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

Author: David Bishop, PhD, Robert A Dyer, ProfPhD, Salome Maswime, PhD, Reitze N Rodseth, ProfPhD, Dominique van Dyk, FCA, Hyla-Louise Kluyts, ProfMMed Anaes, Janat T Tumukunde, MMed Anaes, Farai D Madzimbamuto, FCA ECSA, Abdulaziz M Elkhogia, FRCA, Andrew K N Ndonga, FICS, Zipporah W W Ngumi, ProfFFARCS, Akinyinka O Omigbodun, ProfFWACS, Simbo D Amanor-Boadu, ProfFMCA, Eugene Zoumenou, ProfPhD, Apollo Basenero, MBChB, Dolly M Munlemvo, MD, Coulibaly Youssouf, ProfMD, Gabriel Ndayisaba, ProfMD, Akwasi Antwi-Kusi, FGCS, Veekash Gobin, MD, Patrice Forget, ProfMD, Bernard Mbwele, MSc, Henry Ndasi, DS, Sylvia R Rakotoarison, MD, Ahmadou L Samateh, FWACS, Ryad Mehyaoui, ProfMD, Ushmaben Patel-Mujajati, MMed Anaes, Chaibou M Sani, MD, Tonya M Esterhuizen, MSc, Thandinkosi E Madiba, ProfPhD, Rupert M Pearse, ProfMD Res, Bruce M Biccard, ProfPhD, 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, Simbo D Amanor-Boadu, Al-A Amer, BT Amisi, MA Amuthenu, TWA Anabah, Felix Anani, PGR Anderson, AGB Andriamampionona, L Andrianina, A Anele, R Angelin, N Anjar, O Antùnez, Akwasi Antwi-Kusi, LJC Anyanwu, AA Aribi, OA Arowolo, O Arrey, 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, Apollo Basenero, 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, Bruce M Biccard, 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, Abdulaziz M Elkhogia, 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, Tonya M Esterhuizen, EB Etuk, O Eurayet, OR Eyelade, RF Fanjandrainy, Lionelle Fanou, Z Farina, Maher Fawzy, A Feituri, NL Fernandes, LM Ford, Patrice Forget, 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, Veekash Gobin, 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, 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, Khalfallah, A Khamajeet, SB Khetrish, Kibandwa, W Kibochi, AM Kilembe, AK Kintu, B Kipng'etich, B Kiprop, VMK Kissoon, Theroshnie K Kisten, JK Kiwanuka, Hyla-Louise Kluyts, 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, Thandinkosi E Madiba, 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, Bernard Mbwele, 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, Dolly M Munlemvo, 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, Henry Ndasi, Gabriel Ndayisaba, 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, Akinyinka O Omigbodun, S Omoding, J Omoshoro-Jones, R Onyango, A Onyegbule, O Orjiako, MO Osazuwa, Kpatinvo Oscar, BB Osinaike, AO Osinowo, OM Othin, FFH Otman, J Otokwala, F Ouanes, Ongoïba Oumar, AO Ousseini, S Padayachee, SM Pahlana, J Pansegrouw, FP Paruk, MB Patel, Ushmaben Patel-Mujajati, AP Patience, Rupert M Pearse, 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, Sylvia R Rakotoarison, 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, Reitze N Rodseth, I Rois, W Rois, S Rokhsi, J Roos, Nicolette F Rorke, H Roura, FJ Rousseau, N Rousseau, L Royas, D Roytowski, Devan Rungan, SSR Rwehumbiza, BB Ryabchiy, V Ryndine, CR Saaiman, HK Sabwa, S Sadat, SS Saed, E Salaheddin, H Salaou, M Saleh, HM Salisu-Kabara, Hamza Doles Sama, Ahmadou L Samateh, W Sam-Awortwi (Jnr), N Samuel, DK Sanduku, Chaibou M Sani, LN Sanyang, HN Sarah, A Sarkin-Pawa, R Sathiram, T Saurombe, H Schutte, MP Sebei, MD Sedekounou, MP Segooa, EM Semenya, BO Semo, CS Sendagire, SA Senoga, FS Senusi, T Serdyn, MD Seshibe, GB Shah, R Shamamba, CS Shambare, TN Shangase, SH Shanin, IE Shefren, AA Sheshe, OB Shittu, AS Shkirban, T Sholadoye, A Shubba, N Sigcu, SE Sihope, DS Sikazwe, BS Sikombe, K Simaga Abdoul, WAG Simo, K Singata, AS Singh, S Singh, Usha Singh, V Sinoamadi, N Sipuka, NLM Sithole, S Sitima, David Lee Skinner, GC Skinner, OI Smith, CAG Smits, MSI Sofia, Gaoussou Sogoba, A Sohoub, SS Sookun, O Sosinska, Rosalie Souhe, G Souley, Thiam Souleymane, JM Spicer, Sandra Spijkerman, H Steinhaus, A Steyn, G Steyn, HC Steyn, Heidi L Stoltenkamp, S Stroyer, A Swaleh, E Swayeb, AJ Szpytko, NA Taiwo, A Tarhuni, D Tarloff, Blaise Tchaou, Charles Tchegnonsi, M Tchoupa, MO Teeka, B Thakoor, MM Theunissen, BP Thomas, MB Thomas, A Thotharam, O Tobiko, AM Torborg, SM Tshisekedi, SK Tshisola, R Tshitangano, F Tshivhula, HT Tshuma, Janat Tumukunde, M Tun, IA Udo, DI Uhuebor, KU Umeh, AO Usenbo, JdD Uwiteyimbabazi, DJ Van der Merwe, FH van der Merwe, JE van der Walt, Dominique van Dyk, JG Van Dyk, JJS van Niekerk, S van Wyk, HA van Zyl, B Veerasamy, PJ Venter, AJ Vermeulen, R Villarreal, J Visser, L Visser, M Voigt, Richard P von Rahden, A Wafa, A Wafula, PK Wambugu, P Waryoba, EN Waweru, M Weideman, Robert D Wise, EE Wynne, AI Yahya, AA Yahya, R Yahya, Y Yakubu, JJ Yanga, YM Yangazov, O Yousef, G Yousef, Coulibaly Youssouf, AA Yunus, AS Yusuf, AZ Zeiton, HZ Zentuti, Henry Zepharine, AB Zerihun, S Zhou, A Zidan, Sanogo Zimogo Zié, CZ Zinyemba, A Zo, Lidwine Zomahoun, NZ Zoobei, Eugene Zoumenou, and NZ Zubia
Subjects: Public aspects of medicine, RA1-1270
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: 2019
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2. Vector Error Correction Model: Prediction of Bi-Directional Causality between Gross Domestic Product and Wage Growth in Kenya

Author: Mburu S. Njoroge, Gladys G. Njoroge, and Adolphus Wagala
Abstract: Economic growth and wage growth are very prominent macroeconomic variables in all countries in the World. These two variables are the main signposts signaling the current trends in an economy. To determine the recent behavior of the economy, the government must study and analyze these major variables. The increase in aggregate production in the Kenyan economy has been deteriorating due to the steady rise in the wage bill, especially since the year 2012, in conjunction with the devolved government. An increase in wage rate motivates workers and, in turn, increases the production capacity of a country hence economic growth. An increase in recurrent expenditure implies that the development expenditure will be condensed, which will alter the growth of the economy. The primary goal of this research was to fit vector error correction model on gross domestic product and wage growth data so as to identify the bidirectional causality effects between the two variables. VEC model is superior since it distinguishes between long run and short run relationship among underlying variables in a large sample size. The linear Granger causality test was used to evaluate the causal relationship between the system's variables; hence a causal research design was adopted in this study. This research employed secondary data, which was analyzed using Eviews and STATA statistical software. Data on these target variables was acquired from the World Bank and Central Bank of Kenya. Lastly, this study used yearly time series data for the period 1979 to 2019. It was found that wage growth and GDP granger causes each other and also have a long run relationship since their respective p values were less than 5% significance level. VECM1 (effects of wage growth on GDP) had AIC of -0.2953, RMSE of 1.0039 while the R-squared was 0.7241. Subsequently, effects of GDP on wage growth (VECM2) was found to have an R-squared of 0.7452, AIC of -8.2270 and RMSE of 0.08363. Based on the foregoing findings, it was determined that GDP has more influence on wage growth both in the short and long run. This study thus recommends that the government should keep inflation under control, increase development expenditure to finance projects and fostering a favorable business environment for Small and Medium-sized Enterprises (SMEs) to upsurge total output (productivity) which will in turn, lead to a rise in wage growth, thus a high standard of living for the millions of unemployed Kenyans. Finally, the findings of the current study are expected to be of significance to academicians and also provide appropriate policy options that will help in harmonizing the wage rates, thus managing recurrent expenditure in Kenya.
Published: 2022

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

Author: P, Chivenge, S, Zingore, K S, Ezui, S, Njoroge, M A, Bunquin, A, Dobermann, and K, Saito
Subjects: Soil Science, Agronomy and Crop Science
Abstract: Increasing fertilizer access and use is an essential component for improving crop production and food security in sub-Saharan Africa (SSA). However, given the heterogeneous nature of smallholder farms, fertilizer application needs to be tailored to specific farming conditions to increase yield, profitability, and nutrient use efficiency. The site-specific nutrient management (SSNM) approach initially developed in the 1990 s for generating field-specific fertilizer recommendations for rice in Asia, has also been introduced to rice, maize and cassava cropping systems in SSA. The SSNM approach has been shown to increase yield, profitability, and nutrient use efficiency. Yield gains of rice and maize with SSNM in SSA were on average 24% and 69% when compared to the farmer practice, respectively, or 11% and 4% when compared to local blanket fertilizer recommendations. However, there is need for more extensive field evaluation to quantify the broader benefits of the SSNM approach in diverse farming systems and environments. Especially for rice, the SSNM approach should be expanded to rainfed systems, which are dominant in SSA and further developed to take into account soil texture and soil water availability. Digital decision support tools such as RiceAdvice and Nutrient Expert can enable wider dissemination of locally relevant SSNM recommendations to reach large numbers of farmers at scale. One of the major limitations of the currently available SSNM decision support tools is the requirement of acquiring a significant amount of farm-specific information needed to formulate SSNM recommendations. The scaling potential of SSNM will be greatly enhanced by integration with other agronomic advisory platforms and seamless integration of digital soil, climate and crop information to improve predictions of SSNM recommendations with reduced need for on-farm data collection. Uncertainty should also be included in future solutions, primarily to also better account for varying prices and economic outcomes.
Published: 2022

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

Author: S. Njoroge Kinyanjui, Wageningen University, K.E. Giller, A.G.T. Schut, and S. Zingore
Subjects: Soil test, Nutrient management, Crop yield, Soil organic matter, Soil carbon, engineering.material, PE&RC, Manure, Agronomy, Plant Production Systems, Plantaardige Productiesystemen, engineering, Life Science, Environmental science, Fertilizer, Soil fertility
Abstract: Crop productivity intensification in smallholder farming systems of sub-Saharan Africa (SSA) is urgently required to improve food self-sufficiency. Increased fertilizer use can address nutrient deficiencies that limit crop productivity in SSA. There is however large uncertainty in crop yield responses to fertilizer applications on farmer fields. This uncertainty has been linked to strong heterogeneity in soil fertility between and within farms. Fertilizer recommendations that account for this spatial heterogeneity are therefore required to better advise farmers, reduce investment and environmental risks for sustainable crop productivity intensification. The main objective of this study was to better understand and explain patterns of maize yield and yield responses to fertilizer applications under heterogenous fertility conditions in smallholder farming systems. This would allow for improved targeting of fertilizer applications, and enable better prediction of expected crop yield response to fertilizer use. A series of on-farm experiments assessing maize yield response to fertilizer application under variable soil fertility conditions were established on 23 farmers’ fields in Siaya, western Kenya across multiple seasons. Prior to experiment establishment, farmers were extensively interviewed to obtain information on past crop and nutrient management practices in selected fields. The experiment used was comprised of nutrient omission trials (NOTs) on farmer fields in Siaya to assess patterns of maize yield response to fertilizer applications of 150 kg ha-1 nitrogen (N), 40 kg ha-1 phosphorus (P) and 60 kg ha-1 potassium (K). In Phase 1, plots with treatments including control, PK, NK, NP and NPK were repeated for 7 consecutive seasons in the same plots. In Phase 2 of the experiment, a second set of NOTs including PK, NK, NP and NPK were established in every plot on 6 fields that were previously part of Phase 1. On 13 other fields from Phase 1, all plots received NPK in Phase 2. Yields and above ground biomass were measured every year, soil samples were taken in 2013, 2014, 2016 and 2018 and plant samples were taken in 2016 and 2018. Spatial-temporal patterns in yield and yield responses were studied and compared with soil and farmer characteristics. Yield response to soil nutrient supply was studied with the QUEFTS model, and the RC-P model was used to study fate of fertilizer P. Nutrient balances were calculated. The frequency and magnitude of maize yield response to fertilizer N, P and K varied strongly over space and time, yet observed patterns were not adequately explained by soil chemical parameters or texture. Fertilizing with N, P, and K substantially reduced observed spatial-temporal variability in maize yield response, and resulted in consistently enhanced maize yields. All fields were responsive to N, most fields to P and only 7 to K. On average, NPK yields were about 5 to 5.5 tons ha-1 in the short- and long rainy seasons respectively. Application of only NP or NK resulted in strongly declining yields within a few seasons, with large differences between farms in resilience of soil P and K stocks. Based on observed spatial-temporal patterns, we concluded that blanket fertilizer recommendations in such farming systems result in low fertilizer use efficiencies. We further concluded that current methods for soil analysis do not adequately explain the observed variation in maize yield response to application of N, P and K fertilizers under the highly variable soil fertility conditions encountered in smallholder farming systems. Accounting for past manure application in Phase 1 of the experiment improved our ability to explain the variation in maize yield response to fertilizer application. Mean maize yield response to N, P and K application was 2.8, 1.1 and 0.6 t ha-1 in fields with animal manure previously applied, and 2.3, 3.0 and 1.6 t ha-1 in farms without past manure applications over 7 cropping seasons. Differences in maize yield response in fields with and without past manure applications were mainly related to enhanced soil phosphorus (P) and potassium (K) supply, and larger recovery of applied nitrogen (N) in fields with manure previously applied. Based on these findings, we concluded that the strong influence of past animal manure application on yield response to fertilizer applications merits the inclusion of past manure application as a co-variate in analysis of yield response data from smallholder cropping systems of SSA. The Quantitative Evaluation of the Fertility of Tropical Soils (QUEFTS) model did not adequately estimate crop yield responses to fertilizer applications under variable soil fertility conditions. This was linked to poor estimation of soil N, P and K supply based on current relationships for potential soil nutrient supply in the QUEFTS model. In particular, soil organic carbon (SOC) and P-Olsen were poor indicators of crop N and P uptake from the soil. Maize grain yield in unfertilized control treatment plots provided better estimates of potential soil N, P and K supply, resulting in improved predictions of maize yield response to fertilizer applications. These findings suggest that the standard soil parameters analysed do not accurately inform on the soil fertility status of the field and are of little use for smallholder farmers. Improved relations for estimation of potential soil nutrient in QUEFTS are required for better prediction of expected maize yield response to fertilizer application under variable soil fertility conditions. Maize crops in strongly nutrient-depleted soils responded strongly to balanced NPK fertilization, with yields comparative to long-term means within three seasons. Placement of P fertilizer strongly improved recovery, reducing the need for larger soil P stocks on soils that will typically develop a large insoluble P pool under P fertilization. The RC-P model provided insights in long-term recovery of P and could describe the observed P uptake patterns reasonably well. We concluded that strongly nutrient depleted tropical soils such as those in Siaya with high clay contents that are typical for western Kenya, do not require prior investments to rebuild nutrient stocks and soil organic matter to substantially increase crop yields to 5-5.5 t ha-1. This has important implications for crop productivity intensification in SSA as a large proportion of soils under cultivation are strongly nutrient depleted, and earlier approaches have suggested the need for costly and capital intensive soil fertility replenishment. Results in this thesis clearly demonstrate that sustainable intensification of crop productivity on smallholder farms of SSA is very well possible on all fields under good management, even when soils are strongly nutrient depleted. However, the need for P and K fertilizers and amounts applied should be tailored to specific field conditions to reduce farmer costs in the short term. Accounting for past farm management and assessment of current yields under minimal or no fertilizer applications provides a means for improved targeting of fertilizer applications at the farm level. In the long term, farmers should aim for balanced fertilization to prevent mining of soil stocks. Simplified decision support tools that use field level information to develop improved estimates of fertilizer N, P and K requirements based on refined relationships between soil nutrient supply, nutrient uptake and yield, are required to derive fertilizer recommendations in future.
Published: 2019

