distal tracheo-oesophageal fistula. Diagnosis was confirmed on bronchoscopy and right thoracotomy. The tracheo-oesophageal fistula was ligated and a cervical oesophagostomy and Stamm gastrostomy were performed due to irreparable tear in the long upper pouch. Conclusion This rare subtype of long upper pouch oesophageal atresia poses a diagnostic dilemma that can result in delay in the diagnosis and management. This diagnosis should be suspected if the tip of the orogastric/feeding tube is seen to be far below the level of the carina.

Published
2022
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3. Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Author

Md Hasanuzzaman, Mohamed Ahmed, Ahmed Samir, Charlotte Smith, Lubna Samad, Vaishnavi Govind, Fakher Rahim, Ahmed Moussa, Adesoji O Ademuyiwa, Bobby John, Augusto Zani, Vivek Singh, Muhammad Arshad, Sadaf Altaf, Chan Hon Chui, Pooja Kumari, Thomas Smith, Ayesha Saleem, Matthew HV Byrne, Madhivanan Karthigeyan, Pravin Salunke, Darica Au, Kate Cross, Kokila Lakhoo, Vishal Kumar, Anna Maria Testi, Robyn Brown, Noel Peter, Georgios Tsoulfas, Francesco Pata, Adesoji Ademuyiwa, Tahmina Banu, Bruce Bvulani, Milind Chitnis, Maryam Ghavami Adel, Vrisha Madhuri, Pierfrancesco Lapolla, Andrea Mingoli, Hamidah Alias, Simone de Campos Vieira Abib, Ibukunolu Olufemi Ogundele, Felix M Alakaloko, Emmanuel A Ameh, Laila Hessissen, Kareem O Musa, Georgios Karagiannidis, Manoj Gupta, Maricarmen Olivos, Daniel Rhee, Maryam Khan, Christine Nitschke, Alexandra Valetopoulou, Ashrarur Rahman Mitul, Sabbir Karim, Mahmoud M Saad, Francis Abantanga, Gaetano Gallo, Mohamedraed Elshami, Mahmoud Elfiky, Soham Bandyopadhyay, Muath Alser, Elliott H Taylor, Duha Jasim, Somy Charuvila, Nazmul Islam, William B Lo, Uttam Kumar Nath, Robin Simpson, Zarina Abdul Latiff, Bruno Cirillo, Gioia Brachini, Megan Murphy, Zineb Bentounsi, Anette S Jacobsen, Anna Casey, Mohammed Alhendy, Taiwo Akeem Lawal, Samson Olori, Michael Boettcher, Muhammed Elhadi, Shaun Wilson, Dragana Janić, Amit Sehrawat, Patricia Shinondo, Shireen Anne Nah, Alhassan Abdul-Mumin, Karl-Heinz Frosch, Poorvaprabha Patil, Sarah Muma, Md Asaduzzaman, Athanasios Tragiannidis, Vijayendra Kumar, Mahan Salehi, Sara Ali, Renu Madan, Hafeez Abdelhafeez, Max Pachl, Benjamin Martin, Sonal Nagras, Mihir Sheth, Catherine Dominic, Suraj Gandhi, Divya Parwani, Rhea Raj, Diella Munezero, Rohini Dutta, Nsimire Mulanga Roseline, Kellie McClafferty, Armin Nazari, Smrithi Sriram, Sai Pillarisetti, King-David Nweze, Aishwarya Ashwinee, Gul Kalra, Priyansh Nathani, Khushman Kaur Bhullar, Nehal Rahim, Shweta Madhusudanan, Joshua Erhabor, Manasi Shirke, Aishah Mughal, Sravani Royyuru, Syeda Namayah Fatima Hussain, Daniel Robinson, Mehdi Khan, Alexandre Dukundane, Kwizera Festus, Rohan Pancharatnam, Lorraine Ochieng, Hritik Nautiyal, Leanne Gentle, Ehab Hanafy, Catherine Yang, Gideon Karplus, John Mathew, Olumide Abiodun Elebute, Oluwaseun Ladipo-Ajayi, Okechukwu Hyginus Ekwunife, Sherief Ghozy, Emily Hamilton, Dhruva Ghosh, Ahmed Sherif, Hajar Moujtahid, Ariana Axiaq, Amir Labib, Eman Abdulwahed, Kemal Tolga Saracoglu, Yasin Kara, Ahmed Y Azzam, Omar Elmandouh, Manjul Tripathi, Abdelrahman Azzam, Anfel Bouderbala, Aouabed Nesrine, Ammar Ayman, Mohamed Bonna, Safia Lorabi, Hira Zuberi, Iyad Sultan, Reto M Baertschiger, Kefas John Bwala, AM Umar, Abdurahaman Aremu, Dauda E Suleiman, Tybat Aliyu, Kashaf Turk, Oluseyi Oyebode Ogunsua, Tunde Talib Sholadoye, Musliu Adetola Tolani, Yakubu Alfa, Keffi Mubarak Musa, Ken Muma, Mitchelle Obat, Youssef Sameh Badran, Abdulrahman Ghassan Qasem, Faris Ayasra, Reema Alnajjar, Mohamed Abdel-Maboud, Abdelrahman Bahaa, Ayat M Saadeldin, Mohamed Adwi, Mahmoud Adly, Abdallah Elshenawy, Amer Harky, Kirstie Wright, Jessica Luyt, Olivia White, Nathan