Publications

Background

The social stigma of families of children living with colostomies due to anorectal malformation (ARM) is significant in low-income countries (LICs). Improved access to pediatric surgery has resulted in more 1-stage ARM procedures in Southwestern Uganda, avoiding colostomy creation, but the impact on social stigma experienced by families is unknown. We hypothesized that this change would decrease the social stigma experienced by families.

Methods

A single-center mixed retrospective and prospective cohort study with combined qualitative data of families of children with ARM who underwent corrective surgery compared the stigma experienced by those with colostomies to those without. The Kilifi Stigma Scale of Epilepsy (KSSE) was used to assess social stigma. Multivariable regression analysis assessed differences in the stigma experienced, controlling for age at diagnosis, rurality, distance traveled, sex, and parental education. Subgroup analysis assessed the impact of colostomy duration on stigma, stratified over parental education.

Results

Patient/family dyads with 238 ARM were included; 177 (74%) received a colostomy. Most patients were male (51%), lived in rural areas (71%), and had parents with primary school education (65%). For those without a colostomy, the median KSSE was 0 (Q1-Q3 0-0), compared to 11 (Q1-Q3 3-20) for colostomy. On multivariable analysis, after controlling for age at diagnosis, rurality, distance traveled, sex, and parental education attainment, families of patients with ARM who received a colostomy had a median KSSE score 7.8 points higher than those who did not receive a colostomy (coefficient 7.78, 95% 3.14-12.43, and p = 0.001). When the duration of colostomy (in years) was examined, the median KSSE score increased by 1.58 points for each additional year for a patient who had a colostomy (IRR 1.58, 95% CI: 0.76-2.40, and p < 0.001).

Conclusion

Adopting a 1-stage ARM repair for the select types, which avoids colostomy creation, significantly reduces the experience of stigma and ability to live without fear/abuse. Designing cheap reusable colostomy bags in LMIC settings and increasing access to colostomy appliances should be the goal.

Unlabelled

We evaluated the prevalence, pathogen profile, and antimicrobial resistance (AMR) patterns of bloodstream infections (BSIs) among 392 children with severe febrile illness who presented (July 26, 2022-September 20, 2023) to a referral hospital in Tanzania. We identified a causative pathogen in 9.8% (n=38) of participants. Blood culture analysis confirmed BSI in 5.2% (n=20) of participants with a case fatality rate of 45%. Whole genome sequencing (WGS) of blood culture isolates identified gram-negative bacteria ( ) as the predominant pathogens, many exhibiting extended-spectrum beta-lactamase (ESBL) resistance genes (CTX-M-15, CTX-M-27), rendering them resistant to first-line antimicrobials. We also observed probable nosocomial transmission in ventilated patients based on phylogenetic analyses of tracheal aspirate isolates. There is an urgent need for enhanced AMR surveillance, empiric antibiotic regimens tailored to local AMR patterns, culture-independent diagnostics, and robust infection control practices in resource-limited settings to mitigate BSI-related mortality and minimize nosocomial transmission risk.

Funding

NIAID K23AI144029 (TBK), NIAID K23AI185326 (VTC), Chan Zuckerberg Biohub (JLD, CRL).

Article summary line

Genomic surveillance of severe febrile illness in Tanzanian children reveals high mortality rates and widespread resistance to first-line antibiotics, highlighting the urgent need for tailored treatments and enhanced antimicrobial resistance monitoring.

Background

Some pulse oximeters perform worse in people with darker skin, and this may be due to inadequate diversity of skin pigment in device development study cohorts. Guidance is needed to accurately and equitably characterize skin pigment to ensure diversity in research cohorts. We tested multiple methods for characterizing skin pigment to assess comparability and impact on cohort diversity.

Objectives

Assess reliability and comparability of common skin pigment measurement methodsCompare findings from different anatomical sitesDemonstrate that pigment cannot be assumed from US National Institutes for Health (NIH) race categories.

