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Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study

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العنوان:	Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study
المؤلفون:	Niyi Ade-Ajayi, Dan Poenaru, Damian Clarke, Stephen Tabiri, Larry Akoko, Sharon Cox, Toru Shimizu, Bassey Edem, Kokila Lakhoo, Zaitun M Bokhary, Adesoji Ademuyiwa, Felix Alakaloko, Emmanuel Ameh, Theophilus Teddy Kojo Anyomih, Rouma Bankole, Bruce Bvulani, Milind Chitnis, Miliard Derbew, Stella Eguma, Omolara Faboya, Jacques Fadhili Bake, Intisar Hisham, Nasser Kakembo, Bertille Ki, Phyllis Kisa, Rashmi Kumar, Jerome Loveland, Bothwell Mbuwayesango, Mulewa Mulenga, Emmanuel Owusu Abem, Yona Ringo, John Sekabira, Albert Wandaogo, Anne Wesonga, Ali Hamad, Naomi Jane Wright, Abdelbasit E Ali, Ainhoa Costas-Chavarri, Samuel Osei-Nketiah, William Appeadu-Mensah, Opeoluwa Adesanya, Olalekan Ajai, Aminu Mohammad, Stephanie Van Straten, Robert Jaich, Osman Imoro, Lawal Abdullahi, Roel Matos-Puig, Andrew JM Leather, Ademola Olusegun Talabi, Oludayo Adedapo Sowande, Christopher Bode, Taiwo Akeem Lawal, Samson Olori, Reitze Rodseth, Andre Theron, Emily Rose Smith, Alessandra Bisquera, Anyanwu Lofty John-Chukwuemeka, Justine Seyi-Olajide, Bernadette Béré, Luc Malemo, Elisee Bake, Nwokoro Collins, Aberibigbe M. O. Shonubi, Daniel Sidler, Houégban Romeo, Gbenou Antoine Seraphin, Eugene Zoumenou, Béré Bernadette, Bandré Emile, Tapsoba W. Toussaint, Kabre Yvette, Manuela Ehua, Agbara Kouame, Moulot Olivier, Nandiolo Rose, Mesay Hailemariam Asfaw, Gudeta Didi, Hanna Getachew, Woubedil Kiflu, Samuel Negash, Tihitiena Negussie, Amezene Tadesse, Fiseha Temesgen, Afua Hesse, Francis Atidana Abantanga, Adakudugu Ida, Martin Kyere, Anwar Sadat Seidu, Paul M. Wondoh, Thomas Kirengo, Michael Ganey, Michael Mwachiro, Robert K Parker, Sinkeet Ranketi, Bitiel Banda, Caroline Melhado, Biplab Nandi, Mohakhelha Nyamulani, Johannes Verweij, Moustapha Helle, Paschal Anyanwu, Matthias Igoche, Elizabeth Ogboli-Nwasor, Baba Suleiman, Sholadoye Tunde Talib, Mustapha Abdulazeez, Farinyaro Aliyu, Aliyu Mohammed, Terlumun Patrick, Charles Soo, Akinlabi Emmanuel Ajao, Olayemi Anthony Ajiboye, Michael Abel Alao, Odion-Obomhense Kesiena Helen, Adenike Odewabi, Anuoluwapo Aremo, Taiwo Jones Olaoluwa, Odi Temitope, Kayode Bamigbola, E Uduehe Enono, Abdulsalam Moruf, Roland I Osuoji, Omolara M. Williams, Fatuga Adedeji, Ihediwa Chibuike, Ibironke Desalu, Olumide Abiodun Elebute, Charles Ememonu, Oluwaseun Ladipo-Ajayi, Sola Kushimo, Kayode Olayade, Adebambo Olowu, Okechukwu Hyginus Ekwunife, Victor Ifeanyichukwu Modekwe, Obiechina Sylvester Okwuchukwu, Ngozi Chidinma Osuji, Ezidiegwu Ugochukwu Stanley, Jideofor Okechukwu Ugwu, Chuka Ifeanyichukwu Ugwunne, Collins Chijioke Adumah, Lukmon Amosu, Ibukunolu Ogundele, Aderibigbe M. O. Shonubi, Felix Kumolalo, Olakayode Ogundoyin, Dare Olulana, John Chinda, Osagie Olabisi, Akan Inyang, Ijeoma Esther Nwachukwu, Nurudeen Toyin Abdulraheem, Lukman O. Abdur-Rahman, James O. Adeniran, Muslimat A. Alada, Abdulrasheed A. Nasir, David C. Nwosu, Christopher C Amah, Sebastian Okwuchukwu Ekenze, Uchechukwu Obiora Ezomike, Emmanuel I. Nwangwu, Ijeoma C. Obianyo, Nene E Obianyo, Nwankwo Elochukwu Perpetua, Alfred T Aggo, Tobin Maxwell, Philemon Okoro, James A. Brown, Moses Kasumba, Steve Kyota, Joy Robinson, Seo-Hwa Chung, Savannah smit, Andrew Grieve, Charles Carapinha, Mie Elsen, Nayha Gautam, Shamaman Harilal, Sanele