Epidemiology, management and outcome of gastroschisis in Sub-Saharan Africa: Results of an international survey

Afr J Paediatr Surg. 2015 Jan-Mar;12(1):1-6. doi: 10.4103/0189-6725.150924.

Abstract

Background: The aim was to compare gastroschisis (GS) epidemiology, management and outcome in low-income countries (LIC) in Sub-Saharan Africa (SSA) with middle- (MIC) and high-income countries (HIC).

Materials and methods: A 10-question survey was administered at the 2012 Pan-African Paediatric Surgery Association Congress. RESULTS are presented as median (range); differences were analysed using contingency tests.

Results: A total of 82 delegates (28 countries [66 institutions]) were divided into LIC (n = 11), MIC (n = 6) and HIC (n = 11). In LIC, there were fewer surgeons and more patients. LIC reported 22 cases (1-184) GS/institution/year, compared to 12 cases (3-23)/institution/year in MICs and 15 cases (1-100)/institution/year in HICs. Antenatal screening was less readily available in LIC. Access to parenteral nutrition and neonatal intensive care in LIC was 36% and 19%, compared to 100% in HIC. Primary closure rates were similar in LIC and HIC at 58% and 54%, respectively; however, the majority of staged closure utilised custom silos in LIC and preformed silos in HIC. In LIC, mortality was reported as >75% by 61% delegates and 50-75% by 33%, compared to <25% by 100% of HIC delegates (P < 0.0001).

Conclusions: Gastroschisis is a problem encountered by surgeons in SSA. Mortality is high and resources in many centres inadequate. We propose the implementation of a combined epidemiological research, service delivery training and resource provision programme to help improve our understanding of GS in SSA whilst attempting to improve outcome.

Publication types

  • Multicenter Study

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Digestive System Surgical Procedures / methods*
  • Disease Management*
  • Female
  • Gastroschisis / diagnosis
  • Gastroschisis / epidemiology*
  • Gastroschisis / surgery
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Newborn
  • Male
  • Surveys and Questionnaires*