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Intussusception incidence rates in 9 Zambian hospitals, 2007-2011: prerotavirus vaccine introduction
Evans M Mpabalwani1, Pearson Chitambala, Julia N Chibumbya
1From the *University Teaching Hospital, Department of Paediatrics & Child Health; †University Teaching Hospital, Department of Surgery, Paediatric Surgical Unit; ‡University Teaching Hospital, Virology Laboratory, Lusaka, Zambia; §World Health Organisation, Regional Office for Africa, Zambia; ¶World Health Organisation, Regional Office for Africa, Brazzaville, Republic of Congo; and ‖School of Medicine, Department of Surgery, Paediatric Surgical Unit, Lusaka, Zambia.
Insights
Intussusception is a common cause of intestinal obstruction in infants, peaking at 5-6 months. High fatality rates in Zambia are linked to delayed presentation and diagnosis.
Area of Science:
- Pediatric Surgery
- Public Health
- Vaccinology
Background:
- Intussusception is a leading cause of intestinal obstruction in infants globally.
- The peak age for intussusception (4-6 months) overlaps with rotavirus vaccine administration periods.
- Rotavirus vaccination is associated with intussusception in some regions.
Purpose of the Study:
- To determine the incidence and characteristics of intussusception in infants in Zambia.
- To assess the case fatality rate and contributing factors for intussusception in the study population.
Main Methods:
- A retrospective and prospective survey was conducted across 9 Zambian hospitals from January 2007 to June 2012.
- Children aged 0-24 months undergoing surgery for intussusception were identified.
- Demographic, clinical, and surgical data were collected from hospital records.
Main Results:
- 105 children underwent surgery for intussusception; 86.9% were infants, with a peak age of 5-6 months.
- The estimated annual incidence rate was 12/100,000 children under 2 years, likely an underestimate.
- The overall case fatality rate was high at 33.7%.
Conclusions:
- Intussusception is prevalent in Zambian infants, particularly those aged 2-4 months, coinciding with rotavirus vaccination schedules.
- Delayed presentation and diagnosis significantly contribute to the high mortality rate.
- Public health strategies are needed to address delayed care-seeking behaviors and improve diagnostic timeliness.
Background:
Intussusception, a rare adverse event associated with rotavirus vaccines in some settings, is a common cause of intestinal obstruction in infants and toddlers globally with a peak age of 4-6 months. This age group may overlap with the extended age of administering rotavirus vaccine.
Methods:
A retrospective (January 2007 to June 2009) and prospective (July 2009 to June 2012) survey was conducted in 9 Zambian hospitals. Children between 0 and 24 months who were operated on for intestinal obstruction/intussusception were identified in theatre log books. In the latter part of the survey, patients were recruited prospectively. Demographic, clinical and surgical data from hospital files were collected for each patient.
Results:
One-hundred and five children were identified to have undergone surgery for intussusceptions. Many were boys 57.6% (57/99). Of those with complete data, intussusception was common in infants 86.9% (86/99) and many children (68.0%) were between 3 and 8 months of age with a peak age of 5-6 months. Lusaka had the highest number of children with intussusception with an estimated annual incidence rate of 12/100,000 in children <2 years of age. The overall case fatality rate was very high 33.7% (31/92).
Conclusion:
Intussusception was common in infants with a peak age of 5-6 months, and of particular concern is the group of 2-4 months the age of rotavirus vaccination. The estimated incidence rate of 12/100,000 is an underestimate as many cases may not present for care. The high case fatality rate of 33.7% is due to both delayed presentation and diagnosis in hospital.
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