Skip to main content

Advertisement

SpringerLink
Log in

A retrospective review of gastroschisis epidemiology and referral patterns in northern Ghana

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To describe the epidemiology and referral patterns of gastroschisis patients in northern Ghana.

Methods

A hospital-based retrospective review was undertaken at Tamale Teaching Hospital (TTH) Neonatal Intensive Care Unit (NICU) between 2014 and 2019. Data from gastroschisis patients were compared to patients with other surgical diagnoses. Descriptive and inferential statistics were performed with SAS. Referral flow maps were made with ArcGIS.

Results

From a total of 360 neonates admitted with surgical conditions, 12 (3%) were diagnosed with gastroschisis. Around 91% (n = 10) of gastroschisis patients were referred from other hospitals, traveling 4 h, on average. Referral patterns showed gastroschisis patients were admitted from three regions, whereas patients with other surgical diagnoses were admitted from eight regions. Only 6% (12/201) of expected gastroschisis cases were reported during the 6-year period in all regions. All gastroschisis deaths occurred within the first week of life.

Conclusions

Improving access to surgical care and reducing neonatal mortality related to gastroschisis in northern Ghana is critical. This study provides a baseline to inform future gastroschisis interventions at TTH. Priority areas may include special management of low birth weight newborns, better referral systems, empowerment of community health workers, and increasing access to timely, affordable, and safe neonatal transport.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. CDC (2017) Facts about Gastroschisis | CDC. In: centers for disease control and prevention. https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html. Accessed 21 Jan 2020

  2. Ford K, Poenaru D, Moulot O et al (2016) Gastroschisis: bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg 51:1262–1267. https://doi.org/10.1016/j.jpedsurg.2016.02.090

    Article  PubMed  Google Scholar 

  3. Concepcion TL, Mohamed M, Hiltbrunn K et al (2020) Barriers to surgical care among children in Somaliland: an application of the three delays framework. World J Surg 44:1712–1718. https://doi.org/10.1007/s00268-020-05414-4

    Article  PubMed  Google Scholar 

  4. Scott JW, Lin Y, Ntakiyiruta G et al (2018) Contextual challenges to safe surgery in a resource-limited setting: a multicenter, multiprofessional qualitative study. Ann Surg 267:461–467. https://doi.org/10.1097/SLA.0000000000002193

    Article  PubMed  Google Scholar 

  5. Lindemann J, Jonas E, Kotze U, Krige JEJ (2020) Evolution of bile duct repair in a low and middle-income country (LMIC): a comparison of diagnosis, referral, management and outcomes in repair of bile duct injury after laparoscopic cholecystectomy from 1991 to 2004 and 2005–2017. HPB (Oxford) 22:391–397. https://doi.org/10.1016/j.hpb.2019.07.009

    Article  Google Scholar 

  6. Santiago-Munoz PC, McIntire DD, Barber RG et al (2007) Outcomes of pregnancies with fetal gastroschisis. Obstet Gynecol 110:663–668. https://doi.org/10.1097/01.AOG.0000277264.63736.7e

    Article  PubMed  Google Scholar 

  7. Baerg J, Kaban G, Tonita J et al (2003) Gastroschisis: a sixteen-year review. J Pediatr Surg 38:771–774. https://doi.org/10.1016/jpsu.2003.50164

    Article  CAS  PubMed  Google Scholar 

  8. World Bank Ghana | Data. https://data.worldbank.org/country/GH. Accessed 1 Jul 2020

  9. Ghana Statistical Service (2015) Ghana demographic and health survey 2014. https://dhsprogram.com/publications/publication-FR307-DHS-Final-Reports.cfm. Accessed 24 Jul 2020

  10. Ghana Multiple Indicator Cluster Survey. https://www.unicef.org/ghana/reports/ghana-multiple-indicator-cluster-survey. Accessed 24 Jul 2020

  11. WHO (2018) WHO | Global Health Observatory. In: WHO | Global Health Observatory. http://apps.who.int/gho/portal/hss-v3.jsp. Accessed 9 Sep 2019

  12. WHO Ghana 2018 Annual Report. In: WHO | Regional Office for Africa. https://www.afro.who.int/publications/who-ghana-2018-annual-report. Accessed 24 Jul 2020

