BMJ Global Health最新文献

{"title":"Strategies for mitigating emerging artemisinin-based antimalarial drug resistance in Rwanda: a promising approach for managing therapies in malaria-endemic countries.","authors":"Claude Mambo Muvunyi, Pierre Gashema, Aimable Mbituyumuremyi, Patrick Gad Iradukunda, Emmanuel Edwar Siddig, Jean Damascene Niyonzima, Emmanuel Hakizimana, Noella Umulisa, Abdisalan Mohamed Noor, Jules Mugabo Semahore, Albert Tuyishime, Jean de Dieu Harelimana, Jeanne Umuhire, Yvan Butera, Sabin Nsanzimana","doi":"10.1136/bmjgh-2025-020884","DOIUrl":"10.1136/bmjgh-2025-020884","url":null,"abstract":"<p><p>Malaria treatment failures associated with reduced efficacy of chloroquine (CQ) and amodiaquine (AQ) antimalarial drugs emerged in Rwanda during the 1980s, prompting the policy shift towards adopting artemisinin-based combination therapies in 2006 as an alternative. However, recent findings from malaria surveillance and therapeutic efficacy studies have revealed a countrywide increase in antimalarial drug resistance. Particularly, artemether-lumefantrine (AL) efficacy has significantly decreased, probably due to the emergence of <i>Plasmodium falciparum</i> (<i>Pf</i>) genomic mutations. To mitigate the current drug resistance, Rwanda has adopted targeted multiple first-line therapies. Through the national malaria control program, antimalarial drugs were deployed in accordance with the reported resistance profile. A significant rise in <i>Pfkelch13</i> mutations, particularly A675V associated with AL resistance, was mainly reported in the western region; therefore, artesunate-pyronaridine was recommended. Dihydroartemisinin-piperaquine was considered in eastern and central regions, where <i>R561H</i> mutations were predominant. On the contrary, AL was maintained in the southern region, where the prevalence of the <i>R561H</i> mutation was low. Insights from this data-driven model will inform its extension to other malaria-endemic countries facing emerging <i>Pf</i> genetic diversity.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diverging pathways: exploring the interplay between hospital readmission and postdischarge mortality in paediatric sepsis in low-income settings.","authors":"Cherri Zhang, Niranjan Kissoon, J Mark Ansermino, Vuong Nguyen, Elias Kumbakumba, Stephen Businge, Abner Tagoola, Nathan Kenya-Mugisha, Jerome Kabakyenga, Matthew O Wiens","doi":"10.1136/bmjgh-2025-020128","DOIUrl":"10.1136/bmjgh-2025-020128","url":null,"abstract":"<p><strong>Background: </strong>Mortality and readmission rates are high in low-income countries following hospital discharge; however, few studies have studied the relationship between these outcomes. Hospital readmission is a complex outcome as it reflects illness severity and health-seeking behaviour. This study aims to better understand the heterogeneous nature of hospital readmission, especially as it pertains to mortality.</p><p><strong>Methods: </strong>Secondary analysis of a prospective, multisite, observational cohort study included children aged 0-60 months old admitted to hospital with suspected sepsis. We used Fine-Gray models and Cox proportional hazards regression to identify and contrast risk factors for readmission and postdischarge mortality. We also compared the risk ratio of the two outcomes across several domains, including diagnosis, postdischarge time period and study site.</p><p><strong>Results: </strong>Of 6074 children discharged, 376 (6.2%) died, while 1106 (18.2%) were readmitted shortly after discharge. The median time to death and readmission was 28 (IQR: 9-74) and 79.5 (IQR: 30-130) days, respectively. A few patient characteristics, such as prior care seeking and hypoxaemia, were associated with both mortality and readmission. However, other characteristics, such as malnutrition (adjusted HR (aHR): 5.58 (95% CI: 4.20 to 7.43)), HIV (aHR: 1.89 (95% CI: 1.20 to 2.98)) and unplanned discharge (aHR: 3.31 (95% CI: 2.61 to 4.21)), were strongly predictive of postdischarge mortality but not readmission (aSHR: 0.67 (95% CI: 0.56 to 0.81), 0.64 (95% CI: 0.40 to 1.00) and 0.81 (95% CI: 0.67 to 0.98), respectively). The overall rate ratio of readmission to postdischarge mortality was 3.12 (95% CI: 2.77 to 3.50) and increased over time, mostly due to decreasing mortality.