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Charuvila S, Imam MS, Reza T, Datta PK, Aziz TT, Davidson S, Sumi SA, Alam S, Ismail M, Banu T, Lakhoo K. A Prospective Observational Study of Preoperative Anaemia Management Aided by Bedside Haemoglobin Testers in a Low-Resource Setting. J Pediatr Surg 2024; 59:305-309. [PMID: 38030532 DOI: 10.1016/j.jpedsurg.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
AIM Paediatric-preoperative anaemia management is challenging in settings where clinical judgment is used to diagnose anaemia owing to a lack of timely, affordable preoperative haemoglobin testing. We analysed anaemia management in such a setting after the introduction of point-of-care bedside haemoglobin testers. METHOD 1033 children who underwent surgery at a hospital in Bangladesh were included in this study. 569 underwent major surgery, and 464 underwent minor surgery and belonged to predominantly ASA category 1 or 2. RESULTS 940/1033 children underwent preoperative anaemia testing. Average haemoglobin was 11.7 g/dL. 103/1033 children were deemed clinically anaemic. However, 285 children were found to have anaemia based on bedside testing. Sensitivity of clinical judgement was 33.68% (95 % CI 28.22%-39.49%), and the specificity was 99.08% (95 % CI 98.02%-99.66%). 63/1033 had preoperative anaemia treatment, of whom 60 underwent transfusion. Subgroup analysis of children with haemoglobin <10 g/dL (n = 124) was done to compare conservative vs liberal transfusion strategy. 43/124 of this subset was transfused. Average length of stay for those transfused was 11.7 days, and those who weren't was 9.9 days (p = 0.087). 4 patients in the transfused subgroup required post-op ICU, and only 1 patient in the conservatively managed arm required ICU (p = 0.048). CONCLUSION This study demonstrates the positive impact of bedside haemoglobin testers as they have resulted in a significantly higher proportion of children diagnosed with anaemia at a fraction of the cost and logistics involved in laboratory testing. Further research on haemoglobin thresholds is required to understand the safety and long-term impact of restrictive transfusion in the surgical context. LEVEL OF EVIDENCE 2c (Grading as per the Oxford Centre for Evidence Based Medicine).
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Affiliation(s)
- Somy Charuvila
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK.
| | - Md Sharif Imam
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tanjim Reza
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Pranay Kumar Datta
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tasmiah Tahera Aziz
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Sarah Davidson
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK
| | - Sharmin Alam Sumi
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Sakibul Alam
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Mohammad Ismail
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh.
| | - Kokila Lakhoo
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK.
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Banu T, Sharma S, Chowdhury TK, Aziz TT, Martin B, Seyi-Olajide JO, Ameh E, Ozgediz D, Lakhoo K, Bickler SW, Meara JG, Bundy D, Jamison DT, Klazura G, Sykes A, Yap A, Philipo GS. Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life. World J Surg 2023; 47:3408-3418. [PMID: 37311874 DOI: 10.1007/s00268-023-07087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Congenital anomalies are a leading cause of morbidity and mortality worldwide. We aimed to review the common surgically correctable congenital anomalies with recent updates on the global disease burden and identify the factors affecting morbidity and mortality. METHOD A literature review was done to assess the burden of surgical congenital anomalies with emphasis on those that present within the first 8000 days of life. The various patterns of diseases were analyzed in both low- and middle-income countries (LMIC) and high-income countries (HIC). RESULTS Surgical problems such as digestive congenital anomalies, congenital heart disease and neural tube defects are now seen more frequently. The burden of disease weighs more heavily on LMIC. Cleft lip and palate has gained attention and appropriate treatment within many countries, and its care has been strengthened by global surgical partnerships. Antenatal scans and timely diagnosis are important factors affecting morbidity and mortality. The frequency of pregnancy termination following prenatal diagnosis of a congenital anomaly is lower in many LMIC than in HIC. CONCLUSION Congenital heart disease and neural tube defects are the most common congenital surgical diseases; however, easily treatable gastrointestinal anomalies are underdiagnosed due to the invisible nature of the condition. Current healthcare systems in most LMICs are still unprepared to tackle the burden of disease caused by congenital anomalies. Increased investment in surgical services is needed.
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Affiliation(s)
- Tahmina Banu
- Chittagong Research Institute for Children Surgery (CRICS), Panchlaish, Chittagong, 4203, Bangladesh.