Thompson, Imogen Harrison, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Fatma Mohammed Masoud, Nyararai Togarepi, Elaine Carrolan, Ahmed Saleh, Mahmoud Bassiony, Mostafa Qatora, Mohamed Bahaaeldin, Shady Fadel, Yasmine El Chazli, Kamel Hamizi, Mehdi Anouar Zekkour, Rima Rahmoun, Boutheyna Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine Zerizer, Nacer Khernane, Brahim Saada, Imane Ammouze, Yahya Elkaoune, Ghita Chaoui, Hajar Benaouda, Meryem Gounni, Narjiss Aji, Joana Mafalda Monteiro, Susana Nunes, Maria do Bom-Sucesso, Kerri Becktell, Md Afruzul Alam, Orindom Shing Pulock, Tasmiah Tahera Aziz, Rosanda Ilic, Danica Grujicic, Tijana Nastasovic, Igor Lazic, Mihailo Milicevic, Vladimir Bascarevic, Radovan Mijalcic, Vuk Scepanovic, Aleksandar Stanimirovic, Aleksandra Paunovic, Ivan Bogdanovic, Shahnoor Islam, AKM Amirul Morshed, Mehnaz Akter, Zannat Ara, Mohammed Tanvir Ahammed, Tania Akter, Kamrun Nahar, Fatema Sayed, Ashfaque Nabi, Elif Akova, Evren Aydogmus, Bekir Can Kendirlioglu, Tufan Hicdonmez, Asim Noor Rana, Mohammed A Azab, Alzhraa Salah Abbas, Olanrewaju Moses, Ibiyeye Taiye Taibat, Taiwo Jones, Kalu Ukoha, Olagundoye Goke, Okorie Ikechukwu, Abiodun Idowu Okunlola, Helga Nauhaus, Danelle Erwee, Agata Chylinska, Prasanna Gomes, Elvercio Pereira de Oliveira Junior, Fabiola Leonelli Diz, Mohamed El Kassas, Usama Eldaly, Ahmed Tawheed, Mohamed Abdelwahab, Oudrhiri Mohammed Yassaad, Bechri Hajar, El Ouahabi Abdessamad, Arkha Yasser, Hessissen Laila, Farah Sameer Yahya, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Mariam Lami, Harmit Ghattaura, Eric W Etchill, Stacy Cooper, Kevin Crow, Morgan Drucker, Benjamin Shou, Alan Siegel, Gül Nihal Özdemir, Ehab El Refaee, John George Massoud, Ayah Bassam Ibrahim, Ruaa Bassam Ibrahim, Faris Abu Za'nouneh, Toqa Fahmawee, Ghazwani Salman, Ehab Alameer, Al-Mudeer Ali, Ghazwani Yahia, Khozairi Waleed, Khalil Ghandour, Shaima' Al-Dabaibeh, Ammar Al-Basiti, Hazim Ababneh, Omaima El-Qurneh, Yousef Alalawi, Ahmad Al Ayed, Naif Al Bolowi, Heidi Barola, Aubrey L Pagaduan, Jingdan Fan, Olufemi Oni, Janita Zarrish, Ramsha Saleem, Soha Zahid, Atiqa Amirali, Ahsan Nadeem, Sameer Saleem Tebha, Zonaira Qayyum, Sana Tahir, Anneqa Tahir, Rabbey Raza Khan, Ayesha Mehmood, Taimur Iftikhar Qureshi, Victor Calvagna, Nathalie Galea, Matthew R Schuelke, Kirk David Wyatt, Agnes Vojcek, Seham M Ragab, Abdallah R Allam, Eman Ibrahim Hager, Kıvılcım Karadeniz Cerit, Adnan Dağçınar, Tümay Umuroğlu, Ayten Saraçoğlu, Mustafa Sakar, Can Kıvrak, Gül Çakmak, Ibrahim Sallam, Gamal Amira, Mohamed Sherief, Arissa Ikeda, Licia Portela, Marianne Monteiro Garrigo, Fernanda Lobo, Sima Ester Ferman, Andrew Nwankwo Osuigwe, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Abiodun Folashade Adekanmbi, Olubunmi Motunrayo Fatungase, Olubunmi Obafemi Obadaini, Sarah Al-Furais, Humaida Hemlae, Sreylis Nay, Fabianne Altruda de Moraes Costa Carlesse, Denis Cozzi, Paolo Musiu, Paolo Sapienza, Martina Zambon, Simona Meneghini, Pierfranco Cicerchia, Abdulrahman Omar Taha, Bouaoud Souad, Mebarki Malika, Bioud Belkacem, Fayza Haider, Halwani Yaninga Fuseini, Peter Gyamfi Kwarteng, Abubakari Bawa Abdulai, Sheba Mary Pognaa Kunfah, Stephanie Ajinkpang, Mary Joan Kpiniong, Kingsley Aseye Hattor, Kingsley Appiah Bimpong, Mohamed Elbahnasawy, Sherief Abdelsalam, Amanpreet Brar, Andreea C Matei, Hira Khalid Zuberi, Kishwer Nadeem, Naema Khayyam, Fatima Ambreen Imran, Nida Zia, Sadia Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa Hamdan, Abdeljawad Mazloum, Ali Abodest, Nisreen Ali, Ammar Omran, Alaa Ahmed, Munawar Hraib, Victor Khoury, Abdulrahman Almjersah, Mohammad Ali Deeb, Akram Ahmed, Ahmad Bouhuwaish, Alqasim Abdulkarim, Marwa Biala, Reem Ghamgh, Amani Alamre, Marwa Shelft, Hoda Tawel, Emmanuel Hatzipantelis, Eleni