Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

Abstract

Introduction/purpose

The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited.

Methods

Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016.

Results

2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung’s, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%).

Conclusion

There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.

Appendices

Appendix 1: Data fields

Demographic information	Admission information	Disposition
Patient ID	Ward of admission	Outcome
Date patient case logged	Chief complaint on admission	Transfer
Patient serial number	Duration of symptoms	Discharge date
Patient name	Complications	Total days hospitalized
Date of birth	Complication type	Last update to notes
Date of admission	Final diagnosis
Age	Disease code
Sex	Disease category
Tribe	Surgical management
Village	Date of surgery
District	Surgical code
Distance traveled
Mode of referral
Phone number

Appendix 2: Pediatric surgical conditions collected in database

Code	Condition
1	High anorectal malformation
2	Vestibular anus
3	Other low anorectal malformations
4	Hirschsprung’s disease
5	Intussusception
6	Sacrococcygeal teratoma
7	Other teratomas
8	Wilms tumor
9	Biliary atresia
10	Gastroschisis
11	Omphalocele
12	Burkitt’s lymphoma
13	Other lymphomas
14	Umbilical hernia
15	Inguinal hernia
16	Hydrocele
17	Blunt abdominal trauma
18	Splenic rupture
19	Other forms of trauma
20	Necrotizing fasciitis
21	Abscess/cellulitis
22	Rectal prolapse
23	Pyloric stenosis
24	Hemangioma
25	Constipation/fecal impaction
26	Esophageal atresia with TOF
27	Duodenal obstruction
28	Jejunal atresia
29	Ileal atresia
30	Colonic atresia
31	Cloaca
32	Cystic hygroma/lymphatic malformation
33	Appendicitis
34	GERD
35	Primary peritonitis
36	Typhoid ileal perforation
37	Ovarian tumors
38	Cloacal exstrophy
39	Post-circumcision hemorrhage or sepsis
40	Prune belly syndrome
41	Thyroglossal duct cyst
42	Mesenteric cysts
43	Undescended testicle
44	Rhabdomyosarcoma
45	Choledochal cyst
46	Conjoint twins
00	Other non-coded conditions

Appendix 3: Surgical codes

Code	Type of surgery
1	Colostomy creation
2	Ileostomy creation
3	Stoma refashioning
4	Colostomy closure
5	Ileostomy closure
6	Hydrocelectomy
7	Herniotomy
8	Herniotomy and resection and anastomosis
9	Swenson procedure
10	Soave procedure
11	Duhamel procedure
12	Pull through and closure of stoma
13	Rectal biopsy
14	Excision/trucut biopsy
15	Colostomy and rectal biopsy
16	PSARP
17	PSARP and SCT excision
18	Anoplasty
19	EUA and dilatation
20	Incision and drainage, skin graft, and debridement
21	Laparotomy
22	Laparotomy and reduction
23	Laparotomy, resection, and stoma
24	Laparotomy, resection, and anastomosis
25	Laparotomy, drainage, and lavage
26	Laparotomy and splenectomy
27	Laparotomy and excision
28	Laparotomy reduction and anastomosis
29	Duodenoduodenostomy
30	Duodenal web excision
31	Excision of SCT
32	Gastrojejunostomy
33	Cystgastrostomy
34	Orchiopexy
35	Appendectomy
36	Plication of rectal prolapse
37	Redo circumcision
38	Redo PSARP
39	Nephrectomy
40	Pyloromyotomy
41	Umbilical/epigastric hernia repair
42	Excision of splenic cyst
43	Kasai procedure
44	Omphalocele repair
45	Gastroschisis repair
46	Rectal polyp excision
47	Esophageal atresia and TOF repair
48	Emergency separation of twins
49	Posterior sagittal anorecto-vagino-urethroplasty
50	Lavage and tension sutures