5. 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

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

Author: H.-L. Kluyts, Y. le Manach, D.M. Munlemvo, F. Madzimbamuto, A. Basenero, Y. Coulibaly, S. Rakotoarison, V. Gobin, A.L. Samateh, M.S. Chaibou, A.O. Omigbodun, S.D. Amanor-Boadu, J. Tumukunde, T.E. Madiba, R.M. Pearse, B.M. Biccard, Hippolyte Abadagan, N. Abbas, A. Ibrahim Abdelatif, Traoré Abdoulaye, A. Abd-rouf, A. Abduljalil, A. Abdulrahman, S. Abdurazig, A. Abokris, W. Abozaid, S.O.A. Abugassa, F. Abuhdema, S.A. Abujanah, R. Abusamra, A. Abushnaf, S.A. Abusnina, T.S. Abuzalout, H.M. Ackermann, Y.B. Adamu, A. Addanfour, D.M. Adeleke, T.A. Adigun, A.O. Adisa, Sèhivè Valéry Adjignon, N.A. Adu-Aryee, B.B. Afolabi, A.F.X. Agaba, P.K.A. Agaba, K. Aghadi, H. Agilla, B. Ahmed, El.-Z. Ahmed, Al.-J. Ahmed, M. Ahmed, Rene Ahossi, S.A. Aji, S. Akanyun, I. Akhideno, M. Akhter, O.A. Akinyemi, M. Akkari, Joseph Akodjenou, A.L. AL Samateh, E.S. al Shams, O.T. Alagbe-Briggs, E.A. Alakkari, R.B. Alalem, M. Alashhab, O.I. Alatise, A. Alatresh, M.S.I. Alayeb Alayeb, B.A. Albakosh, F. Albert, A.N.J.D. Alberts, A.D. Aldarrat, A. Alfari, A. Alfetore, M. Algbali, A. Algddar, H.A. Algedar, I.A. Alghafoud, A. Alghazali, M. Alhajj, A. Alhendery Alhendery, F.F.H. Alhoty, A. Ali, Y.A. Ali, Beye Seïdina Alioune, M.A. Alkassem, M.A. Alkchr, T.S. Alkesa, A. Alkilani, F. Alkobty Alkobty, Thomas Allaye, S.B.M. Alleesaib, A. Alli, K. Allopi, N.L. Allorto, A. Almajbery, R. Almesmary, S.H.A. Almisslati, F. Almoraid, H. Alobeidi, M.A. Alomami, Christella S. Alphonsus, O.A. Alqawi, A.A. Alraheem, S.A. Alsabri, A. Alsayed, B. Alsellabi, M. Al-Serksi, M.S.A. Alshareef, A.A. Altagazi, J.S. Aluvale, H.W. Alwahedi, E.A. Alzahra, M.A. Alzarouk, K. Al-Zubaidy, M. Amadou, Maiga Amadou, Simbo D. Amanor-Boadu, Al.-A. Amer, B.T. Amisi, M.A. Amuthenu, T.W.A. Anabah, Felix Anani, P.G.R. Anderson, A.G.B. Andriamampionona, L. Andrianina, A. Anele, R. Angelin, N. Anjar, O. Antùnez, Akwasi Antwi-Kusi, L.J.C. Anyanwu, A.A. Aribi, O.A. Arowolo, O. Arrey, Daniel Zemenfes Ashebir, S.B. Assefa, Guy Assoum, V. Athanse, J.S. Athombo, M. Atiku, E. Atito-Narh, Anatole Atomabe, A. Attia, M. Aungraheeta, D.M.A. Aurélia, O.O. Ayandipo, A.E.T. Ayebale, H.M.Z. Azzaidey, N.B. Babajee, H.B. Badi, E.K. Badianga, R.B. Baghni, M.T. Bahta, M. Bai, Y. Baitchu, A.M. Baloyi, K.A. Bamuza, M.I. Bamuza, L. Bangure, O.B. Bankole, M.L. Barongo, M.M. Barow, Apollo. Basenero, L. Bashiya, C.H. Basson, Sudha Bechan, S. Belhaj, M.M. Ben Mansour, D. Benali, A.S.B. Benamour, A. Berhe, J.D. Bertie, J.J.A. Bester, M. Bester, J.D. Bezuidenhout, K. Bhagwan, D.R. Bhagwandass, K.A.P. Bhat, M.M.Z.U. Bhuiyan, Bruce M. Biccard, F. Bigirimana, C.J. Bikuelo, B.E. Bilby, S.S. Bingidimi, K.E. Bischof, David G. Bishop, C. Bitta, M. Bittaye, Thuli Biyase, C.A. Blake, E. Blignaut, F. Blignaut, B.N. BN Tanjong, A. Bogoslovskiy, P.M. Boloko, S.K.B. Boodhun, I. Bori, F. Boufas, M. Brand, Nicholas T. Brouckaert, J.D. Bruwer, I. Buccimazza, I.M. Bula Bula, Fred Bulamba, B.C. Businge, Y.B. Bwambale, S.R.C. Cacala, M.A. Cadersa, Chris Cairns, F. Carlos, M.E. Casey, A.C. Castro, N.D. Chabayanzara, T.N.O. Chaibva, N.K. Chakafa, C. Chalo, C. Changfoot, M.C. Chari, L. Chelbi, J.T. Chibanda, H.N. Chifamba, N. Chikh, E. Chikumba, P. Chimberengwa, J. Chirengwa, F.M. Chitungo, M.C. Chiwanga, M.M. Chokoe, T.M. Chokwe, B. Chrirangi, M. Christian, B. Church, J.C. Cisekedi, J.N. Clegg-Lamptey, Estie Cloete, Megan Coltman, W. Conradie, N. Constance, Youssouf Coulibaly, L. Cronje, M.A. Da Silva, H. Daddy, L. Dahim, D. Daliri, M.S. Dambaki, A. Dasrath, J.G. Davids, Gareth L. Davies, J.T. De Lange, J.B. de Wet, B. Dedekind, M.A. Degaulle, V. Dehal, P.D. Deka, S. Delinikaytis, I.S. Desalu, Hubert Dewanou, M.B Moussa Deye, C. Dhege, B.S.G. Diale, D.F. Dibwe, B.J.S. Diedericks, J.M. Dippenaar, L. Dippenaar, M.P. Diyoyo, Edith Djessouho, S.N. Dlamini, A. Dodiyi-Manuel, B.A. Dokolwana, D.P. Domoyyeri, Leanne W. Drummond, D.E. du Plessis, W.M. du Plessis, L.J. du Preez, K. Dube, N.Z. Dube, K.D. Dullab, R. Duvenhage, R.C. Echem, S.A. Edaigbini, A.K. Egote, A. Ehouni, G. Ekwen, N.C. Ekwunife, M. El Hensheri, I.E. Elfaghi, M.A. Elfagieh, S. Elfallah, Mahmoud Elfiky, S. Elgelany, A.M. Elghallal, M.G. Elghandouri, Z.S. Elghazal, A.M. Elghobashy, F.T. Elharati, Abdulaziz M. Elkhogia, R.M. Elkhwildi, S. Ellis, L. Elmadani, H.B. Elmadany, H. Elmehdawi, A. Elmgadmi, H. Eloi, D. Elrafifi, G. Elsaadi, R.B. Elsaity, A. Elshikhy, M. Eltaguri, A. Elwerfelli, I.E. Elyasir, A.Z. Elzoway, A.M. Elzufri, E.O. Enendu, B.C. Enicker, E.O. Enwerem, R. Esayas, M. Eshtiwi, A.A. Eshwehdi, J.L. Esterhuizen, Tonya M. Esterhuizen, E.B. Etuk, O. Eurayet, O.R. Eyelade, R.F. Fanjandrainy, Lionelle Fanou, Z. Farina, Maher Fawzy, A. Feituri, N.L. Fernandes, L.M. Ford, Patrice Forget, T. François, T. Freeman, Y.B.M. Freeman, V.M. Gacii, B. Gadi, M. Gagara, A. Gakenia, P.D. Gallou, G.G.N. Gama, M.G. Gamal, Y.G. Gandy, A. Ganesh, Diallo Gangaly, M. Garcia, A.P. Gatheru, S.S.D. Gaya, Oswald Gbéhadé, G. Gerbel, A. Ghnain, R. Gigabhoy, D.G. Giles, G.T. Girmaye, S. Gitau, B. Githae, Said Gitta, Veekash Gobin, Riaz Goga, A.A.G. Gomati, M.E. Gonzalez, J. Gopall, Christina Salmina Gordon, O. Gorelyk, M. Gova, K. Govender, P. Govender, S. Govender, V. Govindasamy, J.T.K. Green-Harris, M.B. Greenwood, S.V. Grey-Johnson, Mariette Grobbelaar, M.A. Groenewald, K.K. Grünewald, Ambroise Guegni, M. Guenane, S. Gueye, Marius Guezo, T. Gunguwo, M.G. Gweder, M. Gwila, L. Habimana, Rodrigue Hadecon, E. Hadia, L. Hamadi, M. Hammouda, M.I. Hampton, R. Hanta, Tim C. Hardcastle, J.A. Hariniaina, S. Hariparsad, A.H. Harissou, R. Harrichandparsad, S.H.A. Hasan, H.B. Hashmi, M.P. Hayes, A. Hdud, S.H. Hebli, H.M.S.N. Heerah, S. Hersi, A.H. Hery, Adam Hewitt-Smith, T.C. Hlako, S.C.H. Hodges, Richard Eric Hodgson, M. Hokoma, H. Holder, E.B. Holford, E. Horugavye, C. Houston, M. Hove, D. Hugo, C.M. Human, H. Hurri, O. Huwidi, A.I. Ibrahim, Traoré Ibrahim, O.K. Idowu, I.E. Igaga, John Igenge, O. Ihezie, K. Ikandi, I.A.R. Ike, J.J.N. Ikuku, M.N. Ilbarasi, I.B.B. Ilunga, J.P.M. Ilunga, N.A.V. Imbangu, Z. Imessaoudene, D.H. Imposo, A.M. Iraya, M. Isaacs, M. Isiguzo, A. Issoufou, P. Izquirdo, A. Jaber, U.V. Jaganath, C.S. Jallow, S. Jamabo, Z.S. Jamal, L. Janneh, M.J. Jannetjies, I. Jasim, Megan A.J. Jaworska, S. Jay Narain, K. Jermi, R. Jimoh, S. Jithoo, M. Johnson, S. Joomye, R.M. Judicael, M. Judicaël, A. Juwid, L.P. Jwambi, R. Kabango, J.K. Kabangu, D.K. Kabatoro, A.N. Kabongo, K. Kabongo, L.T. Kabongo, M.D. Kabongo, N. Kady, S. Kafu, M. Kaggya, B.N.K. Kaholongo, P.C.K. Kairuki, S.I. Kakololo, K. Kakudji, Amina. Kalisa, R. Kalisa, M.R. Kalufwelu, S. Kalume, R.J. Kamanda, M.K. Kangili, H. Kanoun, null Kapesa, P. Kapp, J.K. Karanja, M. Karar, K. Kariuki, K. Kaseke, P.N.K. Kashuupulwa, K.J.P. Kasongo, S.K. Kassa, G.K. Kateregga, M.I.S. Kathrada, P.M. Katompwa, L. Katsukunya, K.A.M. Kavuma, null Khalfallah, A. Khamajeet, S.B. Khetrish, null Kibandwa, W. Kibochi, A.M. Kilembe, A.K. Kintu, B. Kipng’etich, B. Kiprop, V.M.K. Kissoon, Theroshnie K. Kisten, J.K. Kiwanuka, Hyla-Louise Kluyts, M.E.K. Knox, A.K. Koledale, V.L. Koller, M.A. Kolotsi, M. Kongolo, N.D. Konwuoh, W.V.J. Koperski, M.Y.K. Koraz, A.A. Kornilov, M. Zach Koto, Samantha Kransingh, D. Krick, S. Kruger, C. Kruse, W. Kuhn, W.P. Kuhn, A.M. Kukembila, K.L. Kule, M. Kumar, Belinda S. Kusel, V.K. Kusweje, K.J. Kuteesa, Y.Y. Kutor, M.A. Labib, M. Laksari, F. Lanos, T.A. Lawal, Yannick Le Manach, C. Lee, R.M. Lekoloane, S.N. Lelo, B. Lerutla, M.T. Lerutla, A.I. Levin, T.B. Likongo, M.L. Limbajee, D.M. Linyama, C. Lionnet, M.M. Liwani, E. Loots, A. Garrido Lopez, C.L.C. Lubamba, K.F. Lumbala, A.J.M. Lumbamba, John