paediatric surgery across sub-saharan africa: a multi-centre … · 2019-11-21 · paediatric...
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Paediatric Surgery across Sub-Saharan Africa: A Multi-Centre Prospective Cohort Study
Dr Theophilus Teddy Kojo Anyomih, Dr Naomi Wright,PaedSurg Africa Research Collaboration
Extreme Affordability Conference, July 2018
5 billion peopleLack access to surgical care
29% of the worlds unmet need for surgery
50% of the population are children
Up to 1/3 of childhood deaths result from a surgical condition
Congenital anomalies are the 5th leading cause of death in <5-year olds
2015 – the year for global surgery
80% coverage of surgical care per country by 2030
38 retrospective reviews 13 prospective
across 54 countriesin 20-years
Children’s surgery must be recognised in plans to scale up surgical care in SSA!
Research Collaboration
Aim:To form a collaboration of surgeons and allied health professionals involved in children’s surgery across SSAto collectively undertake the largest prospective cohort study of paediatric surgery in this region of the world.
All collaborators as co-authors
Data CollectionOn 5 conditions
Data Collection
Over a 1-month period, during Oct 2016 – April 2017.
Three collaborators per institution per month of data collection.
Using the online database:
Primary outcome: in-hospital mortality.
Secondary outcomes: surgical site infectionwound dehiscenceneed for re-intervention condition specific complications
Data was collected on: patient demographics, time to presentation, clinical status, peri-intervention care, intervention and outcome.
Hospital resources for neonatal & paediatric surgery.
Data Collection
Data Analysis
Chi-squared analysis & Fisher’s exact tests were used to compare outcomes in SSA with published benchmark data from high-income countries.
Multivariate logistic regression analysis was used to identify factors affecting outcome.
Data validated in 10% of centres.
Ethical approval from all centres.
Results
220 collaborators76 hospitals23 countries
Results
1407 cases:
- 111 gastroschisis- 188 anorectal malformation- 250 appendicitis- 225 intussusception- 633 inguinal hernia
All Conditions
Overall all-cause in-hospital mortality: 9.1%
30d mortality 10.0% compared to 0.7% in HICs p<0.0001
139 children died in this study: only 9 would die in HICs
Mortality was significantly associated with:Gastroschisis, higher ASA score, receiving a blood transfusion and anaesthetic nurse compared to doctor.
ResultsMortality SSA
MortalityHIC
P value Odds ratio (95% CI)
All conditions 10.02% 0.65% <0.0001 17.1 (8.7-33.6)P<0.0001
Gastroschisis 75.5% 4.0% <0.0001 74.0 (35.9-152.5)P<0.0001
Anorectalmalformation
17.3% 2.9% <0.0001 6.9 (3.5-13.8)P<0.0001
Appendicitis 0.4% 0.004% 0.02 99.8 (6.2 – 1601)P=0.001
Intussusception 9.4% 0.2% <0.0001 52.7 (27.7-100.4)P<0.0001
Inguinal hernia 0.3% 0% 0.003 82.0 (3.9-1709)P=0.0045
Gastroschisis
75.5% mortality compared to 4.0% in HICs p<0.0001
GA 37wks, weight 2.3kg5% antenatal diagnosis93% outborn
On arrival: 55% septic, 58% hypovolaemic, 76% hypothermicTime to death: 4 days
Mortality associated with: ASA score & improvised silo use.
Hospital Resources & Facilities
0.5 paediatric surgeons/ 1 million population
Resource Percentage of collaborators with a reliable access to the resource
PICU 23%
NICU 27%
Parenteral nutrition 18%
Central line for children/neonates 28%/ 21%
Anaesthetic machine for children/ neonates 67%/ 48%
Air enema/ hydro-enema reduction for intussusception
16%/ 27%
Conclusion
1) Largest prospective cohort study of paediatric surgery in SSA to aid advocacy and policy planning.
2) All conditions had a significantly higher mortality in SSA than HICs.
3) Gastroschisis had the greatest disparity in outcome.
3) Formation of a research collaboration:- enhanced research capacity amongst collaborators- created a platform for ongoing research & interventional studies
Dissemination
• 30 international/ national/ regional presentations to date
• 10 further planned presentations
Wellcome Trust Clinical PhD in Global Health
Clinical Interventional Study
7 hospitals: Ghana, Zambia, Malawi, Tanzania
Aim: Reduce mortality in neonates born with gastroschisis
Future
Future
Global PaedSurgCongenital Anomalies
Thank you to all collaborators who participated in the study
Steering Committee: Naomi Wright, Emmanuel Ameh, Niyi Ade-Ajayi, Kokila Lakhoo, Dan Poenaru, Andrew Leather
Lead Investigators: Luc Malemo, Elisee Bake, Jacques Fadhili Bake, Bertille Ki, Albert Wandaogo, Bernadette Béré, Sharon Cox, Anyanwu Lofty John Chukwuemeka, Aminu Mohammad, Lawal Abdullahi, Colins Nwokoro, AMO Shonubi, Emily Smith.
Country Leads: Anyanwu Lofty John Chukwuemeka, Stephen Tabiri, Sharon Cox, Daniel Sidler.