</p><p><strong>Conclusions: </strong>Readmission as an outcome measure reflects perceived illness severity, health system capacity and complex healthcare-seeking behaviour. Unlike mortality, readmission is not a reliable surrogate for recurrent illness and should not be used as a primary measure of impact for programmes aiming to improve postdischarge outcomes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the opportunity cost of seasonal malaria chemoprevention implementation in Burkina Faso, Mali and Senegal.","authors":"Richmond Owusu, Colin Gilmartin, Halimatou Diawara, Fadima Bocoum, Oumy Ndiaye, Anika Ruisch, Genevieve Cecilia Aryeetey, Darlene Jainie, Monica Kokovena, Damian Walker, Justice Nonvignon","doi":"10.1136/bmjgh-2024-018042","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018042","url":null,"abstract":"<p><p>BackgroundSeasonal malaria chemoprevention (SMC) is a widely implemented malaria prevention strategy for children under five in the Sahel and sub-Sahel regions of Africa. This study aimed to estimate the full opportunity costs associated with SMC implementation in Mali, Burkina Faso and Senegal, addressing a gap in existing research that often focused solely on health system costs.Using a repeated descriptive cross-sectional design, data were collected from April to November 2022 during two SMC cycles. The study involved 376 caregivers in Mali, 398 in Senegal and 373 in Burkina Faso, alongside 127 community health volunteers in Mali, 41 in Senegal and 97 in Burkina Faso. Health worker supervisors recruited were 96 in Mali, 96 in Senegal and 42 in Burkina Faso. Data collection occurred across 15 health facilities in Burkina Faso and Senegal and 16 health facilities in Mali across four districts within each country.Both financial and economic costs were analysed using an ingredients approach, encompassing direct and indirect costs. Financial costs per SMC dose were estimated at US$0.99 in Mali, US$1.42 in Burkina Faso and US$1.51 in Senegal. Economic costs per dose were US$3.02 in Senegal, US$3.14 in Burkina Faso and US$2.96 in Mali. Total annual costs per child receiving four doses ranged from US$3.97 to US$6.05 for financial costs and US$11.85 to US$12.57 for economic costs. Notably, indirect costs, mainly related to productivity losses among caregivers, volunteers and healthcare workers, constituted 50%-66% of total economic costs.The findings highlight the economic cost of SMC implementation, driven largely by productivity losses of caregivers and volunteers which have often been overlooked in policy decisions. This study highlights the need for comprehensive cost assessments in malaria control programmes to inform effective decision-making.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender differences in self-reported hearing loss and hearing aid use: a cross-national comparison.","authors":"Anastasia Lam, Yana C Vierboom, Jessica S West","doi":"10.1136/bmjgh-2024-017655","DOIUrl":"10.1136/bmjgh-2024-017655","url":null,"abstract":"<p><strong>Background: </strong>Objective measurements estimated that 1.57 billion people globally had hearing loss in 2019. However, where audiologists are sparse, self-reported measures have been suggested as alternatives to assess burden. Moreover, research suggests this number varies by gender, due to biological and social mechanisms. Further refining our knowledge of the global prevalence of hearing loss will provide better understanding of which groups are most affected and how to best allocate resources.</p><p><strong>Methods: </strong>Using Gateway to Global Ageing data and the South African National Income Dynamics Study, we estimated the prevalence and men:women ratio of self-reported hearing loss and hearing aid use for 28 countries. Hearing loss was measured as having fair/poor hearing or reporting hearing aid use. We included 664 580 observations of individuals aged 50+ years.</p><p><strong>Results: </strong>We found that the four countries with the highest levels of hearing loss (China 65%, South Korea 39%, Mexico 33%, Brazil 31%) also had the lowest reported hearing aid use (as low as 1% in China). Though men were more likely than women to report hearing loss in nearly all countries, especially in regions with higher hearing aid use (USA, Northern/Western Europe), China, South Korea and South Africa reported no gender difference. As the prevalence of hearing loss and hearing aid use increased with age, gender differences generally decreased.</p><p><strong>Conclusion: </strong>International variation underscores the importance of country context in shaping perceived hearing and hearing aid use. Regions with high levels of hearing loss and low hearing aid use may be especially amenable to interventions.