Lumona, R.F. Lushima, L. Luthuli, H.L. Luweesi, T.S.K. Lyimo, H.M. Maakamedi, B.M. Mabaso, M. Mabina, M.E. Maboya, I. Macharia, A.M. Macheka, A.Z. Machowski, Thandinkosi E. Madiba, A.S.M. Madsen, Farai Madzimbamuto, L.J. Madzivhe, S.C. Mafafo, M. Maghrabi, Diango Djibo Mahamane, A. Maharaj, A.D. Maharaj, M.R. Mahmud, M. Mahoko, N.A. Mahomedy, O. Mahomva, T.M. Mahureva, R.K. Maila, D.M. Maimane, M. Maimbo, S.N. Maina, Dela A. Maiwald, M.D. Maiyalagan, N. Majola, N. Makgofa, V. Makhanya, W.P. Makhaye, N.M. Makhlouf, S. Makhoba, E.K. Makopa, O. Makori, Alex M. Makupe, M.A. Makwela, M.E. Malefo, S.M. Malongwe, D.M. Maluleke, M.R. Maluleke, K. Touré Mamadou, M.P. Mamaleka, Y. Mampangula, R.M. Mamy, M.N.R. Mananjara, M.T.M. Mandarry, D.M. Mangoo, C. Manirimbere, A. Manneh, A. Mansour, I. Mansour, M. Manvinder, D.V. Manyere, V.T. Manzini, J.K. Manzombi, P.M. Mapanda, L.C. Marais, O. Maranga, J.P.B. Maritz, F.K. Mariwa, R.S. Masela, M.M. Mashamba, Doreen M. Mashava, M.V. Mashile, E. Mashoko, O.R. Masia, J.N. Masipa, A.T.M. Masiyambiri, M.W. Matenchi, W. Mathangani, R.C. Mathe, Christopher Y. Matola, P.M. Matondo, R. Matos-Puig, F.F.H. Matoug, J.T. Matubatuba, H.P. Mavesere, R. Mavhungu, S. Maweni, C.J.M. Mawire, T. Mawisa, S. Mayeza, R. Mbadi, M. Mbayabu, N. Mbewe, W.D. Mbombo, T. Mbuyi, W.M.S. Mbuyi, M.W. Mbuyisa, Bernard Mbwele, R.M. Mehyaoui, I.D. Menkiti, L.V.M. Mesarieki, A. Metali, Serge Mewanou, L. Mgonja, N. Mgoqo, S. Mhatu, T.M. Mhlari, S. Miima, I.M. Milod, P. Minani, F. Mitema, A. Mlotshwa, J.E. Mmasi, T. Mniki, B.O. Mofikoya, J.O. Mogale, A. Mohamed, S. Mohamed, T.S. Mohamed, A.M. Mohamed, P. Mohamed, I. Mohammed, F.A.M. Mohammed, M. Mohammed, N.M. Mohammed, M.P. Mohlala, R. Mokretar, F.M. Molokoane, K.N. Mongwe, L. Montenegro, O.D. Montwedi, Q.K. Moodie, M. Moopanar, M. Morapedi, T.G. Morulana, V.L. Moses, P. Mossy, H. Mostafa, S.R. Motilall, S.P. Motloutsi, Kanté Moussa, M. Moutari, O.M. Moyo, P.E. Mphephu, Busi Mrara, C. Msadabwe, V.M. Mtongwe, F.K. Mubeya, K. Muchiri, J. Mugambi, G.I.M. Muguti, A.B. Muhammad, I.F. Mukama, M.M. Mukenga, F.K. Mukinda, P.M. Mukuna, A.R.W. Mungherera, Dolly M. Munlemvo, T.W. Munyaradzi, A.A. Munyika, J.M. Muriithi, M.P. Muroonga, R. Murray, V.K. Mushangwe, M. Mushaninga, V.E.M. Musiba, J.M. Musowoya, S. Mutahi, M.G.H. Mutasiigwa, G. Mutizira, A. Muturi, T. Muzenda, K.R. Mvwala, N.M. Mvwama, A. Mwale, C.N. Mwaluka, J.D. Mwamba, H.A.M. Mwanga, C.M. Mwangi, S. Mwansa, V. Mwenda, I.M. Mwepu, T.M. Mwiti, S.Z. Mzezewa, L. Nabela, M.T.N. Nabukenya, S.M. Nabulindo, K. Naicker, D. Naidoo, L. Naidoo, L.C. Naidoo, N. Naidoo, R. Naidoo, R.D. Naidoo, S. Naidoo, T.D. Naidoo, T.K. Naidu, N.Z. Najat, Y. Najm, F. Nakandungile, P. Nakangombe, C.N. Namata, E.S. Namegabe, A. Nansook, N.P. Nansubuga, C. Nantulu, Rodrigue Nascimento, G.T. Naude, H. Nchimunya, M.A. Ndaie, P.N. Ndarukwa, Henry Ndasi, Gabriel Ndayisaba, D. Ndegwa, R. Ndikumana, Andrew K.N. Ndonga, C. Ndung’u, M.C. Neil, M.S. Nel, E.V. Neluheni, D.S. Nesengani, N.T. Nesengani, L.E. Netshimboni, A.M. Ngalala, B.M. Ngari, N.B.M. Ngari, E. Ngatia, G.K. Ngcobo, T.S. Ngcobo, D. Ngorora, D. Ngouane, K. Ngugi, Zipporah W.W. Ngumi, Z. Nibe, E. Ninise, J.C. Niyondiko, P.W. Njenga, M.N. Njenga, M. Njoroge, S. Njoroge, W. Njuguna, P.N. Njuki, T. Nkesha, T.N. Nkuebe, N.P. Nkuliyingoma, M. Nkunjana, Ernest Nkwabi, R.N. Nkwine, C. Nnaji, I. Notoane, Shaaban Nsalamba, L.M. Ntlhe, C. Ntoto, B. Ntueba, M.T. Nyassi, Z. Nyatela-Akinrinmade, H.O. Nyawanda, N.N. Nyokabi, V.N. Nziene, S. Obadiah, O.J.P. Ochieng, P.K. Odia, O.E.O. Oduor, E.O. Ogboli-Nwasor, S.W.O. Ogendo, O. Ogunbode, T.O. Ogundiran, O. Ogutu, R.W. Ojewola, M. Ojujo, D.O. Ojuka, O.S. Okelo, S. Okiya, N. Okonu, P.R. Olang, Akinyinka O. Omigbodun, S. Omoding, J. Omoshoro-Jones, R. Onyango, A. Onyegbule, O. Orjiako, M.O. Osazuwa, Kpatinvo. Oscar, B.B. Osinaike, A.O. Osinowo, O.M. Othin, F.F.H. Otman, J. Otokwala, F. Ouanes, Ongoïba Oumar, A.O. Ousseini, S. Padayachee, S.M. Pahlana, J. Pansegrouw, F.P. Paruk, M.B. Patel, Ushmaben Patel, A.P. Patience, Rupert M. Pearse, J.D. Pembe, G.N. Pengemale, N. Perez, M.F. Aguilera Perez, A. Mallier Peter, M. Phaff, R.M. Pheeha, B.H. Pienaar, V. Pillay, K.A. Pilusa, M.P. Pochana, O. Polishchuk, Owen S. Porrill, E.F. Post, A. Prosper, M. Pupyshev, A. Rabemazava, M.S. Rabiou, L. Rademan, M. Rademeyer, R.A.R. Raherison, F.R. Rajah, M.S.R. Rajcoomar, Z. Rakhda, A.H.R. Rakotoarijaona, A.H.N. Rakotoarisoa, Sylvia R. Rakotoarison, R.R. Rakotoarison, L. Ramadan, M.L.R. Ramananasoa, M. Rambau, T.P.R. Ramchurn, H.E. Ramilson, Rajesh. J. Ramjee, H. Ramnarain, R. Ramos, T.J. Rampai, S.R. Ramphal, T. Ramsamy, R. Ramuntshi, R. Randolph, D.M.A. Randriambololona, W.A.P. Ras, R.A.F. Rasolondraibe, J.D.L.C. Rasolonjatovo, R.M. Rautenbach, S. Ray, Sarah. R. Rayne, F.A.R. Razanakoto, S.R. Reddy, Anthony R. Reed, J.R. Rian, F.R. Rija, B. Rink, A.T. Robelie, C.A. Roberts, A.G.L. Rocher, S. Rocher, Reitze N. Rodseth, I. Rois, W. Rois, S. Rokhsi, J. Roos, Nicolette F. Rorke, H. Roura, F.J. Rousseau, N. Rousseau, L. Royas, D. Roytowski, Devan. Rungan, S.S.R. Rwehumbiza, B.B. Ryabchiy, V. Ryndine, C.R. Saaiman, H.K. Sabwa, S. Sadat, S.S. Saed, E. Salaheddin, H. Salaou, M. Saleh, H.M. Salisu-Kabara, Hamza. Doles Sama, Ahmadou L. Samateh, W. Sam-Awortwi, N. Samuel, D.K. Sanduku, Chaibou M. Sani, L.N. Sanyang, H.N. Sarah, A. Sarkin-Pawa, R. Sathiram, T. Saurombe, H. Schutte, M.P. Sebei, M.D. Sedekounou, M.P. Segooa, E.M. Semenya, B.O. Semo, C.S. Sendagire, S.A. Senoga, F.S. Senusi, T. Serdyn, M.D. Seshibe, G.B. Shah, R. Shamamba, C.S. Shambare, T.N. Shangase, S.H. Shanin, I.E. Shefren, A.A. Sheshe, O.B. Shittu, A.S. Shkirban, T. Sholadoye, A. Shubba, N. Sigcu, S.E. Sihope, D.S. Sikazwe, B.S. Sikombe, K. Simaga Abdoul, W.A.G. Simo, K. Singata, A.S. Singh, S. Singh, Usha Singh, V. Sinoamadi, N. Sipuka, N.L.M. Sithole, S. Sitima, David Lee Skinner, G.C. Skinner, O.I. Smith, C.A.G. Smits, M.S.I. Sofia, Gaoussou Sogoba, A. Sohoub, S.S. Sookun, O. Sosinska, Rosalie Souhe, G. Souley, Thiam Souleymane, J.M. Spicer, Sandra Spijkerman, H. Steinhaus, A. Steyn, G. Steyn, H.C. Steyn, Heidi L. Stoltenkamp, S. Stroyer, A. Swaleh, E. Swayeb, A.J. Szpytko, N.A. Taiwo, A. Tarhuni, D. Tarloff, Blaise Tchaou, Charles Tchegnonsi, M. Tchoupa, M.O. Teeka, B. Thakoor, M.M. Theunissen, B.P. Thomas, M.B. Thomas, A. Thotharam, O. Tobiko, A.M. Torborg, S.M. Tshisekedi, S.K. Tshisola, R. Tshitangano, F. Tshivhula, H.T. Tshuma, Janat Tumukunde, M. Tun, I.A. Udo, D.I. Uhuebor, K.U. Umeh, A.O. Usenbo, Jd.D. Uwiteyimbabazi, D.J. Van der Merwe, F.H. van der Merwe, J.E. van der Walt, Dominique van Dyk, J.G. Van Dyk, J.J.S. van Niekerk, S. van Wyk, H.A. van Zyl, B. Veerasamy, P.J. Venter, A.J. Vermeulen, R. Villarreal, J. Visser, L. Visser, M. Voigt, Richard P. von Rahden, A. Wafa, A. Wafula, P.K. Wambugu, P. Waryoba, E.N. Waweru, M. Weideman, Robert D. Wise, E.E. Wynne, A.I. Yahya, A.A. Yahya, R. Yahya, Y. Yakubu, J.J. Yanga, Y.M. Yangazov, O. Yousef, G. Yousef, Coulibaly Youssouf, A.A. Yunus, A.S. Yusuf, A.Z. Zeiton, H.Z. Zentuti, Henry Zepharine, A.B. Zerihun, S. Zhou, A. Zidan, Sanogo Zimogo Zié, C.Z. Zinyemba, A. Zo, Lidwine Zomahoun, N.Z. Zoobei, Eugene Zoumenou, and N.Z. Zubia
Subjects: Adult, Male, Risk, medicine.medical_specialty, Adolescent, Population, Risk management tools, Logistic regression, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, law, medicine, Humans, 030212 general & internal medicine, education, Prospective cohort study, Aged, Aged, 80 and over, education.field_of_study, Receiver operating characteristic, business.industry, Middle Aged, Clinical trial, Patient Outcome Assessment, Anesthesiology and Pain Medicine, Calculator, Emergency medicine, Africa, Female, business, Risk assessment
Abstract: Background The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration NCT03044899.
Published: 2018