Tsotridou, Assimina Galli-Tsinopoulou, C-Khai Loh, Doris Lau, Kelvin Ifeanyichukwu Egbuchulem, Olakayode Olaolu Ogundoyin, Isaac Dare Olulana, Oluwasegun Joshua Afolaranmi, AbdulBasit Fehintola, Annika Heuer, Matthias Priemel, Lennart Viezens, Martin Stangenberg, Marc Dreimann, Alonja Reiter, Jasmin Meyer, Leon Köpke, Uduak Offiong, Philip Mari Mshelbwala, Fashie Andrew Patrick, Aminu Muhammed Umar, N Otene ThankGod, Yuki Julius Ng, Syukri Ahmad Zubaidi, Murad Almasri, Rasaq Olaosebikan, Akila Muthukumar, Amon Ngongola, Azad Patel, Abdullahi Nuhu-Koko, Baba Jibrin, Gabriela Guillén, Sergio López, José Andrés Molino, Pablo Velasco, Omar Hamam, Rim Elmandouh, Nensi Melissa Ruzgar, Rachel Levinson, Shashwat Kala, Sarah Ullrich, Emily Christison-Lagay, Janice Hui Ling Wong, Reto Baertschiger, Essam Elhalaby, Guido Seitz, Judith Lindbert, Asimina Galli-Tsinopoulou, Calogero Virgone, Eric Mwangi Irungu, Outani Oumaima, Lily Saldana, Jan Godzinsky, Abdelbasit Ali, Mohamed Bella Jalloh, Nellie Bell, Annette Jacobsen, Israel Fernandez Pineda, Lucas Krauel, Waha Rahama, Hazim Elfatih, Arda Isik, Andrea Hayes-Jordan, Roshni Dasgupta, Krishna Kumar Govindarajan, Marta deAndres Crespo, Nitin James Peters, Santosh Kumar Mahalik, Rajat Piplani, Enono Yhoshu, K S Rajkumar, Sadi A Abukhalaf, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Raja Mari Mohammed Nasef, Benjamin J O'Sullivan, Mohamed Hassanin, Dave R Lal, Brian T Craig, Vishal Michael, M Joseph John, William Bhatti, Swati Daniel, Jyoti Dhiman, Hunar Mahal, Atul Suroy, Shruti Kakkar, Shaina Kamboj, Suraj Singh, AKM Khairul Basher, SM Rezanur Rahman, Md Asif Iqbal, Md Masud Rana, Monica Dobs, Mohamed Atef Mohamed Ghamry, Joana Monteiro, Marco Aurelio Ciriaco Padilha, Lucas Garschagen deCarvalho, Sandip Kumar Rahul, Digamber Chaubey, Rejin Kebudi, Sema Bay Buyukkapu, Kumaravel Sambandan, Smita Kayal, Gunaseelan Karunanithi, Bikash Kumar Naredi, Bibekanand Jindal, Ranya M Baddourah, Ayah Al Shraideh, Ahmad Ozair, Ankur Bajaj, Bal Krishna Ojha, Kaushal Kishor Singh, Atique Anwar, Vinay Suresh, Mohamad K Abou Chaar, Christopher O Bode, Justina O Seyi-Olajide, George C Ihediwa, Edamisan O Temiye, Adeseye M Akinsete, Iqra Effendi, Khaled Mamdouh, Mohamed Atef, Mohamed Faried, Jake A Kloeber, Robert L Owen, Alexander S Roth, J Hudson Barnett, Lucien P Jay, Paul J Galardy, Bernard Mbwele, Irene Nguma, Moshi Moshi Shabani, Amani Twaha, Bilal Matola, Mahmoud Maher Abdelnaby Alrahawy, Simone deOliveira Coelho, Ricardo Vianna deCarvalho, FernandaFerreira daSilva Lima, Moawia Mohammed AliElhassan, Nada Osman Yousif Elhaj, Hytham KS Hamid, Vincent E Nwatah, Adewumi B Oyesakin, RM Jeffri Ismail, Simone deCamposVieira Abib, Mayara Caroline Amorim Fanelli, Fernanda Kelly Marques de Souza, Sandeep Mohindra, Ninad R Patil, Richa Jain, Gopal Nambi, Norehan Johari, Anas Shikha, Win SabaiPhyu Han, Zahidah Ahmad, Yen Yan Lim, Roserahayu Idros, Noorainun Mohd Yusof, David Nelson Jaisingh, Fatema Naser AlFayez, Elana Kleinman, Taylor Ibelli, Rochelle Fayngor, Tzvi Najman, Etai Adam, Daniella Melamed, Cecilia Paasche, Farman Ali Laghari, Zainab Al Balushi, Abdulhakim Awadh SalimAl-Rawas, Ali Al Sharqi, Ammar Saif AlShabibi, Ismail Al Bulushi, Muna Alshahri, Abdulrahman AlMirza, Ola Al Hamadani, Jawaher Al Sharqi, Anisa Al Shamsi, Bashar Dawud, Sareya Al Sibai, Gilbert B Bonsaana, Edmund M Der, Francis A Abantanga, Bardisan Gawrieh, Hassan Salloum, Mohammad Ahmad Almahmod Alkhalil, Waseem Shater, Ali Farid Alelayan, Alaa Guzlan, Asmaa AM Albanna, Dayang AnitaAbdul Aziz, Azrina Syarizad Khutubul Zaman, Biobele J Brown, Ajiboye L Olalekan, Christopher S Lukong, Ezekiel I Ajayi, Luca Pio, Nitin James Peter, Ravi Kishore, Mohammad K Abou Chaar, Dayang Anita Abdul Aziz, Dhruva Nath Ghosh, and Raphael N Vuille-dit-Bille

