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Introduction In the 5 months since it began, the COVID-19 pandemic has placed extraordinary demands on health systems around the world including surgery. Competing health objectives and resource redeployment threaten to retard the scale-up of surgical services in low- and middle-income countries where access to safe, affordable and timely care is low. The key aspiration of the Lancet Commission on global surgery was promotion of resilience in surgical systems. The current pandemic provides an opportunity to stress-test those systems and identify fault-lines that may not be easily apparent outside of times of crisis. Methods We endeavoured to explore vulnerable points in surgical systems learning from the experience of past outbreaks, using examples from the current pandemic, and make recommendations for future health emergencies. The 6-component framework for surgical systems planning was used to categorise the effects of COVID-19 on surgical systems, with a particular focus on low- and middle-income countries. Key vulnerabilities were identified and recommendations were made for the current pandemic and for the future. Results Multiple stress points were identified throughout all of the 6 components of surgical systems. The impact is expected to be highest in the workforce, service delivery and infrastructure domains. Innovative new technologies should be employed to allow consistent, high-quality surgical care to continue even in times of crisis. Conclusions If robust progress towards global surgery goals for 2030 is to continue, the stress points identified should be reinforced. An ongoing process of reappraisal and fortification will keep surgical systems in low- and middle-income countries responsive to “old threats and new challenges”. Multiple opportunities exist to help realise the dream of surgical systems resilient to external shocks.

Road traffic injuries (RTIs) and air pollution present dual burdens that disproportionately affect school-going children in low-income urban settings like Malawi. Despite availability of evidence-based interventions, their implementation often overlooks local contexts and perspectives. This study aimed to elicit stakeholder input on interventions addressing RTIs and air pollution exposure among children in urban Blantyre through stakeholder engagement. It used a mixed method Delphi technique combining expert consultations with community focus groups to achieve consensus on interventions. Successive rounds of prioritization and qualitative discussions explored contextual barriers and facilitators to implementation. Stakeholders identified 40 interventions, 23 for road safety and 17 for air pollution. Measures prioritized by experts included speed limit enforcement, pedestrian infrastructure improvements, and emission controls. Contextual barriers identified by experts and the community included socio-political and financial constraints. Community perspectives emphasized behavioral interventions, while experts highlighted systemic and legislative changes. The study underscored the value of combining expert and community perspectives to design context-sensitive interventions. Synergies between road safety and air pollution interventions offer opportunities for dual benefits but require careful adaptation to urban Malawi’s realities. This study provides a model for participatory design in low-income settings, emphasizing stakeholder engagement for tailored solutions.

Background The purpose of this observational study is to characterize the use of social media content pertaining to global surgery. Methods A search for public posts on social media related to global surgery was performed over a 3-month window, from January 1st, 2019, to March 31st, 2019. Two public domains were included in the search: Instagram and Twitter. Posts were selected by filtering for one hashtag: #GlobalSurgery. A binary scoring system was used for media format, perspective of the poster, timing of the post, tone, and post content. Data were analyzed using Chi-squared tests with significance set to p  < 0.05. Results Overall, 2633 posts with the hashtag #GlobalSurgery were publicly shared on these two social media platforms over the 3-month period. Of these, 2272 (86.3%) referenced content related to global surgery and were original posts. Physicians and other health professionals authored a majority (60.5%, 1083/1788) of posts on Twitter, whereas organizations comprised a majority of the posts on Instagram (59.9%, 290/484). Posts either had a positive (50.2%, 1140/2272) or neutral (49.6%, 1126/2272) tone, with only 0.3% or 6/2272 of posts being explicitly negative. The content of the posts varied, but most frequently (43.4%, 986/2272) focused on promoting communication and engagement within the community, followed by educational content (21.3%, 486/2272), advertisements (18.8%, 427/2272), and published research (13.2%, 299/2272). The majority of global surgery posts originated from the USA, UK, or Canada (67.6%, 1537/2272), followed by international organizations (11.5%, 261/2272). Chi-squared analysis comparing Instagram with Twitter performed examining media content, tone, perspective, and content, finding statistically significant differences ( p  < 0.001) the two platforms for each of the categories. Conclusion The online social media community with respect to global surgery engagement is predominantly composed of surgeons and health care professionals, focused primarily on promoting dialogue within the online community. Social media platforms may provide a scalable tool that can augment engagement between global surgeons, with remaining opportunity to foster global collaboration, community engagement, education and awareness.

