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. MethodsWe 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. FindingsWe 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•4...

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Background Inequitable representation in journal editorial boards may impact women's career progression across surgical, anesthesia, and obstetric (SAO) specialties. However, data from Latin America are lacking. We evaluated women's representation on editorial boards of Latin America SAO journals in 2021. Methods We conducted a cross-sectional analysis, retrieving journals through Scimago Journal and Country Rank 2020. Journals were included if active, focused on SAO topics, and publicly provided information on editorial board staff. Editorial board member names and positions were extracted from journals' websites. Members were classified into senior (e.g., editor-in-chief), academic (e.g., reviewer), and non-academic roles (e.g., administrative office). Women's representation was predicted from first names using Genderize.io. The number of women SAO physicians per country was obtained from articles and governmental reports. Results We included 19 of 25 identified journals and analyzed 1,318 names. Three anesthesiology, seven obstetric, and nine surgical journals represented five Latin American countries. Women held 17% (224/1,318) of board positions [p \ 0.0001; 95% CI(0.14, 0.19)]. Women held fewer academic roles (14.3%, 155/1,084) compared to senior [28.9%, 64/221 (p \ 0.001)] and non-academic roles [38.4%, 5/13 (p = 0.042)]. Surgical journals had fewer women (7.7%, 58/752) compared to anesthesia [25.5%, 52/204 (p = 0.006)] and obstetrics [31.5%, 114/362 (p \ 0.001)]. Women's proportion on editorial boards increased according to the number of women SAO physicians per country (p \ 0.001). Conclusions Our study assessed the composition of editorial boards from Latin America SAO journals and demonstrated that women remain underrepresented. Our findings highlight the need for regional strategies to advance women's careers across SAO specialties.