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Torborg A, Meyer H, El Fiky M, Fawzy M, Elhadi M, Ademuyiwa AO, Osinaike BB, Hewitt-Smith A, Nabukenya MT, Bisegerwa R, Bouaoud S, Abdoun M, El Adib AR, Kifle Belachew F, Gebre M, Taye DB, Kechiche N, Fadalla T, Abdallah B, Chaibou MS, Nyarko MYA, Ki KB, Shalongo S, Mulwafu W, Thomson E, Traore MM, Ndonga A, Bittaye M, Samateh AL, Munlemvo DM, Kalongo JJ, Coulibaly Y, Coulibaly Y, Ravelojaona V, ANDRIAMANARIVO L, RAHERISON AR, RANDRIAMIZAO HMR, RAMKALAWAN K, Omar MA, Ndikontar R, Joseph D, Dahir S, Mohamed M, Ali Daoud H, Ndarukwa P, OTIOBANDA GF, Banguti P, Neil K, Derbew M, Fanny M, Smalle I, Taylor EH, Duvenage H, Hardy A, Kluyts H, Pearse R, Biccard B, AARON OI, Abd Elazeem Mohammed HAS, Abdalkarim B, Abdalla A, Abdallah MAA, Abdeewi S, Abdel Ghafar T, Abdelaleem A, Abdelaleem IA, Abdelgader K, Abdelgadir W, Abdelhafez M, Abdelhalim A, Abdelkabir M, Abdelkader Osman M, Abdelkarim M, Abdelkarim M, Abdelmohsen SM, Abdelnassir M, Abdelrahman ASM, Abdelwahed AE, Abdelzaher M, Abderrahim BA, Abdoulaye T, Abdulai S, Abdulghaffar YA, Abdullah F, Abdullahi LB, Abdullahi M, Abdulrazik S, Abdulsalam KI, Abdulwahed E, Abdus-Salam R, ABE TOLUSHE, Abera Mulugeta G, Aboelghait AA, Abol Oyoun N, Aboubekr B, Abraham M, Abu M, Abuagila AA, Abubakar M, Abugilah M, Abuzeid IA, Achouri D, Acquah SA, Adam NBA, ADAMU AUWAL, Adamu KM, ADAMU MUHAMMAD, ADAMU S, Adane SG, Adeaga M, Adebayo S, Adedire A, Adegoke PA, Ademuyiwa AO, Adeniyi AA, Adeoye I, Aderibigbe G, ADEROUNMU A, ADEYEMI WILLIAMS, ADEYEMO A, Adigun T, Adika ED, ADISA AO, Adjei E, Adjepong-Tandoh EK, Ads AM, ADUMAH DCC, ADUMAH LO, Adzamli I, Afari J, Afedo W, Affan A, AFOLAYAN AO, Agaba S, Agbeno E, Agbonrofo P, Aghadi I, AGU EDITH, Agyen T, Agyen-Mensah K, Ahensan D, Ahmad MH, AHMED A, Ahmed L, Ahmed NYAA, Ahmed R, Ahmed Jroush M, ahmed maghur H, AHOGNI GG, Ait Yahia S, Aji N, Aji SA, Akerele W, Akhideno I, Akinmokun I, AKINNIYI AT, Akinniyi A, AKINYEMI S, Akitoye OA, AKPAETTE IC, Akuma TJ, Akuokor D, Akwei CNA, Al Bashir RBH, Al Gharyani MF, al Islam ben Jouira R, Aladelusi T, Alakaloko F, Alameen H, Alameen Moheyaldeen M, Alaogaly M, Alarabi R, Alawami M, Alazabi BM, Alazabi M, Albakosh BA, ALBDULRRAZIQ HUSAYNMOHAMMEDE, Aldieb A, Aldressi W, Alegbeleye GE, Alfa Y, Alhadad Q, Alhaddad AR, Alhaddad HF, Alhadi A, Alhamali A, Alharam A, Alhlafi M, Alhouwasi B, Alhudhairy S, Ali AMA, Ali AJ, Ali A, Ali A, Ali E, Ali M, Ali S, Ali YY, Ali Ahmed A, Aliozor S, Aljamal S, Alkaseek