Long-Term Impact of a Low-Cost Paediatric Intussusception Air Enema Reduction Simulation-Based Education Programme in...

Area of Science:

• Pediatric Surgery
• Medical Education
• Global Health

Background:

• Intussusception is a common cause of bowel obstruction in infants, often requiring invasive surgery in Low- and Middle-Income Countries (LMICs).
• The Air Enema (AE) non-operative technique, supported by simulation-based education (SBE), was introduced in Myanmar in 2016.
• This study evaluates the long-term impact of AE and SBE on clinical outcomes and healthcare professionals' perspectives.

Purpose of the Study:

• To assess the long-term clinical outcomes of the Air Enema (AE) technique for infant intussusception in Myanmar.
• To evaluate the shift towards non-operative interventions supported by simulation-based education (SBE).
• To explore surgeons' attitudes towards the AE technique and SBE.

Main Methods:

• A 4-year mixed-methods study incorporating prospective clinical outcome data and semi-structured interviews.
• Reflexive thematic analysis (RTA) was used to analyze qualitative data on surgeon attitudes.
• Clinical outcomes included Length of Stay (LoS), recurrence rates, and intestinal resection rates, compared to operative interventions.

Main Results:

• A sustained shift to AE was observed, with high success rates (86.1-91.2%) and significantly reduced LoS (4 vs. 7 days) and Duration of Symptoms (DoS) (1.9/7 vs. 2.5/7).
• Recurrence rates were low (0-5.8%), while intestinal resection rates stabilized at 30.5-31.8% compared to 15.3% pre-intervention.
• RTA identified four key themes, indicating a positive paradigm shift in attitudes and the application of SBE.

Conclusions:

• The Air Enema (AE) technique, supported by simulation-based education (SBE), led to sustained improvements in clinical outcomes for infant intussusception in Myanmar.
• There was a demonstrated shift towards non-operative management and an increased appreciation for SBE among healthcare professionals.
• The findings highlight the successful adaptation and value of SBE in improving pediatric surgical care in LMICs.