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  • Funding NIH K AI PATH Gates Foundation UW MSRTP

    2019-04-22

    Funding NIH K23-AI103105, PATH, Gates Foundation 50274, UW MSRTP, AOA Carolyn Kuckein Fellowship, IDSA Medical Scholars. Declaration of interests
    Abstract Background Safe, timely and accessible global essential surgery and anaesthesia, once neglected in global health, is now an integral part of universal health coverage with the passage of the WHO Resolution 68/15. In the past, hospital-based surgical assessment surveys and indices were important for advocacy and to identify real infrastructure deficits and needs. The Lancet Commission on Global Surgery indicators, however, necessitate a new evaluation approach to anaesthesia, obstetrics, and surgery in low-income countries. Here, we aimed to use indicators from the Lancet Commissions on Global Surgery and other common indicators in global health to create a new global surgery index, which could be used to inform key stakeholders working toward Lancet Commission on Global Surgery goals for 2030. Methods We used the following indicators to generate our index: proportion of the order chir99021 with 2-h access to surgery; surgical workforce density; surgical volume; perioperative mortality rate; proxy for protection against impoverishing expenditure; and proxy for protection against catastrophic expenditure. Indicator thresholds were generated and data for low-income countries were identified and collected from WHO public datasets and published studies. We generated quintile categories relative to the targeted threshold to evaluate indicator data for point assignment. We used descriptive statistics to aggregate assigned points to generate country-level indices and to illustrate the completeness of the available data for each indicator. Findings Somalia showed the lowest country-level surgical capacity index value at 6·67%; Zimbabwe had the highest index value at 60·00%. Mean capacity for all low-income countries was 39·18%. Six of 17 specific categories had no reported data; only caesarean section rate had data reported for all low-income countries. Interpretation The Lancet Commission on Global Surgery indicator-based index is a tool that can be used in real-time surgical infrastructure and capacity-building assessments for the planning and expansion of best practices in low-income countries. In view of the World Health Assembly Resolution, data collection gaps could hinder progress towards the 2030 vision of safe, timely, and accessible global essential surgery and anaesthesia. Stakeholders who use this tool can ensure global quality improvement of essential surgery and anaesthesia through stronger surgical data collection. Funding None. Declaration of interests
    Abstract Background 3 billion people cook, heat, and light their homes using polluting fuels such as biomass and kerosene. Household air pollution is a known risk factor for acute lower respiratory tract infections and non-communicable diseases including stroke, chronic obstructive pulmonary disease, and lung cancer. Exposure to household air pollution has been linked to increased presence of systemic inflammatory biomarkers. Here we aimed to assess whether a change from a traditional wood or kerosene biomass stove to use of a bioethanol-burning stove could reduce the presence of inflammatory biomarkers in pregnant women in Nigeria. Methods Between 2013 and 2015, we recruited pregnant women in Ibadan, Nigeria during their first trimester of pregnancy. Patients were excluded if they cooked for a living, smoked or had a smoker in the household, or had a high-risk pregnancy (age greater than 35 years, multiple gestation, diabetes, HIV infection, previous Caesarean section, or more than three miscarriages). Participants were randomly allocated to either a control group or the intervention group using permuted blocks and the web-based randomisation module available in REDCap. Control participants continued to use their own stove, which was either biomass (ie, firewood) or kerosene, while the intervention group received a bioethanol-burning CleanCook stove. We used ELISA to measure serum concentrations of retinol-binding protein (RBP), malondialdehyde (MDA), TNF-α, IL-6, and IL-8. Our primary outcome was the change in concentrations of these inflammatory biomarkers between baseline and the third trimester. The trial is registered in ClinTrials.gov (NCT02394574).