7. Perioperative patient outcomes in the African Surgical Outcomes Study

Author: Bruce M Biccard, Thandinkosi E Madiba, Hyla-Louise Kluyts, Dolly M Munlemvo, Farai D Madzimbamuto, Apollo Basenero, Christina S Gordon, Coulibaly Youssouf, Sylvia R Rakotoarison, Veekash Gobin, Ahmadou L Samateh, Chaibou M Sani, Akinyinka O Omigbodun, Simbo D Amanor-Boadu, Janat T Tumukunde, Tonya M Esterhuizen, Yannick Le Manach, Patrice Forget, Abdulaziz M Elkhogia, Ryad M Mehyaoui, Eugene Zoumeno, Gabriel Ndayisaba, Henry Ndasi, Andrew K N Ndonga, Zipporah W W Ngumi, Ushmah P Patel, Daniel Zemenfes Ashebir, Akwasi A K Antwi-Kusi, Bernard Mbwele, Hamza Doles Sama, Mahmoud Elfiky, Maher A Fawzy, Rupert M Pearse, Hippolyte Abadagan, N Abbas, A Ibrahim Abdelatif, Traoré Abdoulaye, A Abd-rouf, A Abduljalil, A Abdulrahman, S Abdurazig, A Abokris, W Abozaid, SOA Abugassa, F Abuhdema, SA Abujanah, R Abusamra, A Abushnaf, SA Abusnina, TS Abuzalout, HM Ackermann, YB Adamu, A Addanfour, DM Adeleke, TA Adigun, AO Adisa, Sèhivè Valéry Adjignon, NA Adu-Aryee, BB Afolabi, AFX Agaba, PKA Agaba, K Aghadi, H Agilla, B Ahmed, El-Z Ahmed, Al-J Ahmed, M Ahmed, Rene Ahossi, SA Aji, S Akanyun, I Akhideno, M Akhter, OA Akinyemi, M Akkari, Joseph Akodjenou, AL AL Samateh, ES al Shams, OT Alagbe-Briggs, EA Alakkari, RB Alalem, M Alashhab, OI Alatise, A Alatresh, MSI Alayeb Alayeb, BA Albakosh, F Albert, ANJD Alberts, AD Aldarrat, A Alfari, A Alfetore, M Algbali, A Algddar, HA Algedar, IA Alghafoud, A Alghazali, M Alhajj, A Alhendery Alhendery, FFH Alhoty, A Ali, YA Ali, Beye Seïdina Alioune, MA Alkassem, MA Alkchr, TS Alkesa, A Alkilani, F Alkobty Alkobty, Thomas Allaye, SBM Alleesaib, A Alli, K Allopi, NL Allorto, A Almajbery, R Almesmary, SHA Almisslati, F Almoraid, H Alobeidi, MA Alomami, Christella S Alphonsus, OA Alqawi, AA Alraheem, SA Alsabri, A Alsayed, B Alsellabi, M Al-Serksi, MSA Alshareef, AA Altagazi, JS Aluvale, HW Alwahedi, EA Alzahra, MA Alzarouk, K Al-Zubaidy, M Amadou, Maiga Amadou, Al-A Amer, BT Amisi, MA Amuthenu, TWA Anabah, Felix Anani, PGR Anderson, AGB Andriamampionona, L Andrianina, A Anele, R Angelin, N Anjar, O Antùnez, Akwasi Antwi-Kusi, LJC Anyanwu, AA Aribi, OA Arowolo, O Arrey, SB Assefa, Guy Assoum, V Athanse, JS Athombo, M Atiku, E Atito-Narh, Anatole Atomabe, A Attia, M Aungraheeta, DMA Aurélia, OO Ayandipo, AET Ayebale, HMZ Azzaidey, NB Babajee, HB Badi, EK Badianga, RB Baghni, MT Bahta, M Bai, Y Baitchu, AM Baloyi, KA Bamuza, MI Bamuza, L Bangure, OB Bankole, ML Barongo, MM Barow, L Bashiya, CH Basson, Sudha Bechan, S Belhaj, MM Ben Mansour, D Benali, ASB Benamour, A Berhe, JD Bertie, JJA Bester, M Bester, JD Bezuidenhout, K Bhagwan, DR Bhagwandass, KAP Bhat, MMZU Bhuiyan, F Bigirimana, CJ Bikuelo, BE Bilby, SS Bingidimi, KE Bischof, David G Bishop, C Bitta, M Bittaye, Thuli Biyase, CA Blake, E Blignaut, F Blignaut, BN BN Tanjong, A Bogoslovskiy, PM Boloko, SKB Boodhun, I Bori, F Boufas, M Brand, Nicholas T Brouckaert, JD Bruwer, I Buccimazza, IM Bula Bula, Fred Bulamba, BC Businge, YB Bwambale, SRC Cacala, MA Cadersa, Chris Cairns, F Carlos, ME Casey, AC Castro, ND Chabayanzara, MS Chaibou, TNO Chaibva, NK Chakafa, C Chalo, C Changfoot, MC Chari, L Chelbi, JT Chibanda, HN Chifamba, N Chikh, E Chikumba, P Chimberengwa, J Chirengwa, FM Chitungo, MC Chiwanga, MM Chokoe, TM Chokwe, B Chrirangi, M Christian, B Church, JC Cisekedi, JN Clegg-Lamptey, Estie Cloete, Megan Coltman, W Conradie, N Constance, Youssouf Coulibaly, L Cronje, MA Da Silva, H Daddy, L Dahim, D Daliri, MS Dambaki, A Dasrath, JG Davids, Gareth L Davies, JT De Lange, JB de Wet, B Dedekind, MA Degaulle, V Dehal, PD Deka, S Delinikaytis, IS Desalu, Hubert Dewanou, MB Moussa Deye, C Dhege, BSG Diale, DF Dibwe, BJS Diedericks, JM Dippenaar, L Dippenaar, MP Diyoyo, Edith Djessouho, SN Dlamini, A Dodiyi-Manuel, BA Dokolwana, DP Domoyyeri, Leanne W Drummond, DE du Plessis, WM du Plessis, LJ du Preez, K Dube, NZ Dube, KD Dullab, R Duvenhage, RC Echem, SA Edaigbini, AK Egote, A Ehouni, G Ekwen, NC Ekwunife, M El Hensheri, IE Elfaghi, MA Elfagieh, S Elfallah, S Elgelany, AM Elghallal, MG Elghandouri, ZS Elghazal, AM Elghobashy, FT Elharati, RM Elkhwildi, S Ellis, L Elmadani, HB Elmadany, H Elmehdawi, A Elmgadmi, H Eloi, D Elrafifi, G Elsaadi, RB Elsaity, A Elshikhy, M Eltaguri, A Elwerfelli, IE Elyasir, AZ Elzoway, AM Elzufri, EO Enendu, BC Enicker, EO Enwerem, R Esayas, M Eshtiwi, AA Eshwehdi, JL Esterhuizen, EB Etuk, O Eurayet, OR Eyelade, RF Fanjandrainy, Lionelle Fanou, Z Farina, Maher Fawzy, A Feituri, NL Fernandes, LM Ford, T François, T Freeman, YBM Freeman, VM Gacii, B Gadi, M Gagara, A Gakenia, PD Gallou, GGN Gama, MG Gamal, YG Gandy, A Ganesh, Diallo Gangaly, M Garcia, AP Gatheru, SSD Gaya, Oswald Gbéhadé, G Gerbel, A Ghnain, R Gigabhoy, DG Giles, GT Girmaye, S Gitau, B Githae, Said Gitta, Riaz Goga, AAG Gomati, ME Gonzalez, J Gopall, Christina Salmina Gordon, O Gorelyk, M Gova, K Govender, P Govender, S Govender, V Govindasamy, JTK Green-Harris, MB Greenwood, SV Grey-Johnson, Mariette Grobbelaar, MA Groenewald, KK Grünewald, Ambroise Guegni, M Guenane, S Gueye, Marius Guezo, T Gunguwo, MG Gweder, M Gwila, L Habimana, Rodrigue Hadecon, E Hadia, L Hamadi, M Hammouda, MI Hampton, R Hanta, Tim C Hardcastle, JA Hariniaina, S Hariparsad, AH Harissou, R Harrichandparsad, SHA Hasan, HB Hashmi, MP Hayes, A Hdud, SH Hebli, HMSN Heerah, S Hersi, AH Hery, Adam Hewitt-Smith, TC Hlako, SCH Hodges, Richard Eric Hodgson, M Hokoma, H Holder, EB Holford, E Horugavye, C Houston, M Hove, D Hugo, CM Human, H Hurri, O Huwidi, AI Ibrahim, Traoré Ibrahim, OK Idowu, IE Igaga, John Igenge, O Ihezie, K Ikandi, IAR Ike, JJN Ikuku, MN Ilbarasi, IBB Ilunga, JPM Ilunga, NAV Imbangu, Z Imessaoudene, DH Imposo, AM Iraya, M Isaacs, M Isiguzo, A Issoufou, P Izquirdo, A Jaber, UV Jaganath, CS Jallow, S Jamabo, ZS Jamal, L Janneh, MJ Jannetjies, I Jasim, Megan AJ Jaworska, S Jay Narain, K Jermi, R Jimoh, S Jithoo, M Johnson, S Joomye, RM Judicael, M Judicaël, A Juwid, LP Jwambi, R Kabango, JK Kabangu, DK Kabatoro, AN Kabongo, K Kabongo, LT Kabongo, MD Kabongo, N Kady, S Kafu, M Kaggya, BNK Kaholongo, PCK Kairuki, SI Kakololo, K Kakudji, Amina Kalisa, R Kalisa, MR Kalufwelu, S Kalume, RJ Kamanda, MK Kangili, H Kanoun, null Kapesa, P Kapp, JK Karanja, M Karar, K Kariuki, K Kaseke, PNK Kashuupulwa, KJP Kasongo, SK Kassa, GK Kateregga, MIS Kathrada, PM Katompwa, L Katsukunya, KAM Kavuma, null Khalfallah, A Khamajeet, SB Khetrish, null Kibandwa, W Kibochi, AM Kilembe, AK Kintu, B Kipng'etich, B Kiprop, VMK Kissoon, Theroshnie K Kisten, JK Kiwanuka, MEK Knox, AK Koledale, VL Koller, MA Kolotsi, M Kongolo, ND Konwuoh, WJ Koperski, MYK Koraz, AA Kornilov, M Zach Koto, Samantha Kransingh, D Krick, S Kruger, C Kruse, W Kuhn, WP Kuhn, AM Kukembila, KL Kule, M Kumar, Belinda S Kusel, VK Kusweje, KJ Kuteesa, YY Kutor, MA Labib, M Laksari, F Lanos, TA Lawal, C Lee, RM Lekoloane, SN Lelo, B Lerutla, MT Lerutla, AI Levin, TB Likongo, ML Limbajee, DM Linyama, C Lionnet, MM Liwani, E Loots, A Garrido Lopez, CLC Lubamba, KF Lumbala, AJM Lumbamba, John Lumona, RF Lushima, L Luthuli, HL Luweesi, TSK Lyimo, HM Maakamedi, BM Mabaso, M Mabina, ME Maboya, I Macharia, AM Macheka, AZ Machowski, ASM Madsen, Farai Madzimbamuto, LJ Madzivhe, SC Mafafo, M Maghrabi, Diango Djibo Mahamane, A Maharaj, AD Maharaj, MR Mahmud, M Mahoko, NA Mahomedy, O Mahomva, TM Mahureva, RK Maila, DM Maimane, M Maimbo, SN Maina, Dela A Maiwald, MD Maiyalagan, N Majola, N Makgofa, V Makhanya, WP Makhaye, NM Makhlouf, S Makhoba, EK Makopa, O Makori, Alex M Makupe, MA Makwela, ME Malefo, SM Malongwe, DM Maluleke, MR Maluleke, K Touré Mamadou, MP Mamaleka, Y Mampangula, RM Mamy, MNR Mananjara, MTM Mandarry, DM Mangoo, C Manirimbere, A Manneh, A Mansour, I Mansour, M Manvinder, DV Manyere, VT Manzini, JK Manzombi, PM Mapanda, LC Marais, O Maranga, JPB Maritz, FK Mariwa, RS Masela, MM Mashamba, Doreen M Mashava, MV Mashile, E Mashoko, OR Masia, JN Masipa, ATM Masiyambiri, MW Matenchi, W Mathangani, RC Mathe, Christopher Y Matola, PM Matondo, R Matos-Puig, FFH Matoug, JT Matubatuba, HP Mavesere, R Mavhungu, S Maweni, CJM Mawire, T Mawisa, S Mayeza, R Mbadi, M Mbayabu, N Mbewe, WD Mbombo, T Mbuyi, WMS Mbuyi, MW Mbuyisa, RM Mehyaoui, ID Menkiti, LVM Mesarieki, A Metali, Serge Mewanou, L Mgonja, N Mgoqo, S Mhatu, TM Mhlari, S Miima, IM Milod, P Minani, F Mitema, A Mlotshwa, JE Mmasi, T Mniki, BO Mofikoya, JO Mogale, A Mohamed, S Mohamed, TS Mohamed, AM Mohamed, P Mohamed, I Mohammed, FAM Mohammed, M Mohammed, NM Mohammed, MP Mohlala, R Mokretar, FM Molokoane, KN Mongwe, L Montenegro, OD Montwedi, QK Moodie, M Moopanar, M Morapedi, TG Morulana, VL Moses, P Mossy, H Mostafa, SR Motilall, SP Motloutsi, Kanté Moussa, M Moutari, OM Moyo, PE Mphephu, Busi Mrara, C Msadabwe, VM Mtongwe, FK Mubeya, K Muchiri, J Mugambi, GIM Muguti, AB Muhammad, IF Mukama, MM Mukenga, FK Mukinda, PM Mukuna, ARW Mungherera, TW Munyaradzi, AA Munyika, JM Muriithi, MP Muroonga, R Murray, VK Mushangwe, M Mushaninga, VEM Musiba, JM Musowoya, S Mutahi, MGH Mutasiigwa, G Mutizira, A Muturi, T Muzenda, KR Mvwala, NM Mvwama, A Mwale, CN Mwaluka, JD Mwamba, HAM Mwanga, CM Mwangi, S Mwansa, V Mwenda, IM Mwepu, TM Mwiti, SZ Mzezewa, L Nabela, MTN Nabukenya, SM Nabulindo, K Naicker, D Naidoo, L Naidoo, LC Naidoo, N Naidoo, R Naidoo, RD Naidoo, S Naidoo, TD Naidoo, TK Naidu, NZ Najat, Y Najm, F Nakandungile, P Nakangombe, CN Namata, ES Namegabe, A Nansook, NP Nansubuga, C Nantulu, Rodrigue Nascimento, GT Naude, H Nchimunya, MA Ndaie, PN Ndarukwa, D Ndegwa, R Ndikumana, Andrew KN Ndonga, C Ndung'u, MC Neil, MS Nel, EV Neluheni, DS Nesengani, NT Nesengani, LE Netshimboni, AM Ngalala, BM Ngari, NBM Ngari, E Ngatia, GK Ngcobo, TS Ngcobo, D Ngorora, D Ngouane, K Ngugi, Zipporah WW Ngumi, Z Nibe, E Ninise, JC Niyondiko, PW Njenga, MN Njenga, M Njoroge, S Njoroge, W Njuguna, PN Njuki, T Nkesha, TN Nkuebe, NP Nkuliyingoma, M Nkunjana, Ernest Nkwabi, RN Nkwine, C Nnaji, I Notoane, Shaaban Nsalamba, LM Ntlhe, C Ntoto, B Ntueba, MT Nyassi, Z Nyatela-Akinrinmade, HO Nyawanda, NN Nyokabi, VN Nziene, S Obadiah, OJP Ochieng, PK Odia, OEO Oduor, EO Ogboli-Nwasor, SWO Ogendo, O Ogunbode, TO Ogundiran, O Ogutu, RW Ojewola, M Ojujo, DO Ojuka, OS Okelo, S Okiya, N Okonu, PR Olang, S Omoding, J Omoshoro-Jones, R Onyango, A Onyegbule, O Orjiako, MO Osazuwa, Kpatinvo Oscar, BB Osinaike, AO Osinowo, OM Othin, FFH Otman, J Otokwala, F Ouanes, Ongoïba Oumar, AO Ousseini, S Padayachee, SM Pahlana, J Pansegrouw, FP Paruk, MB Patel, Ushmaben Patel, AP Patience, JD Pembe, GN Pengemale, N Perez, MF Aguilera Perez, A Mallier Peter, M Phaff, RM Pheeha, BH Pienaar, V Pillay, KA Pilusa, MP Pochana, O Polishchuk, Owen S Porrill, EF Post, A Prosper, M Pupyshev, A Rabemazava, MS Rabiou, L Rademan, M Rademeyer, RAR Raherison, FR Rajah, MSR Rajcoomar, Z Rakhda, AHR Rakotoarijaona, AHN Rakotoarisoa, RR Rakotoarison, L Ramadan, MLR Ramananasoa, M Rambau, TPR Ramchurn, HE Ramilson, Rajesh J Ramjee, H Ramnarain, R Ramos, TJ Rampai, SR Ramphal, T Ramsamy, R Ramuntshi, R Randolph, DMA Randriambololona, WAP Ras, RAF Rasolondraibe, JDLC Rasolonjatovo, RM Rautenbach, S Ray, Sarah R Rayne, FAR Razanakoto, SR Reddy, Anthony R Reed, JR Rian, FR Rija, B Rink, AT Robelie, CA Roberts, AGL Rocher, S Rocher, Reitze N Rodseth, I Rois, W Rois, S Rokhsi, J Roos, Nicolette F Rorke, H Roura, FJ Rousseau, N Rousseau, L Royas, D Roytowski, Devan Rungan, SSR Rwehumbiza, BB Ryabchiy, V Ryndine, CR Saaiman, HK Sabwa, S Sadat, SS Saed, E Salaheddin, H Salaou, M Saleh, HM Salisu-Kabara, W Sam-Awortwi (Jnr), N Samuel, DK Sanduku, LN Sanyang, HN Sarah, A Sarkin-Pawa, R Sathiram, T Saurombe, H Schutte, MP Sebei, MD Sedekounou, MP Segooa, EM Semenya, BO Semo, CS Sendagire, SA Senoga, FS Senusi, T Serdyn, MD Seshibe, GB Shah, R Shamamba, CS Shambare, TN Shangase, SH Shanin, IE Shefren, AA Sheshe, OB Shittu, AS Shkirban, T Sholadoye, A Shubba, N Sigcu, SE Sihope, DS Sikazwe, BS Sikombe, K Simaga Abdoul, WAG Simo, K Singata, AS Singh, S Singh, Usha Singh, V Sinoamadi, N Sipuka, NLM Sithole, S Sitima, David Lee Skinner, GC Skinner, OI Smith, CAG Smits, MSI Sofia, Gaoussou Sogoba, A Sohoub, SS Sookun, O Sosinska, Rosalie Souhe, G Souley, Thiam Souleymane, JM Spicer, Sandra Spijkerman, H Steinhaus, A Steyn, G Steyn, HC Steyn, Heidi L Stoltenkamp, S Stroyer, A Swaleh, E Swayeb, AJ Szpytko, NA Taiwo, A Tarhuni, D Tarloff, Blaise Tchaou, Charles Tchegnonsi, M Tchoupa, MO Teeka, B Thakoor, MM Theunissen, BP Thomas, MB Thomas, A Thotharam, O Tobiko, AM Torborg, SM Tshisekedi, SK Tshisola, R Tshitangano, F Tshivhula, HT Tshuma, Janat Tumukunde, M Tun, IA Udo, DI Uhuebor, KU Umeh, AO Usenbo, JdD Uwiteyimbabazi, DJ Van der Merwe, FH van der Merwe, JE van der Walt, Dominique van Dyk, JG Van Dyk, JJS van Niekerk, S van Wyk, HA van Zyl, B Veerasamy, PJ Venter, AJ Vermeulen, R Villarreal, J Visser, L Visser, M Voigt, Richard P von Rahden, A Wafa, A Wafula, PK Wambugu, P Waryoba, EN Waweru, M Weideman, Robert D Wise, EE Wynne, AI Yahya, AA Yahya, R Yahya, Y Yakubu, JJ Yanga, YM Yangazov, O Yousef, G Yousef, AA Yunus, AS Yusuf, AZ Zeiton, HZ Zentuti, Henry Zepharine, AB Zerihun, S Zhou, A Zidan, Sanogo Zimogo Zié, CZ Zinyemba, A Zo, Lidwine Zomahoun, NZ Zoobei, Eugene Zoumenou, NZ Zubia, and Supporting clinical sciences
Subjects: Male, Postoperative Complications/epidemiology, 030230 surgery, Global Health, Severity of Illness Index, Neurosurgical Procedures, Postoperative Complications, 0302 clinical medicine, Gynecologic Surgical Procedures, 030202 anesthesiology, Outcome Assessment, Health Care, Medicine, Orthopedic Procedures, Postoperative Period, Prospective Studies, Young adult, Prospective cohort study, Digestive System Surgical Procedures, Surgical Wound Infection/epidemiology, education.field_of_study, General Medicine, Middle Aged, Hospitals, Surgical Procedures, Operative, Cohort studies, Urologic Surgical Procedures, young adult, Female, pregnancy, Vascular Surgical Procedures, Cohort study, Adult, medicine.medical_specialty, Population, Lower risk, 03 medical and health sciences, Outcome Assessment (Health Care), Severity of illness, Surgical Wound Infection, Humans, Cardiac Surgical Procedures, Mortality, education, business.industry, Cesarean Section, Perioperative, Thoracic Surgical Procedures, Logistic Models, Africa/epidemiology, Africa, Emergency medicine, Observational study, business
Abstract: Summary Background There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. Interpretation Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding Medical Research Council of South Africa.
Published: 2018

