Aim: To compare the participation attendance and involvement of children and young people with and without cerebral palsy (CP) in a low-resource area of Uganda.Method: Eighty-two children and young people with CP aged 6 to 22 years (49 males, 33 females) and 81 age-and sex-matched peers without CP (6 to 22 years; 48 males, 33 females) participated in this population-based, cross-sectional study. Data on attendance and involvement in 20 home and community activities were obtained using Picture My Participation, an instrument intended to measure participation in children with disabilities, particularly in low-and middle-income countries. Nonparametric statistical methods were used to assess between-group differences. Effect size estimates were calculated. Results:Pooled attendance across all activities was lower in children and young people with CP than in children and young people without CP (p < 0.001) and for each activity item (p = 0.004 to p < 0.001). The effect sizes for each activity were 0.2 to 0.7.Between-group differences were larger for community activities than for home activities. Pooled involvement across all activities was less in the group with CP (p < 0.001) and for each activity (p = 0.014 to p < 0.001). The effect sizes for each activity were 0.2 to 0.5. Children and young people in Gross Motor Function Classification System (GMFCS) levels I and II had higher attendance (p < 0.001) and involvement (p = 0.023) than those in GMFCS levels III to V.Interpretation: Participation of young people living with CP in Uganda was restricted, especially for community activities. There is a need to identify contextspecific participation barriers and develop strategies to overcome them.

No abstract

Background: Gluteal fibrosis (GF) is a fibrotic infiltration of the gluteal muscles resulting in functionally limiting contracture of the hips and is associated with injections of medications into the gluteal muscles. It has been reported in numerous countries throughout the world. This study assesses the 5-year postoperative range of motion (ROM) and functional outcomes for Ugandan children who underwent surgical release of GF. Methods: A retrospective cohort study of children who underwent release of GF in 2013 at Kumi Hospital in Eastern Uganda. Functional outcomes, hip ROM, and scar satisfaction data were collected for all patients residing within 40 km of the hospital. Results: One hundred eighteen children ages 4 to 16 at the time of surgery were treated with surgical release of GF in 2013 at Kumi Hospital. Of those 118, 89 were included in this study (79.5%). The remaining 29 were lost to follow-up or lived outside the study’s radius. Detailed preoperative ROM and functional data were available for 53 of the 89 patients. In comparison with preoperative assessment, all patients postoperatively reported ability to run normally (P<0.001), sit upright in a chair (P<0.001), sit while eating (P<0.001), and attend the entire day of school (P<0.001). Passive hip flexion (P<0.001) improved when compared with preoperative measurements. In all, 85.2% (n=75) of patients reported satisfaction with scar appearance as “ok,” “good,” or “excellent” 29.2% (n=26) of patients reported back or hip complaints. Conclusions: Overall, the 5-year postoperative outcomes suggest that surgical release of GF improves ROM and functional quality of life with sustained effect. Level of Evidence: Level IV—case series.

This letter to the editor is on the Invited Review by Bannink Mbazzi and Kawesa on pages 1193–1201 of this issue.

Background: Hundreds of international projects are implemented all over the world. Sustainability of such projects is always questioned. The objective of this study was to analyze landmarks of successful collaboration in global surgical issues between Ukrainian and Canadian institutions from 2006 to 2013. Methods: We completed a descriptive analyses of 3 international projects. Results: In collaboration with Ukrainian obstetrics and gynaecology associations and the Society of Obstetricians and Gynecologists of Canada, an initiative seeking to improve emergency obstetrical care using the Advances in Labour and Risk Management International Program (AIP) was conducted in Ukraine. From 2006 to 2009, 912 providers participated in 18 AIP trainings. Since project termination, 10 AIP training with 435 participants were conducted by a national team. Training is now institutionalized into the Donetsk National Medical University (DNMU) curricula. Since 2010 in collaboration between the University of Toronto, and the DNMU, the Donetsk Telesimulation Satellite Center was established. A telesimulation program has been applied to introduce the Fundamentals of Laparoscopic Surgery course, with the objective to standardize the technical skills of Ukrainian professionals. In total, 137 participants from 11 sites have completed the course. Since 2011, a collaboration between the McGill University and the DNMU to improve disaster management and trauma care has been established. A risk assessment tool geared speci fically toward the European Football Championship Euro 2012 was developed. Trauma training has been conducted and the creation of a database of injury epidemiology. Conclusion: Sustainable partnerships is important to ensure long-term interest in an initiative either funded or not. Capacity building based on bottom-up approaches with the initiative coming from national professionals to ensure national ownership and leadership with long-term commitment is essential. 2. COSECSA, achievements and challenges in improving global surgery. P.G. Jani.