Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study.

BACKGROUND: Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. METHODS: A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. RESULTS: This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. CONCLUSIONS: Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.

Gender dimensions of COVID-19 preventive policies: a global perspective.

The COVID-19 pandemic has had an impact on the global population not just from morbidity and mortality associated with SARS-CoV-2 infection, but also due to measures imposed upon populations to slow the transmission and prevent infections. Measures introduced by policymakers have included self-isolation of infective or potentially infective individuals, social distancing, travel bans, school closures, and mandatory face coverings. Most recently, the introduction of vaccination has been a key preventative measure encouraged by many governments. Considering gender differences in adherence to these measures is important to help guide future policymaking and targeting of advice. Differences also arise in how the preventative measures impact different genders. Some policies have caused greater harm to women, compounding existing problems such as inequality in the paid workforce, sexual- and gender-based violence, and inadequate maternal healthcare. Policymakers must consider the gender differences in response to preventive measures and creating effective and equitable policy.

An OxPLORE Initiative Evaluating Children's Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document.

BACKGROUND: The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children's Surgery (OReCS) document in 2019, listing standards of children's surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children's surgery provision worldwide. METHODS: Our OReCS audit tool was implemented in 10 hospitals providing children's surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital's current capacity for children's surgery. Data were analysed firstly to express the percentage of 'essential' criteria met for each specialty. Secondly, the 'OxPLORE method' was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. RESULTS: The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. CONCLUSIONS: We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children's surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.

COVID-19 Vaccines: Ensuring Social Justice and Health Equity among Refugees in Africa.

COVID-19 poses a particular threat to refugees in Africa. Overcrowded living conditions and lack of effective sanitation make refugees highly vulnerable to infection. Furthermore, migration has the potential to undermine measures to control viral spread. As a result, vaccination of the refugee community in Africa must be considered key in the vaccination plan to end the worldwide COVID-19 pandemic. Although the WHO has approved vaccines for emergency use worldwide in vulnerable groups through the COVID-19 Vaccines Global Access (COVAX) program, there is a lack of a strategy for achieving vaccination in the African refugee population. A specific strategy for refugee vaccination must be among the top priorities at national, regional, and global levels to ensure all refugees and asylum seekers in African countries have equitable and quality vaccine assistance regardless of displacement, statelessness, and financial hardship. We call on leaders in Africa and worldwide to ensure that refugee vaccination is a priority to protect this highly at-risk population and achieve an end to the current pandemic.