8. Effects of manure application on soil health, groundnut productivity and pre-harvest aflatoxin incidence Soil characterisation

Author: H Chalwe, A M Mweetwa, O I Lungu, E Phiri, S Njoroge, and R L Brandenburg
Published: 2017
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9. Phosphorus agronomic efficiency in maize-based cropping systems: A focus on western Kenya

Author: Job Kihara and S Njoroge
Subjects: Phosphorus, Soil Science, chemistry.chemical_element, engineering.material, Zea mays, N fertilizer, chemistry, Agronomy, Crop production, N application, engineering, Fertilizer, Soil fertility, Agronomy and Crop Science, Cropping, Mathematics
Abstract: Phosphorus (P) is facing a quantity and quality supply issue and increasing its use efficiency is important for its continued use and profitability in crop production. The objective of this study was to determine how agronomic efficiency of P (PAE) in different environments and management systems in western Kenya is affected by N application, inherent soil fertility and organic resources. We used data constituting over 2700 data points from 126 farm fields of 25 different studies conducted from 1996 to 2009. Potassium (K) deficiency is negligible in western Kenya while ommission of P and N result in a 50% and 43% reduction in yield, respectively, relative to a full NPK treatment. In poor fields (low control yields) PAE was low in the absence of fertilizer N. Overall, lack of N application decreased PAE from 29 to 19 kg grain kg−1 P. Boundary analysis indicate that maximum yields are reached at about 50 kg P ha−1. Using a marginal rate of return of 100%, maximum P application rate for western Kenya should be 38 kg P ha−1. Without chemical N fertilizer application, organic resources increased PAE by 60–100% compared to continuous maize system without organic resources. Maximum PAE decreased at increased plant-available soil P and soil coarsiness. Our analysis represents best management practices and PAE may be lower than the reported values under farmer's conditions.
Published: 2013

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

Author: S, Njoroge, A W T, Muigai, P N, Njiruh, and S, Kariuki
Subjects: Meat, Anti-Infective Agents, Goats, Drug Resistance, Bacterial, Escherichia coli, Animals, Humans, Microbial Sensitivity Tests, Hazard Analysis and Critical Control Points, Kenya, Abattoirs, Escherichia coli Infections, Needs Assessment
Abstract: To determine the antibiotic resistance patterns of pathogenic Escherichia coli on goat meat carcass at Huruma and Kiserian abattoirs in Kenya.Laboratory based study.Huruma and Kiserian abattoirs in Kenya,400 slaughtered goats inspected by veterinary health officers and approved for human consumption.A Total of 400 slaughtered goats which were inspected by veterinary health officers and approved for human consumption were sampled from Huruma and Kiserian abattoir. Goat carcass swabs were collected by passing each swab tissue on four parts of the carcass mainly neck, right and left forelimbs, right and left hind limbs, and brisket.A total of 54 E. coli isolates were isolated and confirmed to be pathogenic. The percentage of isolates resistant to various microbial agents was recorded as follows: ampicillin (26 %), amoxycillin-clavulanic acid (17%), tetracycline (15%), chroramphenicol (4%), and ceftrixone (2% each). All Escherichia coli isolates were susceptible to gentamicin sulphamethaxazole-trimethomprin, kanamycin, cetriazididine (CAZ, 30pg), ciproxacin, nalidixic acid and chloramphenicol. Isolates were resistant to one or more of the antibiotics tested. Among the drugs tested, resistance was more frequently observed against ampicillin, amoxycillin-clavulanic acid, tetracycline, ceftrixone and chroramphenicol antibiotics. Among the isolates 26(48%) were positive for the stx1 gene, 19(35%) had the eae gene, 10(19%) possessed est gene,while 8(15%) harboured elt gene. Overall five isolates (10%) possessed aspu gene and two (4%) had aggR gene. No isolate possessed ipah gene.This study demonstrated that there is a significant level of antimicrobial resistance in pathogenic E. coli isolated from goat meat from Huruma and Kiserian abattoir. This indicates that goat meat from abattoirs could pose a risk of transmission of pathogenic antibiotic resistant strains to human. Poor hygienic standards and indiscriminate use of antimicrobials are the two main reasons for the presence of resistant pathogens in goat carcasses.Implemention of appropriate hygiene measures to control contamination of meat with pathogenic E. coli.
Published: 2016

