Development of a Gastroschisis Teaching Model to Enable Surgical Task Sharing in Uganda

Gastroschisis mortality is less than 5% in high-income countries, but remains 60-95% in Africa, partly due to absence of prenatal diagnosis and delayed presentation. Midwives are usually the first point of contact and pediatricians often encounter these babies before surgeons. With training, these healthcare providers may be able to serve as task-sharers by initiating resuscitation, applying silos and directing babies to a pediatric surgeon.

A low-cost, non-perishable gastroschisis model was developed that is suitable for hands-on training. The model was piloted with nurses, midwives, pediatricians and pediatric surgeons in Uganda and Rwanda. The model was created using a plastic teaching doll, which replicates newborn anatomy and contains a hollow torso, necessary for securing the simulated intestines. A 3cm defect was created on the anterior abdominal wall of the doll, to the right of the umbilicus. Glue, borax, paint, poly tubing, and mesh fabric were used to create a model of eviscerated intestines.

Modifications were implemented in response to feedback from pediatric surgeons in the U.S. and Uganda. The final cost was $45 per doll. A hands-on training program was conducted in three regions of Uganda, Rwanda and Kenya where 160 nurses, midwives and pediatric resident physicians learned to place silos for gastroschisis. Evaluation based on participant feedback demonstrated high satisfaction with the model and perceived usefulness for learning gastroschisis management.

We describe a training model for gastroschisis silo placement that can be made from readily available materials. Further research is underway to assess clinical impact.