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Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries
Vivian Valin Akello1, Maija Cheung2, Gideon Kurigamba1
1Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
Insights
Pediatric intussusception in Uganda has a high mortality rate, with delayed presentation common in referred patients. Fever at admission significantly increases the risk of death in these children.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Global health
Background:
- Intussusception management differs significantly between high-income and low-income countries.
- Delays in diagnosis and treatment in low-income settings often necessitate surgical intervention.
Purpose of the Study:
- To characterize the burden and outcomes of pediatric intussusception in Uganda.
- To identify factors associated with mortality in pediatric intussusception cases.
Main Methods:
- Prospective case series conducted at a tertiary referral hospital in Uganda.
- Study included 40 pediatric patients diagnosed with intussusception between May 2015 and July 2016.
- All patients underwent surgical treatment for intussusception.
Main Results:
- The male to female ratio was 3:2, with an average symptom duration of 4.5 days before presentation.
- Referred patients presented later (median 4 days) compared to non-referred patients (median 2 days).
- Mortality rate was 32%, and fever on admission was associated with a 20-fold increased likelihood of death.
Conclusions:
- Intussusception in Uganda is associated with high operative and mortality rates.
- Delayed presentation in referred patients contributes to poorer outcomes.
- Fever at admission is a critical predictor of mortality, highlighting the need for improved global pediatric surgical quality metrics.
Purpose:
In high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda.
Methods:
Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda.
Results:
Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040).
Conclusion:
Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery.
Type Of Study:
Diagnostic study.
Level Of Evidence:
III.
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