Methods

We used three subjective methods (perceived Fitzpatrick pFP, Monk Skin Tone MST and Von Luschan VL) and two objective methods (Konica Minolta CM-700d spectrophotometer and Delfin Skin Color Catch DSCC colorimeter) for individual typology angle (ITA), across multiple measurement sites in adults. We calculated ΔE to estimate operator perceptibility thresholds for subjective methods and to determine reproducibility for objective methods. We used each method to categorize participants as ‘light, medium, or dark’ and compared the impact of method selection on cohort diversity.

Results

We studied 789 participants, with 33,856 assessments. The MST had the widest luminosity range, and VL had the least discernible adjacent categories. With ‘dark’ defined as ITA <-30°, 14% of participants were categorized 'dark' as compared to 26% by pFP or 16% by MST. Approximately half of the 'dark' cohort had an ITA <-50°. With an ITA threshold <-50°, only 7% of the cohort was categorized as 'dark.' When 'Black or African American' self-identification was used to define 'dark', 23% of the cohort was categorized as such. Each self-assigned NIH race category included a wide range of ITA and subjective scale categories. Both ITA and L* from the KM-700d and DSCC demonstrated strong correlation (ρ > 0.7).

Conclusion

Common methods for skin pigment characterization, especially the use of race or subjective scales, have significant limitations. When applied to the same cohort, different methods yield significantly different results, and some may overestimate diversity. Previously published ITA thresholds for defining ‘dark’ skin are too light and lead to underrepresentation of people with darker skin.

Objective

To advance surgical education priorities by using electronic health record (EHR) reporting and data visualization on an Acute Care Surgery (ACS).

Design

Operational data from the EHR for the ACS service was displayed on an ACS dashboard using Tableau software. This data included new ACS consults (reason for consult, consult note author – attending surgeon and resident) and operations generated by those consults (type of operation, primary attending surgeon, and assisting resident). All surgeons on the service were included on the dashboard. In collaboration with service and educational leaders, the dashboard was used to address two deficiencies. First, to reduce the administrative burden for residents on ACS service, the new dashboard replaced manually generated weekly consult and operative case lists. Second, as a part of a pilot program to enable faculty assessment of residents’ Entrustable Professional Activities (EPAs) regarding pre-operative evaluation of acute surgical conditions, all faculty on the ACS service had access to the dashboard and received weekly reminders at the end of their service week. To assess the impact of the dashboard on these two education outcomes, resident surveys were used to determine average time spent on weekly consult and operative lists, and the number of EPA assessments completed were compared before, during, and after the pilot program.

Setting

Academic quaternary care hospital with a general surgery residency program comprising 50 clinically active residents.

Participants

Residents and faculty who rotated on the ACS service during the study period.

Results

The dashboard was made available to all faculty on the ACS service and automatically emailed on Saturdays. The dashboard reduced weekly resident administrative work by an average of 60 (range 30-360) minutes per week by obviating the need for manual list creation. Completed perioperative/nonoperative EPA assessments increased from zero to 5.3/month during the pilot period and continued at 2.3/month in the 3 months after the pilot ended.

Conclusion

The ACS dashboard reduced resident workload and enhanced EPA assessment. More opportunities to align resident education with EHR operational tools are likely if surgical education specialists collaborate with healthcare system and/or informatics leadership. When possible, advances in healthcare system technology should also be designed to promote training and education.

Background

Research shows that trauma team formation could potentially improve effectiveness of injury care in rural settings. The aim of this study was to determine the feasibility of rural trauma team training amongst medical trainees and traffic law enforcement professionals in Uganda.

Methods

Prospective multi-centre interrupted time series analysis of an interventional training based on the 4th edition of rural trauma team development course of the American College of Surgeons. Trauma related multiple choice questions (MCQs), and trauma non-technical skills were assessed pre-and post-training between September 2019- August 2023. Acceptability of the training for promulgation to other rural regions and its relevance to participants’ work needs were evaluated on 5- and 3-point Likert scales respectively. The median MCQ scores (IQR) were compared before and after training at 95% CI, regarding p < 0.05 as statistically significant. Triangulation with open-ended questions was obtained. Time series regression models were applied to test for autocorrelation in performance using Stata 15.0. Ethical approval was obtained from Uganda National Council for Science and Technology (Ref: SS 5082).