A, Alkhalifa E, Alkoni S, Allie A, Almelyan K, Almugaddami A, Almujreesi A, Alqady E, Alragheai AA, Alshareea E, Alshareef A, Alsori M, Altomy SA, Al-Touny A, Al-Touny SA, Alum Aguma R, Alwaer NM, Al-zletni H, Alzwai M, Amaambo N, Amah CC, Amary M, Amengle LA, Amesho SLO, Ametepe M, Amkhatirah E, Amnaina MG, Amoah B, Amoah JK, Amo-Aidoo NAS, Amoako-Boateng M, Ampong J, Anane-Fenin B, Anarfi S, Andriamanarivo ML, Aniakwo L, Aniteye E, Ankrah LNA, Anno A, Anyanwu LJC, Anyigba E, Appeadu-Mensah W, Appiah-Thompson P, Apraku-Peprah EL, Aremu SK, Arinaitwe M, Armah R, Arthur A, Arthur D, Asah-Opoku K, Asante M, Asante-Asamani A, Asare A, Asasira L, Ashfersh M, ASHINDOITIANG JA, Ashong J, Ashraf Salah M, Asiedu C, Asiedu I, Asiyanbi K, Asla A, Asman W, Asoegwu EJ, Assalhi M, Assim C, Asudo FD, Atai AG, Ateeqa SB, Atim T, Atindama S, ATIQUI IJLAL, Atrih Z, Attah RA, Awad AK, Awedew AF, Awedew AF, Aween H, Awere-Kyere L, Awindaogo J, Awori Achani M, Ayad K, Azab A, Azas A, Aziza B, Azize DA, AZOUI A, Azouz J, Baba S, Babalola OF, Babiker M, Baddoo D, Badi A, BADMUS SA, Badr H, Bah A, Bah FY, Bah K, Bah MT, Bahroun S, Baidoo E, Baidoo K, Baidoo R, Bakare A, Bakeer HB, Baky Fahmy MA, Balogun J, Bamigboye B, Bankah P, Banson M, Barhouma YE, Barongo M, BASHIR RABIU MOHAMMED, Bassem A, Bedair MAA, Beeharry HR, Beeharry S, Bekele S, Belie O, Belkhair A, Ben Ahmed Y, Ben Ashur A, Ben Hamida B, Benade C, BENMANSEUR S, Bensebti AA, BERDAI MA, Beyuo V, Biala M, Bilson-Amoah E, Bin wali SS, Binnawara M, Birlie Chekol W, Birqeeq G, Biyase T, Blankson PK, Boakye B, Boakye B, Boakye-Acheampong K, Boakye-Yiadom K, Boateng J, Bobaker S, Bode C, Bogoslovskiy A, Bolarinwa ES, Boretti L, Botchway MT, Botha C, BOUDA BD, BOURENANE H, BOUZBID S, Boye J, Branny M, Brown GD, Brown W, Bua E, BWALA KEFASJOHN, Camara B, Camara ML, Carol T, Ceesay W, Chafee K, Chaklie Agegnehu B, Chamir C, Chaziya PYC, Chellan C, Cheniki N, Chennouf S, Chepkoech E, Chilango C, Chinda JY, Chokwe TM, Choutri H, Christian NA, Chukwu I, Chummun G, Cilliers C, Cloete E, Collison C, Cronje L, Daary D, DAD B, Daddy H, Dahilo EA, Dairam J, Dalaf MS, Damson P, Daneji SM, Daniel A, Daoud A, Daoud H, Darat TD, Darko KO, Darko K, Davidson K, Davies A, Dawang YD, Dayal K, Dayie M, de Goede A, de Goede A, Deelawar BW, Derwish K, Desalu I, Dessalegn Beza A, Dhege C, Dhilraj D, Diallo TS, Diaw M, Diaw Diop A, DIENE M, Dieng M, Dippenaar T, Djagbletey R, Djedid NK, Djouonang KT, Dominique S, Drammeh B, Drissi H, du Bruyn A, Dube T, Dufe R, Dung