Georgia Fraulin

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10–1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12–1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02–1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative morbidity and mortality. No data is available on global differences in surgical morbidity and mortality between geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative morbidity and mortality between Indigenous and non-Indigenous populations. This scoping review and meta-analysis was conducted in accordance with PRISMA-ScR and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n=31, North America n=36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients worldwide had 1.26 times higher odds of post-operative morbidity (OR=1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times higher odds of post-operative infection (OR=1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times higher odds of reoperation (OR=1.33, 95% CI: 1.02-1.74, p=0.04) and longer hospital stays (SMD=0.09; 95% CI: 0.02-1.08; p=0.05). In conclusion, we found that Indigenous patients experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there remains a paucity of high-quality research focusing on assessing and improving surgical equity for Indigenous patients worldwide, despite multiple international and national calls to action for reconciliation and decolonization to improve access to quality surgical care for Indigenous populations.

Background: The United Nations Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO) has been marred by widespread allegations of sexual exploitation and abuse (SEA) of women and girls by UN peacekeepers. There is minimal research conducted on the perceptions of communities most affected by the SEA themselves, and even less about those below the age of 18. Methods: Using mixed-methods data, we examined the perceptions of adolescents aged 13–17 on how the lives of women and girls have been affected by the presence of UN peacekeepers within the DRC. SenseMaker, a mixed-methods narrative capture tool, was used to survey participants around six United Nations bases across eastern DRC. Each participant shared a story about the experiences of Congolese women and girls in relation to MONUSCO personnel and interpreted their own stories by answering a series of questions. Patterns of adolescent perspectives (aged 13–17) were analyzed in comparison to all other age groups and emerging qualitative themes were mapped onto quantitative variables. Results: Quantitative data showed that adolescents were more likely, in comparison to all other age groups, to perceive interactions between peacekeepers and women/girls as being initiated by the woman/girl, that the MONUSCO personnel was perceived to be able to offer protection, and that the interactions between local women/girls and peacekeepers were sexual in nature. Three qualitative themes emerged: poverty bringing peacekeepers and women/girls together, material/financial gain through transactional sex and sex work, and support-seeking actions of affected women/girls. Conclusions: Our mixed methods data illustrate the problematic finding that adolescents facing poverty may perceive SEA as protective through the monetary and material support gained. These findings contribute to the growing body of literature on peacekeeping economies and have implications for the prevention of, and response to, peacekeeper-perpetrated SEA.