Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study

Ullrich, Sarah; Kakembo, Nasser; Grabski, David F.; Cheung, Maija; Kisa, Phyllis; Nabukenya, Mary; Tumukunde, Janat; Fitzgerald, Tamara N.; Langer, Monica; Situma, Martin; Sekabira, John; Ozgediz, Doruk

doi:10.1016/j.jss.2019.08.015

Cited by 20 publications

(18 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 14 22 In the same context, Ullrich et al also noted a postoperative mortality rate of 37% and 38% among cases of ARM and JIA, respectively. 16 However, in our series, we noticed higher mortality among cases of JIA and NEC. These were the same categories who developed fever and anastomotic leak after surgery, in addition to some of them being premature.…”

Section: Discussioncontrasting

confidence: 54%

“…10 14 Each year, about 2.5 million children die within the first month of life worldwide, and in Uganda, neonatal mortality has remained as high as 34 per 1000 live births during the past decade, with very little attention given to surgical causes. [15][16][17] Ullrich et al reported neonatal mortality of 36% among neonates with surgical conditions in Uganda, predominantly among cases of ARM (37%) and JIA (38%). 16 A report by Cairo et al indicated a mortality rate of 43% among neonates with intestinal atresia.…”

Section: Open Accessmentioning

confidence: 99%

“…[15][16][17] Ullrich et al reported neonatal mortality of 36% among neonates with surgical conditions in Uganda, predominantly among cases of ARM (37%) and JIA (38%). 16 A report by Cairo et al indicated a mortality rate of 43% among neonates with intestinal atresia. 18 These figures are quite high compared to the findings in Europe, where a mortality is less than 15% among neonates with obstruction.…”

Section: Open Accessmentioning

confidence: 99%

See 2 more Smart Citations

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Otim

Elobu

Mbiine

et al. 2022

World Jnl Ped Surgery

Self Cite

View full text Add to dashboard Cite

BackgroundBowel obstruction is a common surgical emergency in newborns. One-fourth of neonates with obstruction suffer postoperative complications, with high mortality, especially in low-income countries. Factors attributed to mortality include prematurity, late presentation and associated multiple congenital anomalies. The prevalence and the predictors of mortality in our setting have not been well studied. We aimed to describe the early postoperative outcomes and to determine the predictors of mortality among neonates with bowel obstruction.MethodsWe conducted a prospective cohort study during 4 months, when we recruited postoperative neonates from the pediatric surgery unit of Mulago Hospital. We collected data on demographics, clinical presentations, maternal characteristics, the surgical procedure performed, postoperative outcomes, etc. After follow-up for 2 weeks, we analyzed the data using Cox proportional hazards regression models of predictors of mortality.ResultsA total of 76 neonates were recruited, with a male-to-female ratio of 2.2:1. The age ranged from 1 to 26 days, a median of 3 [interquartile range (IQR): 2, 7]. About 67.1% had birth weights ranging between 2.5 kg and 3.5 kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3% were termed; with anorectal malformation (ARM), 31.6% as the leading cause, followed by jejunoileal atresia (JIA), 25%. Nearly 55.3% of neonates developed complications; 53.9% with post-operative fever, 15.8% had wound sepsis. The mortality rate was 44.7% (34/76) and was highest among cases of JIA, 41.2%. The predictors of mortality included prematurity, fever at admission, breastfeeding status, and mother’s parity as well as the cadre of healthcare providers (p<0.005).ConclusionsARM is the predominant cause of bowel obstruction among neonates, followed by JIA. The morbidity and mortality due to bowel obstruction among neonates are unacceptably high. The major predictors of mortality were prematurity, fever at admission, and the cadre of the healthcare providers.

show abstract

Section: Discussioncontrasting

confidence: 54%

Section: Open Accessmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

See 1 more Smart Citation

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Otim

Elobu

Mbiine

et al. 2022

World Jnl Ped Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…This distribution was based on previous research on geographical distribution of paediatric surgical patients presenting to the NRH. 17 The 2014 national population census for Uganda was used to calculate the rate of surgical procedures for children per 100 000 paediatric population for 2014. The paediatric population of Uganda for 2013 was calculated based on the 2014 national census and a population growth of 3.3% per year.…”

Section: Discussionmentioning

confidence: 99%

Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda

et al. 2021

View full text Add to dashboard Cite

ObjectiveThis study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed and the patients and the human resource involved.DesignThe study was a facility-based, record review.SettingThe study was carried out at the National Referral Hospital, all 14 regional referral hospitals and 14 general hospitals in Uganda, representing the highest levels of hospital in the public healthcare sector.ParticipantsThe subjects were children <18 years who underwent major surgery in the study hospitals during 2013 and 2014.ResultsThe study hospitals contribute with an average annual rate of paediatric surgery at 22.0 per 100 000 paediatric population. This is a fraction of the estimated need. Most of the procedures were performed for congenital anomalies (n=3111, 39.4%), inflammation and infection (n=2264, 28.7%) and trauma (n=1210, 15.3%). Specialist surgeons performed 60.3% (n=4758) of the procedures, and anaesthesia was administered by specialist physician anaesthetists in 11.6% (n=917) of the cases.ConclusionsA variety of paediatric surgical procedures are performed in a relatively decentralised system throughout Uganda. Task shifting and task sharing of surgery and anaesthesia are widespread: a large proportion of surgical procedures was carried out by non-specialist physicians, with anaesthesia mostly delivered by non-physician anaesthetists. Reinforcing the capacity and promoting the expansion of the health facilities studied, in particular the general hospitals and regional referral hospitals, could help reduce the immense unmet need for surgical services for children in Uganda.

show abstract

“…In comparison to overall emergency surgical admissions, Didier et al discovered a 4.17% risk of PASE in children under the age of five [ 28 ]. Other African authors discovered a rate of 10.32% in children under the age of five [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

Factors Affecting Survival in Nontraumatic Pediatric Abdominal Surgical Emergencies: A Contemporary Review

Tayade¹,

Lamture²,

Yeola³

2022

Cureus

View full text Add to dashboard Cite

Surgically curable illnesses in the pediatric population are a major public health issue with a high prevalence of 10%-33% of all pediatric admissions, and emergency situations account for 50%-78% of surgical cases. Emergency abdominal surgery in children necessitates proper and prompt surgical and perioperative supportive care. When compared to elective operations, emergency surgery has a greater rate of morbidity and fatality. Staffing concerns, access to operating theaters, and access to diagnostic investigations are all possible causes of this high fatality rate, in addition to patient-related factors. Literature from high-income countries (HICs) discusses the problem, and recommendations are available for high-quality setups with good infrastructure. However, surgical care facilities from resource-poor countries have altogether different challenges and bottlenecks when dealing with children requiring emergency surgical operative procedures to save lives. This review aims to discuss factors affecting the survival of children being operated on for abdominal emergencies in resource-poor setups and suggest recommendations.

show abstract

Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study

Cited by 20 publications

References 43 publications

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda

Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda

Factors Affecting Survival in Nontraumatic Pediatric Abdominal Surgical Emergencies: A Contemporary Review

Contact Info

Product

Resources

About