D, Earl E, Ebrahem OKA, Ebrahim Z, Edena ME, Effa Ngono R, Egbuchulem K, Egdeer A, Eguma SA, Ehimhantie M, EJIOFOR OC, Ejuma LO, Ekenze S, Ekhmaj RA, Ekor O, EKPA S, Ekpemo CS, Ekudo J, Ekwunife OH, El Koraichi A, El Magrahi H, El Mejrab M, El Sadek R, El YOUBI H, Eladani O, Elamesh SAH, Elamien M, Elamin Elnour MA, Elbadawy MA, Elbaseet H, Elderwy AA, Elebute O, Elgamal M, Elgenidy A, Elghareeb A, Elgherwi L, Elhadad R, Elhadi A, Elhassan M, Elkhouly AM, Ellebedy M, ELMAJRI MOHAMEDFUAD, Elmandouh O, Elmandouh R, Elmorsi R, ELOMBILA M, Elsadek M, Elsalhawy S, Elsayem K, Elshafiey M, El-Sharkawi M, Elshazly M, Eltaub D, Eltayeb AA, Eltayeb MEZ, Eltegani Abdalla A, ElWakeel M, Embu H, Emoru A, Enicker B, Enti D, Entsua-Mensah K, Eseile SI, Essuman VA, Et-taghy H, Etwire V, Eyaman KD, Ezbeida M, EZEKIEL ANTHONYSABO, Ezidiegwu SU, Ezomike UO, FABOYA O, Fadlalmola H, FAGBAYIMU OM, Faida H, FALL K, Farahat S, Faraj A, Faraj N, Farghaly A, Farhat KOA, Farinyaro AU, Fathi Bani G, Fattah A, Fawzy M, Fening N, Fentahun Emrie A, Fidieley M, Fikadu Keneni D, Fischer M, Flint M, Fodo N, Fofana N, Fokeerah N, Folami E, Folokwe S, Fonternel D, Fosi Kamga G, Fotso LK, Fourtounas M, Frankish L, Gabier I, Gacii VM, Gaffoor MS, Gagara M, GALADIMA HA, Gamubaka R, Ganey M, Ganiyu OO, Gasa N, Gatheru AP, Gawu VS, Gaya SSD, GAYE I, Gebremichael Ganta A, Gelaw KG, Geldenhuys L, Getachew Tegegn A, Ghemmied M, Ghmagh R, GILES AHEREZA, Ginsburg RG, Girma K, Gjam F, Glover-Addy H, Gobin V, Gomeh P, Gomez D, Gorelyk A, Gossaye A, Govender V, Grant J, Grayson BL, Grobbelaar M, Gueye KR, GUIRO H, Gumede S, Gurure D, Gusibat A, Gyeke-Boafo NK, HACHEMI S, Haddis K, Haidar A, Haif A, Hameed-Ikram S, Hamid H, Hamukwaya D, Hanson NA, Hanzi J, Hardcastle T, Harissou A, Hasan A, Hasan HB, Hasan NB, Hashi AS, Hashish AA, Hassaan I, Hassan S, Hassan SA, Hassan T, Hassan Z, Hassane ML, Hassanein M, Hawu Y, Haywood D, Heelan H, Hendricks N, Hillah A, Hlela Q, HMAMOUCHI B, Hoko Z, Honny D, Honore S, Houidi S, Human T, Hussain E, Hussain Kona MH, Hussein Y, Ibekwe TS, Ibiyemi A, IBIYEYE TAIBAT, Ibrahim IA, Ibrahim LI, Ibrahim S, Ibrahim Abubakar A, Ibrahim Alain T, Idipo F, Idoko G, Idowu O, Idris MEA, Igaga EN, Iindongo E, IITULA P, IKOTUN O, ILLE G, Imposo DH, Invernizzi J, Irungu E, Isbayqah AM, Isbayqah EM, Ismael G, Ismail AM, Itambi AM, Jabang JN, Jaga R, Jaganath U, Jaiteh L, Jallow CS, James O, Javed S, Jithoo S, Jlidi S, Joel L, Johnson M, JONES TAIWO, Jooma Z, Joomye S, Joosab M, JOUINI R, Jubail