Background Safe blood is essential for the care of patients with life-threatening anemia and hemo... more Background Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach. Methods This study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation...
Edible insects have been identified as a possible sustainable food source not only because they a... more Edible insects have been identified as a possible sustainable food source not only because they are rich in proteins and other nutrients required by the body, but they can also cheaply and sustainably support the hungry, the malnourished and the poor. Indisputably, people have been slow to embrace the consumption of edible insects across the globe and narrowly in Siaya County of Western Kenya. Few studies have been conducted to provide information on low uptake and consumption of edible insects in the county, especially pertaining to social, culture and economic factors. A multistage random sampling technique was used in the selection of the respondents in this study, followed by a systematic data collection using a digital questionnaire coded and configured in ODK Collect. A descriptive study design was adopted whereby a semi-structured questionnaire was used to collect data on key variables. Additionally, a key informant interview guide was also used to collect data mainly for tri...
Background Congenital anomalies are the fifth leading cause of mortality in children younger than... more Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•41-2•71], p=0•0001; parenteral nutrition 1•35, [1•05-1•74], p=0•018). Administration of parenteral nutrition (0•61, [0•47-0•79], p=0•0002) and use of a peripherally inserted central catheter (0•65 [0•50-0•86], p=0•0024) or percutaneous central line (0•69 [0•48-1•00], p=0•049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. Funding Wellcome Trust.
BackgroundThe supply of blood in many low‐ and middle‐income nations in Sub‐Saharan Africa (SSA) ... more BackgroundThe supply of blood in many low‐ and middle‐income nations in Sub‐Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA.Study Design and MethodsThe study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a “vein to vein” workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as...
The Government They Deserve: the role of the elite in Sudan&amp;amp;amp;amp;amp;amp;amp;amp;a... more The Government They Deserve: the role of the elite in Sudan&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s political evolution. by Mansour Khalid, London: Keegan Paul International. 1990. 480pp. £25.00hbThe Rainy Season: Haiti since Duvalier. by Amy Wilentz, London: Jonathan Cape. 1989. 427pp. £14.95hbMau Mau: an African crucible. by Robert B Edgerton, London: IB Tauris. 1990. 310pp. £14.94hbA Modern History of Kenya 1895–1980. by William R Ochieng
Background Safe blood is essential for the care of patients with life-threatening anemia and hemo... more Background Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach. Methods This study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation...
Edible insects have been identified as a possible sustainable food source not only because they a... more Edible insects have been identified as a possible sustainable food source not only because they are rich in proteins and other nutrients required by the body, but they can also cheaply and sustainably support the hungry, the malnourished and the poor. Indisputably, people have been slow to embrace the consumption of edible insects across the globe and narrowly in Siaya County of Western Kenya. Few studies have been conducted to provide information on low uptake and consumption of edible insects in the county, especially pertaining to social, culture and economic factors. A multistage random sampling technique was used in the selection of the respondents in this study, followed by a systematic data collection using a digital questionnaire coded and configured in ODK Collect. A descriptive study design was adopted whereby a semi-structured questionnaire was used to collect data on key variables. Additionally, a key informant interview guide was also used to collect data mainly for tri...
Background Congenital anomalies are the fifth leading cause of mortality in children younger than... more Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•41-2•71], p=0•0001; parenteral nutrition 1•35, [1•05-1•74], p=0•018). Administration of parenteral nutrition (0•61, [0•47-0•79], p=0•0002) and use of a peripherally inserted central catheter (0•65 [0•50-0•86], p=0•0024) or percutaneous central line (0•69 [0•48-1•00], p=0•049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. Funding Wellcome Trust.
BackgroundThe supply of blood in many low‐ and middle‐income nations in Sub‐Saharan Africa (SSA) ... more BackgroundThe supply of blood in many low‐ and middle‐income nations in Sub‐Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA.Study Design and MethodsThe study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a “vein to vein” workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as...
The Government They Deserve: the role of the elite in Sudan&amp;amp;amp;amp;amp;amp;amp;amp;a... more The Government They Deserve: the role of the elite in Sudan&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s political evolution. by Mansour Khalid, London: Keegan Paul International. 1990. 480pp. £25.00hbThe Rainy Season: Haiti since Duvalier. by Amy Wilentz, London: Jonathan Cape. 1989. 427pp. £14.95hbMau Mau: an African crucible. by Robert B Edgerton, London: IB Tauris. 1990. 310pp. £14.94hbA Modern History of Kenya 1895–1980. by William R Ochieng
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