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Aim Trauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital. Method In this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality. Results Sixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors. Discussion The in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12–18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively. Conclusion Management of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.

BackgroundGlobal surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature.MethodsWe performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks.Results1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs.ConclusionAuthorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.

Background: Patient reported outcome measures assist in assessing surgical outcomes. Most African countries have a high illiteracy rate. The aim of this study was to develop and validate a pictorial version of the Oxford Shoulder Score (OSS) against the English OSS and Simple Shoulder Test (SST). Methods: A pictorial version of the OSS was developed. There were 12 questions, each modelled on the English OSS. Wong Baker faces were used as a scoring scale. The pictorial score was validated on patients who had shoulder pathology excluding instability at a tertiary center in South Africa between May 2016 and November 2017. Participants were first asked to complete the Pictorial OSS and then the English OSS and SST. Results: 87 participants completed the scores. The pictorial score was internally consistent with a Cronbach’s alpha of 0.95(CI 0.93-0.97). The Spearman Rank correlation coefficient was 0.8. The mean time required to complete the score, used as a surrogate marker of understanding, was 134s (STD 67s) which is less than the time taken to complete the English OSS or SST. Conclusion: The pictorial version of the OSS was reliable, reproducible, valid and acceptable, and can therefore be used in our patient population.