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Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings.

Naomi Wright1, Francis Abantanga2, Michael Amoah3

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This study introduces an intervention bundle to decrease gastroschisis mortality in sub-Saharan Africa. The goal is to improve survival rates for infants with gastroschisis in low-resource settings.

Keywords:
Congenital AnomalyGastroschisisImplementationInterventionLMICLow-Resource SettingMortalityNeonatal Surgical Care

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Area of Science:

  • Paediatric Surgery
  • Global Health
  • Implementation Science

Background:

  • Gastroschisis mortality is disproportionately high in sub-Saharan Africa (SSA) compared to high-income countries.
  • Tertiary paediatric surgery centers in SSA face over 90% mortality rates for gastroschisis.
  • There is a critical need for effective interventions in low-resource settings.

Purpose of the Study:

  • To develop, implement, and evaluate an interventional bundle to reduce gastroschisis mortality in SSA.
  • To prospectively assess the effectiveness of a low-technology intervention in improving clinical outcomes.
  • To examine implementation strategies for sustainability and scalability in resource-limited environments.

Main Methods:

  • A hybrid type-2 effectiveness-implementation, pre-post study design across seven tertiary paediatric surgery centers in SSA.
  • Development of an evidence-based, low-technology interventional bundle informed by systematic reviews, qualitative studies, and Delphi processes.
  • Collection of clinical, service delivery, and implementation outcomes over two years, with statistical analysis including Chi-squared, t-tests, Mann-Whitney U, and time-series analysis.

Main Results:

  • The study aims to establish the primary clinical outcome as all-cause, in-hospital mortality.
  • Secondary outcomes include major complications, length of hospital stay, and time to full enteral feeds.
  • Service delivery and implementation outcomes will also be rigorously evaluated.

Conclusions:

  • This is the first multi-center study targeting gastroschisis mortality reduction in low-resource settings.
  • Successful outcomes will provide a model for sustainability and scale-up of the intervention.
  • Detailed evaluation of clinical and implementation components is crucial for future global health initiatives.