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children

Published
2022
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4. Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Author

Mohamed Ahmed, Ahmad Mansour, Ahmed Samir, Charlotte Smith, Lubna Samad, Vaishnavi Govind, Fakher Rahim, Augusto Zani, Muhammad Arshad, Sadaf Altaf, Chan Hon Chui, Pooja Kumari, Thomas Smith, Ayesha Saleem, Darica Au, Kate Cross, Kokila Lakhoo, Anna Maria Testi, Robyn Brown, Noel Peter, Francesco Pata, Adesoji Ademuyiwa, Tahmina Banu, Bruce Bvulani, Milind Chitnis, Maryam Ghavami Adel, Matthew H V Byrne, Pierfrancesco Lapolla, Andrea Mingoli, Lucy Davies, Dennis Mazingi, Hamidah Alias, Simone de Campos Vieira Abib, Ibukunolu Olufemi Ogundele, Laila Hessissen, Mohammad Ahmad, Maricarmen Olivos, Daniel Rhee, Maryam Khan, Christine Nitschke, Alexandra Valetopoulou, Ashrarur Rahman Mitul, Sabbir Karim, Gaetano Gallo, Mohamedraed Elshami, Mahmoud Elfiky, Soham Bandyopadhyay, Muath Alser, Elliott H Taylor, Duha Jasim, Somy Charuvila, Nazmul Islam, William B Lo, Robin Simpson, Zarina Abdul Latiff, Bruno Cirillo, Gioia Brachini, Megan Murphy, Zineb Bentounsi, Anette S Jacobsen, Anna Casey, Abdulrasheed A Nasir, Taiwo Akeem Lawal, Samson Olori, Michael Boettcher, Muhammed Elhadi, Shaun Wilson, Dragana Janić, Patricia Shinondo, Shireen Anne Nah, Alhassan Abdul-Mumin, Dayang Anita Abdul Aziz, J Benjamin, Karl-Heinz Frosch, Poorvaprabha Patil, Sarah Muma, Emmanuel Uwiringiyimana, Athanasios Tragiannidis, Mahan Salehi, Sara Ali, Hafeez Abdelhafeez, Max Pachl, Benjamin Martin, Sonal Nagras, Mihir Sheth, Catherine Dominic, Suraj Gandhi, Divya Parwani, Rhea Raj, Diella Munezero, Rohini Dutta, Nsimire Mulanga Roseline, Kellie McClafferty, Armin Nazari, Smrithi Sriram, Sai Pillarisetti, Aishwarya Ashwinee, Gul Kalra, Priyansh Nathani, Khushman Kaur Bhullar, Nehal Rahim, Shweta Madhusudanan, Joshua Erhabor, Manasi Shirke, Aishah Mughal, Sravani Royyuru, Daniel Robinson, Mehdi Khan, Alexandre Dukundane, Kwizera Festus, Rohan Pancharatnam, Lorraine Ochieng, Hritik Nautiyal, Leanne Gentle, Ehab Hanafy, Catherine Yang, John Mathew, Olumide Abiodun Elebute, Oluwaseun Ladipo-Ajayi, Okechukwu Hyginus Ekwunife, Sherief Ghozy, Aya Zazo, Salah Eddine Oussama Kacimi, Ahmed Sherif, Krithi Ravi, Nermin Badwi, Hajar Moujtahid, Ariana Axiaq, Eman Abdulwahed, Kemal Tolga Saracoglu, Yasin Kara, Ahmed Y Azzam, Omar Elmandouh, KingDavid Nweze, Syeda Namayah Fatima Hussain, Marta de Andres Crespo, Fatumata Jalloh, Shahnur Shah, Rohini Rajpal, Masooma Rana, Muskaan Abdul Qadir, Abdelrahman Azzam, Mayara Fanelli, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Isadora Schwaab Guerini, Anfel Bouderbala, Sarah Alfurais, Mohamed Gamal, Yara Hijazi, Shatha Tailakh, Hamza AlNaggar, Zain Douba, Sewar Elejla, Abdullah Eldaly, Ekram Sharashi, Tamara Elyan, Aouabed Nesrine, Ammar Ayman, Mohamed Bonna, Safia Lorabi, Hassan Alalami, Rawan Yasser Emam, Mohamad K Abou Chaar, Hira Zuberi, Iyad Sultan, Dhruv Nath Ghosh, Nitin James Peters, Reto M Baertschiger, Kefas John Bwala, AM Umar, Abdurahaman Aremu, Dauda E Suleiman, Tybat Aliyu, Kashaf Turk, Oluseyi Oyebode Ogunsua, Tunde Talib Sholadoye, Musliu Adetola Tolani, Yakubu Alfa, Keffi Mubarak Musa, Mwangi Irungu, Ken Muma, Mitchelle Obat, Youssef Sameh Badran, Abdulrahman Ghassan Qasem, Faris Ayasra, Reema Alnajjar, Mohamed Abdel-Maboud, Abdelrahman Bahaa, Ayat M Saadeldin, Mohamed Adwi, Mahmoud Adly, Abdallah Elshenawy, Amer Harky, Kirstie Wright, Jessica Luyt, Olivia