MJ, Juggoo C, Jumbi TM, Kaabar N, Kabirou M, Kabiru AM, Kabre BY, Kache S, Kacimi SEO, KADAS ABUBAKARSAIDU, KAHANSIM B, Kalipa M, Kalongo JJK, Kalu NE, Kamate B, Kamwangen GM, Kandjimi M, Kanjana-Zondo N, Kankpeyeng L, Kapalamula T, Karadji S, Kargbo MA, Karghul M, Kaskar R, Kasker R, Kasobya F, Kassem O, Kateregga G, Kayima P, Kedwany AM, Ken-Amoah S, Kenneth TK, KERISSE ANEH, KERKENI Y, Khairi R, Khaled M, Khalifa E, Khalifa MS, Khalil MK, Khattab MSI, Khodary AR, Khumalo BF, Khumalo P, Kigayi JP, Kimutai TK, KINDO B, KIRFI ABDULLAHIMUSA, Koggoh P, Koko AA, Kopieniak M, Kotagiri C, Kotey E, Kouicem AT, Kpangkpari R, Kudoh V, Kufonya N, Kuhn W, Kutor J, Kwakye A, Kynes JM, Lambrechts L, Lamiri R, LANRE OLOKONASIRUDEEN, Larvie P, Lateef AK, LATRECHE S, Lawal T, Leballo G, Lebereki S, Lee D, Leeb G, Leonard T, LEYONO-MAWANDZA PDG, Likongo TB, Limalia Z, LIMAN HARUNAUSMAN, Loae N, Lompoli BNE, Lusungu D, M.Mokhtar FALZ, Madany MEDM, Maddy RJ, Madombwe G, Mafabi S, Magashi MK, Maharaj S, Mahfouz SM, Mahlare KRV, Mahmoud F, Maikassoua M, Maison P, Maiwald D, Makhoba P, Makinita SG, Makou epse Tolefac M, Malau TK, Mamathuntsha TG, Mamo TN, Mamuda A, Mandundzo P, Mangray H, Mani S, Manneh EK, Mansour NM, Manyere DV, Mapurisa A, Mare P, Martin ME, Mashaal A, Mashaya S, Masilela PB, Mathebula R, Mathinya T, Matlala TK, Matlou M, Matos-Puig R, Matoug S, Maudarbocus MJ, Mavesere HP, Mavila J, Mayet S, Maygag M, Mbatha N, Mbatudde R, Mbiya Kapinga A, Mbuyamba J, Mbuyi AT, Mdlalose N, Prowling M, Mejeni N, Mekonnen Ejigu Y, Merghani S, Metogo JEN, Mhiri R, Mhone L, Michael A, Miko AM, Milad A, Mishra R, Mjadu L, Mkhontwana N, Mlambo N, Mncwango Z, Mngoma G, Mnguni M, Modekwe VI, Mogane P, Moghazy R, Mogotsi K, Mohalal MS, Mohamed AAA, Mohamed M, Mohamed MEE, Mohamed SA, Mohamedkheir MA, Mohammad AL, Mohammad AD, Mohammad AM, Mohammed A, Mohammed M, Mohammed RI, Mohammed R, Mohammed TSA, Mohammedosman D, Mohsen SM, Molla Getahun A, Moloisi M, Monib FA, Moodley K, Moopanar M, Morgan F, Moris B, Morna M, Moses V, Mostafa MM, Motiang M, Motseoile T, Motshabi P, MOUSSAOUI N, Mpoto DB, MPOY EMY MONKESSA CM, MRARA BUSISIWE, Mshelbwala PM, Msherghi A, Msibi T, Mubunda RK, Muhammad AB, Muhammad S, Muhanguzi J, Muhindo R, Mukenga MM, Mukuna PM, Mulewa D, Munanzvi KS, Mungur L, Munubi A, Munyalo FS, Muriithi JM, Musa AA, Musa K, Musa MAE, Musana F, Musewu TD, Musiitwa AK, Mwangi CM, Mwepu IM, Mwepu MI, Mwika PM, Mwiti TM, Myeni P, Mzoneli N, Naana R, Nabukenya G, Nabunya S, Naidoo A, Naidoo V, Naidu