Results

A total of 500 participants including: 66 (13.2%) traffic police officers, 30 (6.0%) intern doctors, 140 (28.0%) fifth year and 264 (52.8%) third-year medical students were trained. Among the 434 medical trainees who completed the trauma-based MCQ assessment, the median pre- and post-test scores were 60%, IQR (50-65) and 80%, IQR (70-85) respectively. Overall, the mean difference between pre- and post-test scores was statistically significant (z = 16.7%, P|z|=<0.0001). Most participants strongly agreed to promulgate 389 (77.8%), relevance to their educational 405 (81.0%), and work needs 399 (79.8%). Each of the course components was rated above 76.0% as being very relevant. There was an overall increment in median (IQR) trauma-nontechnical skills team performance scores from 12 (9-14) to 17 (15-20) after the training (p < 0.001), with police teams advancing from 9.5 (6.0-12.5) to 19.5 (17.0-21.5) (p < 0.001).

Conclusion

This study demonstrates that rural trauma team development training had a positive effect on the test scores of course participants. The training is feasible, highly acceptable and regarded as relevant amongst medical trainees and traffic law enforcement professionals who provide first-aid to trauma patients in resource-limited settings. The findings could inform the design of future trauma teams in rural communities.

Trial registration

Retrospective registration (UIN: researchregistry9450).

Malaria remains a significant global health challenge, with nearly half of the world’s population at risk of infection. In 2022 alone, malaria claimed approximately 608,000 lives, with 76% of these fatalities occurring in children under the age of five, underscoring the disease’s disproportionate impact on vulnerable populations. Africa bears the highest burden, accounting for 94% of global malaria cases. For over 60 years, the development of a malaria vaccine has been a critical objective for scientists and governments, with substantial efforts directed toward this goal. Recent progress has led to the approval of the first malaria vaccines, RTS,S/AS01 (Mosquirix) and the R21/Matrix-M vaccine. Inspired by the promise of these vaccines, the global malaria community has renewed its focus on malaria eradication, 50 years after flawed earlier eradication efforts in the mid-twentieth century. Since the World Health Organization’s endorsement of RTS,S in 2021 and R21 in 2023, several African countries, beginning with Cameroon, have integrated these vaccines into routine immunization programmes. This review examines the role of routine malaria vaccination in Africa as a key strategy toward malaria elimination, explores challenges and solutions for widespread vaccine implementation, and discusses future directions in the ongoing fight to eliminate malaria on the continent.

Background

In low-income countries, clinicians trained through a context-specific trauma surgery fellowship program (TFP) can help reduce injury-related mortality to levels closer to those observed in higher-resource settings. Successful implementation, however, hinges on buy-in from local clinicians. We therefore assessed clinician support for a potential TFP in Uganda, considering perceived need, curricular recommendations, barriers, and motivating factors.

Methods

After cognitive interviews with experts and questionnaire pilot testing, we cross-sectionally surveyed Ugandan consultants (general surgeons and procedural specialists involved in trauma care) and surgical residents at a tertiary, national referral hospital. Respondent percentages were calculated for multiple-choice answers, and we performed thematic analysis of free-text responses using a primarily inductive approach.

Results

Among 46 faculty (from 13 specialties) and 42 resident respondents, 86% supported a Ugandan TFP. Respondents recommended incorporating emergency general surgery (66%), critical care (84%), and international rotations (76%) into the curriculum. Severe resource and structural deficiencies (82%) and concern about governmental support for post-training employment and compensation (66%) were leading perceived barriers to TFP implementation. Most faculty felt a TFP would improve patient outcomes (93%), overall trainee education (77%), and clinical efficiency (68%). Free-text responses were consistent with survey themes, indicating acute awareness of current trauma system inadequacies and conviction that a TFP would reduce injury-related mortality.