  13. African Development Bank (2019) Ghana - Country Strategy Paper 2019–2023. In: African Development Bank - Building today, a better Africa tomorrow. https://www.afdb.org/en/documents/document/ghana-country-strategy-paper-2019-2023-110049. Accessed 29 Aug 2020

  14. Ministry of Health G (2014) Ghana national newborn health strategy and action plan 2014–2018. https://www.healthynewbornnetwork.org/hnn-content/uploads/FINAL_Ghana-Newborn_Strategy_2014July10.pdf. Accessed 29 Aug 2020

  15. Althabe F, Howson CP, Kinney M et al (2012) Born too soon: the global action report on preterm birth. WHO 4:12–23

    Google Scholar 

  16. World Bank Birth rate, crude (per 1000 people) - Ghana | Data. https://data.worldbank.org/indicator/SP.DYN.CBRT.IN?locations=GH. Accessed 29 Aug 2020

  17. City Population Ghana: Regions, Major Cities and Urban Localities - Population Statistics, Maps, Charts, Weather and Web Information. https://www.citypopulation.de/en/ghana/cities/. Accessed 29 Aug 2020

  18. Brebner A, Czuzoj-Shulman N, Abenhaim HA (2020) Prevalence and predictors of mortality in gastroschisis: a population-based study of 4803 cases in the USA. J Matern Fetal Neonatal Med 33:1725–1731. https://doi.org/10.1080/14767058.2018.1529163

    Article  PubMed  Google Scholar 

  19. Badrinath R, Kakembo N, Kisa P et al (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda. J Pediatr Surg 49:1825–1830. https://doi.org/10.1016/j.jpedsurg.2014.09.031

    Article  PubMed  Google Scholar 

  20. Abdul-Mumin A, Anyomih TTK, Owusu SA et al (2020) Burden of neonatal surgical conditions in Northern Ghana. World J Surg 44:3–11. https://doi.org/10.1007/s00268-019-05210-9

    Article  PubMed  Google Scholar 

  21. Wright NJ, Zani A, Ade-Ajayi N (2015) Epidemiology, management and outcome of gastroschisis in Sub-Saharan Africa: results of an international survey. Afr J Paediatr Surg 12:1–6. https://doi.org/10.4103/0189-6725.150924

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sekabira J, Hadley GP (2009) Gastroschisis: a third world perspective. Pediatr Surg Int 25:327–329. https://doi.org/10.1007/s00383-009-2348-4

    Article  CAS  PubMed  Google Scholar 

  23. Wesonga AS, Fitzgerald TN, Kabuye R et al (2016) Gastroschisis in Uganda: opportunities for improved survival. J Pediatr Surg 51:1772–1777. https://doi.org/10.1016/j.jpedsurg.2016.07.011

    Article  PubMed  Google Scholar 

  24. Apfeld JC, Wren SM, Macheka N et al (2015) Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe. Surgery 158:1475–1480. https://doi.org/10.1016/j.surg.2015.04.037

    Article  PubMed  Google Scholar 

  25. Wright NJ, Sekabira J, Ade-Ajayi N (2018) Care of infants with gastroschisis in low-resource settings. Semin Pediatr Surg 27:321–326. https://doi.org/10.1053/j.sempedsurg.2018.08.004

    Article  PubMed  PubMed Central  Google Scholar 

  26. Blakelock RT, Upadbyay V, Pease PWB, Harding JE (1997) Are babies with gastroschisis small for gestational age? Pediatr Surg Int 12:580–582. https://doi.org/10.1007/BF01371903

    Article  CAS  PubMed  Google Scholar 

  27. Payne NR, Simonton SC, Olsen S et al (2011) Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause. BMC Pediatr 11:90–90. https://doi.org/10.1186/1471-2431-11-90

    Article  PubMed  PubMed Central  Google Scholar 

  28. Grant NH, Dorling J, Thornton JG, Thornton JG (2013) Elective preterm birth for fetal gastroschisis. Cochrane Database Syst Rev 203:CD009394–CD009394. https://doi.org/10.1002/14651858.CD009394.pub2

    Article  Google Scholar 

  29. Harper LM, Goetzinger KR, Biggio JR, Macones GA (2015) Timing of elective delivery in gastroschisis: a decision and cost-effectiveness analysis. Ultrasound Obstet Gynecol 46:227–232. https://doi.org/10.1002/uog.14721