Madziba, Hansraj Mangray, Babalwa Nondela, Ria Naidoo, Arasha Thotharam, Kondjela Sara Hamunyela, Corne De Vos, Enas Musa Ismail, Robert Bahati, Peter Dattani, Ezekiel Kambona, Silas Msangi, Komla Gnassingbé, Hamza Doles Sama, Mary T Nabukenya, Emma Lillie, Rae Oranmore-Brown, Hope Phiri, Victoria Simiyu, Tungamirai Gwatirisa, Houessou Gandjehou, Ebassa Karl, Goutam Chowdhury, Alagie Manneh, Michael Amoah, Boateng Nimako, Allan Kochi, Connie Keung, Robert Kuremu, Heuric Rakotomalala, Habou Oumarou, Okafor David, Faruk A Suleiman, Faturoti Olubukola, Innocent Igwilo, Alwanlehi Eighemhenrio, Andrew Shitta, Musa Ibrahim Zarenawa, Iyekeoretin Evbuomwan, Wabada Samuel, Emmanuel Kayibanda, Joseph Lule, Riikka Valjakka
المصدر:	BMJ Global Health BMJ Global Health, Vol 6, Iss 9 (2021)
سنة النشر:	2020
مصطلحات موضوعية:	Medicine (General), Infectious and parasitic diseases, RC109-216, paediatrics, surgery, 03 medical and health sciences, R5-920, 0302 clinical medicine, Humans, 030212 general & internal medicine, Prospective Studies, Child, Africa South of the Sahara, Original Research, treatment, Health Policy, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, Income, child health, epidemiology
الوصف:	IntroductionAs 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 from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A pResults1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.
تدمد:	2059-7908
الوصول الحر:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a1435ba09d94f5137e6512238c0282cTest https://pubmed.ncbi.nlm.nih.gov/34475022Test
حقوق:	OPEN
رقم الانضمام:	edsair.doi.dedup.....0a1435ba09d94f5137e6512238c0282c
قاعدة البيانات:	OpenAIRE

ResultId	1
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Adeniran</searchLink><br /><searchLink fieldCode="AR" term="%22Muslimat+A%2E+Alada%22">Muslimat A. Alada</searchLink><br /><searchLink fieldCode="AR" term="%22Abdulrasheed+A%2E+Nasir%22">Abdulrasheed A. Nasir</searchLink><br /><searchLink fieldCode="AR" term="%22David+C%2E+Nwosu%22">David C. Nwosu</searchLink><br /><searchLink fieldCode="AR" term="%22Christopher+C+Amah%22">Christopher C Amah</searchLink><br /><searchLink fieldCode="AR" term="%22Sebastian+Okwuchukwu+Ekenze%22">Sebastian Okwuchukwu Ekenze</searchLink><br /><searchLink fieldCode="AR" term="%22Uchechukwu+Obiora+Ezomike%22">Uchechukwu Obiora Ezomike</searchLink><br /><searchLink fieldCode="AR" term="%22Emmanuel+I%2E+Nwangwu%22">Emmanuel I. Nwangwu</searchLink><br /><searchLink fieldCode="AR" term="%22Ijeoma+C%2E+Obianyo%22">Ijeoma C. Obianyo</searchLink><br /><searchLink fieldCode="AR" term="%22Nene+E+Obianyo%22">Nene E Obianyo</searchLink><br /><searchLink fieldCode="AR" term="%22Nwankwo+Elochukwu+Perpetua%22">Nwankwo Elochukwu Perpetua</searchLink><br /><searchLink fieldCode="AR" term="%22Alfred+T+Aggo%22">Alfred T Aggo</searchLink><br /><searchLink fieldCode="AR" term="%22Tobin+Maxwell%22">Tobin Maxwell</searchLink><br /><searchLink fieldCode="AR" term="%22Philemon+Okoro%22">Philemon Okoro</searchLink><br /><searchLink fieldCode="AR" term="%22James+A%2E+Brown%22">James A. Brown</searchLink><br /><searchLink fieldCode="AR" term="%22Moses+Kasumba%22">Moses Kasumba</searchLink><br /><searchLink fieldCode="AR" term="%22Steve+Kyota%22">Steve Kyota</searchLink><br /><searchLink fieldCode="AR" term="%22Joy+Robinson%22">Joy Robinson</searchLink><br /><searchLink fieldCode="AR" term="%22Seo-Hwa+Chung%22">Seo-Hwa Chung</searchLink><br /><searchLink fieldCode="AR" term="%22Savannah+smit%22">Savannah