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

Naomi J Wright, Augusto Zani, Niyi Ade-Ajayi, Naomi J Wright, Augusto Zani, Niyi Ade-Ajayi

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.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Infant with gastroschisis demonstrating abdominal wall defect to the right of the umbilical cord without a covering sac
Figure 2
Figure 2
Primary management choice for gastroschisis in low, middle and high-income countries
Figure 3
Figure 3
Mortality rates from gastroschisis in low, middle and high-income countries

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