Lofty-John Chukwuemeka Anyanwu

Bayero University Kano · Department of Surgery

First referral hospitals, often known as district hospitals, are neglected in the discourse on universal health coverage in low-income and middle-income countries (LMICs). However, these hospitals are important for delivering safe surgery for 313 million people. This study aims to understand the structures, processes and outcomes of patients underg...

Background Death after surgery is devasting for patients, families, and communities, but remains common in low-income and middle-income countries (LMICs). We aimed to use high-quality data from an existing global randomised trial to describe the causes and mechanisms of postoperative mortality in LMICs. To do so, we developed a novel framework, lea...

Background Pulmonary complications are the most common cause of death after surgery. This study aimed to derive and externally validate a novel prognostic model that can be used before elective surgery to estimate the risk of postoperative pulmonary complications and to support resource allocation and prioritisation during pandemic recovery.

Background Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI.

Introduction Telemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries. Method A multi-centre, international, prospective study was embedded i...

Background: Typhoid fever is a potentially lethal systemic illness and it continues to be a significant global health concern, particularly in resource-limited settings. Intestinal perforation is one of the deadliest complications of typhoid fever. It remains of public health importance in sub-Saharan Africa. Materials and Methods: We retrospective...

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published i...

Background Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.

Background: The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low-and middle-income countries, and to...

Background Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI.

SUPPLEMENTARY MATERIAL LINKED TO GLOBALSURG RESEARCH

Cross testicular ectopia is an extremely rare congenital anomaly affecting male children. It is a deviation of testicular descent resulting in unilateral location of both testes which poses a problem in diagnosis and treatment among clinician in the world. Over a period of 4years 4 cases of testicular ectopia were managed by our unit. All of our pa...

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment usually proximal to distal. It is a common cause of intestinal obstruction in children, rarely it can occur in adult. This condition is reported in both developed and developing countries, however there are few publicati...

Introduction: As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data fr...

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism....

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which pati...

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 s...

Introduction: Wilms’ tumour is the most common childhood renal malignancy, with 5-10% of cases presenting bilaterally ¹. However, there is currently no consensus between centres on optimal management of bilateral Wilms’ tumours. This is an international multi-centre case series comparing management and outcomes of bilateral Wilms’ tumours between l...

Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on...

Background Testicular size assessment is an important and initial technique for the evaluation of gonadal function. Our study aims to determine the correlation between paediatric testicular volumes measured with the orchidometer, high-resolution ultrasonography (US) and intra-operative measurements using calipers. Results This is a prospective obs...

Major congenital abdominal wall defects (gastroschisis and omphalocele) may account for up to 21% of emergency neonatal interventions in low- and middle-income countries. In many low- and middle-income countries, the reported mortality of these malformations is 30–100%, while in high-income countries, mortality in infants with major abdominal wall...

Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management.

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a...

IISSSSNN 22007733--99999900 EEaasstt CCeenntt AAffrr JJ SSurg63 COSECSA/ASEA Publication -- East & Central African Journal of Surgery 2017; Vol. 22 (2)Radiological diagnosis of pneumoperitoneum in children with typhoid intestinal perforationLofty -John C. Anyanwu*1, Aminu M. Moha mmad1, Mohammed K. Saleh2, Lawal B. Abdullahi1, A liyu U. Farinyaro1,...

Background: Surgical 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. Methods: This international, prospective, multicentre cohort stu...

Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older...

Background: Intestinal perforation is a serious complication of typhoid fever with high case fatality rates in developing countries. This study aims to determine the factors associated with an adverse clinical outcome among patients managed for typhoid intestinal perforation (TIP) in our hospital. Materials and Methods: We retrospectively reviewed...

Background: Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality. Methods: We retrospectively reviewed the records of all children presenting to our unit with typhoid intestinal perforation (TIP) between Marc...

Background The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence...

Largest prospective cohort study of Paediatric surgery in SSA to aid advocacy and policy planning

Largest prospective cohort study of Paediatric surgery in SSA to aid advocacy and policy planning

A multi-centre prospective cohort study of five common paediatric surgical conditions across sub-Saharan Africa.

Schinzel-Giedion syndrome which is associated with midfacial hypoplasia and coarse dysmorphic features is a multiple congenital malformation syndrome. It is believed that risk of malignancy may be a component of the anomaly. We report herein a case of a 16 months old boy with SGS associated with sacrococcygeal teratoma and cor-triatriatum dexter. H...

Background: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence...

Background Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. Methods Multicentre, international, prospecti...

Promotional poster to recruit collaborators to participate in the study.

