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Pediatric Intussusception in Sub-Saharan Africa: A Systematic Review and Meta-analysis of Surgical Outcomes
Yohannis Derbew Molla1, Kidist Hunegn Setargew2, Mekdes Tsegaye Alebel3
1Department of Surgery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Insights
Pediatric intussusception in Sub-Saharan Africa (SSA) presents late, often requiring surgery and leading to high mortality. Improving early diagnosis and surgical care is crucial for better outcomes in the region.
Area of Science:
- Pediatric Surgery
- Global Health
- Gastroenterology
Background:
- Intussusception is a leading cause of intestinal obstruction in children globally.
- In Sub-Saharan Africa (SSA), delayed diagnosis of intussusception leads to severe complications and poor outcomes.
- While non-surgical treatments have improved outcomes elsewhere, many children in SSA still need surgery.
Purpose of the Study:
- To review the available evidence on surgical outcomes for pediatric intussusception in SSA.
- To analyze patient demographics, symptoms, diagnostic methods, surgical procedures, complications, and mortality rates.
- To identify factors contributing to poor outcomes and inform strategies for improvement.
Main Methods:
- Systematic literature search of studies from 1991-2024 on pediatric intussusception surgery in SSA.
- Data extraction on patient characteristics, clinical presentation, diagnostics, surgical interventions, and outcomes.
- Random-effects meta-analysis to calculate pooled prevalence estimates and evaluate study quality.
Main Results:
- Twenty-four studies from 11 SSA countries involving 2078 children were analyzed.
- Delayed presentation (mean 3.45 days) was common, with the classic triad in 50.4%.
- High rates of postoperative complications (24.5%) and mortality (12.4%) were observed, exceeding global averages.
Conclusions:
- Pediatric intussusception in SSA is marked by delayed presentation, high surgical rates, and concerningly high mortality and complication rates.
- Enhancing early diagnosis and increasing access to non-operative reduction are vital.
- Improving surgical capacity is essential to mitigate the impact of intussusception in the region.
Introduction:
Intussusception is a common cause of acute abdominal pain and intestinal obstruction in children worldwide. However, in areas with limited health-care resources, it is more frequently associated with severe complications and poor outcomes due to delays in diagnosis and treatment. Although nonsurgical treatments have improved outcomes worldwide, many children in Sub-Saharan Africa (SSA) still require surgery for this condition. This study reviews the available evidence on surgical outcomes for pediatric intussusception in SSA.
Methods:
We conducted a systematic search across multiple databases including PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar-for studies published from 1991 to 2024 that reported on surgical treatment of pediatric intussusception in SSA. From these studies, we extracted key details such as patient demographics, symptoms, diagnostic approaches, surgical procedures, complications, and mortality rates. Using random-effects meta-analysis, we calculated pooled prevalence estimates with 95% confidence intervals (CIs). Finally, we evaluated study quality with the Newcastle-Ottawa Scale.
Results:
Twenty-four studies involving 2078 children from 11 SSA countries were included. The pooled mean age at presentation was 13.2 mo, with 64% of cases occurring in males. The classic triad (intermittent abdominal pain, vomiting, and bloody stools) was present in 50.4% (95% CI: 37.3-63.4), and the mean duration of symptoms before presentation was 3.45 d. Ultrasound was used in 58.3% (95% CI: 49.2-66.9), whereas clinical diagnosis alone accounted for 34.7%. Manual reduction was the most common surgical procedure (55.2%; 95% CI: 49.9-60.6), followed by resection with anastomosis (38.2%; 95% CI: 31.0-45.3). Postoperative complications occurred in 24.5% (95% CI: 18.5-30.5), with surgical site infection being the most frequent. The pooled mortality rate was 12.4% (95% CI: 9.2-15.6), substantially higher than global averages.
Conclusions:
Pediatric intussusception in SSA is characterized by delayed presentation, high reliance on surgical management, and unacceptably high mortality and complication rates. Strengthening early diagnosis, expanding access to nonoperative reduction, and improving surgical capacity are essential to reduce the burden of this condition in the region.
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