SummaryBackgroundSurgical 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.MethodsThis 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.FindingsBetween 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).InterpretationCountries 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.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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Background: 50% of those who had ever used an on-line life satisfaction measurement tool were considered optimally satisfied about their lives. Categorization into age, sex, country of origin and religion did not seem to affect the results of the on-line database for life satisfaction scores. In Gaza, Palestine, most of the public believed that being a female doctor would kill any form of life enjoyment and it is a common belief here that doctors tend to wait longer than other female workers are before getting into a stable marital relationship. The aims of our study were to quantify life satisfaction among female doctors in Gaza, compare their results with those from other work sectors and finally to prove that a medical career does not affect adversely life satisfaction for Gazian female doctors. Methods: We used random sample tables to choose the work places for our sample groups. We have interviewed any female worker at the given facility using convenient sampling technique. 50 female doctors and 50 other workers were compared to each other using objective standard measurement tool for life satisfaction which was composed of 14 specific questions with a possible total score from (14 to 70) where 70 is the most satisfied total score and a total score of more than 50 was the cut-off for defining satisfaction. Total average scores and average scores for each question were compared between the two groups using statistical analysis methods. The frequency of use of over the counter medications was also compared between the two groups. Results: Average age for female doctors (FD) and other workers (OW) was comparable (FD 30.16 years, OW 30.4 years). Response rate was 90% between both groups. Average age, number of children per family and matched scores for the 14 questions, were all of no statistical significant difference between married female doctors and married other workers (p = 0.4; 0.7 and 0.6 respectively). Life satisfaction among married female doctors and other workers was not statistically significantly different between the two groups (FD 13/25 VS OW 9/25); p = 0.4. Average age, matched average scores for each of the 14 questions and life satisfaction proportions were not statistically significantly different between single females of the two groups (p = 0.2; 0.4; and 1.0 respectively). Use of the over the counter drugs was statistically more commonly reported among single female doctors; p = 0.02. Interpretation: We have proved that there is no real association between being a female doctor in Gaza and having a low life satisfaction score. We can assure our female doctors they do not have lower enjoyment of their lives compared to other female workers. The average age for female singles between the two groups was not different which stands against the wide belief in our society that female doctors tend to get married later than other workers. Finally, our single female doctors should be discouraged about the non-rationale use of over the counter drugs.