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Published on: February 9, 2011
Burden of Surgical Infections in a Tertiary-Care Pediatric Surgery Service in Uganda
Nasser Kakembo1, David F Grabski2, Tamara N Fitzgerald3
1Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
Insights
In low- and middle-income countries (LMICs), surgical infections in children are common and lead to high mortality. Improving resource allocation for timely diagnosis and surgical intervention is crucial for better outcomes in pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Global Health
Background:
- Delayed presentation of surgical conditions leads to infections in low- and middle-income countries (LMICs).
- The impact of childhood surgical infections on limited resources in LMICs is not well-defined.
- Many primary infections necessitate surgical intervention.
Purpose of the Study:
- To define the burden of infection in pediatric surgical patients in a Ugandan tertiary referral hospital.
- To analyze operative interventions and survival rates for children presenting with infection.
- To inform resource allocation for pediatric surgical care in LMICs.
Main Methods:
- A prospective surgical database from a Ugandan tertiary referral hospital was reviewed.
- Data from January 2012 to August 2016 were analyzed for all pediatric patients presenting with infection.
- Patients were analyzed based on operative intervention and in-hospital survival.
Main Results:
- 20.4% of 3,494 admitted children presented with infection; 64% of these required surgery.
- The in-hospital mortality rate for infected children undergoing surgery was 12.5%.
- Common conditions included abscesses (43.4%), typhoid intestinal perforations (12.0%), and appendicitis (11.0%). High mortality was observed in esophageal atresia with aspiration pneumonia (78.6%), abdominal sepsis (67%), and necrotizing enterocolitis (50%).
Conclusions:
- Pediatric surgical infections represent a significant burden in LMICs, associated with high mortality.
- Timely diagnosis and surgical intervention are critical for improving survival rates.
- Resource allocation should prioritize prompt management of pediatric surgical infections in LMICs.
Abstract:
Delayed presentation of surgical disease often leads to infection in low- and middle-income countries (LMICs). In addition, many primary infections require surgical intervention. The burden of infection in children's surgery in LMICs is poorly defined and may tax the limited availability of surgical resources. A prospective surgical database was reviewed for all children presenting to a Ugandan tertiary referral hospital from January 2012 to August 2016. All patients presenting with infection were included and analyzed by operative intervention and survival. Of the 3,494 children admitted over the time period, 712 (20.4%) presented with infection. A total of 455 patients (64%) with an infection underwent an operation, with an in-hospital mortality rate of 12.5%. Operations involving infections represented 20% of the volume of the children's surgery department. Common conditions were abscesses (n = 308; 43.4%), typhoid intestinal perforations (n = 85; 12.0%), appendicitis (n = 78; 11.0%) and perforated bowel caused by ileocolic intussusception (n = 37; 5.2%). Patients with esophageal atresia presenting with aspiration pneumonia had an in-hospital mortality rate of 78.6%, those with abdominal sepsis a 67% mortality rate, and neonatal infants with necrotizing enterocolitis a 50% mortality rate. There is a high volume of infection in children requiring surgery, contributing to a high mortality rate. Resource allocation for children's surgical care in LMIC should be directed toward timely diagnosis and surgical intervention of these conditions.
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