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Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

  • Maija CheungEmail author
  • Nasser Kakembo
  • Nensi Rizgar
  • David Grabski
  • Sarah Ullrich
  • Arlene Muzira
  • Phyllis Kisa
  • John Sekabira
  • Doruk Ozgediz
Original Article
  • 57 Downloads

Abstract

Introduction/purpose

The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited.

Methods

Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016.

Results

2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung’s, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%).

Conclusion

There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.

Keywords

Global surgery Burden of disease Pediatric surgery Surgical outcomes Uganda 

Notes

Acknowledgements

Griffin Coghill for his work on the data audit examining cases between February 2016 and August 2016.

Funding

There was no external funding for this study.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest for any of the authors.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No informed consent was necessary for this study.

References

  1. 1.
    Farmer DL, Bickler SW (2016) Global pediatric surgery preface. Semin Pediatr Surg 25:1–2CrossRefGoogle Scholar
  2. 2.
    UNICEF and WHO (2017) Levels and trends in child mortality: report 2017. https://www.unicef.org/publications/index_101071.html
  3. 3.
    Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE (2016) Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet (Lond, Engl) 388:3027–3035CrossRefGoogle Scholar
  4. 4.
    Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO global health estimate. Lancet Glob Health 3:S13–S20CrossRefGoogle Scholar
  5. 5.
    Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3:S8–S9CrossRefGoogle Scholar
  6. 6.
    Mullapudi B, Grabski DF, Ameh E, Ozgediz DE, Thangaragah H, Alkire B, Meara J, Bickler SW (2019) An estimate of the number of children and adolescents worldwide without access to surgical and anesthesia care. Bull World Health Org 97:254–258CrossRefGoogle Scholar
  7. 7.
    Global Burden of Disease Pediatrics Collaboration (2016) Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the Global Burden of Disease 2013 Study. JAMA Pediatr 170:267–287CrossRefGoogle Scholar
  8. 8.
    Central Intelligence Agency (2019) The world factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html. Accessed 21 June 2019
  9. 9.
    Linden AF, Sekidde FS, Galukande M, Knowlton LM, Chackungal S, McQueen KAK (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065CrossRefGoogle Scholar
  10. 10.
    Krishnaswami S, Nwomeh BC, Ameh EA (2016) The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 25(1):32–42CrossRefGoogle Scholar
  11. 11.
    Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J et al (2016) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78CrossRefGoogle Scholar
  12. 12.
    Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT (2015) Chapter 1: Essential surgery: key messages of this volume. In: Debas H et al (eds) Essential surgery: disease control priorities, vol 1. 3rd edn. The International Bank for Reconstruction and Development/The World Bank, Washington, DCGoogle Scholar
  13. 13.
    Global Initiative for Children’s Surgery (2019) Optimal resources for children’s surgical care: executive summary. World J Surg 43(4):978–980CrossRefGoogle Scholar
  14. 14.
    Collaborative GlobalSurg (2016) Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Health 1:e000091CrossRefGoogle Scholar
  15. 15.
    Liu C, Kayima P, Riesel J, Situma M, Chang D, Firth P (2017) Brief surgical procedure code lists for outcomes measurement and quality improvement in resource-limited settings. Surgery (US) 162:1163–1176CrossRefGoogle Scholar
  16. 16.
    Akbilgic O, Langham MR, Walter AI, Jones TL, Huang EY, Davis RL (2018) A novel risk classification system for 30-day mortality in children undergoing surgery. PLoS One 13:e0191176CrossRefGoogle Scholar
  17. 17.
    Bickler S, Ozgediz D, Gosselin R, Weiser T, Spiegel D, Hsia R, Dunbar P, McQueen K, Jamison D (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34(3):374–380CrossRefGoogle Scholar
  18. 18.
    Kendig CE, Samuel JC, Varela C, Msiska N, Kiser MM, McLean SE, Cairns BA, Charles AG (2014) Pediatric surgical care in Lilongwe, Malawi: outcomes and opportunities for improvement. J Trop Pediatr 60:352–357CrossRefGoogle Scholar
  19. 19.
    Anderson GA, Ilcisin L, Ngonzi J, Ttendo S, Twesigye D, Benitez NP, Firth P, Nehra D (2018) Validation of an electronic surgical outcomes database at Mbarara regional referral hospital, Uganda. World J Surg 42:54–60CrossRefGoogle Scholar
  20. 20.
    Ahmed NU, Alam MM, Sultana F, Sayeed SN, Pressman AM, Powers MB (2006) Reaching the unreachable: barriers of the poorest to accessing NGO healthcare services in Bangladesh. J Health Popul Nutr 24:456–466Google Scholar