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

Author: Jeremiah M. Okeyo, Fredrick O. Ayuke, John Mukalama, Job Kihara, André Bationo, S Njoroge, Boaz S. Waswa, and Saidou Koala
Subjects: Tillage, Soil management, Crop residue, Geography, Conventional tillage, Mulch-till, biology, Agronomy, Intercropping, Cropping system, Crop rotation, biology.organism_classification
Abstract: Conservation agriculture (CA) offers an opportunity to reverse prevailing land degradation and consequent loss of productivity often occasioned by intensive soil tillage in cropping systems in most parts of sub-Saharan Africa (SSA). A long term experiment was established in Nyabeda Western Kenya in 2003 to evaluate the effect of tillage and crop residue application on maize and soybean yields, and on soil properties. The experiment was set up as a split-split-split plot design with four replicates and involved a factorial combination of tillage system (reduced and conventional tillage), cropping system (continuous cereal, soybean-maize rotation and intercropping), crop residue – maize stover – management (plus and minus crop residue) and nitrogen (N) application. Results showed that tillage influenced performance of maize although significant tillage effects were observed in only 5 out of the 15 seasons analyzed. Overall average maize grain yields were 2.9 ton ha−1 in reduced tillage and 3.6 ton ha−1 in conventional tillage systems. Application of crop residue increased seasonal maize grain yield in reduced tillage (340 kg ha−1) and in conventional tillage (240 kg ha−1), but the only significant crop residue (CR) effect was observed in season 10. Differences in maize yields between the two systems were attributed to phosphorus availability as it was demonstrated that application of crop residue in the reduced tillage resulted in better availability of P than without crop residue application.
Published: 2012

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

Author: L Tengia, C Mutua, B Singer, CS Deveau, S Njoroge, and L Dajoh
Subjects: Community based, medicine.medical_specialty, business.industry, media_common.quotation_subject, Addiction, Human immunodeficiency virus (HIV), Abstinence, medicine.disease_cause, Psychiatry and Mental health, medicine, business, Psychiatry, Addiction treatment, media_common
Abstract: This paper examines a number of outpatient addictions treatment programmes developed in various regions of Kenya. The uptake of outpatient services at four sites between 2007 and 2010 has been examined. A field-based follow-up survey was administered to determine abstinence rates among clients who participated in treatment. Factors involved in recovery outcomes are discussed. Utilization of outpatient addictions treatment and retention in services increased over the three-year period, and field-based follow up with clients showed 42% abstinence rates. Key Words: Outpatient treatment, Alcohol, Drug, Addiction recovery, HIV, Kenya
Published: 2011

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

Author: S. Shamil, S. Njoroge, and Gordon G. Birch
Subjects: Behavioral Neuroscience, Viscosity, Taste, Chromatography, Physiology, Chemistry, Physiology (medical), Organoleptic, Thermodynamics, Sweetness, Sensory Systems
Abstract: Etude, pour 15 glucides, des correlations possibles entre viscosite intrinseque et certaines proprietes moleculaires liees a la conformation d'une part et a la saveur sucree d'autre part
Published: 1988

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

Author: D M Gacuhi, J A Kamau, S Njoroge, and C K Maitai
Subjects: inorganic chemicals, Male, Veterinary medicine, Insecticides, chemistry.chemical_element, Arsenic poisoning, Cattle Diseases, Biology, Sodium Chloride, Kidney, Abomasum, TOXAPHENE POISONING, Toxaphene, Arsenic, Disease Outbreaks, chemistry.chemical_compound, Soil, Arsenic Poisoning, medicine, Animals, integumentary system, General Veterinary, Outbreak, Water, General Medicine, medicine.disease, Kenya, chemistry, Liver, Cattle, Female
Abstract: In a case of poisoning involving 70 cattle analysis of specimens obtained during post mortem examination showed that the toxic substances were arsenic and toxaphene. This was consistent with both the clinical and post mortem findings. Arsenic was detected in water from an abandoned cattle dip in the farm. Soil samples collected in the vicinity of the dip contained both arsenic and toxaphene.
Published: 1975

15. Biocontrol-based strategies for improving soil health and managing plant-parasitic nematodes in coffee production.

Author: Saikai KK, Oduori C, Situma E, Njoroge S, Murunde R, Kimenju JW, Miano DW, Haukeland S, and Coyne D
Abstract: Coffee is an important commodity for Kenya, where production is steadily declining, despite a global rise in demand. Of the various constraints affecting production, plant-parasitic nematodes are a significant, but often overlooked, threat. As a perennial crop, treating plantations once infected with nematodes becomes difficult. The current study evaluated the drenching application of two biocontrol agents, Trichoderma asperellum and Purpureocillium lilacinum , for their nematode control efficacy, as well as their impact on the soil nematode community structure on mature, established coffee trees in Kenya. Seven Arabica coffee field trials were conducted over two years on trees of various ages. All the fields were heavily infested with Meloidogyne hapla , the first report of the species on coffee in Kenya. Both fungal biocontrol agents were detected endophytically infecting roots and recovered from soil but not until six months after initial applications. The population densities of M. hapla had significantly declined in roots of treated trees 12 months after the initial application, although soil nematode density data were similar across treatments. Based upon the maturity index and the Shannon index, treatment with T. asperellum led to improved soil health conditions and enrichment of diversity in the microbial community. Application of P. lilacinum , in particular, led to an increased abundance of fungivorous nematodes, especially Aphelenchus spp., for which P. lilacinum would appear to be a preferred food source. The soils in the trials were all stressed and denuded, however, which likely delayed the impact of such treatments or detection of any differences between treatments using indices, such as the functional metabolic footprint, over the period of study. A longer period of study would therefore likely provide a better indication of treatment benefits. The current study positively demonstrates, however, the potential for using biologically based options for the environmentally and climate-smart management of nematode threats in a sustainable manner on established, mature coffee plantations., Competing Interests: Authors SN and RM are employed by the company RealIPM. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. JWK and DWM supervised CO at University of Nairobi for her MSc and contributed to the experimental design and helped revise the original thesis., (Copyright © 2023 Saikai, Oduori, Situma, Njoroge, Murunde, Kimenju, Miano, Haukeland and Coyne.)
Published: 2023
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16. Enhancing sustainable agri-food systems using multi-nutrient fertilizers in Kenyan smallholder farming systems.

Author: Adolwa IS, Mutegi J, Muthamia J, Gitonga A, Njoroge S, Kiwia A, Manoti D, Mairura FS, and Nchanji EB
Abstract: Persistent food insecurity in the global south has triggered calls for sustainable development worldwide. Moreover, more than a quarter of the world's population suffers from micronutrient deficiencies or hidden hunger. The population bulge, declining soil fertility and inadequate/inappropriate use of farm inputs in Sub-Saharan Africa place it in a precarious position. Multi-nutrient fertilizer blends have been mooted as a key innovation in closing yield gaps and boosting food and nutrition security. This study assessed the extent of multi-nutrient fertilizer blends utilization and yield response across agroecological zones and their on-farm profitability under Kenyan smallholder farmer conditions. We collected data through a detailed household survey conducted in eight counties in Kenya representative of high, medium, and low productivity zones using a sample of 1094 smallholder farmers. Multi-nutrient fertilizers increased maize yields significantly ( P < 0.05 ), eliciting a 400% yield increase compared to the control and 108% greater maize yield than conventional fertilizers in the high potential zone. Conversely, at 3.7 t/ha conventional fertilizers elicited a significant ( P < 0.05 ) yield response in Irish potatoes in the high potential areas. Multi-nutrient fertilizers increased on-farm profitability of crops, specifically for potato production systems where a benefit: cost ratio (BCR) of more than 2 was observed. Farmers may break even when they use multi-nutrient fertilizers on maize particularly in the low potential areas. Therefore, there is considerable potential for multi-nutrient fertilizers to increase crop productivity while being economically viable across agroecological zones and cropping systems. However, the uptake of multi-nutrient fertilizers among farmers is quite low across the country, except for small pockets where limited interventions have been carried out. This calls for sustained efforts to scale multi-nutrient fertilizers with a focus on clear messaging that stresses the need to apply appropriate rates of various nutrients including the secondary nutrients and micro-nutrients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)
Published: 2023
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17. Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis.

Author: Mbai J, Njoroge S, Obonyo M, Otieno C, Owiny M, and Fèvre EM
Subjects: Animals, Commerce, Cross-Sectional Studies, Female, Humans, Kenya epidemiology, Male, Poultry, Public Health, Campylobacter, Campylobacter Infections epidemiology, Campylobacter Infections veterinary, Influenza in Birds epidemiology
Abstract: Live bird markets (LBMs) provide integral hubs for 95% of poultry produced for food. Surveillance systems in LBMs serving smallholder farmers in sub-saharan Africa are often non-functional, and data about public health risks and emerging pathogens are lacking. Studies in Kenya have reported 29-44% Campylobacter prevalence in poultry. We analysed such LBMs in Kenya for likely transmission of Campylobacter from poultry to humans. We conducted a cross-sectional survey among 186 live poultry traders (LPTs) in 14 LBMs in a region with widespread backyard poultry systems. A pretested structured questionnaire was administered to all LPTs having regular contacts with poultry to gather market data and risk information on campylobacteriosis. Campylobacter was detected in individual cloacal cultures and identified through PCR. The median score obtained from the outcome of risk assessment dichotomized respondents into high and low risk categories. We performed logistic regression at 95% confidence interval (CI) to compare market characteristics and Campylobacter positivity to risk categories to identify LBM-associated public health risks. Markets had a median of 13 traders, and mean age of 46.3 ± 13.7 years. Majority 162/186 (87.1%) were males. Market behavioural processes by LPTs varied: Only 58.6% LPTs held bird species separate; onsite slaughter (38.7%); encountered sick-bird (93%) and dead-bird (83%) amidst limited health inspection (31.2%). Campylobacter positivity in live birds was 43/112 (38.4%, 95% CI: 29.4-48.1). Risk information on campylobacteriosis was low 41/114 (36%, 95% CI: 27.2-45.5). Sanitary risks were related to accumulation of litter (adjusted prevalence odds ratio [aPOR]: 19.67, 95% CI: 3.01-128.52). Accessing hand-wash facilities (aPOR: .32, 95% CI: .13-.78) and access to information (aPOR: .24, 95% CI: .09-.61) were protective. Sanitary risks were related to poor hygiene. LBMs could be central surveillance sites for Campylobacter. Public health authorities/actors should consider appropriate targeting to improve sanitary measures and Campylobacter control strategies., (© 2022 The Authors. Transboundary and Emerging Diseases published by Wiley-VCH GmbH.)
Published: 2022
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18. Progress in research on site-specific nutrient management for smallholder farmers in sub-Saharan Africa.

Author: Chivenge P, Zingore S, Ezui KS, Njoroge S, Bunquin MA, Dobermann A, and Saito K
Abstract: Increasing fertilizer access and use is an essential component for improving crop production and food security in sub-Saharan Africa (SSA). However, given the heterogeneous nature of smallholder farms, fertilizer application needs to be tailored to specific farming conditions to increase yield, profitability, and nutrient use efficiency. The site-specific nutrient management (SSNM) approach initially developed in the 1990 s for generating field-specific fertilizer recommendations for rice in Asia, has also been introduced to rice, maize and cassava cropping systems in SSA. The SSNM approach has been shown to increase yield, profitability, and nutrient use efficiency. Yield gains of rice and maize with SSNM in SSA were on average 24% and 69% when compared to the farmer practice, respectively, or 11% and 4% when compared to local blanket fertilizer recommendations. However, there is need for more extensive field evaluation to quantify the broader benefits of the SSNM approach in diverse farming systems and environments. Especially for rice, the SSNM approach should be expanded to rainfed systems, which are dominant in SSA and further developed to take into account soil texture and soil water availability. Digital decision support tools such as RiceAdvice and Nutrient Expert can enable wider dissemination of locally relevant SSNM recommendations to reach large numbers of farmers at scale. One of the major limitations of the currently available SSNM decision support tools is the requirement of acquiring a significant amount of farm-specific information needed to formulate SSNM recommendations. The scaling potential of SSNM will be greatly enhanced by integration with other agronomic advisory platforms and seamless integration of digital soil, climate and crop information to improve predictions of SSNM recommendations with reduced need for on-farm data collection. Uncertainty should also be included in future solutions, primarily to also better account for varying prices and economic outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)
Published: 2022
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19. The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center.

Author: Njoroge S, Kuriloff M, Mueller A, Lopes Perdigao J, Dhir R, and Rana S
Subjects: Adult, Black or African American, Biomarkers blood, Female, Humans, Placenta Growth Factor blood, Pre-Eclampsia blood, Pregnancy, Recurrence, Retrospective Studies, Risk Factors, Tertiary Care Centers statistics & numerical data, Vascular Endothelial Growth Factor Receptor-1 blood, Birth Intervals, Pre-Eclampsia diagnosis
Abstract: Introduction: Women with a history of preeclampsia have a higher risk of recurrent preeclampsia. This study sought to ascertain the relationship between the interbirth interval and the risk of recurrent preeclampsia and difference in angiogenic markers between the two groups., Methods: Data was collected from an ongoing cohort study of women with hypertensive disorders of pregnancy (HDP) enrolled at the admission to the labor and delivery floor. From this dataset, multigravida women with a prior diagnosis of preeclampsia were identified and compared to women with no prior history of preeclampsia., Results: Of the 375 women with HDP who were predominantly African American, 245 were multigravida and 44 (18.0%) had a prior history of preeclampsia. Women with prior preeclampsia had an earlier gestational age of delivery, higher rates of preterm delivery and a higher incidence of preeclampsia with severe features (56.8% vs 29.8%) in the index pregnancy (p-values ≤ 0.001) than those without. The median number of years between history of preeclampsia in previous pregnancy and current pregnancy was 6 years (IQR 3, 8). Among patients with a prior history of preeclampsia, the interbirth interval was not associated with severe preeclampsia (p = 0.60) and there was no difference in angiogenic factors between patients with a prior history of preeclampsia compared to those without., Conclusions: In this study, the duration of the interbirth interval was not identified as a risk factor of developing severe preeclampsia in a subsequent pregnancy and angiogenic factors are not a reflection of maternal predisposition to recurrent preeclampsia., (Copyright © 2021 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)
Published: 2021
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20. Whole Genome Sequencing Reveals Virulence Potentials of Helicobacter pylori Strain KE21 Isolated from a Kenyan Patient with Gastric Signet Ring Cell Carcinoma.