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Carnaghan H, Pereira S, James CP et al (2014) Is early delivery beneficial in gastroschisis? J Pediatr Surg 49:928–933. https://doi.org/10.1016/j.jpedsurg.2014.01.027

    Article  PubMed  Google Scholar 

  31. Meara JG, Leather AJM, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 386:569–624. https://doi.org/10.1016/S0140-6736(15)60160-X

    Article  Google Scholar 

  32. Gething PW, Johnson FA, Frempong-Ainguah F et al (2012) Geographical access to care at birth in Ghana: a barrier to safe motherhood. BMC Public Health 12:991. https://doi.org/10.1186/1471-2458-12-991

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kuupiel D, Adu KM, Bawontuo V, Mashamba-Thompson TP (2019) Geographical accessibility to district hospitals/medical laboratories for comprehensive antenatal point-of-care diagnostic services in the upper east region, Ghana. EClinicalMedicine 13:74–80. https://doi.org/10.1016/j.eclinm.2019.06.015

    Article  PubMed  PubMed Central  Google Scholar 

  34. Iliff PJ (1990) Neonatal surgery in Harare Hospital. Cent Afr J Med 36:11–15

    CAS  PubMed  Google Scholar 

  35. Di Lorenzo M, Yazbeck S, Ducharme JC (1987) Gastroschisis: a 15-year experience. J Pediatr Surg 22:710–712. https://doi.org/10.1016/s0022-3468(87)80610-3

    Article  PubMed  Google Scholar 

  36. Abdur-Rahman LO, Abdulrasheed NA, Adeniran JO (2011) Challenges and outcomes of management of anterior abdominal wall defects in a Nigerian tertiary hospital. Afr J Paediatr Surg 8:159–163. https://doi.org/10.4103/0189-6725.86053

    Article  PubMed  Google Scholar 

  37. Oyinloye AO, Abubakar AM, Wabada S, Oyebanji LO (2020) Challenges and outcome of management of gastroschisis at a tertiary institution in North-Eastern Nigeria. Front Surg. https://doi.org/10.3389/fsurg.2020.00008

    Article  PubMed  PubMed Central  Google Scholar 

  38. Manson J, Ameh E, Canvassar N et al (2012) Gastroschisis: a multi-centre comparison of management and outcome. Afr J Paediatr Surg 9:17–21. https://doi.org/10.4103/0189-6725.93296

    Article  PubMed  Google Scholar 

  39. Bradnock TJ, Marven S, Owen A et al (2011) Gastroschisis: one year outcomes from national cohort study. BMJ. https://doi.org/10.1136/bmj.d6749

    Article  PubMed  PubMed Central  Google Scholar 

  40. Harahap NC, Handayani PW, Hidayanto AN (2019) Barriers and technologies of maternal and neonatal referral system in developing countries: a narrative review. Inform Med Unlocked 15:100184. https://doi.org/10.1016/j.imu.2019.100184

    Article  Google Scholar 

  41. Daniels AA, Abuosi A (2020) Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana. BMC Health Serv Res. https://doi.org/10.1186/s12913-020-4886-3

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hadley GP, Mars M (2001) Improving neonatal transport in the Third World–technology or teaching? S Afr J Surg 39:122–124

    CAS  PubMed  Google Scholar 

  43. World Health Organization WHO | Module 9. Studying the Health Network. In: WHO. https://www.who.int/hac/techguidance/tools/disrupted_sectors/module_09/en/index4.html. Accessed 17 Sep 2020

  44. Wagner AL, Xia L, Pandey P et al (2018) Risk factors during pregnancy and early childhood in rural West Bengal, India: a feasibility study implemented via trained community health workers using mobile data collection devices. Matern Child Health J 22:1286–1296. https://doi.org/10.1007/s10995-018-2509-y

    Article  PubMed  Google Scholar 

  45. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA (2005) Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 115:519–617. https://doi.org/10.1542/peds.2004-1441

    Article  PubMed  Google Scholar 

  46. Geldsetzer P, Mboggo E, Larson E et al (2019) Community health workers to improve uptake of maternal healthcare services: a cluster-randomized pragmatic trial in Dar es Salaam. Tanzania PLoS Med 16:e1002768. https://doi.org/10.1371/journal.pmed.1002768

    Article  PubMed  Google Scholar 

  47. Ngabo F, Nguimfack J, Nwaigwe F et al (2012) Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda. Pan Afr Med J 13:123–142

