Disparity in Access and Outcomes for Emergency Neonatal Surgery: Intestinal Atresia in Kampala, Uganda

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2017 Jul 6

PMID 28677072

Citations 6

Authors

Sarah Cairo

Nasser Kakembo

Phyllis Kisa

Arlene Muzira

Maija Cheung

James Healy

Doruk Ozgediz

John Sekabira

Affiliations

Soon will be listed here.

Abstract

Background/aim: Intestinal atresia is one of the leading causes of neonatal intestinal obstruction (NIO). The purpose of this study was to analyze the presentation and outcome of IA and compare with those from both similar and high-income country settings.

Patients And Methods: A retrospective review of prospectively collected data from patient charts and pediatric surgical database for 2012-2015 was performed. Epidemiological data and patient characteristics were analyzed and outcomes were compared with those reported in other LMICs and high-income countries (HICs). Unmet need was calculated along with economic valuation or economic burden of surgical disease.

Results: Of 98 patients, 42.9% were male. 35 patients had duodenal atresia (DA), 60 had jejunio-ileal atresia (JIA), and 3 had colonic atresia. The mean age at presentation was 7.14 days for DA and 6.7 days for JIA. Average weight for DA and JIA was 2.2 and 2.12 kg, respectively. All patients with DA and colonic atresia underwent surgery, and 88.3% of patients with JIA had surgery. Overall mortality was 43% with the majority of deaths attributable to aspiration, anastomotic leak, and sepsis. 3304 DALYs were calculated as met compared to 25,577 DALYs' unmet.

Conclusion: Patients with IA in Uganda present late in the clinical course with high morbidity and mortality attributable to a combination of late presentation, poor nutrition status, surgical complications, and likely underreporting of associated anomalies rather than surgical morbidity alone.

Level Of Evidence: Level IV, Case series with no comparison group.

Citing Articles

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Etiology and Outcome of Intestinal Obstruction in Neonates: A 5-Year Investigation of Admitted Cases From a Tertiary Neonatal Intensive Care Unit in Northern Iran.

Farrokhkhani P, Farhadi R, Ala S, Mousavi S Clin Med Insights Pediatr. 2023; 17:11795565231196771.

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Otim P, Elobu E, Mbiine R, Kakembo N, Komakech D World J Pediatr Surg. 2022; 5(4):e000377.

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Artificial Intelligence Algorithm-Based Computed Tomography Images in the Evaluation of the Curative Effect of Enteral Nutrition after Neonatal High Intestinal Obstruction Operation.

Dong Y, Wang Z, Zhang Z, Niu B, Chen P, Zhang P J Healthc Eng. 2021; 2021:7096286.

PMID: 34824765 PMC: 8610672. DOI: 10.1155/2021/7096286.

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