Author: Mwangi C, Njoroge S, Tshibangu-Kabamba E, Moloo Z, Rajula A, Devani S, Matsumoto T, Nyerere K, Kariuki S, Revathi G, and Yamaoka Y
Subjects: Carcinoma, Signet Ring Cell diagnosis, Cell Line, Cell Transformation, Neoplastic metabolism, Female, Gastric Mucosa metabolism, Gastric Mucosa microbiology, Helicobacter Infections complications, Helicobacter Infections diagnosis, Helicobacter pylori isolation & purification, Helicobacter pylori pathogenicity, Humans, Interleukin-8 metabolism, Kenya, Middle Aged, Phylogeny, Stomach Neoplasms diagnosis, Virulence, Carcinoma, Signet Ring Cell microbiology, DNA, Bacterial genetics, Helicobacter Infections microbiology, Helicobacter pylori genetics, Stomach Neoplasms microbiology, Exome Sequencing
Abstract: Helicobacter pylori ( H.pylori ) infection is etiologically associated with severe diseases including gastric cancer; but its pathogenicity is deeply shaped by the exceptional genomic diversification and geographic variation of the species. The clinical relevance of strains colonizing Africa is still debated. This study aimed to explore genomic features and virulence potentials of H. pylori KE21, a typical African strain isolated from a native Kenyan patient diagnosed with a gastric cancer. A high-quality circular genome assembly of 1,648,327 bp (1590 genes) obtained as a hybrid of Illumina Miseq short reads and Oxford Nanopore MinION long reads, clustered within hpAfrica1 population. This genome revealed a virulome and a mobilome encoding more than hundred features potentiating a successful colonization, persistent infection, and enhanced disease pathogenesis. Furthermore, through an experimental infection of gastric epithelial cell lines, strain KE21 showed the ability to promote interleukin-8 production and to induce cellular alterations resulting from the injection of a functional CagA oncogene protein into the cells. This study shows that strain KE21 is potentially virulent and can trigger oncogenic pathways in gastric epithelial cells. Expended genomic and clinical explorations are required to evaluate the epidemiological importance of H. pylori infection and its putative complications in the study population.
Published: 2020
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21. Functional Biology and Molecular Mechanisms of Host-Pathogen Interactions for Aflatoxin Contamination in Groundnut ( Arachis hypogaea L.) and Maize ( Zea mays L.).

Author: Soni P, Gangurde SS, Ortega-Beltran A, Kumar R, Parmar S, Sudini HK, Lei Y, Ni X, Huai D, Fountain JC, Njoroge S, Mahuku G, Radhakrishnan T, Zhuang W, Guo B, Liao B, Singam P, Pandey MK, Bandyopadhyay R, and Varshney RK
Abstract: Aflatoxins are secondary metabolites produced by soilborne saprophytic fungus Aspergillus flavus and closely related species that infect several agricultural commodities including groundnut and maize. The consumption of contaminated commodities adversely affects the health of humans and livestock. Aflatoxin contamination also causes significant economic and financial losses to producers. Research efforts and significant progress have been made in the past three decades to understand the genetic behavior, molecular mechanisms, as well as the detailed biology of host-pathogen interactions. A range of omics approaches have facilitated better understanding of the resistance mechanisms and identified pathways involved during host-pathogen interactions. Most of such studies were however undertaken in groundnut and maize. Current efforts are geared toward harnessing knowledge on host-pathogen interactions and crop resistant factors that control aflatoxin contamination. This study provides a summary of the recent progress made in enhancing the understanding of the functional biology and molecular mechanisms associated with host-pathogen interactions during aflatoxin contamination in groundnut and maize., (Copyright © 2020 Soni, Gangurde, Ortega-Beltran, Kumar, Parmar, Sudini, Lei, Ni, Huai, Fountain, Njoroge, Mahuku, Radhakrishnan, Zhuang, Guo, Liao, Singam, Pandey, Bandyopadhyay and Varshney.)
Published: 2020
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22. Gigahertz acoustic vibrations of Ga-doped ZnO nanoparticle array.

Author: Kinyua DM, Long H, Xing X, Njoroge S, Wang K, Wang B, and Lu P
Abstract: In this work, we present an experimental study on the acoustic vibrations of ZnO nanoparticles array with different concentration of Ga dopings by using femtosecond pump-probe technique. The Ga-doped ZnO (GZO) nano-triangle particles with the sizes of 190, 232 and 348 nm are fabricated by nanosphere lithography and pulsed laser deposition method. The result indicates that the frequency of acoustic vibrations of GZO nanoparticles decrease as the Ga-concentration is increased. Importantly, the vibration period of the GZO nanoparticles at the same Ga doping concentration show a nonlinear increase as the nanoparticle size is increased, which is different from the common linear dependency in undoped ZnO nanoparticles. It may be attributed to the crystal structure distortion and elastic characteristics variation due to Ga doping, and the elastic modulus at 7.3% Ga doping is decreased by 30%-60% for GZO nanoparticles with different sizes. The study can be very helpful for evaluating the crystal structure distortion and elastic characteristics of doped nano-materials with optical methods. Besides, it can offer a complementary method of thermal management in ZnO based optoelectronic devices.
Published: 2019
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23. Mitigating Aflatoxin Contamination in Groundnut through A Combination of Genetic Resistance and Post-Harvest Management Practices.

Author: Pandey MK, Kumar R, Pandey AK, Soni P, Gangurde SS, Sudini HK, Fountain JC, Liao B, Desmae H, Okori P, Chen X, Jiang H, Mendu V, Falalou H, Njoroge S, Mwololo J, Guo B, Zhuang W, Wang X, Liang X, and Varshney RK
Subjects: Aflatoxins toxicity, Agriculture methods, Animals, Arachis genetics, Host-Pathogen Interactions, Humans, Plant Diseases genetics, Aflatoxins analysis, Arachis microbiology, Aspergillus, Disease Resistance genetics, Food Contamination prevention & control
Abstract: Aflatoxin is considered a "hidden poison" due to its slow and adverse effect on various biological pathways in humans, particularly among children, in whom it leads to delayed development, stunted growth, liver damage, and liver cancer. Unfortunately, the unpredictable behavior of the fungus as well as climatic conditions pose serious challenges in precise phenotyping, genetic prediction and genetic improvement, leaving the complete onus of preventing aflatoxin contamination in crops on post-harvest management. Equipping popular crop varieties with genetic resistance to aflatoxin is key to effective lowering of infection in farmer's fields. A combination of genetic resistance for in vitro seed colonization (IVSC), pre-harvest aflatoxin contamination (PAC) and aflatoxin production together with pre- and post-harvest management may provide a sustainable solution to aflatoxin contamination. In this context, modern "omics" approaches, including next-generation genomics technologies, can provide improved and decisive information and genetic solutions. Preventing contamination will not only drastically boost the consumption and trade of the crops and products across nations/regions, but more importantly, stave off deleterious health problems among consumers across the globe.
Published: 2019
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24. Tropical surface water quality studies: Implications for the aquatic fate of N-methyl carbamate pesticides.

Author: Ha B, Zamini L, Monn J, Njoroge S, Thimo L, Ondeti M, Murungi JI, and Muhoro CN
Subjects: Carbamates chemistry, Carbaryl analysis, Carbaryl chemistry, Carbofuran analysis, Carbofuran chemistry, Half-Life, Hydrolysis, Kenya, Propoxur analysis, Propoxur chemistry, Rain, Rivers chemistry, Seasons, Structure-Activity Relationship, Tropical Climate, Carbamates analysis, Pesticides analysis, Water Pollutants, Chemical analysis, Water Quality
Abstract: Water quality assessment was conducted on the Ruiru River, a tributary of an important tropical river system in Kenya, to determine baseline river conditions for studies on the aquatic fate of N-methyl carbamate (NMC) pesticides. Measurements were taken at the end of the long rainy season in early June 2013. Concentrations of copper (0.21-1.51 ppm), nitrates (2.28-4.89 ppm) and phosphates (0.01-0.50 ppm) were detected at higher values than in uncontaminated waters, and attributed to surface runoff from agricultural activity in the surrounding area. Concentrations of dissolved oxygen (8-10 ppm), ammonia (0.02-0.22 ppm) and phenols (0.19-0.83 ppm) were found to lie within normal ranges. The Ruiru River was found to be slightly basic (pH 7.08-7.70) with a temperature of 17.8-21.2°C. The half-life values for hydrolysis of three NMC pesticides (carbofuran, carbaryl and propoxur) used in the area were measured under laboratory conditions, revealing that rates of decay were influenced by the electronic nature of the NMCs. The hydrolysis half-lives at pH 9 and 18°C decreased in the order carbofuran (57.8 h) > propoxur (38.5 h) > carbaryl (19.3 h). In general, a decrease in the electron density of the NMC aromatic ring increases the acidity of the N-bound proton removed in the rate-limiting step of the hydrolysis mechanism. Our results are consistent with this prediction, and the most electron-poor NMC (carbaryl) hydrolyzed fastest, while the most electron-rich NMC (carbofuran) hydrolyzed slowest. Results from this study should provide baseline data for future studies on NMC pesticide chemical fate in the Ruiru River and similar tropical water systems.
Published: 2018
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25. Safety and Effectiveness of Sodium Stibogluconate and Paromomycin Combination for the Treatment of Visceral Leishmaniasis in Eastern Africa: Results from a Pharmacovigilance Programme.

Author: Kimutai R, Musa AM, Njoroge S, Omollo R, Alves F, Hailu A, Khalil EA, Diro E, Soipei P, Musa B, Salman K, Ritmeijer K, Chappuis F, Rashid J, Mohammed R, Jameneh A, Makonnen E, Olobo J, Okello L, Sagaki P, Strub N, Ellis S, Alvar J, Balasegaram M, Alirol E, and Wasunna M
Subjects: Administration, Intravenous, Adolescent, Adult, Africa, Eastern, Child, Child, Preschool, Coinfection, Drug Therapy, Combination, Female, HIV Infections drug therapy, Humans, Male, Middle Aged, Pharmacovigilance, Prospective Studies, Recurrence, Treatment Outcome, Young Adult, Antimony Sodium Gluconate administration & dosage, Antiprotozoal Agents administration & dosage, Leishmaniasis, Visceral drug therapy, Paromomycin administration & dosage
Abstract: Introduction: In 2010, WHO recommended a new first-line treatment for visceral leishmaniasis (VL) in Eastern Africa. The new treatment, a combination of intravenous (IV) or intramuscular (IM) sodium stibogluconate (SSG) and IM paromomycin (PM) was an improvement over SSG monotherapy, the previous first-line VL treatment in the region. To monitor the new treatment's safety and effectiveness in routine clinical practice a pharmacovigilance (PV) programme was developed., Methods: A prospective PV cohort was developed. Regulatory approval was obtained in Sudan, Kenya, Uganda and Ethiopia. Twelve sentinel sites sponsored by the Ministries of Health, Médecins Sans Frontières (MSF) and Drugs for Neglected Diseases initiative (DNDi) participated. VL patients treated using the new treatment were consented and included in a common registry that collected demographics, baseline clinical characteristics, adverse events, serious adverse events and treatment outcomes. Six-monthly periodic safety update reports (PSUR) were prepared and reviewed by a PV steering committee., Results: Overall 3126 patients were enrolled: 1962 (62.7%) from Sudan, 652 (20.9%) from Kenya, 322 (10.3%) from Ethiopia and 190 (6.1%) from Uganda. Patients were mostly male children (68.1%, median age 11 years) with primary VL (97.8%). SSG-PM initial cure rate was 95.1%; no geographical differences were noted. HIV/VL co-infected patients and patients older than 50 years had initial cure rates of 56 and 81.4%, respectively, while 1063 (34%) patients had at least one adverse event (AE) during treatment and 1.92% (n = 60) had a serious adverse event (SAE) with a mortality of 1.0% (n = 32). There were no serious unexpected adverse drug reactions., Conclusions: This first regional PV programme in VL supports SSG-PM combination as first-line treatment for primary VL in Eastern Africa. SSG-PM was effective and safe except in HIV/VL co-infected or older patients. Active PV surveillance of targeted safety, effectiveness and key VL outcomes such us VL relapse, PKDL and HIV/VL co-infection should continue and PV data integrated to national and WHO PV databases.
Published: 2017
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26. Understanding variability in crop response to fertilizer and amendments in sub-Saharan Africa.

