Hirschsprung's disease in low- and middle-income countries

Area of Science:

• Pediatric surgery
• Gastroenterology
• Global health

Background:

• Hirschsprung's disease (HD) is a common cause of pediatric bowel obstruction in low- and middle-income countries (LMICs).
• Patients in LMICs often experience delayed diagnosis and management, leading to increased morbidity and mortality.
• Multifactorial barriers, including socioeconomic and cultural factors, limit timely diagnosis and access to specialized care.

Purpose of the Study:

• To describe the unique challenges and outcomes of Hirschsprung's disease management in LMICs.
• To identify opportunities for improving the diagnosis, treatment, and post-operative care of HD patients in resource-limited settings.

Main Methods:

• Review of clinical presentation, diagnostic methods, surgical management, and post-operative outcomes in LMICs.
• Analysis of factors contributing to delayed diagnosis and treatment.
• Discussion of resource limitations and their impact on patient care.

Main Results:

• Delayed presentation is common in LMICs, resulting in higher rates of obstruction, malnutrition, perforation, and mortality.
• Diagnosis often relies on clinical and radiographic findings due to limited pathology services.
• Multi-stage surgical procedures, including initial diversion, are more prevalent than single-stage pull-through.
• Post-operative complication and mortality rates are higher in LMICs.

Conclusions:

• Improving care for Hirschsprung's disease in LMICs requires addressing diagnostic delays, socioeconomic barriers, and resource limitations.
• Enhancing workforce training and infrastructure is crucial for better surgical outcomes.
• Despite challenges, recent advances show potential for improved patient care in these regions.