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From positionality statements to reflexive statements of principle-informed process.","authors":"Raphael Lencucha","doi":"10.1136/bmjgh-2025-020866","DOIUrl":"10.1136/bmjgh-2025-020866","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of core outcome sets for effectiveness trials focused on infants and children with wasting and nutritional oedema.","authors":"Allison I Daniel, Kirrily de Polnay, Michael McCaul, Jaden Bendabenda, Zita Weise Prinzo, Celeste E Naude","doi":"10.1136/bmjgh-2024-017225","DOIUrl":"10.1136/bmjgh-2024-017225","url":null,"abstract":"<p><strong>Introduction: </strong>The 2023 WHO guideline on the prevention and management of wasting and nutritional oedema includes recommendations informed by best evidence from systematic reviews addressing critical and important outcomes. Multiple outcomes across trials were a challenge during guideline development, highlighting a need to establish core outcome sets (COS) for wasting and nutritional oedema. Informed by Core Outcome Measures in Effectiveness Trials (COMET) Initiative best practice methods, we aimed to develop six COS for effectiveness trials around prevention and management of wasting and nutritional oedema in infants and children.</p><p><strong>Methods: </strong>Guideline Development Group and UNICEF/WHO Technical Advisory Group on Wasting and Nutritional Oedema members were invited to participate in a Delphi process to establish these COS. This involved scoring outcomes in two rounds of a survey (Likert scale from 1 to 9), with consensus in the second round defined as a minimum of 70% of the expert panel giving a score of at least 7 and <15% scoring 3 or below.</p><p><strong>Results: </strong>Twenty-five of 36 invited participants completed each survey, followed by multiple consensus meetings to reach agreement on the outcomes. Through this Delphi process, we developed six COS for infants <6 months of age with wasting and/or nutritional oedema and/or underweight in (1) inpatient and (2) outpatient/community settings, infants and children 6-59 months of age with severe wasting and/or nutritional oedema in (3) inpatient and (4) outpatient/community settings, infants and children 6-59 months of age with moderate wasting in (5) outpatient/community settings and (6) prevention of wasting and nutritional oedema.</p><p><strong>Conclusion: </strong>Primary research, future guidelines and related decision-making stand to be strengthened by these six COS, including the most critical outcomes from a child health perspective to be evaluated in future effectiveness trials on wasting and nutritional oedema. Uptake of these COS will inform their further development.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 5","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional and national burden of chikungunya: force of infection mapping and spatial modelling study.","authors":"Hyolim Kang, Ahyoung Lim, Megan Auzenbergs, Andrew Clark, Felipe J Colón-González, Henrik Salje, Hannah Clapham, Jean Paul Carrera, Jong-Hoon Kim, Maya Malarski, Sandra López-Vergès, Zulma M Cucunubá, Thiago Cerqueira-Silva, William John Edmunds, Sushant Sahastrabuddhe, Oliver J Brady, Kaja Abbas","doi":"10.1136/bmjgh-2024-018598","DOIUrl":"10.1136/bmjgh-2024-018598","url":null,"abstract":"<p><strong>Introduction: </strong>Chikungunya virus, an arbovirus transmitted by <i>Aedes</i> mosquitoes, causes epidemics in tropical regions with potential risk in higher latitudes. Our aim is to estimate the global, regional and national burden of chikungunya across affected and environmentally suitable at-risk regions.</p><p><strong>Methods: </strong>We used a random forest model to predict force of infection and estimate chikungunya burden at high spatial resolution (5×5 km) using covariates from climatic, socioeconomic and ecological domains. We used a focal scenario to estimate the observed burden (lower bound) and an at-risk scenario to estimate the potential burden (upper bound) of chikungunya transmission.</p><p><strong>Results: </strong>We predicted global long-term average annual force of infection at 0.012 (95% UI: 0.007 to 0.019) for focal scenario and 0.013 (95% UI: 0.005 to 0.03) for at-risk scenario in 103 countries. We estimated global chikungunya burden annually of 14.4 million (95% UI: 11.0 to 17.8 million) infections and 0.96 million (95% UI: 0.56 to 1.6 million) disability-adjusted life years (DALYs) in the focal scenario, and 34.9 million infections (95% UI: 26.7 to 43.1 million) and 2.3 million DALYs (95% UI: 1.4 to 3.8 million) in the at-risk scenario for 2020. The chronic phase accounts for 54% of chikungunya burden, with relatively higher burden among 40-60-year-old population, with mortality disproportionately affecting children under 10 and adults over 80.