Neonatal surgery in Africa: a systematic review and meta-analysis of challenges of management and outcome

Ekenze, Sebastian O.; Ajuzieogu, Obinna V.; Nwomeh, Benedict C.

doi:10.1016/s0140-6736(15)60830-3

Cited by 28 publications

(25 citation statements)

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“…Examples cited included the increased prevalence of cloacae and vestibular fistulae in their South African patient group, as opposed to recto-vaginal, recto-prostatic and anorectal malformation without fistula which wass more common in the Northern regions of the continent [1]. Although there has been an improvement in neonatal surgical outcomes in Africa over the last few decades and despite a recent review has showed that ARMs in African countries represent an important subject of publication, most of the evidence-based medical protocols still originate in firstworld countries [16]. Therefore, there is a need within the African context to find common points of departure, and to determine what findings can be extrapolated to our context, to improve intensive care facilities and staffing, coordination with rural and regional centers and to establish international collaborations with experts in the field, Demographic studies are of importance as they may lead to better insights into the etiological origins of ARMs.…”

Section: Discussionmentioning

confidence: 99%

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

et al. 2015

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Purpose Aim of study was to evaluate the differences in incidence and presentation of anorectal malformations (ARMs) between selected Pediatric Surgery Divisions in the Republic of South Africa (ZAR) and Italy. Methods A retrospective cohort study involved analysis of clinical records of patients with ARM born between 2005 and 2012. Type of ARM, maternal age, birth weight, gestational age, presence of associated anomalies and delayed diagnosis were analyzed. Results 335 patients were included in this study. Of note, statistically significant differences between the African and European patient groups were observed in a male predominance in the ZAR patient population. In addition, female recto-perineal fistulas were diagnosed in significantly more Italian patients than in ZAR. Furthermore, a more advanced maternal age and a lower gestational age was noted in the European cohort with a minimal delay in initial diagnosis as opposed to the African counterpart. Both centers reported recto-perineal fistula as the most common malformation in male patients. Conclusion With the exception of perineal fistulas in females, the incidence of specific subtypes of ARMs was similar in the two groups. This may be of importance when extrapolating European study conclusion to the South African setting.

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Section: Discussionmentioning

confidence: 99%

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

et al. 2015

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“…10 A meta-analysis from the pediatric surgical literature reported an overall pediatric perioperative mortality rate in African countries from 2005 to 2014 as 29.4%. 11 Possible contributors to this high pediatric mortality rate were delayed presentation and inadequate facilities in 39 studies (77%), dearth of trained support personnel in 32 studies (63%), and insufficient or absent neonatal intensive care services in 29 studies (57%). 11 Almost all of these mortality estimates are based upon retrospective mortality reports obtained by review of hospital surgery log books, a limitation that makes the estimates subject to multiple potential biases.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

“…First, the pediatric perioperative mortality rate that we report (1.7%) across the 24 Kenyan hospitals we studied is lower than previous estimates for larger groupings across Africa, but still 100 to 200 times more than pediatric perioperative mortality rate in high-resource settings. [9][10][11] Second, use of a Safe Surgery Checklist was associated with decreased mortality in the pediatric surgical population.…”

Section: Perioperative Medicinementioning

confidence: 99%

“…16 Studies from Africa directly linking ASA status to pediatric perioperative mortality are not available, but a meta-analysis has shown that mortality is higher in surgeries that would classify as ASA III cases, such as neonatal bowel perforation, congenital diaphragmatic hernia, ruptured omphalocele, and gastroschisis. 11 A study from Brazil, an upper middle-income country, has been able to link pediatric cardiac arrest in a large academic urban center with the following risk factors: age younger than 1 yr, ASA greater than III, and emergency surgery, with the most common causes of death related to the airway and medications. 17 To our knowledge, this study is the first to demonstrate a link between ASA status and pediatric perioperative mortality rate in the East Africa setting with prospectively collected data.…”

Section: Factors Influencing Pediatric Surgical Mortalitymentioning

confidence: 99%

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Pediatric Perioperative Mortality in Kenya

et al. 2020

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Background The global surgery access imbalance will have a dramatic impact on the growing population of the world’s children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery–specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care. To establish a baseline pediatric perioperative mortality rate and factors associated with mortality in Kenya, the authors designed a prospective cohort study and measured 24-h, 48-h, and 7-day perioperative mortality. Methods The authors trained anesthesia providers to electronically collect 132 data elements for pediatric surgical cases in 24 government and nongovernment facilities at primary, secondary, and tertiary hospitals from January 2014 to December 2016. Data assistants tracked all patients to 7 days postoperative, even if they had been discharged. Adjusted analyses were performed to compare mortality among different hospital levels after adjusting for prespecified risk factors. Results Of 6,005 cases analyzed, there were 46 (0.8%) 24-h, 62 (1.1%) 48-h, and 77 (1.7%) 7-day cumulative mortalities reported. In the adjusted analysis, factors associated with a statistically significant increase in 7-day mortality were American Society of Anesthesiologists Physical Status of III or more, night or weekend surgery, and not having the Safe Surgery Checklist performed. The 7-day perioperative mortality rate is less in the secondary (1.4%) and tertiary (2.4%) hospitals when compared with the primary (3.7%) hospitals. Conclusions The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low–middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Furthermore, certain regions of China have shown much higher preponderance of this condition than in other parts of the world [ 15 – 18 ]. In Africa, for example, spina bifida has been recorded as being low in occurrence in comparison to other birth defects but questions have arisen with regard to record-taking and data management [ 19 ]. Gender preponderance differs according to country; in the USA, spina bifida is thought to be more prevalent in girls than in boys [ 20 , 21 ].…”

Section: Epidemiologymentioning

confidence: 99%

Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans

et al. 2017

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Spina bifida is among the phenotypes of the larger condition known as neural tube defects (NTDs). It is the most common central nervous system malformation compatible with life and the second leading cause of birth defects after congenital heart defects. In this review paper, we define spina bifida and discuss the phenotypes seen in humans as described by both surgeons and embryologists in order to compare and ultimately contrast it to the leading animal model, the mouse. Our understanding of spina bifida is currently limited to the observations we make in mouse models, which reflect complete or targeted knockouts of genes, which perturb the whole gene(s) without taking into account the issue of haploinsufficiency, which is most prominent in the human spina bifida condition. We thus conclude that the need to study spina bifida in all its forms, both aperta and occulta, is more indicative of the spina bifida in surviving humans and that the measure of deterioration arising from caudal neural tube defects, more commonly known as spina bifida, must be determined by the level of the lesion both in mouse and in man.

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Neonatal surgery in Africa: a systematic review and meta-analysis of challenges of management and outcome

Cited by 28 publications

References 1 publication

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

Comparison in the incidence of anorectal malformations between a first- and third-world referral center

Pediatric Perioperative Mortality in Kenya

Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans

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