smit</searchLink><br /><searchLink fieldCode="AR" term="%22Andrew+Grieve%22">Andrew Grieve</searchLink><br /><searchLink fieldCode="AR" term="%22Charles+Carapinha%22">Charles Carapinha</searchLink><br /><searchLink fieldCode="AR" term="%22Mie+Elsen%22">Mie Elsen</searchLink><br /><searchLink fieldCode="AR" term="%22Nayha+Gautam%22">Nayha Gautam</searchLink><br /><searchLink fieldCode="AR" term="%22Shamaman+Harilal%22">Shamaman Harilal</searchLink><br /><searchLink fieldCode="AR" term="%22Sanele+Madziba%22">Sanele Madziba</searchLink><br /><searchLink fieldCode="AR" term="%22Hansraj+Mangray%22">Hansraj Mangray</searchLink><br /><searchLink fieldCode="AR" term="%22Babalwa+Nondela%22">Babalwa Nondela</searchLink><br /><searchLink fieldCode="AR" term="%22Ria+Naidoo%22">Ria Naidoo</searchLink><br /><searchLink fieldCode="AR" term="%22Arasha+Thotharam%22">Arasha Thotharam</searchLink><br /><searchLink fieldCode="AR" term="%22Kondjela+Sara+Hamunyela%22">Kondjela Sara Hamunyela</searchLink><br /><searchLink fieldCode="AR" term="%22Corne+De+Vos%22">Corne De Vos</searchLink><br /><searchLink fieldCode="AR" term="%22Enas+Musa+Ismail%22">Enas Musa Ismail</searchLink><br /><searchLink fieldCode="AR" term="%22Robert+Bahati%22">Robert Bahati</searchLink><br /><searchLink fieldCode="AR" term="%22Peter+Dattani%22">Peter Dattani</searchLink><br /><searchLink fieldCode="AR" term="%22Ezekiel+Kambona%22">Ezekiel Kambona</searchLink><br /><searchLink fieldCode="AR" term="%22Silas+Msangi%22">Silas Msangi</searchLink><br /><searchLink fieldCode="AR" term="%22Komla+Gnassingbé%22">Komla Gnassingbé</searchLink><br /><searchLink fieldCode="AR" term="%22Hamza+Doles+Sama%22">Hamza Doles Sama</searchLink><br /><searchLink fieldCode="AR" term="%22Mary+T+Nabukenya%22">Mary T Nabukenya</searchLink><br /><searchLink fieldCode="AR" term="%22Emma+Lillie%22">Emma Lillie</searchLink><br /><searchLink fieldCode="AR" term="%22Rae+Oranmore-Brown%22">Rae Oranmore-Brown</searchLink><br /><searchLink fieldCode="AR" term="%22Hope+Phiri%22">Hope Phiri</searchLink><br /><searchLink fieldCode="AR" term="%22Victoria+Simiyu%22">Victoria Simiyu</searchLink><br /><searchLink fieldCode="AR" term="%22Tungamirai+Gwatirisa%22">Tungamirai Gwatirisa</searchLink><br /><searchLink fieldCode="AR" term="%22Houessou+Gandjehou%22">Houessou Gandjehou</searchLink><br /><searchLink fieldCode="AR" term="%22Ebassa+Karl%22">Ebassa Karl</searchLink><br /><searchLink fieldCode="AR" term="%22Goutam+Chowdhury%22">Goutam Chowdhury</searchLink><br /><searchLink fieldCode="AR" term="%22Alagie+Manneh%22">Alagie Manneh</searchLink><br /><searchLink fieldCode="AR" term="%22Michael+Amoah%22">Michael Amoah</searchLink><br /><searchLink fieldCode="AR" term="%22Boateng+Nimako%22">Boateng Nimako</searchLink><br /><searchLink fieldCode="AR" term="%22Allan+Kochi%22">Allan Kochi</searchLink><br /><searchLink fieldCode="AR" term="%22Connie+Keung%22">Connie Keung</searchLink><br /><searchLink fieldCode="AR" term="%22Robert+Kuremu%22">Robert Kuremu</searchLink><br /><searchLink fieldCode="AR" term="%22Heuric+Rakotomalala%22">Heuric Rakotomalala</searchLink><br /><searchLink fieldCode="AR" term="%22Habou+Oumarou%22">Habou Oumarou</searchLink><br /><searchLink fieldCode="AR" term="%22Okafor+David%22">Okafor David</searchLink><br /><searchLink fieldCode="AR" term="%22Faruk+A+Suleiman%22">Faruk A Suleiman</searchLink><br /><searchLink fieldCode="AR" term="%22Faturoti+Olubukola%22">Faturoti Olubukola</searchLink><br /><searchLink fieldCode="AR" term="%22Innocent+Igwilo%22">Innocent Igwilo</searchLink><br /><searchLink fieldCode="AR" term="%22Alwanlehi+Eighemhenrio%22">Alwanlehi Eighemhenrio</searchLink><br /><searchLink fieldCode="AR" term="%22Andrew+Shitta%22">Andrew Shitta</searchLink><br /><searchLink fieldCode="AR" term="%22Musa+Ibrahim+Zarenawa%22">Musa Ibrahim Zarenawa</searchLink><br /><searchLink fieldCode="AR" term="%22Iyekeoretin+Evbuomwan%22">Iyekeoretin Evbuomwan</searchLink><br /><searchLink fieldCode="AR" term="%22Wabada+Samuel%22">Wabada Samuel</searchLink><br /><searchLink fieldCode="AR" term="%22Emmanuel+Kayibanda%22">Emmanuel Kayibanda</searchLink><br /><searchLink fieldCode="AR" term="%22Joseph+Lule%22">Joseph Lule</searchLink><br /><searchLink fieldCode="AR" term="%22Riikka+Valjakka%22">Riikka Valjakka</searchLink> ) Array ( [Name] => TitleSource [Label] => Source [Group] => Src [Data] => BMJ Global Health<br />BMJ Global Health, Vol 6, Iss 9 (2021) ) Array ( [Name] => DatePubCY [Label] => Publication Year [Group] => Date [Data] => 2020 ) Array ( [Name] => Subject [Label] => Subject Terms [Group] => Su [Data] => <searchLink fieldCode="DE" term="%22Medicine+%28General%29%22">Medicine (General)</searchLink><br /><searchLink fieldCode="DE" term="%22Infectious+and+parasitic+diseases%22">Infectious and parasitic diseases</searchLink><br /><searchLink fieldCode="DE" term="%22RC109-216%22">RC109-216</searchLink><br /><searchLink fieldCode="DE" term="%22paediatrics%22">paediatrics</searchLink><br /><searchLink fieldCode="DE" term="%22surgery%22">surgery</searchLink><br /><searchLink fieldCode="DE" term="%2203+medical+and+health+sciences%22">03 medical and health sciences</searchLink><br /><searchLink fieldCode="DE" term="%22R5-920%22">R5-920</searchLink><br /><searchLink fieldCode="DE" term="%220302+clinical+medicine%22">0302 clinical medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Humans%22">Humans</searchLink><br /><searchLink fieldCode="DE" term="%22030212+general+%26+internal+medicine%22">030212 general & internal medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Prospective+Studies%22">Prospective Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Child%22">Child</searchLink><br /><searchLink fieldCode="DE" term="%22Africa+South+of+the+Sahara%22">Africa South of the Sahara</searchLink><br /><searchLink fieldCode="DE" term="%22Original+Research%22">Original Research</searchLink><br /><searchLink fieldCode="DE" term="%22treatment%22">treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Policy%22">Health Policy</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Health%2C+Environmental+and+Occupational+Health%22">Public Health, Environmental and Occupational Health</searchLink><br /><searchLink fieldCode="DE" term="%22Infant%2C+Newborn%22">Infant, Newborn</searchLink><br /><searchLink fieldCode="DE" term="%22Infant%22">Infant</searchLink><br /><searchLink fieldCode="DE" term="%223%2E+Good+health%22">3. Good health</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+Outcome%22">Treatment Outcome</searchLink><br /><searchLink fieldCode="DE" term="%22030220+oncology+%26+carcinogenesis%22">030220 oncology & carcinogenesis</searchLink><br /><searchLink fieldCode="DE" term="%22Income%22">Income</searchLink><br /><searchLink fieldCode="DE" term="%22child+health%22">child health</searchLink><br /><searchLink fieldCode="DE" term="%22epidemiology%22">epidemiology</searchLink> ) Array ( [Name] => Abstract [Label] => Description [Group] => Ab [Data] => IntroductionAs 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 from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A pResults1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres. ) Array ( [Name] => ISSN [Label] => ISSN [Group] => ISSN [Data] => 2059-7908 ) Array ( [Name] => URL [Label] => Access URL [Group] => URL [Data] => <link linkTarget="URL" linkTerm="https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a1435ba09d94f5137e6512238c0282c" linkWindow="_blank">https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a1435ba09d94f5137e6512238c0282c</link><br /><link linkTarget="URL" linkTerm="https://pubmed.ncbi.nlm.nih.gov/34475022" linkWindow="_blank">https://pubmed.ncbi.nlm.nih.gov/34475022</link> ) Array ( [Name] => Copyright [Label] => Rights [Group] => Cpyrght [Data] => OPEN ) Array ( [Name] => AN [Label] => Accession Number [Group] => ID [Data] => edsair.doi.dedup.....0a1435ba09d94f5137e6512238c0282c )
RecordInfo	Array ( [BibEntity] => Array ( [Languages] => Array ( [0] => Array ( [Text] => Undetermined ) ) [Subjects] => Array ( [0] => Array ( [SubjectFull] => Medicine (General) [Type] => general ) [1] => Array ( [SubjectFull] => Infectious and parasitic diseases [Type] => general ) [2] => Array ( [SubjectFull] => RC109-216 [Type] => general ) [3] => Array ( [SubjectFull] => paediatrics [Type] => general ) [4] => Array ( [SubjectFull] => surgery [Type] => general ) [5] => Array ( [SubjectFull] => 03 medical and health sciences [Type] => general ) [6] => Array ( [SubjectFull] => R5-920 [Type] => general ) [7] => Array ( [SubjectFull] => 0302 clinical medicine [Type] => general ) [8] => Array ( [SubjectFull] => Humans [Type] => general ) [9] => Array ( [SubjectFull] => 030212 general & internal medicine [Type] => general ) [10] => Array ( [SubjectFull] => Prospective Studies [Type] => general ) [11] => Array ( [SubjectFull] => Child [Type] => general ) [12] => Array ( [SubjectFull] => Africa South of the Sahara [Type] => general ) [13] => Array ( [SubjectFull] => Original Research [Type] => general ) [14] => Array ( [SubjectFull] => treatment [Type] => general ) [15] => Array ( [SubjectFull] => Health Policy [Type] => general ) [16] => Array ( [SubjectFull] => Public Health, Environmental and Occupational Health [Type] => general ) [17] => Array ( [SubjectFull] => Infant, Newborn [Type] => general ) [18] => Array ( [SubjectFull] => Infant [Type] => general ) [19] => Array ( [SubjectFull] => 3. Good health [Type] => general ) [20] => Array ( [SubjectFull] => Treatment Outcome [Type] => general ) [21] => Array ( [SubjectFull] => 030220 oncology & carcinogenesis [Type] => general ) [22] => Array ( [SubjectFull] => Income [Type] => general ) [23] => Array ( [SubjectFull] => child health [Type] => general ) [24] => Array ( [SubjectFull] => epidemiology [Type] => general ) ) [Titles] => Array ( [0] => Array ( [TitleFull] => Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study [Type] => main ) ) ) [BibRelationships] => Array ( [HasContributorRelationships] => Array ( [0] => Array ( [PersonEntity] => Array ( [Name] => Array ( [NameFull] => Niyi Ade-Ajayi ) ) ) [1] => Array ( [PersonEntity] => Array ( [Name] => Array ( [NameFull] => Dan Poenaru ) ) ) [2] => Array ( [PersonEntity] => Array ( [Name] => Array ( [NameFull] => Damian Clarke ) ) ) [3] => Array ( [PersonEntity] => Array ( [Name] => Array ( [NameFull] => Stephen Tabiri ) 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