Post‐injury malaria: a risk factor for wound infection and protracted recovery

Sundet, Mads; Heger, Tove; Husum, Hans

doi:10.1046/j.1365-3156.2003.01190.x

Cited by 11 publications

(11 citation statements)

References 6 publications

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“…Traumatic events like tissue damage, blood loss, and surgery trigger cascades of inflammatory mediators to cause immunodepression with increased risk to develop malaria parasitaemia [ 26 ]. In a study among traumatized land mine and war victims in Cambodia [ 27 ], about 33% of asymptomatic malaria carriers developed posttrauma and postsurgery symptomatic malaria.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana

Amponsah

Charwudzi

2017

Anesthesiology Research and Practice

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Introduction Several studies suggest that preoperative anaemia (PA) is associated with adverse postoperative outcomes, but little is known about these outcomes in the Central Region of Ghana. This study aims to determine the prevalence of PA among noncardiac surgical patients and its implications for their postoperative outcomes. Methods This study was designed as an observational study; data including demographics and clinical and laboratory results were collected from the patients' records and through interviews. Results A total of 893 inpatient surgical cases undergoing elective and emergency operations, aged 15 years and above with mean age of 44.2 ± 17.0 yrs, were enrolled. The prevalence of PA was 54.3%, mostly microcytic with or without hypochromia (57.2%). The prevalence was higher in females than males (p ≤ 0.001). Preoperative anaemia was significantly associated with prolonged length of hospital stay (OR: 2.12 (95% CI: 1.49–3.10)). Allogeneic blood transfusion significantly prolonged the length of hospital stay (OR 4.48 (95% CI: 2.67–7.51)). 15.5% of the anaemic patients received oral iron supplements compared to 2.2% of nonanaemic patients (p ≤ 0.001). Conclusion Preoperative anaemia is common among noncardiac surgical patients. It is independently and significantly associated with prolonged hospital stay leading to the use of increased healthcare resources. It is also the main predictor for perioperative allogeneic blood transfusions and the use of haematinics.

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Section: Discussionmentioning

confidence: 99%

Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana

Amponsah

Charwudzi

2017

Anesthesiology Research and Practice

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“…Diseases affecting surgical outcome are endemic, and so is malnutrition. 13 In cal centers as part of external relief programs. Such emergency interventions often prove to be "too much, too late".…”

Section: Introductionmentioning

confidence: 99%

Non-Doctors as Trauma Surgeons? A Controlled Study of Trauma Training for Non-Graduate Surgeons in Rural Cambodia

Heng

Davoung²,

Husum³

2008

Prehosp. Disaster med.

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Introduction:Due to the accelerating global epidemic of trauma, efficient and sustainable models of trauma care that fit low-resource settings must be developed. In most low-income countries, the burden of surgical trauma is managed by non-doctors at local district hospitals.Objective:This study examined whether it is possible to establish primary trauma surgical services of acceptable quality at rural district hospitals by systematically training local, non-graduate, care providers.Methods:Seven district hospitals in the most landmine-infested provinces of Northwestern Cambodia were selected for the study. The hospitals were referral points in an established prehospital trauma system. During a four-year training period, 21 surgical care providers underwent five courses (150 hours total) focusing on surgical skills training. In-hospital trauma deaths and postoperative infections were used as quality-of care indicators. Outcome indicators during the training period were compared against pre-intervention data.Results:Both the control and treatment populations had long prehospital transport times (three hours) and were severely injured (median Injury Severity Scale Score = 9). The in-hospital trauma fatality rate was low in both populations and not significantly affected by the intervention. The level of post-operative infections was reduced from 22% to 10.3% during the intervention (95% confidence interval for difference 2.8–20.2%). The trainees' selfrating of skills (Visual Analogue Scale) before and after the training indicated a significantly better coping capacity.Conclusions:Where the rural hospital is an integral part of a prehospital trauma system, systematic training of non-doctors improves the quality of trauma surgery. Initial efforts to improve trauma management in low-income countries should focus on the district hospital.

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“…First, that preoperative malaria infection is an actionable independent predictor of readmission in the pediatric surgical population in rural Ghana. Previous studies have shown that malaria is a leading cause of perioperative hyperpyrexia, increases the rate of surgical site infections, increases postoperative recovery and that surgery can cause reactivation malaria [23][24][25][26][27][28]. The burden of malaria infection in this region is highest in the pediatric population due to the immunological and behavioral drivers [29].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

Peiffer

Ssentongo

Keeney

et al. 2020

Preprint

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Background/Purpose: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods: This is a retrospective review of perioperative morbidity and mortality in children <18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.Results: We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions: Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.

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Post‐injury malaria: a risk factor for wound infection and protracted recovery

Cited by 11 publications

References 6 publications

Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana

Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana

Non-Doctors as Trauma Surgeons? A Controlled Study of Trauma Training for Non-Graduate Surgeons in Rural Cambodia

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

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