Quantifying delays and self-identified barriers to timely access to pediatric surgery at Mbarara Regional Referral Hospital, Uganda

Pilkington, Mercedes; Situma, Martin; Winthrop, Andrea; Poenaru, Dan

doi:10.1016/j.jpedsurg.2018.02.045

Cited by 29 publications

(28 citation statements)

References 15 publications

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“…19 24 effeCTs on surgICal praCTICe Paediatric surgical services in Africa are characterised by significant delays in health-seeking and within the referral chain. 25 The mobility restrictions imposed on patients by shelter-in-place measures, as well as reduced income during the pandemic, will presumably cause further delays in presentation that may adversely affect outcomes.…”

Section: Rationing Of Surgical Servicesmentioning

confidence: 99%

Mitigating the impact of COVID-19 on children's surgery in Africa

et al. 2020

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Section: Rationing Of Surgical Servicesmentioning

confidence: 99%

Mitigating the impact of COVID-19 on children's surgery in Africa

et al. 2020

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“…Delivery outside a hospital setting is significantly associated with delayed diagnosis of ARM (40). It is sometimes up to the mothers and more experienced family members to identify children with gross structural anomalies (47). This is of course fraught with challenges, as most mothers had never heard of ARM (48).…”

Section: Delay In Presentation and Treatmentmentioning

confidence: 99%

Overview of Anorectal Malformations in Africa

Lawal

2019

Front. Surg.

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Anorectal malformation is one of the most common structural congenital malformations treated by pediatric surgeons globally. The outcome of care is largely dependent on the spectrum, clinical features, associated malformations, expertise of the surgeons, and available perioperative facilities. Africa has a large burden of unmet surgical needs in children, and as in other low resource settings, local pediatric surgeons are faced with different and challenging clinical scenarios, hence, adopt various measures to enable children with surgically correctable congenital malformations to survive. There are increasing collaborations between local surgeons and experts in other continents, which often involves surgeons traveling to Africa on missions or well-structured partnerships. It is highly beneficial for the physician who is interested in global-surgery to understand the terrain in low resource settings and prepare for possible changes in management plan. This review highlights the epidemiology, clinical presentation, treatment, and outcome of care of children with anorectal malformations in Africa and provides options adopted by pediatric surgeons working with limited resources.

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“…Pediatric surgery in sub-Saharan Africa is disadvantaged by limited resources, high numbers of sick patients relative to the number of providers, and high frequency of delayed presentations with advanced pathologies [13]. Lack of finances and transportation are significant barriers to care, and cultural preference for traditional medicines and home remedies may significantly delay patient presentations [4,17].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Sub-Saharan Africa

Peiffer

Ssentongo

Keeney

et al. 2020

Preprint

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Background/Purpose Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients in eastern Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children <18 years at Eastern Regional Hospital (ERH) in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study and secondary analysis was performed. Results We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Major procedures, gastrointestinal surgery, surgical trauma, surgical infection and having insurance were significantly associated with prolonged LOS. Age and male gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant and actionable risk factor for readmission in the pediatric surgical population in sub-Saharan Africa. Preventing readmission in patients with malaria could reduce readmission rates by 74%, leading to potential cost-savings and reductions in morbidity.

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Quantifying delays and self-identified barriers to timely access to pediatric surgery at Mbarara Regional Referral Hospital, Uganda

Cited by 29 publications

References 15 publications

Mitigating the impact of COVID-19 on children's surgery in Africa

Mitigating the impact of COVID-19 on children's surgery in Africa

Overview of Anorectal Malformations in Africa

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Sub-Saharan Africa

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