Major abdominal wall defects in the low- and middle-income setting: current status and priorities

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Congenital malformations

Background:

• Major congenital abdominal wall defects, including gastroschisis and omphalocele, represent a significant burden in low- and middle-income countries (LMICs).
• These conditions necessitate emergency neonatal interventions, accounting for up to 21% of such procedures in LMICs.
• There is a stark disparity in survival rates, with mortality ranging from 30-100% in LMICs compared to less than 5% in high-income countries (HICs).

Purpose of the Study:

• To review the challenges in managing major congenital abdominal wall defects in resource-limited settings.
• To assess current best practices from high-income countries for applicability in LMICs.
• To identify opportunities for improved outcomes through priority setting and collaborations.

Main Methods:

• Literature review focusing on management of gastroschisis and omphalocele.
• Comparative analysis of outcomes and resource utilization between LMICs and HICs.
• Discussion of challenges in neonatal care and surgical interventions in resource-limited environments.

Main Results:

• Significant disparities in mortality rates for gastroschisis and omphalocele between LMICs and HICs.
• Resource limitations in LMICs pose substantial challenges to effective management.
• Current HIC best practices may require adaptation for successful implementation in LMICs.

Conclusions:

• Urgent need for tailored strategies to manage congenital abdominal wall defects in LMICs.
• Potential for improving outcomes through targeted interventions, resource allocation, and international collaboration.
• Addressing the management gap is critical to reduce preventable mortality and morbidity in affected infants.