  21. 21.
    Ozgediz D, Jamison D, Cherian M, McQueen K (2011) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bulletin World Health Organ 86(8):646–647Google Scholar
  22. 22.
    Walker IA, Obua AD, Mouton F, Ttendo S, Wilson IH (2010) Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bulletin World Health Organ 88(12):897–906CrossRefGoogle Scholar
  23. 23.
    Ogundoyin OO, Olulana DI, Lawal TA (2016) Childhood intussusception: impact of delay in presentation in a developing country. Afr J Paediatr Surg 13:166–169CrossRefGoogle Scholar
  24. 24.
    Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH (2015) Patterns of congenital malformations and barriers to care in Eastern Democratic Republic of Congo. PLoS One 10:e0132362CrossRefGoogle Scholar
  25. 25.
    Albutt K, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG (2018) Access to safe, timely, and affordable surgical care in Uganda: a stratified randomized evaluation of nationwide public sector surgical capacity and core surgical indicators. World J Surg 42(8):2303–2313CrossRefGoogle Scholar
  26. 26.
    Badrinath R, Kakembo N, Kisa P, Langer M, Ozgediz D, Sekabira J (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala. Uganda J Pediatr Surg 49:1825–1830CrossRefGoogle Scholar
  27. 27.
    Butler EK, Tran TM, Fuller AT, Brammell A, Vissoci JR, de Andrade L, Makumbi F, Luboga S, Muhumuza C, Ssennono VF et al (2016) Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatr Surg Int 32(11):1075–1085CrossRefGoogle Scholar
  28. 28.
    Bickler SW, Sanno-Duanda B (2000) Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Org 78:1330–1336Google Scholar
  29. 29.
    Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A (2019) Global burden of postoperative death. Lancet 393:401CrossRefGoogle Scholar
  30. 30.
    Livingston MH, DCruz J, Pemberton J, Ozgediz D, Poenaru D (2015) Mortality of pediatric surgical conditions in low and middle income countries in Africa. J Pediatr Surg 50:760–764CrossRefGoogle Scholar
  31. 31.
    Sekabira J (2015) Paediatric surgery in Uganda. J Pediatr Surg 50:236–239CrossRefGoogle Scholar
  32. 32.
    Kiser MM, Samuel JC, Mclean SE, Muyco AP, Cairns BA, Charles AG (2012) Epidemiology of pediatric injury in Malawi: burden of disease and implications for prevention. Int J Surg 10:611–617CrossRefGoogle Scholar
  33. 33.
    Hsia RY, Ozgediz D, Mutto M, Jayaraman S, Kyamanywa P, Kobusingye OC (2010) Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy. Int J Emerg Med 3:165–172CrossRefGoogle Scholar
  34. 34.
    Butler EK, Tran TM, Fuller AT, Brammell A, Vissoci JR, de Andrade L, Makumbi F, Luboga S, Muhumuza C, Ssennono VF et al (2016) Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatr Surg Int 32:1075–1085CrossRefGoogle Scholar
  35. 35.
    Kurigamba G, Cheung M, Akello V, Nanyanga I, Kyilyewala C, Elobu A, Semakula D, Awale M, Ozgediz D, Mabweijano J (2019) Missed injuries in trauma in Uganda: the extent, factors and short-term outcomes. Oral Presentation: International Surgical Congress of the Association of Surgeons of Great Britain and Ireland, May 9, 2019Google Scholar
  36. 36.
    Ruzgar N, Cheung M, Ullrich S, Kisa P, Ozgediz D (2019) Needs Assessment of Rural Providers for the Development of a Pediatric Emergency Surgical Care Course in Uganda. Poster: Bethune Round Table, Alberta, Canada, June 2019Google Scholar
  37. 37.
    Kisa P, Grabski DF, Ozgediz D, Ajiko M, Aspide R, Baird R, Barker G, Birabwa-Male D, Blair G, Cameron B et al (2019) Unifying children’s surgery and anesthesia stakeholders across institutions and clinical disciplines: challenges and solutions from Uganda. World J Surg 43(6):1435–1449CrossRefGoogle Scholar
  38. 38.
    Anderson GA, Bohnen J, Spence R, Ilcisin L, Ladha K, Chang D (2018) Data improvement through simplification: implications for low-resource settings. World J Surg 42:2725–2731CrossRefGoogle Scholar
  39. 39.
    Spence RT, Chang DC, Chu K, Panieri E, Mueller JL, Hutter MM (2017) An online tool for global benchmarking of risk-adjusted surgical outcomes. World J Surg 41:24–30CrossRefGoogle Scholar
  40. 40.
    Anderson JE, Rose J, Noorbakhsh A, Talamini MA, Finlayson SRG, Bickler SW, Chang DC (2014) An efficient risk adjustment model to predict inpatient adverse events after surgery. World J Surg 38:1954–1960CrossRefGoogle Scholar
  41. 41.
    Anderson JE, Lassiter R, Bickler SW, Talamini MA, Chang DC (2012) Brief tool to measure risk-adjusted surgical outcomes in resource-limited hospitals. Arch Surg 147:798–803CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryYale University School of MedicineNew HavenUSA
  2. 2.Yale University School of MedicineNew HavenUSA
  3. 3.Department of SurgeryUniversity of Virginia School of MedicineCharlottesvilleUSA
  4. 4.Department of SurgeryMakerere University, Mulago HospitalKampalaUganda

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