Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...
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Background and purpose Childhood injury is of great significance globally and epidemiological data on the subject in most developing countries are inadequate. Informed demographics can help direct resources toward research and programs most likely to reduce the burden.Methods A survey to determine the prevalence, mechanism of injury, and intervention measures was conducted using pretested questionnaires distributed to consented parents/guardians of children 15 years and younger who presented at six selected hospitals (representing public and private and low or high income clientele hospitals) for healthcare needs for any reason. Results were analyzed using Epi Info (6.04) and SPSS software (version 15).Results There were 1088 respondents comprising parents (96.5%) and guardians (3.5%). Most were 21-40 years old (86.2%) and 51.9% of them had more than three children living with them. Over 50% had witnessed injuries of their wards within the previous 12 months and about a quarter admitted that a child was injured more than once. The risk of injury was twice in the male child mainly in the 1-4 years age group. Most injuries (65.2%) occurred at home, with 98% being unintentional from falls (62.6%) and 71.9% of the times the parents witnessed the injury as it occurred. The intentional injuries (2%) followed assaults during fights among peers. Treatment was provided at home in 58.5% of children by the parents, whereas only 27.5% took their wards to the hospital; 12.6% received treatment at patent medicine stores and 1.3% from the herbal/ traditional bone setters' home. Two deaths resulted from the injuries from fall, whereas six children had residual deformity as a result of home injury. Three-quarter (74.8%) of the respondents believed childhood injuries were preventable.Conclusion Childhood injuries are not uncommon in the community. The significant proportions of respondents using inappropriate means of treatment and who believed that injuries are not preventable represent targets for health education and counseling in the community. Ann
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