Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

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Ionosphere parameters determination is used to characterize its composition in particles. These results have been compared to data curried from Ouagadougou station. The present study deals with Total Electron Contents (TEC) results determined by Thermosphere-Ionosphere-Electrodynamics General Circulation Model (TIEGCM) version 1.94 and International Reference Ionosphere (IRI) version 2012 during solar cycle 22. The minimum and maximum phases of solar cycle 22 are considered in this study for TEC determination. The station is located at Ouagadougou, in western Africa, characterized by its latitude (12.4˚N) and longitude (358.5˚E). The present study completes the two previous articles on hmF2 and foF2 parameters determination on the same station by comparison between TEC results carried out from TIEGCM and IRI models. So that, quiet time condition is determined by Aa (≤20 nT) for the five quietest days in each characteristic month of seasons. Rz values characterize minimum and maximum solar cycle phases.

Ionosphere layer is the atmosphere region which reflects radio waves for telecommunication. The density in particles in this layer influences the quality of communication. This study deals with the effects of Total Electron Contents (TEC) on the critical frequency of radio waves in the F2-layer. Total Electron Contents parameter symbolizes electron bulk surface density in ionosphere layer. Above critical frequency value in F2 layer (foF2), radio waves pass through ionosphere. The knowledge of this value enables to calibrate transmission frequencies. In this study, we consider TEC effects on foF2 under quiet time conditions during the maximum and the minimum of solar cycle 22, at Ouagadougou station, in West Africa. The study also considers the effects of seasons and the hourly variability of TEC and foF2. This work shows winter anomaly on foF2 and TEC on minimum and maximum of solar cycle phase respectively. Running International Reference Ionosphere (IRI) model enables to carry out the effects of TEC on foF2 by use of their monthly average values. This leads to a new approach to calibrate radio transmitters.

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