Accepted for Publication: June 5, 2014.
Published Online: January 21, 2015. doi:10.1001/jamasurg.2014.2246.
Study concept and design: Vaughan, Chima, Mehes, Lee, Dordunoo, de Wildt, Abdullah, Sampson.
Acquisition, analysis, or interpretation of data: Vaughan, Sesay, Chima, Sitch, Kamara, Leigh, Sampson.
Drafting of the manuscript: Vaughan, Chima, Mehes, Sampson.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Vaughan.
Obtained funding: Vaughan, Sampson.
Administrative, technical, or material support: Vaughan, Sesay, Chima, Mehes, Lee, Dordunoo, de Wildt, Kamara, Abdullah, Sampson.
Study supervision: Chima, Sitch, de Wildt, Leigh, Abdullah, Sampson.
Conflict of Interest Disclosures: None reported.
Funding/Support: We thank the Wolfson Foundation, the Arthur Thompson Trust, and the Royal College of Surgeons for providing grants to support this research (Ms Vaughan).
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Tamba Ansumana, research assistant for the Johns Hopkins Austere Anesthesia Health Outcomes Research Group, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, and M. Koroma, MBBS, a senior anesthesiologist from Sierra Leone (Department of Anesthesiology, Prince Christian Maternity Hospital) for their support with data collection in Sierra Leone. We also thank S. Choo, MD, and H. Perry, MD, PhD, both at Bloomberg School of Public Health, Johns Hopkins University, and L. Roberts, MD, Birmingham University, for assistance with research design and analysis. Finally, we extend our deep appreciation to the dedicated clinical staff in Sierra Leone who shared their time to contribute to this study. None were financially compensated.