</p><p><strong>Conclusion: </strong>While chikungunya transmission has high geographical uncertainty, high force of infection is not limited to tropical regions and is distributed across all continents. Our estimates of chikungunya burden are useful for prioritisation of regions and target age groups for chikungunya vaccine introduction.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 10","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal care surveillance for monitoring malaria prevalence and intervention coverage: a multicountry analysis.","authors":"Anna Munsey, Peder Digre, Joseph Hicks, Joseph Wagman, Molly Robertson, Manzidatou Alao, Aurore Ogouyemi Hounto, Adama Gansane, Siaka Debe, Baltazar Candrinho, Perpetua Uhomoibhi, Okefu Oyale Okoko, Ruth Lemwayi, Sijenunu Aron, Chabu C Kangale, Bupe M Kabamba, John Miller, Patrick Walker, Julie Gutman","doi":"10.1136/bmjgh-2024-018572","DOIUrl":"10.1136/bmjgh-2024-018572","url":null,"abstract":"<p><p>Estimates of malaria prevalence and intervention coverage in Africa are primarily based on nationally representative household (HH) surveys. However, the expense and infrequency limit the utility of HH surveys for operational action by malaria programmes. We assessed whether data collected during first antenatal care (ANC1) visits, consisting of data on malaria prevalence using rapid diagnostic tests, ownership of insecticide-treated nets (ITNs) and treatment-seeking for children with fever, could provide relevant data to guide decision-makers. Malaria prevalence among ANC1 attendees in select areas of six countries (Benin, Burkina Faso, Mozambique, Nigeria, Tanzania and Zambia) was compared with prevalence data among children under 5 and school-aged children from cross-sectional HH surveys in the same areas. To examine the relationship between prevalence among ANC1 attendees and children, we fitted a linear trend to the log-OR of the risk of testing positive. The predictive performance of the model was assessed by leave-one-out cross-validation (LOOCV). District-level ANC1 prevalence and prevalence among children are correlated (Spearman's rank correlation, r=0.79, 95% CI=0.65 to 0.88, p<0.001) and ANC1 prevalence is predictive of prevalence among children (LOOCV mean absolute error=6.5%). To understand whether data on ITN ownership collected at ANC1 are representative of ownership in the underlying communities, we assessed the district-level proportion of HH ownership in five countries (Benin, Burkina Faso, Mozambique, Nigeria and Zambia) and fitted an ordinal regression model to the ranking of ownership by district. Reported rates of treatment-seeking for children under 5 with fever, testing for malaria and treatment for the HH and ANC1 settings were compared. Estimates of malaria prevalence and ITN coverage derived from ANC1 attendees correlate well with HH survey estimates and may be useful in monitoring malaria prevalence and prevention efforts. In contrast, data on treatment-seeking does not appear useful.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health impact and cost-effectiveness of COVID-19 booster vaccination strategies in the early post-Omicron era: a dynamic modelling study.","authors":"Thao P Le, Eamon Conway, Edifofon Akpan, Isobel R Abell, Patrick Abraham, Christopher M Baker, Patricia T Campbell, Deborah Cromer, Michael J Lydeamore, Yasmine McDonough, Ivo Mueller, Gerard Ryan, Camelia Walker, Yingying Wang, Natalie Carvalho, Jodie McVernon","doi":"10.1136/bmjgh-2024-016096","DOIUrl":"10.1136/bmjgh-2024-016096","url":null,"abstract":"<p><strong>Introduction: </strong>Following widespread exposure to Omicron variants, SARS-CoV-2 has transitioned to endemic circulation. Populations now have diverse infection and vaccination histories, resulting in heterogeneous immune landscapes. Careful consideration of the value of ongoing vaccination is required through the post-Omicron phase of COVID-19 management to minimise disease burden. We demonstrate the utility of a modelling approach to address this question, supporting recommendations for targeted vaccine use across different country settings.</p><p><strong>Methods: </strong>We integrated immunological, transmission, clinical and cost-effectiveness models and simulated populations with different characteristics and immune landscapes over the early post-Omicron period. We calculated the expected number of infections, hospitalisations and deaths for different vaccine scenarios. Costs (from a healthcare perspective) were estimated for exemplar country income-level groupings in the Western Pacific Region using pandemic-era vaccine prices and healthcare-seeking behaviour assumptions. We assessed the impact and cost-effectiveness of targeted vaccination strategies. Results are reported as incremental costs and disability-adjusted life years averted compared with no additional vaccination. Parameter and stochastic uncertainty were captured through scenario and sensitivity analysis.