White, Nathan Thompson, Imogen Harrison, Sara Kader Alsaeiti, Fatma Saleh Benkhial, Mohammed Miftah Faraj Almihashhish, Eman Salem Muftah Burzeiza, Raja Mari Mohammed Nasef, Hend Mohammed Masoud, Mabroukah Saeid Alshamikh, Fatma Mohammed Masoud, Nyararai Togarepi, Elaine Carrolan, Mohamed Hassanin O'Sullivan, Ahmed Saleh, Mahmoud Bassiony, Mostafa Qatora, Mohamed Bahaaeldin, Shady Fadel, Yasmine El Chazli, Kamel Hamizi, Mehdi Anouar Zekkour, Rima Rahmoun, Boutheyna Drid, Salma Naje Abu Teir, Mohamed Yazid Kadir, Yassine Zerizer, Nacer Khernane, Brahim Saada, Imane Ammouze, Yahya Elkaoune, Ghita Chaoui, Hajar Benaouda, Meryem Gounni, Narjiss Aji, Joana Mafalda Monteiro, Susana Nunes, Maria do Bom-Sucesso, Dave R. Lal, Brian T. Craig, Kerri Becktell, Md Afruzul Alam, Orindom Shing Pulock, Tasmiah Tahera Aziz, Rosanda Ilic, Danica Grujicic, Tijana Nastasovic, Igor Lazic, Mihailo Milicevic, Vladimir Bascarevic, Radovan Mijalcic, Vuk Scepanovic, Aleksandar Stanimirovic, Aleksandra Paunovic, Ivan Bogdanovic, Shahnoor Islam, AKM Amirul Morshed, A. K. M. Khairul Basher, Mehnaz Akter, S. M. Rezanur Rahman, Zannat Ara, Mohammed Tanvir Ahammed, Tania Akter, Kamrun Nahar, Fatema Sayed, Ashfaque Nabi, Md. Asif Iqbal, Md. Masud Rana, Md. Asaduzzaman, Md. Hasanuzzaman, Elif Akova, Evren Aydogmus, Bekir Can Kendirlioglu, Tufan Hicdonmez, Arshiya Adhnon, Asim Noor Rana, Hani Humad, Anjan Madasu, Mohammed A Azab, Alzhraa Salah Abbas, Olanrewaju Moses, Ibiyeye Taiye Taibat, Taiwo Jones, Kalu Ukoha, Olagundoye Goke, Okorie Ikechukwu, Abiodun Idowu Okunlola, Helga Nauhaus, Danelle Erwee, Agata Chylinska, Prasanna Gomes, Marco Aurelio Ciriaco Padilha, Elvercio Pereira de Oliveira Junior, Lucas Garschagen de Carvalho, Fabiola Leonelli Diz, Mohamed El Kassas, Usama Eldaly, Ahmed Tawheed, Mohamed Abdelwahab, Oudrhiri Mohammed Yassaad, Bechri Hajar, El Ouahabi Abdessamad, Arkha Yasser, Hessissen Laila, Farah Sameer Yahya, Yasir Al-Agele, Maria Teresa Peña Gallardo, Jacqueline Elizabeth Montoya Vásquez, Juan Luis García León, Sebastián Shu Yip, Mariam Lami, Harmit Ghattaura, Eric W Etchill, Stacy Cooper, Kevin Crow, Morgan Drucker, Benjamin Shou, Alan Siegel, Gül Nihal Özdemir, Ehab El Refaee, John George Massoud, Ayah Bassam Ibrahim, Ruaa Bassam Ibrahim, Faris Abu Za'nouneh, Ranya M. Baddourah, Toqa Fahmawee, Ayah Al_Shraideh, Ghazwani Salman, Ehab Alameer, Al-Mudeer Ali, Ghazwani Yahia, Khozairi Waleed, Mohamad K. Abou Chaar, Khalil Ghandour, Shaima' Al-Dabaibeh, Ammar Al-Basiti, Hazim Ababneh, Omaima El-Qurneh, Yousef Alalawi, Ahmad Al Ayed, Naif Al Bolowi, Amos HP Loh, Heidi Barola, Aubrey L Pagaduan, Jingdan Fan, Adesoji O. Ademuyiwa, Christopher O. Bode, Justina O. Seyi-Olajide, Felix M. Alakaloko, George C. Ihediwa, Kareem O. Musa, Edamisan O. Temiye, Olufemi Oni, Adeseye M. Akinsete, Janita Zarrish, Ramsha Saleem, Soha Zahid, Atiqa Amirali, Ahsan Nadeem, Sameer Saleem Tebha, Zonaira Qayyum, Sana Tahir, Anneqa Tahir, Rabbey Raza Khan, Ayesha Mehmood, Taimur Iftikhar Qureshi, Victor Calvagna, Nathalie Galea, Matthew R Schuelke, Jake A. Kloebe, Robert L. Owen, Alexander S. Roth, J. Hudson Barnett, Lucien P. Jay, Kirk David Wyatt, Paul J. Galardy, Agnes Vojcek, Mahmoud Maher Abdelnaby Alrahawy, Seham M Ragab, Abdallah R Allam, Eman Ibrahim Hager, Kıvılcım Karadeniz Cerit, Adnan Dağçınar, Tümay Umuroğlu, Ayten Saraçoğlu, Mustafa Sakar, Can Kıvrak, Gül Çakmak, Ibrahim Sallam, Gamal Amira, Mohamed Sherief, Simone de Oliveira Coelho, Arissa Ikeda, Licia Portela, Marianne Monteiro Garrigo, Ricardo