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Reducing Gastroschisis Mortality: A Quality Improvement Initiative at a Ugandan Pediatric Surgery Unit
A Wesonga1, M Situma1, K Lakhoo2
1Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Kabale Road, Mbarara, Uganda.
Insights
A new protocol significantly reduced gastroschisis mortality in Uganda from 98% to 59%. This feasible, locally-derived approach demonstrates that dedicated teams can improve outcomes even with limited resources.
Area of Science:
- Pediatric Surgery
- Global Health
- Neonatal Care
Background:
- Gastroschisis survival exceeds 90% in high-income countries due to advanced care.
- Sub-Saharan Africa faces high gastroschisis mortality (75-100%) due to limited resources.
- Uganda reports a particularly high mortality rate of 98% for gastroschisis.
Purpose of the Study:
- To develop and implement a feasible, sustainable, locally-derived protocol to reduce gastroschisis mortality in Western Uganda.
- To address the critical gap in neonatal surgical care for gastroschisis in resource-limited settings.
Main Methods:
- A locally derived gastroschisis care protocol was developed with input from nursing staff.
- Data was collected from January to October 2018, including interviews with nursing staff.
- The new protocol was implemented at a referring hospital in Western Uganda.
Main Results:
- Seventeen babies with gastroschisis were managed using the new protocol.
- Seven out of 17 babies survived and were well at one-month follow-up.
- Gastroschisis mortality was reduced from 98% to 59%.
Conclusions:
- A dedicated healthcare team can significantly decrease gastroschisis mortality with a locally adapted protocol.
- Minimal resources are not an insurmountable barrier to improving surgical outcomes in neonates.
- The study highlights the potential for substantial mortality reduction (nearly 40%) through protocol implementation.
Introduction:
With modern treatment, survival of gastroschisis exceeds 90% in high-income countries. Survival in these countries has been largely attributed to prenatal diagnosis, delivery at tertiary facilities with timely resuscitation, timely intervention, parenteral nutrition and intensive care facilities. In sub-Saharan Africa, due to lack of these facilities, mortality rates are still alarmingly high ranging from 75 to 100%. In Uganda the mortality is 98%.
Aim:
The aim of this study was to reduce gastroschisis mortality in a feasible, sustainable way using a locally derived gastroschisis care protocol at a referring hospital in Western Uganda.
Methods:
Data collection was performed from January to October 2018. Nursing staff were interviewed regarding the survival and management of gastroschisis babies. A locally derived protocol was created with staff input and commitment from all the team members.
Results:
Four mothers absconded and 17 babies were cared for using the newly designed protocol. Seven survived and were well at one month post discharge follow-up, reducing the mortality for this condition from 98 to 59%.
Conclusion:
A dedicated team with minimal resources can significantly reduce the mortality in gastroschisis by almost 40% using a locally derived protocol.