Author: Kihara J, Nziguheba G, Zingore S, Coulibaly A, Esilaba A, Kabambe V, Njoroge S, Palm C, and Huising J
Abstract: Improved understanding of soil fertility factors limiting crop productivity is important to develop appropriate soil and nutrient management recommendations in sub-Saharan Africa. Diagnostic trials were implemented in Kenya, Malawi, Mali, Nigeria and Tanzania, as part of the African Soils Information Service (AfSIS) project, to identify soil fertility constraints to crop production across various cropping systems and soil fertility conditions. In each country, one to three sites of 10 km × 10 km were included with each site having 12-31 field trials. The treatments tested included a control, an NPK treatment, three treatments in which the N, P and K nutrients were omitted one at a time from the NPK treatment, and three treatments in which secondary and micronutrients (Ca, Mg, S, Zn and B) simply referred here as multi-nutrients, manure and lime were added to the NPK. The field trials were conducted for 1-2 seasons; the test crop was maize except in Mali where sorghum was used. Nitrogen was limiting in all sites and generally the most limiting nutrient except in Sidindi (Kenya) and Kontela (Mali) where P was the most limiting. The general pattern in Kiberashi (Tanzania) shows none of the nutrients were limiting. K is mainly limiting in only one site (Mbinga) although incidences of K limitation were seen in almost all sites. Addition of multi-nutrients and manure further improved the yields of NPK in most sites. Cluster analyses revealed that maize crop in 11% of fields were highly responsive to nitrogen application, 25% (i.e., 21% poor and 4% fertile) 'non-responsive' to any nutrient or soil amendment, 28% being 'low responsive' and 36% of 'intermediate response'. This study indicates that constraints to crop production vary considerably even within a site, and that addressing limitations in secondary and micronutrients, and increasing soil carbon can improve response to fertilizers. For sustainable crop production intensification in smallholder farming systems in SSA, there is need to develop management strategies to improve efficiency of fertilizer use and of other inputs, recognizing the site-specific nutrient response patterns at various spatial scales.
Published: 2016
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27. Ceftriaxone-resistant Salmonella enterica serotype typhimurium sequence type 313 from Kenyan patients is associated with the blaCTX-M-15 gene on a novel IncHI2 plasmid.

Author: Kariuki S, Okoro C, Kiiru J, Njoroge S, Omuse G, Langridge G, Kingsley RA, Dougan G, and Revathi G
Subjects: Ampicillin pharmacology, Bacterial Proteins genetics, Ceftriaxone, Cefuroxime pharmacology, Chloramphenicol pharmacology, Drug Resistance, Multiple, Bacterial genetics, Kenya, Microbial Sensitivity Tests, Plasmids genetics, Salmonella typhimurium genetics, Serogroup, Anti-Bacterial Agents pharmacology, Salmonella typhimurium drug effects
Abstract: Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although nontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible for a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium isolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital in Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol, cefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to β-lactams, including to ceftriaxone, was associated with carriage of a combination of blaCTX-M-15, blaOXA-1, and blaTEM-1 genes. The genes encoding resistance to heavy-metal ions were borne on the novel IncHI2 plasmid pKST313, which also carried a pair of class 1 integrons. All nine isolates formed a single clade within S. Typhimurium ST313, the major clone of an ongoing invasive NTS epidemic in the region. This emerging ceftriaxone-resistant clone may pose a major challenge in the management of invasive NTS in sub-Saharan Africa., (Copyright © 2015, Kariuki et al.)
Published: 2015
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28. MOLECULAR CHARACTERISATION AND ANTIMICROBIAL RESISTANCE PATTERNS OF ESCHERICHIA COLI ISOLATES FROM GOATS SLAUGHTERED IN PARTS OF KENYA.

Author: Njoroge S, Muigai AW, Njiruh PN, and Kariuki S
Subjects: Abattoirs standards, Animals, Goats, Hazard Analysis and Critical Control Points methods, Humans, Kenya epidemiology, Microbial Sensitivity Tests, Needs Assessment, Anti-Infective Agents pharmacology, Drug Resistance, Bacterial, Escherichia coli drug effects, Escherichia coli isolation & purification, Escherichia coli Infections epidemiology, Escherichia coli Infections prevention & control, Meat microbiology, Meat standards
Abstract: Objective: To determine the antibiotic resistance patterns of pathogenic Escherichia coli on goat meat carcass at Huruma and Kiserian abattoirs in Kenya., Design: Laboratory based study., Setting: Huruma and Kiserian abattoirs in Kenya,, Subjects: 400 slaughtered goats inspected by veterinary health officers and approved for human consumption., Methods: A Total of 400 slaughtered goats which were inspected by veterinary health officers and approved for human consumption were sampled from Huruma and Kiserian abattoir. Goat carcass swabs were collected by passing each swab tissue on four parts of the carcass mainly neck, right and left forelimbs, right and left hind limbs, and brisket., Results: A total of 54 E. coli isolates were isolated and confirmed to be pathogenic. The percentage of isolates resistant to various microbial agents was recorded as follows: ampicillin (26 %), amoxycillin-clavulanic acid (17%), tetracycline (15%), chroramphenicol (4%), and ceftrixone (2% each). All Escherichia coli isolates were susceptible to gentamicin sulphamethaxazole-trimethomprin, kanamycin, cetriazididine (CAZ, 30pg), ciproxacin, nalidixic acid and chloramphenicol. Isolates were resistant to one or more of the antibiotics tested. Among the drugs tested, resistance was more frequently observed against ampicillin, amoxycillin-clavulanic acid, tetracycline, ceftrixone and chroramphenicol antibiotics. Among the isolates 26(48%) were positive for the stx1 gene, 19(35%) had the eae gene, 10(19%) possessed est gene,while 8(15%) harboured elt gene. Overall five isolates (10%) possessed aspu gene and two (4%) had aggR gene. No isolate possessed ipah gene., Conclusion: This study demonstrated that there is a significant level of antimicrobial resistance in pathogenic E. coli isolated from goat meat from Huruma and Kiserian abattoir. This indicates that goat meat from abattoirs could pose a risk of transmission of pathogenic antibiotic resistant strains to human. Poor hygienic standards and indiscriminate use of antimicrobials are the two main reasons for the presence of resistant pathogens in goat carcasses., Recommendations: Implemention of appropriate hygiene measures to control contamination of meat with pathogenic E. coli.
Published: 2013

29. Sodium stibogluconate (SSG) & paromomycin combination compared to SSG for visceral leishmaniasis in East Africa: a randomised controlled trial.

Author: Musa A, Khalil E, Hailu A, Olobo J, Balasegaram M, Omollo R, Edwards T, Rashid J, Mbui J, Musa B, Abuzaid AA, Ahmed O, Fadlalla A, El-Hassan A, Mueller M, Mucee G, Njoroge S, Manduku V, Mutuma G, Apadet L, Lodenyo H, Mutea D, Kirigi G, Yifru S, Mengistu G, Hurissa Z, Hailu W, Weldegebreal T, Tafes H, Mekonnen Y, Makonnen E, Ndegwa S, Sagaki P, Kimutai R, Kesusu J, Owiti R, Ellis S, and Wasunna M
Subjects: Adolescent, Adult, Africa, Eastern, Antimony Sodium Gluconate adverse effects, Antiprotozoal Agents adverse effects, Child, Child, Preschool, Drug Therapy, Combination adverse effects, Drug Therapy, Combination methods, Drug-Related Side Effects and Adverse Reactions epidemiology, Female, Humans, Male, Middle Aged, Paromomycin adverse effects, Treatment Outcome, Young Adult, Antimony Sodium Gluconate administration & dosage, Antiprotozoal Agents administration & dosage, Leishmaniasis, Visceral drug therapy, Paromomycin administration & dosage
Abstract: Background: Alternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India., Methods: A multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM (20 mg/kg/day for 21 days) and PM plus sodium stibogluconate (SSG) combination (PM, 15 mg/kg/day and SSG, 20 mg/kg/day for 17 days) with SSG (20 mg/kg/day for 30 days) for treatment of VL in East Africa. Patients aged 4-60 years with parasitologically confirmed VL were enrolled, excluding patients with contraindications. Primary and secondary efficacy outcomes were parasite clearance at 6-months follow-up and end of treatment, respectively. Safety was assessed mainly using adverse event (AE) data., Findings: The PM versus SSG comparison enrolled 205 patients per arm with primary efficacy data available for 198 and 200 patients respectively. The SSG & PM versus SSG comparison enrolled 381 and 386 patients per arm respectively, with primary efficacy data available for 359 patients per arm. In Intention-to-Treat complete-case analyses, the efficacy of PM was significantly lower than SSG (84.3% versus 94.1%, difference = 9.7%, 95% confidence interval, CI: 3.6 to 15.7%, p = 0.002). The efficacy of SSG & PM was comparable to SSG (91.4% versus 93.9%, difference = 2.5%, 95% CI: -1.3 to 6.3%, p = 0.198). End of treatment efficacy results were very similar. There were no apparent differences in the safety profile of the three treatment regimens., Conclusion: The 17 day SSG & PM combination treatment had a good safety profile and was similar in efficacy to the standard 30 day SSG treatment, suggesting suitability for VL treatment in East Africa., Clinical Trials Registration: www.clinicaltrials.govNCT00255567.
Published: 2012
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30. Geographical variation in the response of visceral leishmaniasis to paromomycin in East Africa: a multicentre, open-label, randomized trial.

Author: Hailu A, Musa A, Wasunna M, Balasegaram M, Yifru S, Mengistu G, Hurissa Z, Hailu W, Weldegebreal T, Tesfaye S, Makonnen E, Khalil E, Ahmed O, Fadlalla A, El-Hassan A, Raheem M, Mueller M, Koummuki Y, Rashid J, Mbui J, Mucee G, Njoroge S, Manduku V, Musibi A, Mutuma G, Kirui F, Lodenyo H, Mutea D, Kirigi G, Edwards T, Smith P, Muthami L, Royce C, Ellis S, Alobo M, Omollo R, Kesusu J, Owiti R, and Kinuthia J
Subjects: Adolescent, Adult, Africa, Eastern, Antiprotozoal Agents adverse effects, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Paromomycin adverse effects, Treatment Outcome, Young Adult, Antiprotozoal Agents administration & dosage, Geography, Leishmania donovani isolation & purification, Leishmaniasis, Visceral drug therapy, Paromomycin administration & dosage
Abstract: Background: Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was shown to be an efficacious first-line treatment with low toxicity in India., Methods: This was a 3-arm multicentre, open-label, randomized, controlled clinical trial to compare three treatment regimens for VL in East Africa: paromomycin sulphate (PM) at 15 mg/kg/day for 21 days versus sodium stibogluconate (SSG) at 20 mg/kg/day for 30 days; and the combination of both dose regimens for 17 days. The primary efficacy endpoint was cure based on parasite-free tissue aspirates taken 6 months after treatment., Findings: Overall, 135 patients per arm were enrolled at five centres in Sudan (2 sites), Kenya (1) and Ethiopia (2), when the PM arm had to be discontinued due to poor efficacy. The trial has continued with the higher dose of PM as well as the combination of PM and SSG arms. These results will be reported later. Baseline patient characteristics were similar among treatment arms. The overall cure with PM was significantly inferior to that with SSG (63.8% versus 92.2%; difference 28.5%, 95%CI 18.8% to 38.8%, p<0.001). The efficacy of PM varied among centres and was significantly lower in Sudan (14.3% and 46.7%) than in Kenya (80.0%) and Ethiopia (75.0% and 96.6%). No major safety issues with PM were identified., Conclusion: The efficacy of PM at 15 mg/kg/day for 21 days was inadequate, particularly in Sudan. The efficacy of higher doses and the combination treatment warrant further studies.
Published: 2010
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31. An outbreak of arsenic and toxaphene poisoning in Kenyan cattle.

Author: Maitai CK, Kamau JA, Gacuhi DM, and Njoroge S
Subjects: Abomasum analysis, Animals, Arsenic analysis, Cattle, Cattle Diseases epidemiology, Female, Kenya, Kidney analysis, Liver analysis, Male, Sodium Chloride analysis, Soil analysis, Toxaphene analysis, Water analysis, Arsenic Poisoning, Cattle Diseases chemically induced, Disease Outbreaks veterinary, Insecticides poisoning, Toxaphene poisoning
Abstract: In a case of poisoning involving 70 cattle analysis of specimens obtained during post mortem examination showed that the toxic substances were arsenic and toxaphene. This was consistent with both the clinical and post mortem findings. Arsenic was detected in water from an abandoned cattle dip in the farm. Soil samples collected in the vicinity of the dip contained both arsenic and toxaphene.
Published: 1975
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31 results on '"S Njoroge"'

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

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

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

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

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

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

7. Perioperative patient outcomes in the African Surgical Outcomes Study

8. Effects of manure application on soil health, groundnut productivity and pre-harvest aflatoxin incidence Soil characterisation

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

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

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

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

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

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

15. Biocontrol-based strategies for improving soil health and managing plant-parasitic nematodes in coffee production.

16. Enhancing sustainable agri-food systems using multi-nutrient fertilizers in Kenyan smallholder farming systems.

17. Campylobacter positivity and public health risks in live bird markets in Busia, Kenya: A value chain analysis.

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

19. The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center.

20. Whole Genome Sequencing Reveals Virulence Potentials of Helicobacter pylori Strain KE21 Isolated from a Kenyan Patient with Gastric Signet Ring Cell Carcinoma.

21. Functional Biology and Molecular Mechanisms of Host-Pathogen Interactions for Aflatoxin Contamination in Groundnut ( Arachis hypogaea L.) and Maize ( Zea mays L.).

22. Gigahertz acoustic vibrations of Ga-doped ZnO nanoparticle array.

23. Mitigating Aflatoxin Contamination in Groundnut through A Combination of Genetic Resistance and Post-Harvest Management Practices.

24. Tropical surface water quality studies: Implications for the aquatic fate of N-methyl carbamate pesticides.

25. Safety and Effectiveness of Sodium Stibogluconate and Paromomycin Combination for the Treatment of Visceral Leishmaniasis in Eastern Africa: Results from a Pharmacovigilance Programme.

26. Understanding variability in crop response to fertilizer and amendments in sub-Saharan Africa.

27. Ceftriaxone-resistant Salmonella enterica serotype typhimurium sequence type 313 from Kenyan patients is associated with the blaCTX-M-15 gene on a novel IncHI2 plasmid.

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

29. Sodium stibogluconate (SSG) & paromomycin combination compared to SSG for visceral leishmaniasis in East Africa: a randomised controlled trial.

30. Geographical variation in the response of visceral leishmaniasis to paromomycin in East Africa: a multicentre, open-label, randomized trial.

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

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