Conclusions

Ugandan clinicians who care for injured patients view a TFP as crucial to improving injury-related outcomes, despite known barriers. TFP implementation should incorporate curricular recommendations from this survey and address widespread concerns about financial and infrastructural support from the national government and local institutions.

Introduction

Disparities in anorectal malformation (ARM) outcomes between high- and low-income countries may be due to delayed diagnosis in the latter setting. The Three Delays model, comprising delays in seeking, accessing, and receiving care, provides a framework for exploring these challenges. We sought to examine the frequency and nature of the preoperative delays in children presenting for surgical correction of low ARMs.

Methods

We conducted a cross-sectional study examining the delays in care among children with low ARMs in Southwestern Uganda between June 2021 and July 2023. Delayed diagnosis was defined as a diagnosis made >48 h of life. Potential associated factors such as caregiver, community, and aspect of health-care system factors were examined. Statistical significance was set at P < 0.05.

Results

A total of 80 patients were included in the study. The median age at diagnosis was 29.2 d. In 82% of patients, the parents diagnosed the abnormality and 74% experienced delayed diagnosis. Among delays in seeking care, 23% of caregivers reported no knowledge of their child’s disease. For delays in reaching care, 37% encountered financial problems, and 28% lacked an appropriate diagnosis from a health center, contributing to delays in receiving care.

Conclusions

Delays in care are frequent for children with low ARMs. Finances and caregivers’ and health-care workers’ knowledge contribute significantly to these delays. To mitigate these delays, we recommend improving referral processes, prioritizing newborn screening examinations, advocating for a national child health insurance policy, and enhancing the training of primary health-care providers.

Background

In Uganda, only two public hospitals provide pediatric surgery services. With less than 10 pediatric surgeons serving approximately 20 million children in Uganda, most patients with anorectal malformations (ARMs) must make several trips to the hospital before undergoing surgery. As a result, households borrow money, sell assets, or solicit contributions from friends and relatives to meet healthcare expenses. We used a cross-sectional study to examine methods families use to raise funds for the treatment of ARMs at a single institution in Southwestern Uganda.

Methods

This cross-sectional study was conducted in the pediatric surgery unit at a Regional Referral Hospital/University Teaching Hospital in Southwestern Uganda from June 2021 to July 2023. Participants included caretakers of children presenting with ARMs for treatment at our referral hospital.

Results

A total of 157 participants were enrolled. Mothers were the main caregivers (77.9%) present at the hospital. Out of a median monthly household income of UGX200 000 (US$51.68), families spent a median of UGX50 000 (US$12.92) to travel to the hospital. To raise funds for healthcare expenses, 68% of households reported selling assets.

Conclusion

Families sell household assets to afford ARMs treatment in Southwestern Uganda. Financial protection by the government through a national child health insurance policy would shield families from substantial health-related expenditures and decrease this burden. In addition, targeted policy to strengthen pediatric surgical capacity through workforce expansion and skills training such as the Pediatric Emergency Surgery Course, may minimize costs, improve timeliness of care, and prevent case cancellations.

Background

The purpose of this study was to develop and validate a mortality risk algorithm for pediatric surgery patients treated at KidsOR sites in 14 low- and middle-income countries.

Methods

A SuperLearner machine learning algorithm was trained to predict post-operative mortality by hospital discharge using the retrospectively and prospectively collected KidsOR database including patients treated at 20 KidsOR sites from June 2018 to June 2023. Algorithm performance was evaluated by internal-external cross-validated AUC and calibration.

Findings

Of 23,905 eligible patients, 21,703 with discharge status recorded were included in the analysis, representing a post-operative mortality rate of 3.1% (671 mortality events). The candidate algorithm with the best cross-validated performance was an extreme gradient boosting model. The cross-validated AUC was 0.945 (95% CI 0.936 to 0.954) and cross-validated calibration slope and intercept were 1.01 (95% CI 0.96 to 1.06) and 0.05 (95% CI -0.10 to 0.21). For Super Learner models trained on all but one site and evaluated in the holdout site for sites with at least 25 mortality events, overall external validation AUC was 0.864 (95% CI 0.846 to 0.882) with calibration slope and intercept of 1.03 (95% CI 0.97 to 1.09) and 1.18 (95% CI 0.98 to 1.39).