    Google Scholar 

  48. Becker DM, Tafoya CA, Becker SL et al (2016) The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 21:294–311. https://doi.org/10.1111/tmi.12657

    Article  PubMed  Google Scholar 

  49. Goley SM, Sakula-Barry S, Kelly A, Wright N (2019) Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: systematic review protocol. BMJ Paediatr Open. https://doi.org/10.1136/bmjpo-2019-000538

    Article  PubMed  PubMed Central  Google Scholar 

  50. Goldenberg RL, Nathan RO, Swanson D et al (2018) Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG 125:1591–1599. https://doi.org/10.1111/1471-0528.15287

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Nwanna-Nzewunwa OC, Kouo Ngamby M, Shetter E et al (2019) Informing pre-hospital care planning using pilot trauma registry data in Yaoundé, Cameroon. Eur J Trauma Emerg Surg 45:877–884. https://doi.org/10.1007/s00068-018-0939-2

    Article  PubMed  Google Scholar 

  52. Pittalis C, Brugha R, Gajewski J (2019) Surgical referral systems in low- and middle-income countries: a review of the evidence. PLoS ONE 14:e0223328. https://doi.org/10.1371/journal.pone.0223328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Fleming M, King C, Rajeev S et al (2017) Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal. BMC Health Serv Res 17:676. https://doi.org/10.1186/s12913-017-2624-2

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kironji AG, Hodkinson P, de Ramirez SS et al (2018) Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review. BMC Health Serv Res 18:291. https://doi.org/10.1186/s12913-018-3091-0

    Article  PubMed  PubMed Central  Google Scholar 

  55. Hussein J, Kanguru L, Astin M, Munjanja S (2012) The effectiveness of emergency obstetric referral interventions in developing country settings: a systematic review. PLoS Med. https://doi.org/10.1371/journal.pmed.1001264

    Article  PubMed  PubMed Central  Google Scholar 

  56. Wright N, Abantanga F, Amoah M et al (2019) Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 4:7–12. https://doi.org/10.12688/wellcomeopenres.15113.1

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge all staff of the Neonatal Intensive Care Unit (NICU) and the Head of Research and Development Department, Mr. Alhassan Mohammed Shamudeen, of the Tamale Teaching Hospital.

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana

    Alhassan Abdul-Mumin, Francis A. Abantanga & Stephen Tabiri

  2. Tamale Teaching Hospital, Salaga Road, Tamale, Ghana

    Alhassan Abdul-Mumin, Sheila A. Owusu, Francis A. Abantanga & Stephen Tabiri

  3. Department of Public Health, Robbins College of Health and Human Services, Baylor University, 1621 S. 5th Street, Waco, TX, 76706, USA

    Cesia Cotache-Condor, Andie Grimm & Emily R. Smith

  4. King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Science, King’s College London, London, SE5 9RJ, UK

    Naomi Wright

  5. Duke Global Health Institute, Duke University, Durham, NC, USA

    Emily R. Smith

  6. Sissala West District Hospital, Upper West Region, Gwollu, Ghana

    Haruna Mahama

Authors
  1. Alhassan Abdul-Mumin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cesia Cotache-Condor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheila A. Owusu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andie Grimm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haruna Mahama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naomi Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francis A. Abantanga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Emily R. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stephen Tabiri
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Global Initiative for Children Surgery

Contributions

Data collection: SAO and HM; conceptualization: AA-M, ERS, and CC-C, ST; methodology: AA-M, ERS, CC-C, and ST; formal analysis and investigation: CC-C; writing—original draft preparation: CC-C and AG; writing—review and editing: AA-M, ERS, CC-C, AG, NW, FAA, SO, HM, and ST: supervision: AA-M and ERS.

Corresponding author

Correspondence to Emily R. Smith.

Ethics declarations

Conflict of interest

None.

Ethical approval

Permission and ethical clearance to conduct this retrospective chart review was granted by the research and development department and the Ethical Review Committee of the TTH. As this was a retrospective study, there were no contacts between patients/relatives and investigators.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdul-Mumin, A., Cotache-Condor, C., Owusu, S.A. et al. A retrospective review of gastroschisis epidemiology and referral patterns in northern Ghana. Pediatr Surg Int 37, 1069–1078 (2021). https://doi.org/10.1007/s00383-021-04898-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-04898-y

Keywords

Search

Navigation