Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession (‘non-specialists’, non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.

Colonisation and its aftermath: reimagining global surgery

To synthesize the literature on use of the P4 suicidality screener since its introduction in 2010 and to summarize results from 2 randomized clinical trials. A PubMed search was conducted from 2010 to 2023 to retrieve studies reporting on use of the P4. Also, data was extracted from the CAMMPS and SCOPE trials in which the P4 was periodically administered over 12 months when the 9th item of the PHQ-9 was endorsed. A total of 21 research studies using the P4 were found, of which 12 provided some data on P4 findings. Additionally, another 7 protocol papers reported intended use of the P4 as a study measure. In our 2 trials, the 9th item was endorsed 259 (12.5%) times in 2068 administrations of the PHQ-9. Higher risk suicidal ideation was identified in 4.1% (12/294) of CAMMPS participants and 2.8% (7/250) of SCOPE participants. No suicide attempts occurred over the 12 months in either trial. The P4 has had moderate use as a brief suicidality screener and is an efficient way to identify the small proportion of depressed patients with higher risk suicidality. Studies comparing the P4 with other common suicidality screeners would further inform use. 

P4 suicidality screener: Literature synthesis and results from two randomized trials.

Pregnancy and postpartum are sensitive periods for mental health problems due to increased stressors and demands, and the prevalence of intentional self-harming behaviors such as suicidal behavior and ideation may increase. Changes in the provision of prenatal care services and utilization of health services and adverse living conditions during the COVID-19 epidemic may also trigger or exacerbate mental illnesses. To investigate the prevalence of suicidal behavior and ideation encountered during pregnancy and postpartum period, its change in the COVID-19 pandemic, and the related factors. A systematic review and meta-analysis of observational studies was conducted. A search was conducted in April 2021 and updated in April 2023 on Web of Science, PubMed, PsycINFO, EBSCO, Turk Medline, Turkish Clinics, and ULAKBIM databases. Two authors independently conducted the search, selection of articles, data extraction, and quality assessment procedures, and an experienced researcher controlled all these steps. Joanna Briggs Institute's Critical Appraisal Checklists were used to assess the quality of the studies. The meta-analysis included 38 studies and the total sample size of the studies was 9 044 991. In this meta-analysis, the prevalence of suicidal behavior in women during pregnancy and postpartum periods was 5.1 % (95 % CI, 0.01–1.53), suicidal ideation 7.2 % (95 % CI, 0.03–0.18), suicide attampt 1 % (95 % CI, 0.00–0.07) and suicidal plan 7.8 % (95 % CI, 0.06–0.11). Rate of suicidal behavior, ideation/thought increased and attempts in the pandemic process (2.5% vs 19.7 %; 6.3% vs 11.3 %; 3.6% vs 1.4 %, respectively). Prevalences of suicidal behavior, ideation, attempts, and plan in the postpartum period was higher than during pregnancy (1.1% vs 23.4 %; 6.1% vs 9.2 %; 0.5% vs 0.7 %; 7.5% vs 8.8 %, respectively). This systematic review showed that suicidal behavior increases due to many factors such as individual and obstetric characteristics, economic and socio-cultural factors, domestic violence, and a history of physical and mental illness. This study revealed that suicidal behavior in the perinatal period is quite common, especially in high-risk groups, and it increases even more during the pandemic period. Being aware of the sensitivity of the perinatal period in terms of suicidal behavior, healthcare professionals can improve mother-baby health by identifying high-risk groups and providing preventive and health-promoting services. Registration number: CRD42021246334. 

The prevalence of suicidal behavior and ideation during pregnancy and postpartum period, its variation in the COVID-19 pandemic, and the related factors: A systematic review and meta-analysis of observational studies

Introduction: Suicide during the antenatal period is one of the major indirect causes of maternal death. This study aims to determine the prevalence of suicidal risk and its related factors among the patients attending the antenatal clinic of a tertiary care center. 
Method: This is a cross-sectional study conducted in the antenatal clinic Patan Hospital, Lalitpur, Nepal among 124 pregnant patients using purposive sampling and face-to-face interviews applying a semi-structured proforma and P4 suicide screener. Ethical approval was obtained. The percentage of patients with suicide risk was calculated and stratified into minimal, lower, and higher risk of suicide. The association between suicide risk and different sociodemographic and clinical variables was done using the Chi-square test. A p-values ≤0.05 was considered statistically significant. 
Result: The prevalence of suicide risk was 32 out of 124 patients (25.8%). When risk stratification was done a maximum of 22(17.7%) had a higher risk for suicide. The risk was associated the employment status (p=0.039), history of previous suicide attempts (p=0.04), and diagnosed mental disorder (p=0.027). 
Conclusion: Our study shows the suicide risk among antenatal females was 25.8% reaffirming the need for proper screening and referral.

