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Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study
Insights
Paediatric surgical conditions have high mortality in sub-Saharan Africa (SSA) compared to high-income countries (HICs). Improving resuscitation and perioperative care is crucial to reduce these unacceptable outcomes for children in SSA.
Area of Science:
- Global Health
- Paediatric Surgery
- Surgical Outcomes
Background:
- Infectious disease mortality is declining in sub-Saharan Africa (SSA), leading to an increasing burden of surgical conditions in children.
- Limited data exist on paediatric surgical outcomes in SSA, hindering targeted interventions.
- This study addresses the critical need for data on paediatric surgical outcomes in SSA.
Purpose of the Study:
- To compare outcomes of common paediatric surgical conditions in SSA with benchmark data from high-income countries (HICs).
- To identify factors associated with mortality in paediatric surgical patients in SSA.
Main Methods:
- A multicentre, prospective cohort study involving 51 hospitals in 19 SSA countries.
- Data collected on 1407 children (birth to 16 years) with gastroschisis, anorectal malformation, intussusception, appendicitis, or inguinal hernia.
- Comparison of in-hospital mortality rates in SSA with published HIC data, using statistical analysis to identify risk factors.
Main Results:
- Mortality rates were significantly higher in SSA for all studied conditions compared to HICs.
- Gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), and intussusception (9.4% vs 0.2%) showed stark differences.
- Neonatal mortality was particularly high (41.9%), with surgical condition, ASA score, and blood transfusion need being significant predictors of mortality.
Conclusions:
- Mortality from common paediatric surgical conditions in SSA is unacceptably high, especially for neonates.
- Urgent interventions are needed to improve resuscitation and perioperative care at district and paediatric surgical centres.
- Addressing these gaps can significantly improve survival rates for children undergoing surgery in SSA.
Introduction:
As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).
Methods:
A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant.
Results:
1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.
Conclusion:
Mortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.
