Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical 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. Methods: This 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. Findings: Between 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). Interpretation: Countries 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

Participatory processing diagnosis of fried sweetpotato in Nigeria & Ghana. Understanding the drivers of trait preferences and the development of multi-user RTB product profiles, WP1, step 3

A participatory processing diagnosis on fried sweetpotato was conducted with expert fryers to better understand desirable and non-desirable quality characteristics from their perspective. The study encompassed 20 expert fryers across 8 communities in Nigeria (Kano and Kwara States) and Ghana (Bawku, Upper East Region). In both countries, the desirable characteristics of raw sweetpotato for use in the frying operation included; smooth skin, regular shape, big root size, no holes, no off-odours and firmness. The main unit operations involved in preparation were five namely; peeling, slicing, washing, salting and deep frying. Deep frying was the most important unit operation determining the quality of fried sweetpotato product (involved pre-heating vegetable oil 120-185°C). During processing important attributes included; hard when slicing, non-sticky and non-slippery in the hands, uniform colour of slices, non or slight surface moisture and no off-odours. The fried sweetpotato desirable traits were; colour (uniform light brown or yellow/golden, orange with a brown tint), dry/filling/satisfying, hard/strong -at first bite, crispy, not soggy, not oily, and slight-moderately sugary. Preference of the varieties from most to least preferred by processors in Ghana was; Obare, Purupuru, Kuffour and Amuskwera with weighted scores of 32, 21, 16 and 11 respectively. In Nigeria, processors in Kwara State liked Alausa (32) most followed by Pakurumo (21), Tomude (18), Aragbe (12), Mother's Delight (9) and Elege (6) while for those in Kano state it was; Dan Izala (36), Dan China (24), Dan Bakalori (18), Dan Madagali (14), Dan Barmawa (8), Dan Silver (6) and Mother's Delight (6)

Repeatability and genetic advances in early maturing maize hybrid trials conducted under Striga-infested and non-infested conditions.

In sub-Saharan Africa (SSA), maize (Zea mays L.) is both a cash crop and an important staple crop. However, Striga hermonthica infection constrains its production and productivity. A total of 159 hybrids from 21 international trials were evaluated under Striga-infested (STRINF) and Striga non-infested (STRNON) conditions at Mokwa and Abuja, Nigeria, from 2010 to 2021. The data were used to (i) determine the genetic enhancements in grain yield and Striga adaptive traits and (ii) assess the repeatability of the trials in identification of promising hybrids. Significant annual genetic gains in grain yield of 3.40% and 3.71% with increases of 76.87 and 127.02 kg ha - 1 yr - 1 were recorded under STRINF and STRNON conditions, respectively. The genetic gains in grain yield were associated with 3.04 and 2.25% decreases in Striga damage ratings at 8 and 10 weeks after planting (WAP), respectively, and 1.27% in the number of emerged Striga plants at 10 WAP. The results indicated that ears per plant and flowering dates had the highest consistency in repeatability estimates while the number of emerged Striga plants at 8 and 10 WAP recorded the lowest consistency in repeatability estimates. Generally, substantial progress has been achieved with a good level of repeatability estimates for the early maturing maize hybrid trials evaluated under STRINF and STRNON conditions.Those results have demonstrated that the breeding strategies adopted during the 12-year breeding period have been effective, and that the potential of the trials in the exploration of the genetic potential of the hybrids for commercialization in the SSA for food security and poverty alleviation

Securing Sweetpotato Planting Material for Farmers in Dryland Africa: Gender-Responsive Communication Approaches to Scale Triple S

AbstractTriple S (Storage in Sand and Sprouting) is a root-based system for conserving and multiplying sweetpotato planting material at the household level. In sub-Saharan Africa, farmers predominantly source planting material by cutting vines from volunteer plants that sprout from roots left in the field from a previous crop. However, it takes 6 to 8 weeks after the rains start to produce enough vines for planting material, and normally these vines are infected by sweetpotato diseases and pests carried over from previous crops. Where rainfall is unpredictable, farmers can use Triple S to take advantage of the whole growing season, planting and harvesting early to obtain food, higher yields, and income. Triple S facilitates household retention and adoption of new sweetpotato varieties, notably the beta-carotene-rich, orange-fleshed varieties. Triple S PLUS is the combined innovation package of core Triple S components and complementary components used to scale the innovation. These included good agricultural practices, different storage containers, local multiplication and sales of planting material, and a multimedia communication strategy for training and extension to encourage the uptake of Triple S. Components were at different levels of scaling readiness. This chapter explores evidence from Ethiopia and Ghana (2018–2019) on the extent to which exposure to different communication channels and their combinations influenced the uptake of Triple S PLUS by male and female farmers, the partnering arrangements that supported this, and the resulting changes in food security. We discuss implications for future scaling initiatives.</jats:p

Q&A: Methods for estimating genetic gain in sub‐Saharan Africa and achieving improved gains

Abstract Regular measurement of realized genetic gain allows plant breeders to assess and review the effectiveness of their strategies, allocate resources efficiently, and make informed decisions throughout the breeding process. Realized genetic gain estimation requires separating genetic trends from nongenetic trends using the linear mixed model (LMM) on historical multi‐environment trial data. The LMM, accounting for the year effect, experimental designs, and heterogeneous residual variances, estimates best linear unbiased estimators of genotypes and regresses them on their years of origin. An illustrative example of estimating realized genetic gain was provided by analyzing historical data on fresh cassava (Manihot esculenta Crantz) yield in West Africa (https://github.com/Biometrics‐IITA/Estimating‐Realized‐Genetic‐Gain). This approach can serve as a model applicable to other crops and regions. Modernization of breeding programs is necessary to maximize the rate of genetic gain. This can be achieved by adopting genomics to enable faster breeding, accurate selection, and improved traits through genomic selection and gene editing. Tracking operational costs, establishing robust, digitalized data management and analytics systems, and developing effective varietal selection processes based on customer insights are also crucial for success. Capacity building and collaboration of breeding programs and institutions also play a significant role in accelerating genetic gains

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Surgical 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