Epidemiology, management and outcome of gastroschisis in Sub-Saharan Africa: Results of an international survey

Abstract

Background:The aim was to compare gastroschisis (GS) epidemiology, management and outcome in low-income countries (LIC) in Sub-Saharan Africa (SSA) with middle- (MIC) and high-income countries (HIC).Materials and Methods:A 10-question survey was administered at the 2012 Pan-African Paediatric Surgery Association Congress. Results are presented as median (range); differences were analysed using contingency tests.Results:A total of 82 delegates (28 countries [66 institutions]) were divided into LIC (n = 11), MIC (n = 6) and HIC (n = 11). In LIC, there were fewer surgeons and more patients. LIC reported 22 cases (1-184) GS/institution/year, compared to 12 cases (3-23)/institution/year in MICs and 15 cases (1-100)/institution/year in HICs. Antenatal screening was less readily available in LIC. Access to parenteral nutrition and neonatal intensive care in LIC was 36% and 19%, compared to 100% in HIC. Primary closure rates were similar in LIC and HIC at 58% and 54%, respectively; however, the majority of staged closure utilised custom silos in LIC and preformed silos in HIC. In LIC, mortality was reported as >75% by 61% delegates and 50-75% by 33%, compared to <25% by 100% of HIC delegates (P < 0.0001).Conclusions:Gastroschisis is a problem encountered by surgeons in SSA. Mortality is high and resources in many centres inadequate. We propose the implementation of a combined epidemiological research, service delivery training and resource provision programme to help improve our understanding of GS in SSA whilst attempting to improve outcome.

Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria

“…Hasan et al used sterile saline bags or urobags for silo reconstruction and observed that almost all the patients (39/40) developed sepsis and had poor outcomes (21). An international survey identified likely reasons for the limited use of preformed silos in low and middle-income countries to include the lack of availability, expertise, and expense (13).…”

“…Occasionally, we have had cause to improvise by sharing the bottle contents into different burettes for administration to babies who may benefit from it. An international survey reported that only 19% of tertiary pediatric surgery centers in low-income countries had access to parenteral nutrition (13). Wright and colleagues rightfully noted that the challenges to the provision of parenteral nutrition in resource-limited settings include lack of infrastructure and availability of neonate-specific parenteral nutrition bags, difficulty in achieving central venous access and shorter bench life of neonatal parenteral nutrition where available (22).…”

“…Similar to many reports from Africa (6)(7)(8)(9)(10)(11)(12), the mortality recorded in this study was high. This may be connected to the delayed transfer to a tertiary healthcare facility, non-availability of parenteral nutrition and neonatal intensive care; factors that have been attributed to the improved survival rates in patients with gastroschisis in the developed world (7,13,25). Most of the deaths were due to clinically diagnosed sepsis, though this was not proven by positive culture results in most cases.…”

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series

“…In a study conducted from a population-based of gastroschisis cases in California, only 4.6% died 10 . In low-and middle-income countries, NB have lower survival rate 11,[16][17][18] A study conducted in Jamaica showed a frequency of death from gastroschisis of 79%, sepsis being the main cause (82% of cases) 16 . In a study conducted in Uganda, death frequency was 98% of cases 17 .…”

Cost-effectiveness of neonatal surgery for congenital anomalies in low-income and middle-income countries: a systematic review protocol

“…For example, gastroschisis mortality has been reported as 75%-100% in many paediatric surgical centres across Sub-Saharan Africa compared with less than 4% in HICs. [6][7][8] Disturbingly, published high mortality rates from congenital anomalies may even be an underestimate of the true burden of disease due to sizeable hidden mortality. Children who do not reach health facilities and die at home or in transit are traditionally not accounted for.…”