SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

BackgroundPeripheral arterial disease (PAD) is rarely sought for and generally under-diagnosed even in diabetics in developing countries like Nigeria. PAD is easily detected and diagnosed by the ankle-brachial index, a simple and reliable test.ObjectivesTo determine the prevalence of PAD in diabetic subjects aged 50–89 years and the value of ankle-brachial index measurement in the detection of PAD.MethodA cross-sectional descriptive study of 219 diabetic subjects aged 50–89 years was carried out. The participants were administered a pre-tested questionnaire and measurement of ankle-brachial index (ABI) was done. The ankle-brachial index < 0.90 was considered equivalent to peripheral arterial disease.ResultsThe overall prevalence of PAD was 52.5%. The prevalence of symptomatic PAD was 28.7% whilst that of asymptomatic PAD was 71.3%. There were a number of associations with PAD which included, age (p < 0.05), sex (p < 0.05), and marital status (p < 0.05). The use of the ankle-brachial index in the detection of PAD was clearly more reliable than the clinical methods like history of intermittent claudication and absence or presence of pedal pulses.ConclusionThe prevalence of PAD is relatively high in diabetic subjects in the south-western region of Nigeria. Notable is the fact that a higher proportion was asymptomatic. Also the use of ABI is of great value in the detection of PAD as evidenced by a clearly more objective assessment of PAD compared to both intermittent claudication and absent pedal pulses.

Background: In many developing countries obesity and obesity-related morbidity are now becoming a problem of increasing importance. Obesity is associated with a number of disease conditions, including hypertension, type 2 diabetes mellitus, cardiovascular diseases, cancer, gallstones, respiratory system problems and sleep apnoea. Objectives:The aim of this study was to determine the prevalence of hypertension and obesity, as classified according to waist circumference (WC), and further to determine whether there was any association between abdominal obesity and hypertension amongst adults attending the Baptist Medical Centre, Ogbomoso, Nigeria. Method:A cross-sectional descriptive study of 400 adults aged 18 years or older was conducted. Blood pressure and WC measurements were taken and participants completed a standardised questionnaire.Results: A group of 400 participants were randomly selected (221 women; 179 men), with a mean age of 48.7 ± 16.6 years. The overall prevalence of obesity as indicated by WC was 33.8% (men = 8.9%; women = 53.8%). Women were significantly more sedentary than men (50.8% for men vs 62.4% for women, p < 0.05). Most of the obese participants' families also preferred high-energy foods (85.2%, p > 0.05). Overall prevalence of hypertension amongst the study population was 50.5%, but without a significant difference between men and women (52.0% for men vs 49.3% for women, p > 0.05). The prevalence of hypertension amongst the obese subset, however, was 60.0%. Conclusion:Prevalence of abdominal obesity was found to be particularly significant amongst women in this setting and was associated with hypertension, physical inactivity and the consumption of high-energy diets.

BackgroundIn many developing countries obesity and obesity-related morbidity are now becoming a problem of increasing importance. Obesity is associated with a number of disease conditions, including hypertension, type 2 diabetes mellitus, cardiovascular diseases, cancer, gallstones, respiratory system problems and sleep apnoea.ObjectivesThe aim of this study was to determine the prevalence of hypertension and obesity, as classified according to waist circumference (WC), and further to determine whether there was any association between abdominal obesity and hypertension amongst adults attending the Baptist Medical Centre, Ogbomoso, Nigeria.MethodA cross-sectional descriptive study of 400 adults aged 18 years or older was conducted. Blood pressure and WC measurements were taken and participants completed a standardised questionnaire.ResultsA group of 400 participants were randomly selected (221 women; 179 men), with a mean age of 48.7 ± 16.6 years. The overall prevalence of obesity as indicated by WC was 33.8% (men = 8.9%; women = 53.8%). Women were significantly more sedentary than men (50.8% for men vs 62.4% for women, p < 0.05). Most of the obese participants’ families also preferred high-energy foods (85.2%, p > 0.05). Overall prevalence of hypertension amongst the study population was 50.5%, but without a significant difference between men and women (52.0% for men vs 49.3% for women, p > 0.05). The prevalence of hypertension amongst the obese subset, however, was 60.0%.ConclusionPrevalence of abdominal obesity was found to be particularly significant amongst women in this setting and was associated with hypertension, physical inactivity and the consumption of high-energy diets.

BackgroundPresumptive treatment for malaria is common in resource-limited settings, yet controversial given the imprecision of clinical diagnosis. The researchers compared costs of diagnosis and drugs for two strategies: (1) empirical treatment of malaria via clinical diagnosis; and (2) empirical diagnosis followed by treatment only with Giemsa smear confirmation.MethodsPatients with a diagnosis of clinical malaria were recruited from a mission/university teaching hospital in southwestern Nigeria. The patients underwent free Giemsa thick (diagnosis) and thin (differentiation) smears, but paid for all anti-malarial drugs. Clinical diagnosis was made on clinicians' judgments based on symptoms, including fever, diarrhoea, headache, and body aches. The paediatric regimen was artesunate (6-9 tablets of 3 mg/kg on day one and 1.5 mg/kg for the next four days) plus amodiaquine (10 mg/kg day 1-2 and 5 mg/kg on day three in suspension). Adults were given two treatment options: option one (four and one-half 50 mg artesunate tablets on day one and nine tablets for the next four days, plus three 500 mg sulphadoxine/25 mg pyrimethamine tablets) and option two (same artesunate regimen plus nine 200 mg tablets of amodiaquine at 10 mg/kg day 1-2 and 5 mg/kg on day three). The researchers calculated the costs of smears/drugs from standard hospital charges.ResultsDoctors diagnosed 304 patients (170 adults ages >16 years and 134 pediatric) with clinical malaria, prescribing antimalarial drugs to all. Giemsa thick smears were positive in 115/304 (38%). The typical patient cost for a Giemsa smear was 550 Naira (US$3.74 in 2009). For children, the cost of testing all, but treating only Giemsa positives was N888 ($6.04)/child; the cost of empiric treatment of all who were clinically diagnosed was lower, N660 ($4.49)/child. For adults, the cost of testing all, but treating only Giemsa positives was N711 ($4.84)/adult for treatment option one (artesunate and sulphadoxine/pyrimethamine) and N730 ($4.97)/adult for option two (artesunate and amodiaquine). This contrasts to lower costs of empiric treatment for both options one (N610 = $4.14/adult) and two (N680=$4.63/adult).ConclusionsEmpiric treatment of all suspected cases of malaria was cheaper (at the end of the dry to the beginning of the rainy season) than only treating those who had microscopy-confirmed diagnoses of malaria, even though the majority of patients suspected to have malaria were negative via microscopy. One can acknowledge that giving many malaria-uninfected Nigerians anti-malarial drugs is undesirable for both their personal health and fears of drug resistance with overuse. Therefore, funding of rapid diagnostic tests whose performance exceeds the Giemsa smear is needed to achieve an ideal of diagnostic confirmation before treatment.