Vianna de Carvalho, Fernanda Lobo, Sima Ester Ferman, Fernanda Ferreira da Silva Lima, Moawia Mohammed Ali Elhassan, Nada Osman Yousif Elhaj, Hytham K. S. Hamid, Emmanuel A. Ameh, Vincent E. Nwatah, Adewumi B. Oyesakin, Andrew Nwankwo Osuigwe, Chisom Adaobi Nri-Ezedi, Eric Okechukwu Umeh, Nellie Patiala, Abiodun Folashade Adekanmbi, Olubunmi Motunrayo Fatungase, Olubunmi Obafemi Obadaini, Sarah Al-Furais, Humaida Hemlae, Sreylis Nay, R M Jeffri Ismail, Simonede Campos Vieira Abib, Fabianne Altruda de Moraes Costa Carlesse, Mayara Caroline Amorim Fanelli, Fernanda Kelly Marques de Souza, Denis Cozzi, Paolo Musiu, Paolo Sapienza, Martina Zambon, Simona Meneghini, Pierfranco Cicerchia, Abdulrahman Omar Taha, Bouaoud Souad, Mebarki Malika, Bioud Belkacem, Ayman Meelad, Hajier Salim Alrashed, Fayza Haider, Fatema Naser Al Fayez, Halwani Yaninga Fuseini, Peter Gyamfi Kwarteng, Abubakari Bawa Abdulai, Sheba Mary Pognaa Kunfah, Gilbert B. Bonsaana, Stephanie Ajinkpang, Edmund M. Der, Francis A. Abantanga, Mary Joan Kpiniong, Kingsley Aseye Hattor, Kingsley Appiah Bimpong, Mohamed Elbahnasawy, Sherief Abdelsalam, Reto M. Baertschiger, Amanpreet Brar, Andreea C Matei, Hira Khalid Zuberi, Kishwer Nadeem, Naema Khayyam, Fatima Ambreen Imran, Nida Zia, Sadia Muhammad, Muhammad Rafie Raza, Muhammad Rahil Khan, Alaa Hamdan, Abdeljawad Mazloum, Ali Abodest, Nisreen Ali, Bardisan Gawarieh, Ammar Omran, Almed Moussa, Alaa Ahmed, Munawar Hraib, Victor Khoury, Abdulrahman Almjersah, Mohammad Ali Deeb, Almahmod Alkhalil, Akram Ahmed, Ali Alelayan, Ali Hammed, Wassem Shater, Ahmad Bouhuwaish, Alqasim Abdulkarim, Marwa Biala, Reem Ghamgh, Amani Alamre, Marwa Shelft, Asmaa A. M. Albanna, Hoda Tawel, Emmanuel Hatzipantelis, Eleni Tsotridou, Assimina Galli-Tsinopoulou, C-Khai Loh, Doris Lau, Azrina Syarizad Khutubul, Raphael N. Vuille-dit-Bille, Stefan G. Holland-Cunz, Nima Allafi, Kelvin Ifeanyichukwu Egbuchulem, Olakayode Olaolu Ogundoyin, Isaac Dare Olulana, Biobele J. Brown, Oluwasegun Joshua Afolaranmi, AbdulBasit Fehintola, Annika Heuer, Matthias Priemel, Lennart Viezens, Martin Stangenberg, Marc Dreimann, Alonja Reiter, Jasmin Meyer, Leon Köpke, Uduak Offiong, Philip Mari Mshelbwala, Fashie Andrew Patrick, Aminu Muhammed Umar, N Otene ThankGod, Kazeem O. O. Ibrahim, Dupe S. Ademola-Popoola, Olayinka T. Sayomi, Alege Abdurrzzaq, Ademola A. Adeyeye, Khadijah O. Omokanye, Lukman O Abdur-Rahman, Olubisi Olutosin Bamidele, Shakirullah AbdulAzeez, Aminat Akinoso, Michael O. Adegboye, Yuki Julius Ng, Syukri Ahmad Zubaidi, Murad Almasri, Rasaq Olaosebikan, Akila Muthukumar, Amon Ngongola, Azad Patel, Abdullahi Nuhu-Koko, Baba Jibrin, Ajiboye L. Olalekan, Christopher S. Lukong, Ezekiel I. Ajayi, Gabriela Guillén, Sergio López, José Andrés Molino, Pablo Velasco, Omar Hamam, Rim Elmandouh, Nensi Melissa Ruzgar, Rachel Levinson, Shashwat Kala, Sarah Ullrich, Emily Christison-Lagay, Aya Sabry Mortada, Mahmoud Ahmed Ebada, Eman Seif Alnaser Solimam, Khaled Abualkher, Amr Mohammed Elsayed Yousf, Mohamed Mohamed Holail, Reem Mohamed Almowafy, Janice Hui Ling Wong, Reto Baertschiger, Essam Elhalaby, Mahmoud M. Saad, Guido Seitz, Judith Lindbert, Francis Abantanga Georgios Tsoulfas, Asimina Galli-Tsinopoulou, Calogero Virgone, Mohammad K. Abou Chaar, Eric Mwangi Irungu, Outani Oumaima, Lily Saldana, Jan Godzinsky, Abdelbasit Ali, Mohamed Bella Jalloh, Nellie Bell, Annette Jacobsen, Israel Fernandez Pineda, Lucas Krauel, Waha Rahama, Hazim Elfatih, Arda Isik, Andrea Hayes-Jordan, and Roshni Dasgupta