Prevalence of suicide risk and its associated factors in patients presenting in antenatal clinic

Global surgery is interpreted differently and may lack an in-depth understanding which is complicated by socio-economy and culture. Global surgery and global health have become part of health care service following the report of the Lancet Commission. Sustainability, ethical principles, and decolonization are some important ongoing issues for recipient societies. Incorporating societal dimensions, socio-cultural values, patients’ needs, and affordability requires a tailored approach and not blindly pursuing the best technology. The recent COVID-19 has exposed the unethical and inequity in terms of equitable healthcare, vaccine rollout and its  access, and unprecedented high mortality observed in some societies. Surgery has been a neglected stepchild of global health and in addition global surgery must not be a slave of technology for the promotion of the ‘gold standard’, especially corporate-led commercialized services because a sustainable and effective surgical service at a reduced cost is desirable for all, be resource-rich or poor. Global surgery and global health include health security and universal health coverage. Stakeholders of global surgery need to be aware that ‘one size does not fit all’ and are required to consider the diverse conditions.

/pdf/global-surgery-and-global-health-one-size-does-not-fit-all-hh1ryxfw.pdf

Global surgery and global health: One size does not fit all

The purpose of present paper is to study the factors affecting the occupational aspiration of students. A descriptive survey method has been used in this study. A total sample of 150 students were selected. The findings of present study revealed that most of the students believe that parents and family, socio-economic status & friends and peer group are major factors which have been affecting the occupational aspiration.

study of factors affecting the occupational aspiration of students of senior secondary level

Abstract Objective  The aim of this study was to understand the level of handwashing knowledge, and handwashing practices as well as to determine the availability of handwashing facilities in the schools. Materials and Methods  A survey was conducted on 17th October 2019 to determine the availability of handwashing facilities along with the level of handwashing knowledge and practices among school students of Borsojai High School situated in Kamrup Metropolitan City, Guwahati, Assam. The study population consisted of randomly selected students of 9th and 10th classes during the academic year 2019 to 2020. The quantitative data were analysed using the IBM-SPSS, version 20.0. Result  Fifty-six school students from classes 9 to 10th of mean age 15.53 years participated in the current study. It is evident that school-aged students have sufficient knowledge of handwashing, and they widely recognise the importance of handwashing (94.6%) to prevent diseases (39.3%) and to remove germs (48.2%). Conclusion  To encourage hand hygiene in school students, parents can also be sensitised through the parents teacher meeting. This will improve the health and reduce the absenteeism from school due to infectious diseases.

Knowledge and Practice of Handwashing by School Students in Kamrup Metropolitan, Assam, India: A Cross Sectional Survey

Child sexual abuse (CSA) is a worldwide problem. It is associated with a range of adverse consequences. There has been no report assessing media reporting of CSA in Nepal. We aimed to assess the pattern of reporting of news by media on the topic of CSA in Nepal. We did a content analysis of articles from online archives in the two most popular English-language newspapers published in Nepal on reporting of CSA from the period between June 1, 2020, and August 31, 2021. A predesigned proforma was used and a descriptive analysis was carried out. A total of 142 English newspaper articles reporting on CSA were analysed. The majority of reports (83.1%, n = 118) had an episodic framing. Overall, 90.1% of the reports mentioned some form of action taken by the authorities indicating the criminal justice point of view for CSA. The information identifying the victim(s) was presented in 15 news reports. 28.9% ( n = 43) of news reports had some information about possible steps to prevent events and none of the news reports provided a child helpline number or contact information for any other child support/welfare services. The reports presented an episodic frame and focused on details of individual cases and steps taken by the criminal justice system. There is a gross lack of information about the causes of CSA and steps to prevent them like an expert opinion, help lines, crisis management, etc. There is an urgent need to develop national guidelines in order to improve the media reporting of CSA.

Media Reporting of Child Sexual Abuse in Nepal: A Content Analysis

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