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...

The authors conducted formative research (a) to identify stakeholders' concerns related to typhoid fever and the need for disease information and (b) to develop a communication strategy to inform stakeholders and address their concerns and motivate for support of a school-based vaccination program in Pakistan. Data were collected during interactive and semi-structured focus group discussions and interviews, followed by a qualitative analysis and multidisciplinary consultative process to identify an effective social mobilization strategy comprised of relevant media channels and messages. The authors conducted 14 focus group discussions with the parents of school-aged children and their teachers, and 13 individual interviews with school, religious, and political leaders. Parents thought that typhoid fever was a dangerous disease, but were unsure of their children's risk. They were interested in vaccination and were comfortable with a school-based vaccination if conducted under the supervision of trained and qualified staff. Teachers and leaders needed information on typhoid fever, the vaccine, procedures, and sponsors of the vaccination program. Meetings were considered the best form of information dissemination, followed by printed materials and mass media. This study shows how qualitative research findings can be translated into an effective social mobilization and communication approach. The findings of the research indicated the importance of increasing awareness of typhoid fever and the benefits of vaccination against the disease. Identification and dissemination of relevant, community-based disease and vaccination information will increase demand and use of vaccination.

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Background: The most effective prenatal care and successful births are always dependent on accurate gestational age estimation (GA). The gestational age play important role in biochemical tests interpretation. Objective: The study was carried out to find the ultra-sonographic measurements done to check the placental thickness. It is an important factor for the gestational age estimation. Study design: This is a cross-sectional study conducted at Al Nafees Medical College and Hospital, Islamabad for the duration of one year from June 2021 to May 2022. Material and Methods: The study was conducted on 325 pregnant women that visited tertiary care unit for a period of one year. All women were fully aware of the study and written consent was taken from them. Results: the thickness of placenta found at different gestational age. From 15 to 39 weeks of gestation the data was collected and no. of cases having placental thickness were recorded. Maximum and minimum placental thickness in mm was measured and average was taken. The age range of the women was 18-36 years. The 26 years was the mean age. The statistical significance was found by SPSS tool Conclusions: In this study there was found a strong link between week of gestational age and thickness of placenta. Placental thickness along with other parameters were studied in each week by ultrasound and the results were analyzed. In case where the exact duration of pregnancy is unknown, placental thickness can give information about age of fetus and other features like intrauterine stunted growth. Keywords: Placental thickness and gestational age.

Objective: To determine the role of Sclerotherapy for treating encysted hydrocele in the paediatric population. Study Design: Prospective Study Place and Duration of Study: Department of Paediatric Surgery, Children Hospital Pakistan Institute of Medical Sciences, Islamabad for six months (1st November,2021 to 30th April,2022) Patients and Methods: This study on the captioned topic involved 39 patients aging 2 to 12 years who attended the outpatient department with the complaints of scrotal swelling. In order to rule out non-communicationg hydroceles, these patients were examined clinically and scrotal ultrasound was advised to all the patients which was carried out by them accordingly. In this study, the single team performed the above said procedure on Operation theatre days regularly. The incidence of complications was also monitored with each follow up visits on 1st, 3rd and 6th weeks after the procedure. Results: Study was conducted on 39 children having mean age 4.77 ± 2.860. Pre and post volumes of hydrocele fluid were satistically significant (p≤0.05) with average of 9.00 and 3.269 respectively. Complication rates were decreasing at every follow-up and these were not statisticaly significant (p≥0.05), recurrence complication was significant (p≤0.05). Conclusion: Sclerotherapy has been found to be a positive alternate approach, which is simpler to perform, less time consuming and involving lower complication rate. Keywords: Encysted Hydrocele, Paediatric Population, Sclerotherapy