Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

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Introduction Globalization and other relevant phenomena such as healthcare workforce, ageing of the population, brain drain etc. all necessitate medical curricula to transcend national medicine and encompass a more global approach. This is especially true in the context of developing countries which currently act as passive recipients of ongoing global decisions, health inequities or pandemics. The aim of this research was to study the Knowledge, Attitude, and Practice of Sudanese medical students towards global health education and the impact of extra-curricular activities on their knowledge and attitudes. Methods This was a descriptive cross-sectional institutional based study. The study was conducted in five Sudanese Universities and participants were selected using systematic random sampling. An online-based, self-administered questionnaire was used, samples were collected between November 2019 until April 2020 and data was analyzed using SPSS version 25. Results 1176 medical students were involved. The study revealed a poor level of knowledge among 72.4%, and only 2.3% of respondents revealed a good level of knowledge. Mean knowledge scores between Universities slightly vary and have shown positive correlation according to the grade of the medical student. Regarding attitude, the results demonstrated the high level of interest of medical students in global health, their agreement in including global health in their official medical education curriculum (64.8%) and their consideration of including global health as part of their future career (46.8%). Conclusion The study concluded that there is a knowledge gap among Sudanese medical students regarding global health education, although students showed good attitudes and willingness to include global health in their official curriculum. Recommendations Global health education should be implemented in the official curriculums of Sudanese Universities, and Universities should do global partnerships and increase the learning and teaching opportunities in this interesting field.

Background: CYP2C19*2 has been identified as the most common allelic variant of CYP2C19 affecting the response to Proton pump inhibitors (PPI). This study aims to detect CYP2C19*2 allele in H. pylori-infected Sudanese population, owing its probable effect on H. pylori eradication. Methods: Antral biopsies was collected from 30 patients attending endoscopy units. Extraction of DNA was performed through QIAamp® DNA Mini Kit. Samples were screened for Urease C (UreC) gene of H. pylori using conventional PCR. Detection of CYP2C19*2 was performed in positive H. pylori samples using Real time-PCR. Results: The mean age of patients was 40.7 (±20.2 SE). Positive samples for UreC were 24 (80%) samples. Among them, four samples (16.6%) were found positive for CYP2C19*2 allele presence. Gender was found to be statistically associated with the presence of the allele (p < 0.05). Conclusion: This study illustrates that CYP2C19*2 is of modest prevalence among H. pylori-infected Sudanese population. The determination of genotypic and allelic frequencies of CYP2C19 gene among different populations will provide data to be used to personalize treatment according to individual genetic profile, and minimize the possible adverse side effects of CYP2C19 substrates.