P, Nakyanzi C, Nambi E, Nampawu MJ, Nampiina G, Namutebi H, Nana B, Nanda JSY, Nanimambi J, Nantongo B, Napolitano L, Naser A, Nassar AS, Nassar MS, Nasser N, Nawezo JG, NDIAYE A, NDIAYE CAT, Ndiaye F, Ndibarekera SH, Ndjoko SM, Ndlovu M, Nduwayezu R, Negash S, Nehema S, Neil K, Neizer M, NEJMI S, Nezam-Parast M, Ng How Tseung K, Ngcelwane T, Ngene I, Nghidinwa H, Ngissah R, Ngock GFFN, Ngouane D, Ngumi Z, Nibret Y, NIENGO OUTSOUTA G, Njie M, NJOKANMA RA, Nkhata L, Nkhuna NT, Nkosi N, Nkosi S, Nkwembe CM, Nnaji C, Nneji-Akazie T, Nongqo N, Nortey M, Noutakdie Tochie J, Nsaful J, Nsimire BB, Nte SK, Ntshingila C, Ntsie NP, Ntsoane D, Ntumy MY, Nuer-Allornuvor G, Nuhu S, Nutsuklo P, Nwachukwu CU, NWAFULUME NNAEMEKA, Nwangwu E, Nwankwo EP, Nyame CA, Nyamekye E, Nyankah E, Nyoka-Mokgalong C, Oase D, Obande JO, Obbeng A, Obeng-Adjei GI, Obianyo I, Obianyo NE, Obiechina S, OBRI AI, ODI TEMITOPE, Odingo J, Oelofsen S, Ofori E, Ofori-Adjei D, Ogaji IM, Ogundoyin OO, OGUNLEYE OLABISI, OGUNS A, Ogunsua O, Ohemeng-Mensah E, Ojediran O, Ojediran O, Ojewuyi A, Ojewuyi O, Ojo A, OJO OO, Ojo O, Okedare A, Okenwa SC, Oko AG, Okojie N, Okonkwo LN, Okoth P, Okunlola AI, Okunlola CK, Okurut M, Oladimeji M, Oladiran A, Olagunju GR, Olajide ARL, Olajide AT, Olang PR, Olayinka O, Olori S, Olulana D, Olulana DI, Olusanya B, Omar DE, Omar MA, Onakpoya U, ONeil M, Onen H, ONYEKA C, Oosthuizen A, Opandoh I, Opiyo S, Oppong J, Orewole TO, Orji M, Osagie O, Osagie OT, Osaheni O, Osama Sleem A, Osawa FO, Osei F, Osei-Nketiah S, Osei-Poku D, Osman A, Osman Ahmed M, Osman Suliman SO, Otchere K, Othman AAA, Othman E, Othman M, Otim P, Otim T, Otman RH, Otoki V, OUDJHIH M, OUEDRAOGO I, OUEDRAOGO PJ, Ousmane Hamady I, Ouyahia A, OWOJUYIGBE A, Owoo C, Owoo P, Owusu Boamah M, Oyedele A, Oyedepo O, Oyegbola C, Panday J, Parker EUE, Parker I, Parker RK, Pembe JN, Percivale B, Pereko J, Pérez M, Perumal N, Pillay L, Pretorius R, Prinsloo R, Pryce C, Puryag A, QUADRI OR, Quansah K, Quarcoopome C, Quarshie A, Quartson E, Quashie-Sam J, Rabiu A, Rabiu T, Rahma M, Rahman GA, Rais M, Rajah C, Rakotondrainibe A, Ramakrishnan R, Ramatou S, Ramdawon B, Ramdhani K, Ramkaun Y, RAPHAEL OSELE, Raslan HMA, Redelinghuys C, Riffi O, Rikhotso H, Roberts CAP, Robertson C, Roland N, Roos J, S. Abdalgadir E, Saad A, Saad MM, Saad El-Tanekhy A, Saadi C, Saadu T, Saber M, Sabir Yassin FM, Sabo VY, Sabra TA, Saeid DA, Safar A, Sagboze S, Sahnoun L, Salahu BM, Salami K, Salawu AI, Saleh H, Saleh IA, Saleh KM, Salele AM, Salem