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Murine Ileocolic Bowel Resection with Primary Anastomosis
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Pilot bowel management program at Mbarara Hospital, Uganda.

Stephen Trinidad1,2, Felix Oyania3, Crispus Bingana4

  • 1Cincinnati Children's Hospital Medical Center, Cincinnati, USA. Stephenmtrinidad01@gmail.com.

Pediatric Surgery International
|November 14, 2023
PubMed
Summary

A pilot bowel management program (BMP) in Uganda successfully reduced involuntary bowel movements in children with Hirschsprung

Keywords:
Anorectal malformationBowel management programFecal incontinenceGlobal healthHirschsprung’s disease

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Global Health

Background:

  • Hirschsprung's disease (HD) and anorectal malformations (ARM) are congenital conditions often leading to chronic constipation and fecal incontinence in children.
  • Effective bowel management programs (BMPs) are crucial for improving quality of life in affected children, but access is limited in low-income countries.
  • This study piloted the first BMP in Uganda to address these challenges.

Purpose of the Study:

  • To describe the implementation and outcomes of a pilot bowel management program (BMP) for children with Hirschsprung's disease (HD) and anorectal malformations (ARM) in Uganda.
  • To evaluate the program's impact on involuntary bowel movements (IBMs) and healthcare provider confidence.

Main Methods:

  • A pilot BMP was established in Uganda, involving training local healthcare staff (surgeons, nurses, physiotherapists) to manage patients with HD or ARM.
  • Patients received initial clean-out procedures, followed by education for parents on performing daily enemas or irrigations.
  • Patient outcomes, specifically rates of involuntary bowel movements (IBMs), and provider confidence were assessed using questionnaires before and after BMP implementation, with statistical comparison using Fischer's exact test.

Main Results:

  • Twelve pediatric patients (median age 4.5 years, 10 male) participated, with 10 initially experiencing daily involuntary bowel movements (IBMs).
  • Following BMP implementation, significant reductions in both daytime (p=0.0001) and nighttime (p=0.002) IBMs were observed.
  • All participating healthcare staff reported increased confidence in managing these complex pediatric conditions.

Conclusions:

  • The pilot BMP in Uganda demonstrated successful treatment of constipation and fecal incontinence in children with HD and ARM.
  • This initiative highlights the feasibility of implementing BMPs in low-income countries, despite resource and follow-up challenges.
  • Establishing local BMPs can significantly improve outcomes for children with these conditions in resource-limited settings.