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

• Published in: African journal of paediatric surgery Vol. 12; no. 1; pp. 1 - 6
• Main Authors: Wright, Naomi J, Zani, Augusto, Ade-Ajayi, Niyi
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2015; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Africa; Africa South of the Sahara - epidemiology; Care and treatment; Digestive System Surgical Procedures - methods; Disease Management; epidemiology; Female; Gastroschisis; Gastroschisis - diagnosis; Gastroschisis - epidemiology; Gastroschisis - surgery; Gestational Age; Humans; Incidence; Infant, Newborn; Male; management; Medical economics; Medical research; Original; outcome; Surveys and Questionnaires; Sub-Saharan Africa
• ISSN: 0189-6725; 0974-5998
• DOI: 10.4103/0189-6725.150924

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). 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. 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). 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.