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Paediatric Surgery across Sub-Saharan Africa: A Multi-Centre Prospective Cohort Study

Authors:
Naomi Wright at Oxford University Hospitals NHS Trust
Naomi Wright
Luc Kalisya Malemo at McGill University Health Centre
Luc Kalisya Malemo
Elisee Bake
Elisee Bake
Elisee Bake
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Jacques F. Bake at HEAL Africa Hospital
Jacques F. Bake
  • HEAL Africa Hospital
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Abstract

Protocol poster outlining the study objectives, data collection, analysis and proposed outcomes. *** This won the COSECSA prize for the best conference poster ***
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All content in this area was uploaded by Naomi Wright on Jun 17, 2017
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PaedSurg Africa
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5 billion people
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... In addition, 25% present with complex GS. In some infants this may reflect postnatal factors such as bowel exposure, contamination, damage and/ or torsion of the vascular pedicle resulting in intestinal ischaemia and necrosis 44 . Even those with simple GS commonly present with very edematous and matted bowel, making reduction and closure even more challenging. ...
... It is estimated that 63-79% of infants with GS in LMICs undergo general anesthesia for bowel reduction and abdominal wall closure 6 . Neonatal anesthesia can be life-threatening in this setting due to a lack of specialist training, resources and the higher American Association of Anaesthesiologists (ASA) score of the newborn at the time of surgery due to the limited pre-hospital management and in-hospital resuscitation 44,51 . In addition, neonates with GS are often born early; in Durban, South Africa 64% were preterm and 72% <2.5kg and in Harare, Zimbabwe 43% were preterm and 72% <2.5kg 5,42 . ...
... In HICs, the challenge is usually overcome as a result of appropriately trained personnel that can be dedicated to the task, a wide range of central lines that can be inserted via peripheral and central veins. In addition, the deployment of specialist equipment such as ultrasound aids effective venous access 44 . Dedicated personnel such as nurse specialists, equipment such as mobile ultrasound machines and suitable consumables are often unavailable in low-resource settings. ...
Care of Infants With Gastroschisis in Low-Resource Settings
Article
  • Sep 2018
  • Semin Pediatr Surg
ABSTRACT There is great global disparity in the outcome of infants born with gastroschisis. Mortality approaches 100% in many low income countries. Barriers to better outcomes include lack of antenatal diagnosis, deficient pre-hospital care, ineffective neonatal resuscitation and venous access, limited intensive care facilities, poor access to the operating theatre and safe neonatal anesthesia, and lack of neonatal parenteral nutrition. However, lessons can be learned from the evolution in management of gastroschisis in high-income countries, generic efforts to improve neonatal survival in low- and middle-income countries as well as specific gastroschisis management initiatives in low-resource settings. Micro and meso-level interventions include educational outreach programs, and pre and in hospital management protocols that focus on resuscitation and include the delay or avoidance of early neonatal anesthesia by using a preformed silo or equivalent. Furthermore, multidisciplinary team training, nurse empowerment, and the intentional involvement of mothers in monitoring and care provision may contribute to improving survival. Macro level interventions include the incorporation of ultrasound into World Health Organisation antenatal care guidelines to improve antenatal detection and the establishment of the infrastructure to enable parenteral nutrition provision for neonates in low- and middle-income countries. On a global level, gastroschisis has been suggested as a bellwether condition for evaluating access to and outcomes of neonatal surgical care provision.
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