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kabir Chowdhury
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh
| | - Tasmiah Tahera Aziz
- Chittagong Research Institute for Children Surgery (CRICS), Panchlaish, Chittagong, 4203, Bangladesh
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Emmanuel Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Alicia Sykes
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Ahmed S, Karim A, Chowdhury TK, Pulock OS, Tamanna N, Akter M, Biswas P, Afroz F, Pinky SD, Alabbi AN, Jamil TR, Tasnim Z, Dev D, Marma M, Aziz TT, Hakim HAN, Basher AKMK, Shahin NHB, Banu T. Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh. PLoS One 2023; 18:e0289878. [PMID: 37578982 PMCID: PMC10424860 DOI: 10.1371/journal.pone.0289878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021. METHODS This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients. RESULTS The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery. CONCLUSIONS This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.
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Affiliation(s)
- Shakera Ahmed
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tanvir Kabir Chowdhury
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- University of South Carolina, Columbia, SC, United States of America
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Puja Biswas
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Fahmida Afroz
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | - Zarin Tasnim
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Dipa Dev
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Mraching Marma
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | | | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
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Mazingi D, Chowdhury TK, Aziz TT, Tamanna N, Lakhoo K, Banu T, Mustafa S. Building back better children's surgical services toward universal health coverage: Perspectives from Bangladesh and Zimbabwe. Front Public Health 2023; 11:1073319. [PMID: 36761126 PMCID: PMC9906807 DOI: 10.3389/fpubh.2023.1073319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Children's surgical services are crucial, yet underappreciated, for children's health and must be sufficiently addressed to make and sustain progress toward universal health coverage (UHC). Despite their considerable burden and socioeconomic cost, surgical diseases have been relatively neglected in favor of communicable diseases living up to their inauspicious moniker: 'the neglected stepchild of global health'. This article aims to raise awareness around children's surgical diseases and offers perspectives from two prototypical LMICs on strengthening surgical services in the context of health systems recovery following the COVID-19 experience to make and sustain progress toward UHC. Approach We used a focused literature review supplemented by the perspectives of local experts and the 6-components framework for surgical systems planning to present two case studies of Bangladesh and Zimbabwe. The lived experiences of the authors are used to describe the impact of COVID-19 on respective surgical systems and offer perspectives on building back the health system and recovering essential health services for sustainability and resilience. Findings We found that limited high-level policy and planning instruments, an overburdened and under-resourced health and allied workforce, underdeveloped surgical infrastructure (from key utilities to essential medical products), lack of locally generated research, and the specter of prohibitively high out-of-pocket costs for children's surgery are common challenges in both countries that have been exacerbated by the COVID-19 pandemic. Discussion Continued chronic underinvestment and inattention to children's surgical diseases coupled with the devastating effect of the COVID-19 pandemic threaten progress toward key global health objectives. Urgent attention and investment in the context of health systems recovery is needed from policy to practice levels to improve infrastructure; attract, retain and train the surgical and allied health workforce; and improve service delivery access with equity considerations to meet the 2030 Lancet Commission goals, and make and sustain progress toward UHC and the SDGs.
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Affiliation(s)
- Dennis Mazingi
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tanvir Kabir Chowdhury
- Department of Paediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chattogram, Bangladesh
| | - Tasmiah Tahera Aziz
- Chittagong Research Institute for Children Surgery (CRICS), Chattogram, Bangladesh
| | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery (CRICS), Chattogram, Bangladesh
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery (CRICS), Chattogram, Bangladesh
| | - Saqif Mustafa
- Global Health Policy Unit, The University of Edinburgh, Edinburgh, United Kingdom
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Sykes AG, Seyi-Olajide J, Ameh EA, Ozgediz D, Abbas A, Abib S, Ademuyiwa A, Ali A, Aziz TT, Chowdhury TK, Abdelhafeez H, Ignacio RC, Keller B, Klazura G, Kling K, Martin B, Philipo GS, Thangarajah H, Yap A, Meara JG, Bundy DAP, Jamison DT, Mock CN, Bickler SW. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries. World J Surg 2022; 46:2114-2122. [PMID: 35771254 PMCID: PMC9334432 DOI: 10.1007/s00268-022-06622-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.