F, Salem O, Salih MAIA, Salisu I, Sall M, SAMB CF, Sangak IA, Sanoussi NM, Sanya D, Sanyang AB, Sarpong P, SARR JN, Schnaubelt R, Searyoh K, SECK NF, Secka AS, Seif M, Seilbea Y, Semret Hailu B, Sepenu P, Sewlall J, Seyi-Olajide J, Shai S, Shalaby AMO, SHAPHAT IBRAHIM, Shava G, Sheidu Owuda A, Sheshe AA, Shetiwy M, Shezi N, Shihab MH, Shitakumuna H, Shitaye N, Shitta AH, Sholadoye TT, Shouasha P, Shu'aibu NG, Shuiap NM, Sibeko B, Sikhakhane S, Sikwete G, Sime Gizaw H, Simelane N, Simon E, Singh U, SIRAJALDIN A, Siriboe E, Siyothula T, Siyotula T, Smart-Yeboah A, SMITH S, Solala S, Soliman EA, Solo CE, Sombéwendin Charles I, Sonaike M, Songden DZ, Sottie D, Soualili Z, Soula E, Souleymane S, SOWANDE OA, Spytko A, Srir DOM, Ssebuguzi L, Stegmann GF, Strauss L, Struwig E, Succi M, Suleiman AR, Suliman M, Swartz M, Taha TM, Takai IU, Takou BH, Takrouney MH, Takure A, TALABI AO, Tall M, Taute C, Tawfik M, Taylor J, Tembe DS, Temesgen F, Tesfaye E, Theko D, Thiart M, Thompson R, Thuer L, Tientcheu Fabrice T, Tilahun ZB, Tilahun Woldetsadik T, Timo M, Timotews N, Tjiyokola D, Tolani MA, TOUABTI S, Traoré D, Tsegha LJ, Tseli M, Tumuhimbise C, Tumukunde J, Tunkara SFS, Turshan L, Turton E, Uchendu CC, UDIE GU, UDOSEN JE, Ugalahi M, Ugwu EM, UGWU IE, Ugwu JO, Ugwunne CA, Ukpabio UE, Umar AM, UMEH CL, Ungen R, Usang U, Usenbo T, Usman MI, UWAYESU R, Van Aswegen B, van der Byl A, van der Linde P, van der Walt S, van Schalkwyk HP, van Tonder C, van Vuuren S, van Wyk J, van Zyl S, Wabule A, Wacays A, Waheed Mowafy G, Waisiko B, Walawah D, Walithandia E, Wamwaki J, Wataaka N, Wessels N, Wessels N, Williams E, WILLIAMS O, Woldegiorgis A, Wolfaardt G, Wondossen M, Woodun R, Workineh ST, Wubetu S, Yahia M, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N, Yakubu H, Yakubu SY, Yalewu DZ, YAMEOGO TAC, Yeboah F, YENYI AHUKA LONGOMBE T, Younes E, Young C, Younis N, Younus TYI, YUSUF STEPHEN, Zaki F, Zbida I, Zenda T, ZERIZER Y, Zingoni K, Zitouni H, ZONGO PV, Zubi A, Zulu N, Zulu N. Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study. Lancet 2024; 403:1482-1492. [PMID: 38527482 DOI: 10.1016/s0140-6736(24)00103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa. METHODS This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407. FINDINGS We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals). INTERPRETATION Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue. FUNDING Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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