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Epidemiology of intussusception among infants in Togo, 2015-2018
Enyonam Tsolenyanu1,2, Komlatsè Akakpo-Numado3, Djatougbe Eliane Akolly1
1Department of Paediatrics, Medical School of Lome, Togo, West Africa.
Insights
Intussusception in Togolese infants is primarily treated with surgery, often requiring intestinal resection. This study highlights a concerningly high case fatality rate, emphasizing the need for improved pediatric surgical care and early diagnosis in the region.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health Surveillance
Background:
- Intussusception is the primary cause of bowel obstruction in infants and young children.
- Understanding its epidemiology and management in low-resource settings is crucial for improving outcomes.
Purpose of the Study:
- To describe the epidemiology, diagnosis, and treatment of intussusception in Togolese infants.
- To evaluate the outcomes of intussusception management over a four-year period.
Main Methods:
- Active surveillance was conducted among infants under one year with intussusception from 2015-2018.
- Brighton Collaboration Level 1 criteria confirmed diagnoses.
- Data collected included demographics, clinical presentation, diagnostic methods, treatment, and outcomes.
Main Results:
- 41 cases of intussusception were reported, peaking between 5-7 months of age, with male predominance.
- Diagnosis involved clinical symptoms, ultrasound, and surgery. Treatment was exclusively surgical, with intestinal resection in 68% of cases.
- A high case fatality rate of 23% was observed, with a median delay of 4 days in seeking care.
Conclusions:
- Intussusception management in Togo relies exclusively on surgical therapy.
- The high rate of intestinal resection and significant case fatality underscore challenges in timely diagnosis and treatment.
- Enhanced surveillance and intervention strategies are needed to reduce mortality in Togolese infants with intussusception.
Introduction:
intussusception is the leading cause of bowel obstruction in infants and young children. We describe the epidemiology and diagnostic and treatment characteristics of intussusception among Togolese infants over a 4-year period.
Methods:
we implemented active surveillance among infants younger than 1 year of age admitted with intussusception from 2015 to 2018 at Sylvanus Olympio Teaching Hospital and in 2018 at Campus Teaching Hospital. Brighton Collaboration Level 1 case definition criteria were used to confirm the diagnosis of intussusception.
Results:
during four years, 41 cases of intussusception, with an annual range of 8 to 14 cases (median: 10) were reported; and the highest number of cases (89%) was enrolled at Sylvanus Olympio teaching hospital. Intussusception was uncommon in the first 2 months of life, peaked from 5 to 7 months old (63%), with male predominance (63%), and showed no significant seasonality. One third of cases (34%) were transferred to the sentinel surveillance site from another health facility; and the median delay in seeking care was 4 days (range: 0-11) with ≥ 48-hour delay in 59% of cases. Clinical symptoms, ultrasound and surgery were combined to diagnose intussusception in all the cases (100%). The treatment was exclusively surgical, and intestinal resection was common (28/41, 68%). A high case fatality rate (23%) was observed and the average length of hospital stay was 10 days (range: 1-23).
Conclusion:
active surveillance for intussusception in Togo has highlighted exclusive use of surgical therapy; often associated to an intestinal resection with a very high case fatality rate.
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