To minimise the chance of nosocomial spread HCW welfare HCW life insurance cover in the event of death or incapacitation.19 Psychological support.13 Frequent personal protective equipment training and retraining. Hand hygiene for in-hospital guardians.49 To facilitate social distancing and minimise the chance of nosocomial spread Visitor policy Restrict all non-essential visitors.49 Restrict visitors for suspected or confirmed cases.49 Restrict visitation by any ill individual or family member.49 To reduce the number of vectors and minimise the chance of nosocomial spread Child protection Designate areas separate from general wards for children who may require protection during the pandemic. Twenty-eight million surgical operations are estimated to be cancelled and low-income and middle-income countries (LMICs) such as Africa will be hardest hit.23 The expectation that surgical volumes will bounce back rapidly is implausible, particularly in countries where there was already baseline fragility, and it may take longer than the 45 weeks forecast to make up the backlog.23 Current surgical rationing policies are based on a classification of the urgency of the patient’s intervention, such as the National Confidential Enquiry into Patient Outcome and Death system.19 24 Effects on surgical practice Paediatric surgical services in Africa are characterised by significant delays in health-seeking and within the referral chain.25 The mobility restrictions imposed on patients by shelter-in-place measures, as well as reduced income during the pandemic, will presumably cause further delays in presentation that may adversely affect outcomes. The change to non-operative treatment in eligible patients for certain conditions, for example, appendicitis that is being contemplated, may find less success in Africa, where a higher proportion of patients have complicated disease not amenable to non-operative treatment.26 It also has the potential to prolong hospital stay,27 which increases the chances of nosocomial transmission of the virus.

Introductionthe first cases of COVID-19 were reported in China in December 2019. Since then, the disease has evolved to become a global pandemic. Zimbabwe reported its first case on 20th March 2020, and the number has been increasing steadily. However, Zimbabwe has not witnessed the exponential growth witnessed in other countries so far, and the trajectory seems different. We set out to describe the epidemiological trends of COVID-19 in Zimbabwe from when the first case was confirmed to June 2020.Methodsdata were collected from daily situation reports that were published by the Zimbabwean Ministry of Health and Child Care from 20th March to 27th June 2020. Missing data on the daily situation reports was not imputed.Resultsas of 27th June 2020, Zimbabwe had 567 confirmed COVID-19 cases. Eighty-two percent of these were returning residents and 18% were local transmission. The testing was heavily skewed towards returnees despite a comprehensive testing strategy. Of the confirmed cases, 142 were reported as recovered. However, demographic data for the cases were missing from the reports. It was not possible to estimate the probable period of infection of an active case, and case fatality in Zimbabwe was about 1% for the first 4 months of the pandemic.Conclusionthe epidemiological trends of COVID-19 experienced in Zimbabwe between March and June 2020 are somewhat different from what has been observed elsewhere. Further research to determine the reasons for the differences is warranted, to inform public health practice and tailor make suitable interventions.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

Injury is a leading cause of morbidity and mortality among children and adolescents worldwide, yet national-level indicators for tracking injury prevention progress are limited and/or underdeveloped. This study aims to establish a set of population health status indicators for monitoring child injury prevention efforts, focusing on the top causes of unintentional injuries in children and adolescents. The study follows a three-phase process: a scoping review to identify and map existing indicators, a filtering process to assess their validity, reliability, sensitivity, availability, accessibility and universality and a modified Delphi method to identify the most important indicators and arrange them into implementation tiers. These indicators will facilitate cross-country comparisons, support the measurement of country progress on the implementation of evidence-based interventions and increase visibility for this urgent global problem.

