Raghav Badrinath1, Nasser Kakembo2, Phyllis Kisa2, Monica Langer3, Doruk Ozgediz4, John Sekabira2. 1. Yale University School of Medicine, New Haven, CT, USA. 2. Makerere University, Kampala, Uganda. 3. Maine Medical Center, Portland, ME, USA. 4. Yale University School of Medicine, New Haven, CT, USA. Electronic address: doruk.ozgediz@yale.edu.
Abstract
PURPOSE: Reported outcomes of neonatal surgery in low-income countries (LICs) are poor. We examined epidemiology, outcomes, and met and unmet need of neonatal surgical diseases in Uganda. METHODS: Pediatric general surgical admissions and consults from January 1, 2012, to December 31, 2012, at a national referral center in Uganda were analyzed using a prospective database. Outcomes were compared with high-income countries (HICs), and met and unmet need was estimated using burden of disease metrics (disability-adjusted life years or DALYs). RESULTS: 23% (167/724) of patients were neonates, and 68% of these survived. Median age of presentation was 5days, and 53% underwent surgery. 88% survived postoperatively, while 55% died without surgery (p<0.001). Gastroschisis carried the highest mortality (100%) and the greatest mortality disparity with HICs. An estimated 5072 DALYs were averted by neonatal surgery in Uganda (met need), with 140,154 potentially avertable (unmet need). Approximately 3.5% of the need for neonatal surgery is met by the health system. CONCLUSIONS: More than two thirds of surgical neonates survived despite late presentation and lack of critical care. Epidemiology and outcomes differ greatly with HICs. A high burden of hidden mortality exists, and only a negligible fraction of the population need for neonatal surgery is met by health services.
PURPOSE: Reported outcomes of neonatal surgery in low-income countries (LICs) are poor. We examined epidemiology, outcomes, and met and unmet need of neonatal surgical diseases in Uganda. METHODS: Pediatric general surgical admissions and consults from January 1, 2012, to December 31, 2012, at a national referral center in Uganda were analyzed using a prospective database. Outcomes were compared with high-income countries (HICs), and met and unmet need was estimated using burden of disease metrics (disability-adjusted life years or DALYs). RESULTS: 23% (167/724) of patients were neonates, and 68% of these survived. Median age of presentation was 5days, and 53% underwent surgery. 88% survived postoperatively, while 55% died without surgery (p<0.001). Gastroschisis carried the highest mortality (100%) and the greatest mortality disparity with HICs. An estimated 5072 DALYs were averted by neonatal surgery in Uganda (met need), with 140,154 potentially avertable (unmet need). Approximately 3.5% of the need for neonatal surgery is met by the health system. CONCLUSIONS: More than two thirds of surgical neonates survived despite late presentation and lack of critical care. Epidemiology and outcomes differ greatly with HICs. A high burden of hidden mortality exists, and only a negligible fraction of the population need for neonatal surgery is met by health services.
Authors: Ava Yap; Arlene Muzira; Maija Cheung; James Healy; Nasser Kakembo; Phyllis Kisa; David Cunningham; George Youngson; John Sekabira; Reza Yaesoubi; Doruk Ozgediz Journal: Surgery Date: 2018-05-23 Impact factor: 3.982
Authors: Emily R Smith; Tessa Concepcion; Stephanie Lim; Sam Sadler; Dan Poenaru; Anthony T Saxton; Mark Shrime; Emmanuel Ameh; Henry E Rice Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Sarah B Cairo; Justice Agyei; Kavira Nyavandu; David H Rothstein; Luc Malemo Kalisya Journal: Pediatr Surg Int Date: 2018-02-16 Impact factor: 1.827