Pilot bowel management program at Mbarara Hospital, Uganda
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In brief
In brief
This pilot study demonstrates successful implementation of Uganda's first bowel management program for children with Hirschsprung disease and anorectal malformations. Through staff training and individualized enema regimens, the program significantly reduced involuntary bowel movements while building local provider capacity in a resource-limited setting.
Written by the GCMD Library team from the article.
Abstract
Purpose
Children with Hirschsprung’s disease (HD) and anorectal malformations (ARM) may benefit from a bowel management program (BMP) to treat constipation and fecal incontinence. This study describes a pilot BMP in Uganda.
Methods
Patients treated for HD or ARM were recruited for the BMP. Local staff underwent training and progressively took over decision-making. The rates of patient involuntary bowel movements (IBMs) and provider confidence were evaluated pre- and post-BMP with questionnaires. The results were compared with Fischer’s exact test.
Results
Ten staff—2 surgeons, 6 nurses and 2 physiotherapists—and 12 patients participated. Patient median age was 4.5 years (IQR 3–6.6) and ten were male. Ten reported at least daily IBMs prior to the BMP. All patients underwent a clean-out. The parents were then taught to perform daily enemas or irrigations. Specific regimens were determined by patient history and imaging and titrated throughout the BMP. There were differences in the rates of both daytime and nighttime IBMs before and after the BMP (p = 0.0001 and 0.002, respectively). All staff reported increased confidence.
Conclusions
We describe the first BMP in Uganda. BMPs can successfully treat constipation and fecal incontinence in low-income countries, although there are challenges with resources and follow-up.