</p><p><strong>Results: </strong>Across different population demographics and income levels, we consistently found that annual elder-targeted boosting strategies are most likely to be cost-effective or cost-saving (>75% probability of being cost-effective among older, high-income settings; >50% probability of being cost-effective in younger, middle-income settings), while paediatric programmes are unlikely to be cost-effective. Results remained broadly consistent while accounting for uncertainties in the epidemiological and economic models, although they were sensitive to the cost of home-based care and vaccination. Use of pandemic-era vaccine prices may underestimate current vaccine prices available in upper-middle-income and high-income settings, potentially overestimating the cost-effectiveness of boosting in these settings. Half-yearly boosting may only be cost-effective in higher income settings with older population demographics and higher cost-effectiveness thresholds.</p><p><strong>Conclusion: </strong>Competing health priorities and resource constraints mean COVID-19 vaccine allocation needs to be carefully considered in context. These results, reflecting modelling conducted on the early post-Omicron period, demonstrate the value of continued booster vaccinations to protect against severe COVID-19 disease outcomes across high-income and middle-income settings and show that the biggest health gains relative to vaccine costs are achieved by targeting older age groups.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Ethiopian Surgical Outcome Study (Ethio-SOS): a 7-day multicentre national prospective observational cohort study.","authors":"Atalel Fentahun Awedew, Fitsum Kifle Belachew, Katherine R Iverson, Tesfay Yohannes Ambese, Kokeb Desita Belihu, Abiy Dawit Tantu, Leake Gebrargs Gebreslase, Masresha G Teklehaimanot, Kalkidan Kifle, Nigat Amsalu Addis, Peniel Kenna Dula, Bruce Biccard, Andualem Deneke","doi":"10.1136/bmjgh-2025-020147","DOIUrl":"10.1136/bmjgh-2025-020147","url":null,"abstract":"<p><strong>Introduction: </strong>Safe surgical care is a cost-effective intervention for addressing a wide range of conditions, yet postoperative complications remain a leading global cause of disability, mortality and economic loss, disproportionately affecting low- and middle-income countries. This study aims to generate robust epidemiological data on postoperative outcomes for surgical patients in Ethiopia.</p><p><strong>Method: </strong>This 7 day national observational cohort study included adult patients undergoing elective and non-elective surgeries, using a convenience sampling method to recruit as many hospital sites as possible from all regions of Ethiopia. The primary outcomes measured were 7 day in-hospital mortality and postoperative complications. Statistical analysis included descriptive statistics and logistic regression models to identify risk factors for mortality and complications.</p><p><strong>Results: </strong>A total of 4412 surgical patients across 46 Ethiopian hospitals were included in this study. The median patient age was 30 years (IQR: 25-42), with a predominance of female participants 2772/4412 (62.8%) and American Society of Anaesthesiologists (ASA) classification class I-II classifications. The overall complication rate was 19.8% (873/4412), with 4.2% (184/4412) experiencing severe complications (Clavien-Dindo grades III-IV) necessitating reoperation. The overall mortality rate was 0.4% (17/4412), with a median age at death of 40 years (IQR=29-49). Our findings suggest that the key drivers of perioperative mortality and postoperative complications were higher ASA class, comorbidities, cancer surgery, infections and emergency surgical procedures.</p><p><strong>Conclusion: </strong>One in five surgical patients in Ethiopia experiences postoperative complications and a high rate of reoperation, despite exhibiting a low-risk profile, young age and a low rate of high-risk surgical procedures. This suggests a need for more evidence-based interventions to strengthen the foundations, care processes and quality of the surgical system to achieve safe and effective care and improve overall surgical outcomes in the country.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}