Surgical treatment outcome of children with neural-tube defect: A prospective cohort study in a high volume center in Addis Ababa, Ethiopia.

Introduction: Prevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center. Research question: The primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality. Material and methods: Single-center prospective study of all surgically treated NTDs from April 2019 to May 2020. Results: A total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01). Discussion and conclusion: The study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.

Harnessing water fleas for water reclamation: A nature-based tertiary wastewater treatment technology.

Urbanisation, population growth, and climate change have put unprecedented pressure on water resources, leading to a global water crisis and the need for water reuse. However, water reuse is unsafe unless persistent chemical pollutants are removed from reclaimed water. State-of-the-art technologies for the reduction of persistent chemical pollutants in wastewater typically impose high operational and energy costs and potentially generate toxic by-products (e.g., bromate from ozonation). Nature-base solutions are preferred to these technologies for their lower environmental impact. However, so far, bio-based tertiary wastewater treatments have been inefficient for industrial-scale applications. Moreover, they often demand significant financial investment and large infrastructure, undermining sustainability objectives. Here, we present a scalable, low-cost, low-carbon, and retrofittable nature-inspired solution to remove persistent chemical pollutants (pharmaceutical, pesticides and industrial chemicals). We showed Daphnia's removal efficiency of individual chemicals and chemicals from wastewater at laboratory scale ranging between 50 % for PFOS and 90 % for diclofenac. We validated the removal efficiency of diclofenac at prototype scale, showing sustained performance over four weeks in outdoor seminatural conditions. A techno-commercial analysis on the Daphnia-based technology suggested several technical, commercial and sustainability advantages over established and emerging treatments at comparable removal efficiency, benchmarked on available data on individual chemicals. Further testing of the technology is underway in open flow environments holding real wastewater. The technology has the potential to improve the quality of wastewater effluent, meeting requirements to produce water appropriate for reuse in irrigation, industrial application, and household use. By preventing persistent chemicals from entering waterways, this technology has the potential to maximise the shift to clean growth, enabling water reuse, reducing resource depletion and preventing environmental pollution.

Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes.

BACKGROUND: Traumatic brain injury (TBI) is an important cause of trauma-related mortality and morbidity in Ethiopia. There are significant resource limitations along the entire continuum of care, and little is known about the neurosurgical activity and patient outcomes. METHODS: All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia were prospectively registered from October 2012 to December 2016. Data registration included surgical procedures, complications, reoperations, discharge outcomes, and mortality. RESULTS: A total of 1087 patients were included. The most common procedures were elevation of depressed skull fractures (49.5%) and craniotomies (47.9%). Epidural hematoma was the most frequent indication for a craniotomy (74.7%). Most (77.7%) patients were operated within 24 hours of admission. The median hospital stay for depressed skull fracture operations or craniotomies was 4 days. Decompressive craniectomy was only done in 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cerebrospinal fluid leak was the most common complication (7.9%). The overall mortality was 8.2%. Diagnosis, admission Glasgow Coma Scale (GCS) score, surgical procedure, and complications were significant predictors of discharge GCS score (P < 0.01). Age, admission GCS score, and length of hospital stay were significantly associated with mortality (P ≤ 0.005). CONCLUSIONS: The injury panorama, surgical activity, and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services benefit a large number of patients in the greater Addis region and are qualitatively comparable with reports from high-income countries.

Four-Year Treatment Outcomes of Children Operated for Neural Tube Defect in Addis Ababa, Ethiopia: A Retrospective Study.

BACKGROUND: Closure of neural tube defects (NTDs) in children is a common neurosurgical procedure in Ethiopia, but we know little about the outcomes. The aim of this study was to study outcomes and to identify predictors of mortality and morbidity of surgically treated NTDs. METHODS: Between July 2013 and August 2014, all patients operated for NTDs were prospectively registered in a database and followed for a minimum of 4 years after the initial surgery. RESULTS: A total of 88 children primary operated for NTD closure in the period between July 2013 to August 2014 were included in the study. The median age at primary NTD closure was 29 days. The commonest site of defect was lumbar (60.2%) followed by lumbosacral (11.4%). There was no perioperative mortality, however, 23 (26.1%) of the children developed wound-related complications including cerebrospinal fluid leak and infection. Preoperative cerebrospinal fluid leakage (P = 0.013) was associated with risk of postoperative complications. We acquired 4-years follow-up data for 61 (69%) of the cases. At 4 years, 25 (41%) of these children had died. Presence of hydrocephalus and reduced motor function were found to be negative predictors for survival. CONCLUSIONS: Overall, the prognosis was poor. The study provides a basis for identifying patients at risk to improve the standard of care.

Drying characteristics of faecal sludge from different on-site sanitation facilities.

Drying is one of the treatment techniques used for the dual purpose of safe disposal and energy recovery of faecal sludge (FS). Limited data are available regarding the FS drying process. In this paper the drying properties of FS were investigated using samples from ventilated improved pit (VIP) latrines and urine diversion dry toilets (UDDT) and an anaerobic baffle reactor (ABR) from a decentralized wastewater treatment systems. Moisture content, total solids content, volatile solids content, water activity, coupled thermogravimetry & differential thermal analysis (TGA-DTA) and calorific value tests were used to characterize FS drying. Drying kinetics and water activity measured at different moisture content during drying (100 °C) were similar for the samples from different on-site sanitation facilities. Experimental heat of drying results revealed that FS requires two to three times that of the latent heat of vaporization of water for drying. Drying temperature was more significant than the sludge source in determining the final volatile solids content of the dried samples. This was reinforced by the dynamic TGA that showed considerable thermal degradation (2-11% dry solid mass) near 200 °C. Below 200 C, the calorific value of the dried samples exhibited no significant difference. The average calorific values of VIP, UDDT and ABR samples at 100 °C were 14.78, 15.70, 17.26 MJ/kg dry solid, respectively. This suggests that the fuel value of FS from the aforementioned sanitation facilities will not be significantly affected by drying temperature below 200 °C. Based on this study, the most suitable temperature for drying of FS for a solid fuel application was found to be 150 °C.

Isothermal drying characteristics and kinetics of human faecal sludges.

Background: Drying is an important step for the thermochemical conversion of solid fuels, but it is energy-intensive for treating highly moist materials. Methods: To inform the thermal treatment of faecal sludge (FS), this study investigated the drying characteristics and kinetics of various faecal wastes using thermogravimetric analysis and isothermal heating conditions. Results: The findings show that FS from anaerobic baffled reactor (ABR) and ventilated improved pit (VIP) latrines exhibit similar drying characteristics, with maximum drying rates at 0.04 mg/min during a constant rate period that is followed by a distinct falling rate period. On the contrary, fresh human faeces (HF) and FS from urine-diverting dry toilets (UDDT) exhibited a falling rate period regime with no prior or intermittent constant rate periods. The absence of constant rate period in these samples suggested limited amounts of unbound water that can be removed by dewatering and vice versa for VIP and ABR faecal sludges. The activation energies and effective moisture diffusivity for the sludges varied from 20 to 30 kJ/mol and 3∙10 -7 to 1∙10 -5 m 2/s at 55°C and sludge thickness of 3mm. The Page model was consistent in modelling the different sludges across all temperatures. Conclusions: These results presented in this study can inform the design and development of innovative drying methods for FS treatment.