BMJ Global Health (Sep 2021)

Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study

  • ,
  • Niyi Ade-Ajayi,
  • Dan Poenaru,
  • Damian Clarke,
  • Stephen Tabiri,
  • Larry Akoko,
  • Sharon Cox,
  • Toru Shimizu,
  • Bassey Edem,
  • Kokila Lakhoo,
  • Zaitun M Bokhary,
  • Adesoji Ademuyiwa,
  • Felix Alakaloko,
  • Emmanuel Ameh,
  • Theophilus Teddy Kojo Anyomih,
  • Rouma Bankole,
  • Eric Borgstein,
  • Bruce Bvulani,
  • Milind Chitnis,
  • Miliard Derbew,
  • Stella Eguma,
  • Omolara Faboya,
  • Jacques Fadhili Bake,
  • Intisar Hisham,
  • Nasser Kakembo,
  • Bertille Ki,
  • Phyllis Kisa,
  • Rashmi Kumar,
  • Jerome Loveland,
  • Bothwell Mbuwayesango,
  • Mulewa Mulenga,
  • Emmanuel Owusu Abem,
  • Yona Ringo,
  • John Sekabira,
  • Justina Seyi-Olajide,
  • Albert Wandaogo,
  • Anne Wesonga,
  • Ali Hamad,
  • Naomi Jane Wright,
  • Abdelbasit E Ali,
  • Ainhoa Costas-Chavarri,
  • Samuel Osei-Nketiah,
  • William Appeadu-Mensah,
  • Opeoluwa Adesanya,
  • Olalekan Ajai,
  • Aminu Mohammad,
  • Stephanie Van Straten,
  • Robert Jaich,
  • Osman Imoro,
  • Lawal Abdullahi,
  • Roel Matos-Puig,
  • Andrew JM Leather,
  • Emma Thomson,
  • Ademola Olusegun Talabi,
  • Oludayo Adedapo Sowande,
  • Christopher Bode,
  • Taiwo Akeem Lawal,
  • Samson Olori,
  • Reitze Rodseth,
  • Andre Theron,
  • Emily Rose Smith,
  • Alessandra Bisquera,
  • Anyanwu Lofty John-Chukwuemeka,
  • Justine Seyi-Olajide,
  • Bernadette Béré,
  • Luc Malemo,
  • Elisee Bake,
  • Nwokoro Collins,
  • Aberibigbe M. O. Shonubi,
  • Daniel Sidler,
  • Houégban Romeo,
  • Gbenou Antoine Seraphin,
  • Eugene Zoumenou,
  • Béré Bernadette,
  • Bandré Emile,
  • Tapsoba W. Toussaint,
  • Kabre Yvette,
  • Manuela Ehua,
  • Agbara Kouame,
  • Moulot Olivier,
  • Nandiolo Rose,
  • Mesay Hailemariam Asfaw,
  • Gudeta Didi,
  • Hanna Getachew,
  • Woubedil Kiflu,
  • Samuel Negash,
  • Tihitiena Negussie,
  • Amezene Tadesse,
  • Fiseha Temesgen,
  • Afua Hesse,
  • Francis Atidana Abantanga,
  • Adakudugu Ida,
  • Martin Kyere,
  • Anwar Sadat Seidu,
  • Paul M. Wondoh,
  • Thomas Kirengo,
  • Michael Ganey,
  • Michael Mwachiro,
  • Robert K Parker,
  • Sinkeet Ranketi,
  • Bitiel Banda,
  • Caroline Melhado,
  • Biplab Nandi,
  • Mohakhelha Nyamulani,
  • Johannes Verweij,
  • Moustapha Helle,
  • Paschal Anyanwu,
  • Matthias Igoche,
  • Elizabeth Ogboli-Nwasor,
  • Baba Suleiman,
  • Sholadoye Tunde Talib,
  • Mustapha Abdulazeez,
  • Farinyaro Aliyu,
  • Aliyu Mohammed,
  • Terlumun Patrick,
  • Charles Soo,
  • Akinlabi Emmanuel Ajao,
  • Olayemi Anthony Ajiboye,
  • Michael Abel Alao,
  • Odion-Obomhense Kesiena Helen,
  • Adenike Odewabi,
  • Anuoluwapo Aremo,
  • Taiwo Jones Olaoluwa,