(1) Background: This study explored the challenges faced by schoolchildren while commuting to school, particularly the hazards associated with poor road conditions, exposure to high-speed traffic, and traffic-related air pollution (TRAP). (2) Methods: The research focused on community perspectives gathered through four focus group discussions (FGDs) involving parents and teachers from two primary schools in Blantyre City. Employing qualitative analysis with NVivo, themes, sub-themes, and codes were developed collaboratively within the research team. (3) Results: The community identified road safety risks, emphasizing concerns about different actors’ risky behaviors, poor infrastructure (such as sidewalks, crossings, and signals), and personal safety issues. Proposed solutions for road safety involved educational initiatives for students, infrastructure enhancement, and enforcing stricter penalties. The study revealed a lack of awareness about air pollution among participants, which they often associated solely with unpleasant odors. Suggestions for addressing air pollution centered on educational interventions related to waste disposal and hygiene practices. (4) Conclusions: This research underscores the community’s adeptness at identifying road safety issues and proposing viable interventions. However, it highlights the need for enhanced education and awareness regarding air pollution. The paper advocates for community engagement to comprehensively address these challenges, fostering community cohesion, and empowering community members to advocate for change.

IntroductionRoad injuries are a leading cause of death in the 5–19 age group and pedestrian school children are a key vulnerable group. However, the road crash risks faced by school children in Malawi remain understudied. This study aims to describe and quantify the prevalence.MethodsWe performed an observational study from July to December 2022. Data were collected through a knowledge, attitudes and practices survey, mobility survey, school-zone speed and pedestrian observations and star ratings for schools’ assessments in six schools in Blantyre.ResultsWe surveyed 2466 students aged 12–16 and conducted safety assessments in the areas around these schools. Among surveyed children, 134 (5.4%) and 732 (29.7%) had been involved in a crash or ‘near-miss’ in the last 6 months. Receipt of road safety education in the past was not associated with involvement in a crash. 63.4% of vehicle observations were above the standard 30 km/hour safe speed limit, and star ratings from 2 to 5 stars.DiscussionDespite receipt of road-safety education, road crashes continue to affect students walking to school. Improvement of road markings, signs and pedestrian crossings is a key intervention to improve safety across all schools. Modest infrastructural improvements are required to raise star ratings to at least three in study sites.ConclusionsImproving road safety for school children in Malawi requires targeted action focusing on ground truth assessments. Enhanced road safety awareness and practices at designated crossings, reduced speeds and improved infrastructure are potential targets.

the first cases of COVID-19 were reported in China in December 2019. Since then, the disease has evolved to become a global pandemic. Zimbabwe reported its first case on 20 March 2020, and the number has been increasing steadily. However, Zimbabwe has not witnessed the exponential growth witnessed in other countries so far, and the trajectory seems different. We set out to describe the epidemiological trends of COVID-19 in Zimbabwe from when the first case was confirmed to June 2020. data were collected from daily situation reports that were published by the Zimbabwean Ministry of Health and Child Care from 20 March to 27 June 2020. Missing data on the daily situation reports was not imputed. as of 27 June 2020, Zimbabwe had 567 confirmed COVID-19 cases. Eighty-two percent of these were returning residents and 18% were local transmission. The testing was heavily skewed towards returnees despite a comprehensive testing strategy. Of the confirmed cases, 142 were reported as recovered. However, demographic data for the cases were missing from the reports. It was not possible to estimate the probable period of infection of an active case, and case fatality in Zimbabwe was about 1% for the first 4 months of the pandemic. the epidemiological trends of COVID-19 experienced in Zimbabwe between March and June 2020 are somewhat different from what has been observed elsewhere. Further research to determine the reasons for the differences is warranted, to inform public health practice and tailor make suitable interventions.