Improving care and survival of newborns with surgical conditions in Tanzania (TINY Tanzania): a focus on gastroschisis
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In brief
In brief
This implementation science study describes the nationwide scale-up of gastroschisis care in Tanzania, training 420 providers across seven regions and establishing a centralized database tracking 332 patients. While decentralization proved feasible and increased access to care using preformed silo bags, overall survival reached 28.5%, with late presentation and infection remaining major barriers to achieving the 60% survival rates seen at the initial referral center.
- Gastroschisis mortality in sub-Saharan Africa exceeds 90%; implementation of a Care Bundle at MNH increased survival to 60%.
- Step-wedge implementation trained 420 providers across 7 Tanzanian regions, making decentralized gastroschisis care feasible and acceptable.
- Nationwide database captured 332 patients in 1 year; 90% treated with preformed silos achieved 28.5% overall survival across all centers.
- Late presentation and infection remain primary barriers to survival despite protocol dissemination and provider training.
- Context-relevant implementation science strategies are essential for sustainable improvement in neonatal surgical outcomes in resource-limited settings.
Written by the GCMD Library team from the article.
Abstract
Purpose
Gastroschisis is associated with over 90% mortality in many sub-Saharan African countries. The introduction of the Gastroschisis Care Bundle at Muhimbili National Hospital (MNH) increased survival up to 60%. We aim to explain the impact of using implementation science methods to decentralize the care of babies with gastroschisis to other parts of Tanzania.
Methods
We used a Step-Wedge Implementation Science design to scale up gastroschisis care through training of providers, dissemination and current revision of evidence-based care protocols, advocacy, and engagement with stakeholders. We used mixed methods for data collection. Anonymous patient and provider evaluation data were collected using a nationwide Gastroschisis Database via REDCap. We evaluated the implementation and effectiveness of the care bundle in different hospitals in Tanzania.
Results
Decentralizing care nationally was feasible, acceptable, and adaptable. A total of nine trainings have been conducted training 420 providers (14 Master Trainers) reaching seven regions of Tanzania. The three advocacy national campaigns have ensured community reach and patient engagement. A countrywide gastroschisis database was developed to collect data on patients with gastroschisis, hosted locally at MNH with 332 patients’ data entered in 1 year. The majority (90.2%) were treated using preformed silo bags with an overall survival of 28.5% in all centers. Late presentation and infection remain to be the main challenge.
Conclusion
To achieve quality and sustainable surgical care, there is a need to design, implement, evaluate, and continuously improve context-relevant strategies to achieve and sustain the survival of neonates with congenital anomalies. Decentralization enables clear connectedness of hospitals, bringing care closer to patients.