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Affiliation(s)
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Simone Abib
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Keller
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Karen Kling
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Hariharan Thangarajah
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald A P Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA.
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Karim A, Banu T, Akter M, Mazid AHMT, Pulock OS, Aziz TT, Hayee S, Tamanna N, Chuwdhury GS, Haque A, Yeasmin F, Mitu MA, Yeasmin F, Rashid H, Kuri AK, Das A, Majumder K, Barua D, Rahaman MM, Akter S, Munia NN, Sultana J, Usaila F, Sifat S, Nourin NA, Uddin MF, Bhowmik M, Ahammed T, Sharik N, Mehnaz Q, Bhuiyan MNH. Knowledge and Attitude towards COVID-19: A Cross Sectional Study in Bangladesh through Phone and Online Survey. J Clin Exp Invest 2020. [DOI: 10.29333/jcei/9143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Banu T, Karim A, Adel MG, Lakhoo K, Aziz TT, Das A, Sharmeen N, Yapo B, Ferdous KMNU, Kabir KA, Zahid MK, Ford K, Ahsan MQ, Akter M, Alam MA, Hoque M. Multicenter Study of 342 Anorectal Malformation Patients: Age, Gender, Krickenbeck Subtypes, and Associated Anomalies. Eur J Pediatr Surg 2020; 30:447-451. [PMID: 31655491 DOI: 10.1055/s-0039-1695789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Published studies based on Krickenbeck classification of anorectal malformations (ARMs) are still insufficient to assess the global as well as regional relative incidence of different ARM subtypes, gender distribution, and associated anomalies. The primary purpose of this study was to provide an estimate of those in Global Initiative for Children's Surgery (GICS) research group. MATERIALS AND METHODS We collected ARM data prospectively for 1 year from four institutes of different geographic locations. A total of 342 patients were included in this study (195, 126, 11, and 10 from Bangladesh, Iran, Papua New Guinea, and Oxford, United Kingdom, respectively). RESULTS Overall male to female ratio was 1:1. The most frequent ARM subtype was perineal fistula (23.7% = 81/342). About 48.5% (166/342) patients had at least one associated anomaly. Cardiac and genitourinary systems were the most commonly affected systems, 31.6% (108/342) and 18.4% (63/342), respectively. These organ-systems were followed by anomalies of vertebral/spinal (9.9% = 34/342), musculoskeletal (4.4% = 15/342), and gastrointestinal/abdominal (3.2% = 11/342) systems. Rectovesical fistula had the highest percentage (96.4% = 27/28) of associated anomalies. About 18.1% (62/342) patients had multiple anomalies. ARMs (both isolated and with associated anomalies) occurred equally in males and females. Comparison between patients from Bangladesh and Iran showed differences in relative incidence in ARM subtypes. In addition, Iranian patient group had higher percentage of associated anomalies compared with Bangladeshi (73 vs. 35.4%). CONCLUSION Our study provides important insights about ARM subtypes, gender distribution and associated anomalies based on Krickenbeck classification especially from Bangladesh and Iran.
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Affiliation(s)
- Tahmina Banu
- Global Initiative for Children's Surgery (GICS).,Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Maryam Ghavami Adel
- Global Initiative for Children's Surgery (GICS).,Department of Pediatric Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Kokila Lakhoo
- Global Initiative for Children's Surgery (GICS).,Oxford Children's Hospital and University of Oxford, Oxford, United Kingdom
| | | | - Arni Das
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Nugayer Sharmeen
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Benjamin Yapo
- Global Initiative for Children's Surgery (GICS).,National Department of Health, Mt Hagen Highlands Regional Hospital, Mount Hagen, Papua New Guinea
| | - Kazi Md Noor-Ul Ferdous
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Kh Ahasanul Kabir
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Mirza Kamrul Zahid
- Global Initiative for Children's Surgery (GICS).,Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
| | - Kathryn Ford
- Global Initiative for Children's Surgery (GICS).,Oxford Children's Hospital and University of Oxford, Oxford, United Kingdom
| | - Md Qumrul Ahsan
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Department of Pediatric Surgery, Chattogram Ma O Shishu Hospital, Bangladesh
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Md Afruzul Alam
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | - Mozammel Hoque
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh.,Department of Pediatric Surgery, Chattogram Ma O Shishu Hospital, Bangladesh
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