ObjectivesTrauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma.MethodsThis is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs).ResultsThere were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%.ConclusionThe spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.

None of the male cloacal patients presented in the neonatal period, proximal hypospadias was the common external genital abnormality and half of them had a vagina. Surgical outcome was satisfactory. The scarcity of reported cases of this group is a subject of further research.

There is unequal access to surgical health care in underdeveloped countries such as Bangladesh. Bangladesh has a large young population, with 70 % of the population living in rural areas. All of the pediatric surgical services of the country are situated in major cities. We therefore organized an outreach service with the aim of providing surgical services to these rural children by utilizing the existing facilities of primary and secondary care centers. The program originated at the Department of Pediatric Surgery, Chittagong Medical College and Hospital in Sept 2008. The data presented here are from its 2008 beginning to Nov 2011. A yearly plan is sent to the Divisional Director of Health Services for Chittagong Division, who notifies all of the concerned district hospitals (DHs) and Upazila Health Complexes (UHCs). A member of the outreach team contacts each center via telephone 1 month prior to the visit to help organize it. Doctors at each participating hospital in which day surgery is possible are informed as to which commonly performed day surgeries are available, and they then select the appropriate patients to be examined at that visit. The local doctors are also advised to choose other pediatric surgical patients as outpatients. The local doctors perform the follow-up. If necessary, patients are referred to our department for further management. During the study period, we made 32 visits to 5 DHs and 10 UHCs. In all, 674 children were seen as outpatients, and 407 underwent surgery, of which inguinal hernia repair was the most common. There were no deaths. Outreach service is a good way to extend curative care to the grass-roots population.

No abstract

Introduction: Birth defects are one of the most common causes of disability in developed and developing countries. Birth defects are structural or functional anomalies, including metabolic disorders, which are present at the time of birth. Although the worldwide incidence of birth defects is estimated at 3-7%, the rate varies widely between countries. In this paper, we categorized the birth defects most commonly seen in Bangladesh and their outcome. We hope to use this information to guide the strategies used to manage these problems. Materials and Methods: This hospital based, descriptive study was done in the Department of Pediatric Surgery in Chittagong Medical College and Hospital from January 2008 to December 2012. Records of all patients with birth defects in our hospital and departmental database were reviewed. Types of birth defects, age, sex, surgery performed and outcome were analyzed in patients admitted during this period. Data were analyzed by SPSS 17. Statistical analysis was performed by the chi-square test and mean and percentage values were calculated. P<0.05 was considered to be statistically significant. Results: During this five year period, there were 5661 patients of birth defects admitted in this department. Of these, 5156 had a single congenital anomaly and 505 had multiple congenital anomalies. The male to female ratio was 2.1: 1. Birth defects comprised 44.61% of all Pediatric surgical admissions and 0.90% of total hospital admissions. The gastrointestinal system was the most common organ system involved, followed by the genitourinary system. Inguinal hernias were the most common gastrointestinal abnormality and hypospadias were the most common genitourinary case. A total of 3921 operations were performed for birth defects, representing 69.26% of total admission for birth defects. Most operations were done for gastrointestinal and genito-urinary defects. Inguinal herniotomy was the most commonly performed operation followed by laparotomy for various indications. There were 225 deaths for birth defects. While this is only 3.97% of all admissions for birth defects, this represents 51.49% of all (pediatric) deaths during the study period. The most common cause of death was anorectal malformations followed by gastroschisis. Conclusion: The study helps assess the burden of birth defects in the Bangladeshi society. There is a need for more extensive, nationwide screening studies to determine the birth prevalence, types and distribution of birth defects in Bangladesh.

Our study provides some insight into the OOP expenditure in different health care settings in Bangladesh. This study might be useful in developing a strategy to minimize the OOP expenditure in this country.

No abstract

Background Lump or mass formation due to delayed presentation after appendicitis is common, and it is frequently complicated by perforation, gangrene, pus, or abscess formation. Care of patients and management vary between developed world and developing country. The aim of the study is to analyze outcome of early surgery for appendicular mass from a developing country perspective. 220 patients of appendicular mass who underwent early appendectomy over a period of 5 years in the Department of Pediatric Surgery, at author’s institute were retrospectively reviewed. Early appendectomy was defined as appendectomy done within 24 h of admission. Presentation, examination findings, investigations, type of surgery, operative findings, post-operative complications, and hospital stay were analyzed. Results Age of patients ranged from 2 to 12 years (mean 9.04 ± 2.54 years) and male to female ratio was 2:1. Abdominal pain was the most common presentation followed by vomiting and fever. Mean pain duration was 4.35 ± 4.23 days. There was raised temperature in 140 (63.64%) patients, 154 (74.04%) had tachycardia, and 75.86% had raised WBC count. Laparoscopic appendectomy was done in 31 (14.09%) patients, and the rest 189 (85.91%) patients underwent open surgery. Perforated appendix was the most common (171 patients, 77.73%) peri-operative finding followed by formation of pus (135 patients, 61%). Pus was found more in patients less than 5 years old (18 patients out of 23) than patients more than 5 years old (114 patients out of 197) (P = 0.045). Younger patients also had significantly more complications (39.13% vs 17.26%, P = .000) and hospital stays (mean 15.61 days vs 9.87 days, P = 0.014) than older boys. Complications developed in 42 (19.09%) patients, and wound dehiscence (26 patients, 11.82%) was the most common complication. Conclusion Early appendectomy for appendicular mass is a feasible option in the developing world, and laparoscopic appendectomy has good prospect.