Subjects
Medicine
Abstract

Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.Design A multicentre, international, collaborative cohort study.Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measure All-cause mortality at 30 days and 90 days.Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p

Published
2022
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5. Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study

Author

Niyi Ade-Ajayi, Dan Poenaru, Damian Clarke, Stephen Tabiri, Larry Akoko, Sharon Cox, Toru Shimizu, Bassey Edem, Kokila Lakhoo, Zaitun M Bokhary, Adesoji Ademuyiwa, Felix Alakaloko, Emmanuel Ameh, Theophilus Teddy Kojo Anyomih, Rouma Bankole, Eric Borgstein, Bruce Bvulani, Milind Chitnis, Miliard Derbew, Stella Eguma, Omolara Faboya, Jacques Fadhili Bake, Intisar Hisham, Nasser Kakembo, Bertille Ki, Phyllis Kisa, Rashmi Kumar, Jerome Loveland, Bothwell Mbuwayesango, Mulewa Mulenga, Emmanuel Owusu Abem, Yona Ringo, John Sekabira, Justina Seyi-Olajide, Albert Wandaogo, Anne Wesonga, Ali Hamad, Naomi Jane Wright, Abdelbasit E Ali, Ainhoa Costas-Chavarri, Samuel Osei-Nketiah, William Appeadu-Mensah, Opeoluwa Adesanya, Olalekan Ajai, Aminu Mohammad, Stephanie Van Straten, Robert Jaich, Osman Imoro, Lawal Abdullahi, Roel Matos-Puig, Andrew JM Leather, Emma Thomson, Ademola Olusegun Talabi, Oludayo Adedapo Sowande, Christopher Bode, Taiwo Akeem Lawal, Samson Olori, Reitze Rodseth, Andre Theron, Emily Rose Smith, Alessandra Bisquera, Anyanwu Lofty John-Chukwuemeka, Justine Seyi-Olajide, Bernadette Béré, Luc Malemo, Elisee Bake, Nwokoro Collins, Aberibigbe M. O. Shonubi, Daniel Sidler, Houégban Romeo, Gbenou Antoine Seraphin, Eugene Zoumenou, Béré Bernadette, Bandré Emile, Tapsoba W. Toussaint, Kabre Yvette, Manuela Ehua, Agbara Kouame, Moulot Olivier, Nandiolo Rose, Mesay Hailemariam Asfaw, Gudeta Didi, Hanna Getachew, Woubedil Kiflu, Samuel Negash, Tihitiena Negussie, Amezene Tadesse, Fiseha Temesgen, Afua Hesse, Francis Atidana Abantanga, Adakudugu Ida, Martin Kyere, Anwar Sadat Seidu, Paul M. Wondoh, Thomas Kirengo, Michael Ganey, Michael Mwachiro, Robert K Parker, Sinkeet Ranketi, Bitiel Banda, Caroline Melhado, Biplab Nandi, Mohakhelha Nyamulani, Johannes Verweij, Moustapha Helle, Paschal Anyanwu, Matthias Igoche, Elizabeth Ogboli-Nwasor, Baba Suleiman, Sholadoye Tunde Talib, Mustapha Abdulazeez, Farinyaro Aliyu, Aliyu Mohammed, Terlumun Patrick, Charles Soo, Akinlabi Emmanuel Ajao, Olayemi Anthony Ajiboye, Michael Abel Alao, Odion-Obomhense Kesiena Helen, Adenike Odewabi, Anuoluwapo Aremo, Taiwo Jones Olaoluwa, Odi Temitope, Kayode Bamigbola, E Uduehe Enono, Abdulsalam Moruf, Roland I Osuoji, Omolara M. Williams, Fatuga Adedeji, Ihediwa Chibuike, Ibironke Desalu, Olumide Abiodun Elebute, Charles Ememonu, Oluwaseun Ladipo-Ajayi, Sola Kushimo, Kayode Olayade, Adebambo Olowu, Okechukwu Hyginus Ekwunife, Victor Ifeanyichukwu Modekwe, Obiechina Sylvester Okwuchukwu, Ngozi Chidinma Osuji, Ezidiegwu Ugochukwu Stanley, Jideofor Okechukwu Ugwu, Chuka Ifeanyichukwu Ugwunne, Collins Chijioke Adumah, Lukmon Amosu, Ibukunolu Ogundele, Aderibigbe M. O. Shonubi, Felix Kumolalo, Olakayode Ogundoyin, Dare Olulana, John Chinda, Osagie Olabisi, Akan Inyang, Ijeoma Esther Nwachukwu, Nurudeen Toyin Abdulraheem, Lukman O. Abdur-Rahman, James O. Adeniran, Muslimat A. Alada, Abdulrasheed A. Nasir, David C. Nwosu, Christopher C Amah, Sebastian Okwuchukwu Ekenze, Uchechukwu Obiora Ezomike, Emmanuel I. Nwangwu, Ijeoma C. Obianyo, Nene E Obianyo, Nwankwo Elochukwu Perpetua, Alfred T Aggo, Tobin Maxwell, Philemon Okoro, James A. Brown, Moses Kasumba, Steve Kyota, Joy Robinson, Seo-Hwa Chung, Savannah smit, Andrew Grieve, Charles Carapinha, Mie Elsen, Nayha Gautam, Shamaman Harilal, Sanele Madziba, Hansraj Mangray, Babalwa Nondela, Ria Naidoo, Arasha Thotharam, Kondjela Sara Hamunyela, Corne De Vos, Enas Musa Ismail, Robert Bahati, Peter Dattani, Ezekiel Kambona, Silas Msangi, Komla Gnassingbé, Hamza Doles Sama, Mary T Nabukenya, Emma Lillie, Rae Oranmore-Brown, Hope Phiri, Victoria Simiyu, Tungamirai Gwatirisa, Houessou Gandjehou, Ebassa Karl, Goutam Chowdhury, Alagie Manneh, Michael Amoah, Boateng Nimako, Allan Kochi, Connie Keung, Robert Kuremu, Heuric Rakotomalala, Habou Oumarou, Okafor David, Faruk A Suleiman, Faturoti Olubukola, Innocent Igwilo, Alwanlehi Eighemhenrio, Andrew Shitta, Musa Ibrahim Zarenawa, Iyekeoretin Evbuomwan, Wabada Samuel, Emmanuel Kayibanda, Joseph Lule, and Riikka Valjakka

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).Methods A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p

Published
2021
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6. Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Author