Interpretation

The KidsOR post-operative mortality risk algorithm had outstanding cross-validated discrimination and strong cross-validated calibration. Across all external validation sites, discrimination of Super Learner models trained on the remaining sites was excellent, though re-calibration may be necessary prior to use at new sites. This model has the potential to inform clinical practice and guide resource allocation at KidsOR sites world-wide.

Type of study and level of evidence

Observational Study, Level III.

Background

Anorectal malformations (ARMs) have an incidence of up to 1 in 4000 live births and can require immediate neonatal surgery due to associated intestinal blockage. Due to limited surgical access, Ugandan children present late and undergo three separate staged operations: (1) initial colostomy formation; (2) repair of the ARM (called anoplasty); and (3) colostomy closure. Three operations result in long treatment duration, potential complications with each procedure, delays in care, and stigmata associated with colostomies. By offering primary repair for ARMs in a resource-limited setting, we expect to: reduce healthcare expenditure by families, length of treatment, length of hospital stay, frequency of hospital visits, and social rejection.

Materials and methods

A pragmatic clinical trial was performed examining the effectiveness of primary repair (prospective arm) and comparing it with the three-stage repairs (retrospective arm).

Results

Of the 241 patients included for analysis-157 patients had a three-stage repair, whereas 84 patients had one- or two-stage repair. The median [IQR age at the last surgery (days) was 730.0 (365.0, 1460.0) vs 180.0 (90.0, 285.0)] in three-stage and one- or two-stage repairs, respectively. There was no difference in postoperative complications compared to patients who had three-stage repair. Patients who had a two-stage repair had less time with colostomy than those with three-stage repair. Non-inferiority analysis demonstrated that the primary repair approach was non-inferior to the three-stage approach.

Conclusions

Primary repair for ARM is effective in low-income settings. It allows for less time with colostomy with no difference in post-operative complications. The decision on approach for treatment depends on the surgeon’s experience and clinical judgment.

The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child’s health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2-21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children’s surgery through initiatives like the Optimal Resources for Children’s Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.

Background

One of the greatest challenges to conducting multicenter research studies in low and middle-income countries (LMICs) is the heterogeneity in regulatory processes across sites. Previous studies have reported variations in requirements with a lack of standardization in the Institutional Review Board (IRB) processes between centers, imposing barriers for approval, participation, and development of multicenter research.

Objectives

To describe the regulatory process, variability and challenges faced by pediatric researchers in LMICs during the IRB process of an international multicenter observational point prevalence study (Global PARITY).

Design

A 16-question multiple-choice online survey was sent to site principal investigators (PIs) at PARITY study participating centers to explore characteristics of the IRB process, costs, and barriers to research approval. A shorter survey was employed for sites that expressed interest in participating in Global PARITY and started the approval process, but ultimately did not participate in data collection (non-participating sites) to assess IRB characteristics.

Results

Of the 91 sites that sought IRB approval, 46 were successful in obtaining approval and finishing the data collection process. The survey was completed by 46 (100%) participating centers and 21 (47%) non-participating centers. There was a significant difference between participating and non-participating sites in IRB approval of a waiver consent and in the requirement for a legal review of the protocol. The greatest challenge to research identified by non-participating sites was a lack of research time and the lack of institutional support.

Conclusions

Global collaborative research is crucial to increase our understanding of pediatric critical care conditions in hospitals of all resource-levels and IRBs are required to ensure that this research complies with ethical standards. Critical barriers restrict research activities in some resource limiting countries. Increasing the efficiency and accessibility of local IRB review could greatly impact participation of resource limited sites and enrollment of vulnerable populations.

