Children with Appendicitis on the US-Mexico Border Are Socioeconomically Disadvantaged and Best Served by a Freestanding Children's Hospital

Abstract

conditions, in which congenital malformations, tumors, injuries, and infections can be fatal if left untreated. There has been limited analysis of the burden of pediatric surgical diseases in Uganda despite the significant socioeconomic impact on children and families. METHODS: We performed a review of 3,494 pediatric surgical admissions at a Ugandan tertiary referral hospital, from January 2012 to August 2016, through a prospectively collected database. RESULTS: There were 2,071 children (60%) who underwent surgery during admission. Fifty-nine percent were male and 41% female. Twenty-six percent of admissions were in neonates less than 1 month old and 50% were in children less than 1 year. Only 28% of patients were older than 3 years. Congenital anomalies including Hirshprungs, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnosis (32%), followed by hernias (10.2%), tumors (8.1%), and intussusception (6.6%). Mortality rates were substantially higher than those of high-income countries; for example, intussusception and pyloric stenosis had mortality rates of 29% and 11%, respectively. The mortality rates of various surgical procedures were also higher, illustrated by colostomy and ileostomy closure carrying a mortality rate of 7%. CONCLUSIONS: In low-income countries, there is a high burden of infant congenital anomalies, combined with higher mortality rates of both untreated disease states and surgical procedures compared to those in high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope such a database will facilitate evaluation of quality improvement and capacity-building initiatives.