Charles Mock, Jonathan Lord, Monica Langer, Niyi Ade-Ajayi, Dan Poenaru, Harshjeet Singh Bal, Massimo Caputo, Damian Clarke, Fred Bulamba, Lubna Samad, David Cunningham, George Youngson, Michael Cooper, Tamara Fitzgerald, Henry Rice, Patrick Kamalo, Emily R Smith, Bistra Zheleva, David Drake, Emily Smith, Lars Hagander, Bassey Edem, Sridhar Gibikote, Jessica Ng, David Spiegel, Saurabh Saluja, Peter Ssenyonga, Thiago Augusto Hernandes Rocha, Joao Vissoci, Nubia Rocha, Mark Shrime, Henry E Rice, Mohamed Abdelmalak, Nurudeen Abdulraheem, Edna Adan Ismail, Eltayeb Ahmed, Sunday Ajike, Olugbemi Benedict Akintububo, Brendan Allen, Emmanuel Ameh, Shanthi Anbuselvan, Jamie Anderson, Theophilus Teddy Kojo Anyomih, Leopold Asakpa, Gudeta Assegie, Jason Axt, Ruben Ayala, Frehun Ayele, Rouma Bankole, Tahmina Banu, Tim Beacon, Stephen Bickler, Zaitun Bokhari, Hiranya Kumar Borah, Eric Borgstein, Nick Boyd, Jason Brill, Britta Budde-Schwartzman, Marilyn Butler, Bruce Bvulani, Sarah Cairo, Juan Francisco Campos Rodezno, Milind Chitnis, Maija Cheung, Bruno Cigliano, Tessa Concepcion, Scott Corlew, Sergio D’Agostino, Shukri Dahir, Bailey Deal, Miliard Derbew, Sushil Dhungel, Elizabeth Drum, Stella Eguma, Beda R. Espineda, Samuel Espinoza, Faye Evans, Jacques Fadhili Bake, Diana Farmer, Tatiana Fazecas, Mohammad Rafi Fazli, Graham Fieggen, Anthony Figaji, Jean Louis Fils, Randall Flick, Gacelle Fossi, George Galiwango, Mike Ganey, Zipporah Gathuya, Maryam Ghavami Adel, Vafa Ghorban Sabagh, Hetal Gohil, Laura Goodman, David Grabski, Sarah Greenberg, Russell Gruen, Rahimullah Hamid, Erik Hansen, William Harkness, Mauricio Herrera, Intisar Hisham, Andrew Hodges, Sarah Hodges, Ai-Xuan Holterman, Andrew Howard, Romeo Ignacio, Dawn Ireland, Enas Ismail, Rebecca Jacob, Anette Jacobsen, Deeptiman James, Ebor Jacob James, Adiyasuren Jamiyanjav, Kathy Jenkins, Guy Jensen, Maria Jimenez, Tarun John K Jacob, Walter Johnson, Anita Joselyn, Nasser Kakembo, Neema Kaseje, Bertille Ki, Phyllis Kisa, Peter Kim, Krishna Kumar, Rashmi Kumar, Charlotte Kvasnovsky, Ananda Lamahewage, Christopher Lavy, Colin Lazarus, Chelsea Lee, Basil Leodoro, Allison Linden, Katrine Lofberg, Jerome Loveland, Leecarlo Millano Lumban Gaol, Vrisha Madhuri, Pavrette Magdala, Luc Kalisya Malemo, Aeesha Malik, John Mathai, Marcia Matias, Bothwell Mbuwayesango, Merrill McHoney, Liz McLeod, Mubarak Mohamed, Ivan Molina, Ashika Morar, Zahid Mukhtar, Mulewa Mulenga, Bhargava Mullapudi, Jack Mulu, Byambajav Munkhjargal, Arlene Muzira, Mary Nabukenya, Mark Newton, Karissa Nguyen, Laurence Isaaya Ntawunga, Peter M. Nthumba, Alp Numanoglu, Benedict Nwomeh, Kristin Ojomo, Keith Oldham, Maryrose Osazuwa, Doruk Ozgediz, Emmanuel Owusu Abem, Shazia Peer, Norgrove Penny, Robin Petroze, Vithya Priya, Ekta Rai, Lola Raji, Vinitha Paul Ravindran, Desigen Reddy, Yona Ringo, Amezene Robelie, Jose Roberto Baratella, David Rothstein, Coleen Sabatini, Soumitra Saha, Lily Saldaña Gallo, John Sekabira, Bello B. Shehu, Ritesh Shrestha, Sabina Siddiqui, David Sigalet, Martin Situma, Adrienne Socci, Etienne St-Louis, Jacob Stephenson, Erin Stieber, Richard Stewart, Vinayak Shukla, Thomas Sims, Faustin Felicien Mouafo Tambo, Robert Tamburro, Mansi Tara, Ahmad Tariq, Reju Thomas, Leopold Torres Contreras, Stephen Ttendo, Benno Ure, Luca Vricella, Luis Vasquez, Vijayakumar Raju, Jorge Villacis, Gustavo Villanova, Catherine deVries, Amira Waheeb, Saber Waheeb, Albert Wandaogo, Anne Wesonga, Sigal Willner, Nyo Nyo Win, Hussein Wissanji, Paul Mwindekuma Wondoh, Garreth Wood, Benjamin Yapo, Yasmine Yousef, Denle'wende' Sylvain Zabsonre, Luis Enrique, Zea Salazar, and Adiyasuren Zevee

Subjects
Medicine
Abstract

Objectives The optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.Design This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participants We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measures We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).Findings There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.Conclusions We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.

Published
2020
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7. Clinical presentation and management of childhood intussusception in South Africa

Author

Milind Chitnis, Jacqueline E. Tate, Michelle J. Groome, Sello Machaea, Shabir A. Madhi, Marion Arnold, Jerome Loveland, Mari Kirsten, Ashwini Maharaj, Sharon Cox, A. Withers, Umesh D. Parashar, Corné de Vos, and Susanna M. le Grange

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Perforation (oil well), Surgical intervention, Enema, Outcomes, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, South Africa, 0302 clinical medicine, Intussusception (medical disorder), Pediatric surgery, medicine, Humans, 030212 general & internal medicine, Child, Retrospective Studies, business.industry, Mortality rate, Infant, General Medicine, Bowel resection, medicine.disease, Abdominal mass, Surgery, Paediatric, Intestinal Perforation, Reduction methods, Pediatrics, Perinatology and Child Health, Vomiting, Original Article, Female, medicine.symptom, business, Intussusception
Abstract

Purpose We assessed management and outcomes for intussusception at nine academic hospitals in South Africa. Methods Patients ≤ 3 years presenting with intussusception between September 2013 and December 2017 were prospectively enrolled at all sites. Additionally, patients presenting between July 2012 and August 2013 were retrospectively enrolled at one site. Demographics, clinical information, diagnostic modality, reduction methods, surgical intervention and outcomes were reviewed. Results Four hundred seventy-six patients were enrolled, [54% males, median age 6.5 months (IQR 2.6–32.6)]. Vomiting (92%), bloody stool (91%), abdominal mass (57%), fever (32%) and a rectal mass (29%) represented advanced disease: median symptom duration was 3 days (IQR 1–4). Initial reduction attempts included pneumatic reduction (66%) and upfront surgery (32%). The overall non-surgical reduction rate was 28% and enema perforation rate was 4%. Surgery occurred in 334 (70%), 68 (20%) patients had perforated bowel, bowel resection was required in 61%. Complications included recurrence (2%) and nosocomial sepsis (4%). Length of stay (LOS) was significantly longer in patients who developed complications. Six patients died—a mortality rate of 1%. There was a significant difference in reduction rates, upfront surgery, bowel resection, LOS and mortality between centres with shorter symptom duration compared longer symptom duration. Conclusion Delayed presentation was common and associated with low success for enema reduction, higher operative rates, higher rates of bowel resection and increased LOS. Improved primary health-care worker education and streamlining referral pathways might facilitate timely management.

Published
2021

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