Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study

Abstract

IntroductionAs childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant.Results1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.

Pediatric Surgical Waitlist in LMICs during the COVID-19 Pandemic

“…A recent prospective cohort study spanning 19 Sub-Saharan African (SSA) countries demonstrated that mortality from pediatric surgical disease is signi cantly higher in SSA than HIC: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. [19] Our ndings suggest that delay in surgical treatment is likely a contributing factor and that COVID-19 exacerbated these delays.…”

Accuracy of ultrasonography for diagnosis of pediatric acute appendicitis: The experience of a Senegalese tertiary hospital

“…The appendix location is a crucial information which guide the ~ 8 ~ surgical incision as almost all appendectomies are done in with the open fashion in our environment [3] .…”

“…Acute appendicitis (AA) is the most common digestive emergency in pediatric surgery [1,2] . In LMICs, it is still a challenging disease which still has a higher morbidity and mortality [3] . Acute appendicitis usually depicts a classical clinical presentation.…”

Challenges with pediatric anesthesia and intraoperative ventilation of the child in the resource‐constrained setting

“…[22][23][24] There are multiple reasons for these poor outcomes including inadequate training in pediatric anesthesia, lack of pediatric specific standardized care pathways and inadequate pediatric specific equipment and physiologic monitoring capabilities. 23,25,26 Broad prospective perioperative data collection is needed to better understand the problems including the burden of pediatric surgical complications. Risk factors and types of complications need to be identified to enable the development of appro-…”