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...

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend starting breastfeeding within the first hour after birth, exclusively breastfeeding (EBF) for the first six months, and continuing for up to two years or beyond, in addition to adequate complementary foods. A structured and pretested questionnaire was used to collect data from 384 mothers attending antennal health care at Brikama District Hospital in Brikama, Gambia, from 1st June to 30th June.   The mean age (standard deviation (SD)) of the women was 26.69(±5.67) years and ranged from 16 to 49 years. Majority of the women were married (92.19 %) and from extended families (67.19 %).  The findings indicate that majority of participants knew about EBF (88.28%) from health workers (58.22%). Furthermore, most mothers preferred breastfeeding for up to two years of age (58.85%) and agreed that babies should be breastfed on demand (65.63%). The knowledge and attitude of mothers towards EBF was very high and positive. Overall, most respondents knew about (85.94%) and favored (69.79%) EBF.

Background. In Africa, it has been estimated that 50 million cattle and 70 million sheep and goats are at risk of animal African trypanosomiasis, and three million cattle die annually. Methods. This study was conducted in all the regions of The Gambia except Kombo Saint Mary Island (Banjul). Structured questionnaires were administered to 440 randomly selected livestock owners and 23 livestock assistants, and 7 focus group discussions were held for both livestock owners and livestock assistants. The data were analyzed mainly using descriptive statistics and content analysis methods. Results. A total of 94.5% and 75% of livestock owners reported having seen tsetse and horse flies, respectively, while 100% of livestock assistants reported having seen tsetse flies. Forty-seven percent of the livestock owners indicated a positive attitude toward control measures, while 42% of them had no idea how to control tsetse flies. On the other hand, 57% of livestock assistants believe that tsetse and horse flies are the main reasons why AAT is still in their community. There was a statistically significant difference between all the respondents’ characteristics and the practices done by livestock owners to prevent AAT vectors from biting their animals. Conclusion. This study shows that trypanosomiasis is still a major problem for livestock health and production in The Gambia, and it requires disease and vector control.

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Climate Change is unequivocal and occurring at an alarming pace. Increasing greenhouse gas emissions, their concentration in the atmosphere and increased energy absorption have resulted in in changes in climate. This study was a cross sectional study conducted from April 12th to May 12th, 2021. The survey was conducted online using Google form that was circulated via "WhatsApp" groups and emails received from the University admissions office. This study comprises of students in their; first year 26.5%, second year 22.8%, third year 17.9% and fourth-year students 32.8%. Students from the school of Medicine and allied health science showed a satisfactory knowledge of 67% towards the causes of global warming. Students from the school of Engineering also demonstrated a satisfactory knowledge towards the impact of global warming 61% and its solution 69%. In conclusion, students at the University of The Gambia demonstrated a satisfactory understanding of the causes of global warming (63%) and a fair awareness of the consequences (52%) and remedies to global warming (54%). We recommend that, climate change awareness course should be incorporated into the curriculum of the University of The Gambia and should be made mandatory for every student.