Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda
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In brief
In brief
Prospective database review of 3,465 pediatric surgical admissions at a Ugandan tertiary center reveals high burden of congenital anomalies (38.6% of cases) with substantially elevated mortality compared to high-income countries—gastroschisis mortality reached 90.1%. Over half of admissions were infants under one year, highlighting the critical need for neonatal surgical capacity and quality improvement initiatives in low-resource settings.
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Abstract
Introduction/purpose
The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited.
Methods
Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016.
Results
2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung’s, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%).
Conclusion
There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.