Introduction

A significant burden of unmet pediatric surgical disease exists in low- and middle-income countries. We sought to assess the associations between the installation of a pediatric operating room (OR) and clinical and economic outcomes for families with children in Ethiopia.

Methods

A retrospective cohort study was performed of children who underwent elective surgery in a tertiary-level Ethiopian public hospital, comparing patient outcomes before and after OR installation in August 2019. Clinical data were collected via chart review, and an inpatient economic survey was administered to patient caregivers. Interrupted time series analysis investigated trends in surgical volume over time. The relative economic benefit was determined by comparing the patients’ household income to the monetary health benefit gained using the value of statistical life method.

Results

One thousand one hundred and ninety-six patients were included from August 2018 to July 2022. Surgery averted 20,541 disability-adjusted life years (DALYs) cumulatively or 17 DALYs per patient. Monthly case volume and DALYs averted significantly increased postinstallation. The median annual household income of the economic survey responders (n = 339) was $1337 (IQR 669-2592). 27.7% (n = 94/339) lived in extreme poverty, and 41.3% (n = 140/339) experienced catastrophic healthcare expenditure. Net monetary health benefit was $29.3 million or $26,646 per patient. The ratio of net monetary health benefit to household annual income was 60:1.

Conclusions

Installing a pediatric OR in a public Ethiopian hospital ensures increased access to surgery for those most impoverished in Ethiopia and improves equitable access to surgical care. Greater investment in expanding pediatric surgical infrastructure can help address global inequities in child health.

Objective

This study aimed to assess the feasibility and acceptability of a new low-cost otolaryngology simulation training curriculum for medical students in Rwanda. Given the limited access to hands-on training and equipment in low-middle-income countries, building confidence in performing basic otolaryngology skills is vital for all medical students, especially where all graduates initially serve in primary care before specializing.

Study design

Preintervention and postintervention assessments of simulation training.

Setting

Conducted at the University of Global Health Equity in Rwanda.

Methods

The simulation program comprised 3 primary components: (1) a low-cost, moderate-fidelity model for cricothyrotomy and tracheostomy practice, (2) a low-cost, low-fidelity ear model for foreign body and cerumen removal, and a high-fidelity manikin for practicing, (3) epistaxis management, and (4) nasal foreign body removal. Students underwent pretest and posttest assessments measuring their knowledge, experience, perceived skill, and confidence in performing these procedures. A survey collected feedback on the program.

Results

A total of 29 medical students participated in the simulation program, integrated into a 1-week otolaryngology “boot camp” preceding a 3-week clerkship rotation. All models were created using basic, locally available materials, at a total cost of $1.02 for cricothyrotomy and $0.20 for foreign body models. Knowledge and perceived confidence increased for all 3 simulations. All students found the simulations useful, enjoyable, and anticipated using these skills in future training.

Conclusion

The study’s results demonstrated that the low-cost otolaryngology simulation was well-received and enhanced knowledge, interest, and confidence in performing basic otolaryngology skills across all simulations.

Background

Advanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms (LUTs); however, the degree and duration of pain relief, changes in LUTs severity and underlying factors associated with the extent of symptom relief remain inadequately understood. Surgical castration has proven effective in relieving both bone pain and urinary symptoms for metastatic prostate cancer patients.

Objective

To determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital (MNH).

Methods

We conducted a prospective cohort study for a period of 6 months involving men with advanced Prostate cancer (PCa) undergoing surgical castration at MNH and followed them for 30 days. The international prostate symptoms score tool was used to assess changes in LUTs, and the pain rating scale was used for assessing changes in bone pain symptoms before and after surgery. Logistic regression model was used to determine factors associated with complete bone pain relief.

