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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...

Over 66 per cent of children in sub-Saharan Africa remain affected by poor developmental outcomes, exacerbating early inequalities. UNICEF and WHO evolved the Care for Child Development package (CCD) as a community-based initiative to support caregivers to develop stronger relationships with young children and support nurturing care. The Baby Friendly Community Initiative (BFCI) is a global WHO strategy to promote optimal maternal, infant and young child nutrition at the community level. This paper provides insights into the feasibility and lessons learned from rural Kenya in providing CCD training and supporting its implementation alongside the BFCI. Findings from qualitative interviews with caregivers and implementers of the BFCI revealed that training community health volunteers on CCD, enabled them to deliver CCD messages alongside those of the BFCI during counselling sessions. However, a more integrated approach to training as well as practical training opportunities, refresher training and provision of materials that facilitate the programme will enable further support for nurturing care in Kenya.

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Marine contamination arising from land-based sources is on the rise along the Kenyan Coast. We carried out a decadal pollution survey between 2008 and 2018 to determine the levels of various pollutants (nutrients, trace metals, persistent organic pollutants, and 210 Po) in water, sediment, and biota collected from selected locations in Kenya. Nutrient levels in water ranged between <0.10 and 1560.00, <0.10 and 1320.00, and <0.10 and 3280.00 μg/L for PO 4 3−-P, (NO 2 − + NO 3 −)-N, and NH 4 +-N, respectively, while Chl-a values ranged between 0.02 and 119.37 mg/L. Total PAH, PCBs, and OCPs in sediment from the studied locations ranged from BDL-37800, 0.012-7.99 and BDL-6.10 ng/g. High level of PAH in Kilindini port was primarily from petroleum sources. DDD + DDE/DDT ratio was above 0.5 suggesting historical input. Sediment trace metal concentration from selected locations in Kenyan estuaries had various ranges, that is, Al (0.06-9804284.00 μg/g), Zn (3.82-367.20 μg/g), Cu (7.5-169.60), Cd (DL −2.40 μg/g), Mn (BDL-169.60 μg/g), Cr (2.55-239.10 μg/g), and Pb (BDL-135.60) μg/g dw. Surface sediment 210 Po activities ranged between 20.29 and 43.44 Bq kg −1 dw. Chl-a and PO 4 3−-P data revealed enhance primary productivity in Mombasa peri-urban creeks and estuarine areas. Although the reported concentrations of trace metals and POPs are low in most locations from Kenya, there is a potential risk of bioaccumulation of these contaminants in marine biota; thus, there is a need for continuous monitoring to protect both ecosystem and human health.