  • Odi Temitope,
  • Kayode Bamigbola,
  • E Uduehe Enono,
  • Abdulsalam Moruf,
  • Roland I Osuoji,
  • Omolara M. Williams,
  • Fatuga Adedeji,
  • Ihediwa Chibuike,
  • Ibironke Desalu,
  • Olumide Abiodun Elebute,
  • Charles Ememonu,
  • Oluwaseun Ladipo-Ajayi,
  • Sola Kushimo,
  • Kayode Olayade,
  • Adebambo Olowu,
  • Okechukwu Hyginus Ekwunife,
  • Victor Ifeanyichukwu Modekwe,
  • Obiechina Sylvester Okwuchukwu,
  • Ngozi Chidinma Osuji,
  • Ezidiegwu Ugochukwu Stanley,
  • Jideofor Okechukwu Ugwu,
  • Chuka Ifeanyichukwu Ugwunne,
  • Collins Chijioke Adumah,
  • Lukmon Amosu,
  • Ibukunolu Ogundele,
  • Aderibigbe M. O. Shonubi,
  • Felix Kumolalo,
  • Olakayode Ogundoyin,
  • Dare Olulana,
  • John Chinda,
  • Osagie Olabisi,
  • Akan Inyang,
  • Ijeoma Esther Nwachukwu,
  • Nurudeen Toyin Abdulraheem,
  • Lukman O. Abdur-Rahman,
  • James O. Adeniran,
  • Muslimat A. Alada,
  • Abdulrasheed A. Nasir,
  • David C. Nwosu,
  • Christopher C Amah,
  • Sebastian Okwuchukwu Ekenze,
  • Uchechukwu Obiora Ezomike,
  • Emmanuel I. Nwangwu,
  • Ijeoma C. Obianyo,
  • Nene E Obianyo,
  • Nwankwo Elochukwu Perpetua,
  • Alfred T Aggo,
  • Tobin Maxwell,
  • Philemon Okoro,
  • James A. Brown,
  • Moses Kasumba,
  • Steve Kyota,
  • Joy Robinson,
  • Seo-Hwa Chung,
  • Savannah smit,
  • Andrew Grieve,
  • Charles Carapinha,
  • Mie Elsen,
  • Nayha Gautam,
  • Shamaman Harilal,
  • Sanele Madziba,
  • Hansraj Mangray,
  • Babalwa Nondela,
  • Ria Naidoo,
  • Arasha Thotharam,
  • Kondjela Sara Hamunyela,
  • Corne De Vos,
  • Enas Musa Ismail,
  • Robert Bahati,
  • Peter Dattani,
  • Ezekiel Kambona,
  • Silas Msangi,
  • Komla Gnassingbé,
  • Hamza Doles Sama,
  • Mary T Nabukenya,
  • Emma Lillie,
  • Rae Oranmore-Brown,
  • Hope Phiri,
  • Victoria Simiyu,
  • Tungamirai Gwatirisa,
  • Houessou Gandjehou,
  • Ebassa Karl,
  • Goutam Chowdhury,
  • Alagie Manneh,
  • Michael Amoah,
  • Boateng Nimako,
  • Allan Kochi,
  • Connie Keung,
  • Robert Kuremu,
  • Heuric Rakotomalala,
  • Habou Oumarou,
  • Okafor David,
  • Faruk A Suleiman,
  • Faturoti Olubukola,
  • Innocent Igwilo,
  • Alwanlehi Eighemhenrio,
  • Andrew Shitta,
  • Musa Ibrahim Zarenawa,
  • Iyekeoretin Evbuomwan,
  • Wabada Samuel,
  • Emmanuel Kayibanda,
  • Joseph Lule,
  • Riikka Valjakka

DOI
https://doi.org/10.1136/bmjgh-2020-004406
Journal volume & issue
Vol. 6, no. 9

Abstract

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Introduction As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).Methods A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant.Results 1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.Conclusion Mortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.