Results

A total of 210 participants with a mean age of 72.3 years were recruited. The LUTS score showed a decrease of 7.1 points after surgical castration (95% CI: 6.4 to 7.7, p < 0.001). The bone pain score showed an absolute decrease of 39.8% (95% CI: 34.7 to 44.9, p < 0.001) after surgical castration, with more than half of the patients (111, 52.9%) reporting bone pain relief within the first two weeks. Among the factors associated with greater pain relief were being in a marital union (aOR 2.73, 95% CI: 1.26 to 5.89, p < 0.011). Normal BMI was also linked to pain relief in bivariate analysis (OR 1.92, 95% CI: 1.03 to 3.61, p < 0.035). Additionally, patients with severe bone pain before surgical castration were more likely to achieve complete pain relief compared to those with mild or moderate pain (odds ratio 8.32, 95% CI: 3.63 to 19.1, p < 0.001).

Conclusion

Surgical castration improves both bone pain and lower urinary tract symptoms in patients with advanced prostate cancer. Notably, patients experiencing severe bone pain reported resolution of bone pain symptoms within the first and second weeks, respectively, indicating the prompt effectiveness of the surgery on these symptoms.

Purpose

To address the need for a pediatric surgical checklist for adult providers.

Background

Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications.

Methods

Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2023 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias.

Results

Forty-two papers with 8,529,061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies.

Conclusion

The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes.

Funding

Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.

The OpenOximetry Repository is a structured database storing clinical and lab pulse oximetry data, serving as a centralized repository and data model for pulse oximetry initiatives. It supports measurements of arterial oxygen saturation (SaO2) by arterial blood gas co-oximetry and pulse oximetry (SpO2), alongside processed and unprocessed photoplethysmography (PPG) data and other metadata. This includes skin color measurements, finger diameter, vital signs (e.g., arterial blood pressure, end-tidal carbon dioxide), and arterial blood gas parameters (e.g., acid-base balance, hemoglobin concentration). Data contributions are encouraged. All data, from desaturation studies to clinical trials, are collected prospectively to ensure accuracy. A common data model and standardized protocols for consistent archival and interpretation ensure consistent data archival and interpretation. The dataset aims to facilitate research on pulse oximeter performance across diverse human characteristics, addressing performance issues and promoting accurate pulse oximeters. The initial release includes controlled lab desaturation studies (CLDS), with ongoing updates planned as further data from clinical trials and CLDS become available.

Introduction

Anorectal malformations (ARMs) may be associated with congenital anomalies affecting other body parts namely vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb (VACTERL) with varying incidences of 7%-60% . Genitourinary defects might occur approximately in 50% of all patients with anorectal malformations hence patients should be evaluated from birth to rule out these defects.

Objective

To identify urological anomalies associated with anorectal malformation in southwestern Uganda.

Study design

This was a descriptive retrospective cohort study conducted at our regional referral hospital in Southwestern Uganda involving patients who have undergone surgical correction of ARMs between June 2021 and July 2023.

Results

The overall prevalence of renal anomalies in our study patient population was 18.05%. Of those with ARM-associated renal anomalies, Specific anomalies included; renal agenesis (6.8%), hydronephrosis, (4.5%), duplex collecting system (3.8%), crossed fused kidney (1.5%), and ectopic kidney (0.75%). (Table) DISCUSSION: We found that the prevalence of ARM-associated renal anomalies was 18.05%, and the commonest anomaly was unilateral agenesis (6.8%) similar to other studies. Previous data have shown renal anomalies are common anomalies in ARM. While the exact values vary across studies, they all concluded that the rate of associated anomalies is extremely high in ARMs and warrants a thorough preoperative investigation once the ARMs are detected. This finding therefore underscores the importance of thorough evaluation and a multidisciplinary approach of care and follow-up system for ARM management including urologists even when the children are asymptomatic now. The main limitation of our study was missing information on patients’ charts, we were not able to get the diagnosis since most patients didn’t have their discharge forms at the time of evaluation.

Conclusion

ARM associated with renal anomalies may remain undiagnosed and asymptomatic. Those identified as asymptomatic need to be followed in a multidisciplinary fashion including pediatric urologists.

Introduction

Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals.

Methods

We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary’s Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes.

Results

There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge.

Conclusions

In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures.