Talia Pindyck1,2, Umesh Parashar2, Jason M Mwenda3, Amezene Tadesse4, George Armah5, Richard Omore6, Bagrey Ngwira7, Bhavin Jani8, Evans M Mpabalwani9, Bothwell Mbuwayesango10, Jacqueline Tate2. 1. Epidemic Intelligence Services (EIS). 2. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 3. WHO Regional Office for Africa, WHO/AFRO, Republic of Congo, Brazzaville. 4. Department of Surgery, School of Medicine, Addis Ababa University. 5. Noguchi Memorial Institute for Medical research, College of Health Sciences, University of Ghana. 6. Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya. 7. College of Medicine, University of Malawi. 8. WHO Country Office for Tanzania. 9. Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia. 10. Department of Pediatrics and Child Health, University of Zimbabwe, College of Health Sciences, Brazzaville, Republic of Congo, Harare, Zimbabwe.
Abstract
OBJECTIVES: Morbidity and mortality from intussusception, the leading cause of bowel obstruction in infants, is higher in Africa than in other regions of the world, but the reasons have not been well examined. We sought to identify risk and protective factors associated with death or intestinal resection following intussusception. METHODS: Infants with intussusception from 7 sub-Saharan African countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe) were enrolled through active, hospital-based surveillance from February 2012 to December 2016. We examined demographic, clinical, and socioeconomic factors associated with death or intestinal resection following intussusception, using multivariable logistic regression. RESULTS: A total of 1017 infants <1 year of age with intussusception were enrolled. Overall, 13% of children (133/1017) died during the hospitalization, and 48% (467/966) required intestinal resection. In multivariable analyses, female sex [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2-3.3], longer duration of symptoms before presentation (OR 1.1; 95% CI 1.0-1.2), and undergoing intestinal resection (OR 3.4; 95% CI 1.9-6.1) were associated with death after intussusception. Diagnosis by ultrasound or enema (OR 0.4; 95% CI 0.3-0.7), and employment of a household member (OR 0.7; 95% CI 0.4-1.0) were protective against intestinal resection. CONCLUSIONS: Delays in hospital presentation and female sex were significantly associated with death, whereas higher socioeconomic status and availability of radiologic diagnosis reduced likelihood of undergoing resection. Efforts should be intensified to improve the awareness, diagnosis, and management of intussusception in sub-Saharan African countries to reduce morbidity and mortality from intussusception in these resource-limited settings.
OBJECTIVES: Morbidity and mortality from intussusception, the leading cause of bowel obstruction in infants, is higher in Africa than in other regions of the world, but the reasons have not been well examined. We sought to identify risk and protective factors associated with death or intestinal resection following intussusception. METHODS: Infants with intussusception from 7 sub-Saharan African countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe) were enrolled through active, hospital-based surveillance from February 2012 to December 2016. We examined demographic, clinical, and socioeconomic factors associated with death or intestinal resection following intussusception, using multivariable logistic regression. RESULTS: A total of 1017 infants <1 year of age with intussusception were enrolled. Overall, 13% of children (133/1017) died during the hospitalization, and 48% (467/966) required intestinal resection. In multivariable analyses, female sex [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2-3.3], longer duration of symptoms before presentation (OR 1.1; 95% CI 1.0-1.2), and undergoing intestinal resection (OR 3.4; 95% CI 1.9-6.1) were associated with death after intussusception. Diagnosis by ultrasound or enema (OR 0.4; 95% CI 0.3-0.7), and employment of a household member (OR 0.7; 95% CI 0.4-1.0) were protective against intestinal resection. CONCLUSIONS: Delays in hospital presentation and female sex were significantly associated with death, whereas higher socioeconomic status and availability of radiologic diagnosis reduced likelihood of undergoing resection. Efforts should be intensified to improve the awareness, diagnosis, and management of intussusception in sub-Saharan African countries to reduce morbidity and mortality from intussusception in these resource-limited settings.
Authors: N T van Heek; D C Aronson; E M Halimun; R Soewarno; J C Molenaar; A Vos Journal: J Pediatr Gastroenterol Nutr Date: 1999-10 Impact factor: 2.839
Authors: Marc Schiesser; Philipp Kirchhoff; Markus K Müller; Markus Schäfer; Pierre-Alain Clavien Journal: Surgery Date: 2009-03-27 Impact factor: 3.982
Authors: Evans M Mpabalwani; Pearson Chitambala; Julia N Chibumbya; Belem Matapo; Helen Mutambo; Jason M Mwenda; Olusegun Babaniyi; Lupando Munkonge Journal: Pediatr Infect Dis J Date: 2014-01 Impact factor: 2.129