Collaborators: Nurudeen Abdulraheem, Anyanwu Lofty John Chukwuemeka, Aminu Mohammad, Lawal Abdullahi, Farinyaro Aliyu, Aliyu Mohammed, Mustapha Abdulazeez, Sowande OA, Collins Adumah, Ademola Talabi, Omolara M. Williams, Omolara Faboya, Olalekan Ajai, Abdulsalam Moruf, Roland I Osuoji, Adesoji Ademuyiwa, Felix Alakaloko, Chris Bode, Ihediwa Chibuike
Elebute Olumide Abiodun, Charles Ememonu, Justine Seyi-Olajide, ChidiogoUmeogu, Oluwaseun Ladipo-Ajayi, Sola Kushimo, Ibironke Desalu, Adebambo Olowu, Kayode Olayede, Taiwo Jones Olaoluwa, Odi Temitope, Lukman O.Abdur-Rahman, Abdulrasheed A. Nasir, James O.Adeniran, Nwosu D C, Alada M A, Shonubi A.M.O, Nwokoro Collins, IbukunoluOgundele, Lukmon Amosu, Charles Soo, Terlumun Patrick, Bassey Edem, Kayode Bamigbola, Anuoluwapo Aremo, Adenike Odewabi, OpeoluwaAdesanya, Stella Eguma, Akan Inyang, Ijeoma Esther Nwachukwu, Musa Ibrahim Zarenawa, Paschal Anyanwu, Emmanuel Ameh, Matthias Igoche, Osagie Olabisi, Samson Olori, Sholadoye Tunde Talib, Elizabeth Ogboli-Nwasor, Baba Suleiman, Taiwo Lawal, Olakayode Ogundoyin, Dare Olulana, Bashir Bello Mohammed, Basheer Abdullahi Jabo, Lukong Christopher Suiye, Philemon Okoro, Tobin Maxwell, Alfred T Argo, Ijeoma C Obianyo, Nene Obianyo, Christopher C Amah, Nwankwo Elochukwu Perpetua, Ezomike Uchechukwu, Jideofor Okechukwu Ugwu, Okechukwu HyginusEkwunife, Victor Ifeanyichikwu Modekwe, Chuka Ifeanyichukwu Ugwunne
Ngozi Chidinma Osuji, Obiechina Sylvester Okwuchukwu, EzidiegwuUgochukwu Stanley, Felix Kumolalo, Akinlabi Emmanuel Ajao, Michael Abel Alao, Olayemi Anthony Ajiboye, Odion-obomhense kesiena Helen, WabadaSamuel, Sharon Cox, Toru Shimizu, Babalwa Nondela, Milind Chitnis, NayhaGautam, Mie Elsen, Andrew Grieve, Jerome Loveland, Robert Jaich, Andre Theron, Stephanie Van Straten, Seo-Hwa Chung, Savannah Smit, Charles Carapinha, Daniel Sidler, Kondjela Sara Hamunyela, Corne De Vos, Ria Naidoo, Arasha Thotharam, Roel Matos-Puig, Damian Clarke, HansrajMangray, S Harilal, Zaitun M Bokhary, Robert Bahati, Yona Ringo, Peter Dattani, Silas Msangi, Ezekiel Kambona, Eric Borgstein, Emma Thompson, Johannes Verweij, Biplab Nandi, Caroline Melhado, Bitiel Banda, AbdelbasitE Ali, Enas Musa Ismail, Ali Hamad, Michael Ganey, Sinkeet Ranketi, Robert K Parker, Mike Mwachiro, Thomas Kirengo, Joy Robinson, Ted Sugimoto, Riikka Valjakka, Afua Hesse, William Appeadu-Mensah, Samuel Osei-Nketiah, Stephen Tabiri, Paul M. Wondoh, Theophilus Teddy Kojo Anyomih, Anwar Sadat Seidu, Adakudugu Ida M, Martin Kyere, Francis AtidanaAbantanga, Emmanuel Owusu Abem, Osman Imoro, James A. Brown
Moses Kasumba, Steve Kyota, Miliard Derbew, Mesay Hailemariam Asfaw, Amezene Tadesse, Samuel Negash, Hanna Getachew, Tihitiena Negussie, Gudeta Didi, Woubedil Kiflu, Fiseha Temesgen, Phyllis Kisa, John Sekabira, Nasser Kakembo, Mary T Nabukenya, Rae Oranmore-Brown, Bruce Bvulani, Mulewa Mulenga, Emma Lillie, Victoria Simiyu, Hope Phiri, Tungamirai Gwatirisa, Bothwell Mbuwayesango, Rouma Bankole, Moulot Olivier, Agbara Kouame, Manuela Ehua, Nandiolo Rose, Bertille Ki, Albert Wandaogo, Béré Bernadette, Tapsoba Tousiant, Kabre Yvette, BandréEmile, Luc Malemo, Jacques Fadhili Bake, Elisee Bake, Ag GbenouAntoine Seraphin, Moustapha Helle, Hamza Sama, Gnassingbé, Mohakhelha Nyamulani, Faturoti Olubukola, Andrew Shitta, John Chinda, Faruk A Suleiman, Innocent Igwilo, Alwanlehi Eighemhenrio, Okafor David, Larry Akoko, Allan Kochi, Rashmi Kumar, Intisar Hisham, Connie Keung, Michael Amoah, Boateng Nimako, Alagie Manneh, Goutam Chowdhury, Joseph Lule, Ainhoa Costas-Chavarri, Emmanuel Kayibanda, IyekeoretinEvbuomwan, Eugene Zoumenou, Ebassa Karl , Heuric Rakotomalala, Fatuga Adedeji, Anne Wesonga, Robert Kuremu, Houessou Gandjehou, Reitze Rodseth, Tihitena Negussie Mammo, Habou Oumarou.