Protocol poster outlining the study objectives, data collection, analysis and proposed outcomes. *** This won the COSECSA prize for the best conference poster ***

Background Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Developmen...

Background: Breast cancer is the most common cancer that affects women worldwide. Many women, however, are not exposed to information that will promote awareness and early detection of this disease. We undertook this study to determine the missed opportunities to breast awareness information at the maternal and child health (MCH) services of our ho...

Parasitic twin is a rare malformation, which involves two fetuses attached to each other, whereby one of the pair is viable and develops into a mature embryo (the host twin) called the autosite, while the second twin (parasite) is usually nonviable, but survives on the host twin; the site and extend of their attachment are varied and may be associa...

Background: The few studies available in the literature on Wilms’ tumour (WT) from sub-Saharan Africa have reported a dismal outcome for children with the tumour. This study evaluated the risk factors that have been correlated with outcome in the literature and compare these with outcome among our patients. Materials and Methods: Cases of histolog...

Repair of congenital groin hernia/hydrocele is the most common surgical procedure performed by paediatric surgeons. There is dearth of literature comparing the outcomes of open herniotomy in children using various surgical approaches. This study was aimed at evaluating the efficacy of open herniotomy by comparing external ring incision, hernial sac...

Congenital anomalies are abnormalities of prenatal origin, and their prevalence varies worldwide. The objective of this study was to determine the prevalence and spectrum of overt congenital anomalies in live born neonates in selected hospitals in the Kano metropolis of North western Nigeria, as well as the associated maternal, paternal and neonata...

The poor outcome for patients with Wilms' tumour (WT) in developing countries has been predicated on late presentation, poverty and low rate of chemotherapeutic access. This study aims to evaluate the effects of an institutionalised approach to improving outcome for patients managed in a tertiary hospital in Nigeria. Oncology records of children di...

The megalourethra is a rare congenital anomaly of the penile urethra. It is characterized by the congenital absence of the corpus spongiosum and/or corpus cavernosum. It is especially common associated with Prune-Belly syndrome, and with upper tract abnormalities. We present a 2 weeks old boy with congenital megalourethra because of its association...

Scrotoschisis is a congenital extrusion of the testis through a defect in the scrotum. The condition is extremely rare, with only a few cases reported in the literature. We present 2 full term neonates one of whom had bilateral and the other right scrotoschisis and a contralateral communicating hydrocele. They presented at the ages of 7 and 22 days...

Persistent cloaca is a severe form of malformation of the anorectum. A distal colostogram is important in the planning of its treatment. We report herein a case of a girl who had barium stone formation within her vagina following a distal colostogram. Water soluble contrasts are recommended for this procedure.

Background: Neural tube defects (NTDs) are congenital malformations of the cranium, spine, and nervous system. About 350,000 infants are born with NTDs yearly worldwide. This study aimed to determine the prevalence and spectrum of NTDs in live-born neonates in the Kano Metropolis of North-western Nigeria. Materials and Methods: This is a prospectiv...

Construction of an enterostomy is a common procedure in pediatric surgery. However, caring for the child with a stoma is challenging for parents in developing countries. Modern devices such as colostomy bags and accessories are expensive and not readily available. The purpose of this study was to describe methods of effluent collection and peristom...

Background: Typhoid enteritis is rare in developed countries. The increasing prevalence of typhoid fever with enteric perforation in our environment is alarming. Peritonitis follows enteric perforation due to typhoid enteritis. Surgical treatments and repair of the perforated areas due to typhoid enteritis varies between institutions with high mor...

Gastrointestinal (GI) bleeding could result from various conditions in a child, and could be life threatening. Severe GI bleeds are, however, rare and their incidence is relatively unknown. Here, we report on two children who presented with GI bleeding following ingestion of NSAID. Two female children presented to our unit with GI bleeding. One was...

Necrotizing fasciitis is a rare life-threatening condition characterized by rapidly spreading infection in the subcutaneous tissues. Most of the time, the infection is precipitated by an event that produces a break in the epidermis. The authors report the case of a 55-year-old farmer who developed a necrotizing fasciitis of the left lower limb foll...

The objective of this study is to document the common bacteria found in the smegma in the subpreputial space of asymptomatic boys in our environment, their antimicrobial susceptibility pattern, and to determine if they differ from those commonly isolated from children with established urinary tract infections in our sub-region. Between May 2009 and...

Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the...

Pentalogy of Cantrell is a rare upper midline syndrome that may present in association with anomalies outside the torso. The pentad - the supraumbilical body wall defect, sternal defect, deficiency of the anterior diaphragm, defect of the diaphragmatic pericardium, and the intracardiac anomalies - was first described by Cantrell et al., in 1958. Th...