Burden of Neonatal Surgical Conditions in Northern Ghana

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Abstract

Background

Congenital anomalies have risen to become the fifth leading cause of under-five mortality globally. The majority of deaths and disability occur in low- and middle-income countries including Ghana. This 3-year retrospective review aimed to define, for the first time, the characteristics and outcomes of neonatal surgical conditions in northern Ghana.

Methods

A retrospective study was conducted to include all admissions to the Tamale Teaching Hospital (TTH) neonatal intensive care unit (NICU) with surgical conditions between January 2014 and January 2017. Data were collected on demographics, diagnosis and outcomes. Descriptive analysis was performed on all data, and logistic regression was used to predict determinants of neonatal mortality. p < 0.05 was deemed significant.

Results

Three hundred and forty-seven neonates were included. Two hundred and sixty-one (75.2%) were aged 7 days or less at presentation, with males ( n = 177, 52%) slightly higher than females ( n = 165, 48%). The majority were delivered by spontaneous vaginal delivery ( n = 247, 88%); 191 (58%) were born in hospital. Congenital anomalies accounted for 302 (87%) of the neonatal surgical cases and 45 (96%) deaths. The most common anomalies were omphalocele ( n = 48, 13.8%), imperforate anus ( n = 34, 9.8%), intestinal obstruction ( n = 29, 8.4%), spina bifida ( n = 26, 7.5%) and hydrocephalus ( n = 19, 5.5%). The overall mortality rate was 13.5%. Two-thirds of the deaths ( n = 30) from congenital anomalies were conditions involving the digestive system with gastroschisis having the highest mortality of 88%. Omphalocele ( n = 11, 23.4%), gastroschisis ( n = 7, 14.9%) and imperforate anus ( n = 6, 12.8%) contributed to the most deaths. On multivariate analysis, low birthweight was significantly associated with mortality (OR 3.59, CI 1.4–9.5, p = 0.009).

Conclusion

Congenital anomalies are a major global health problem associated with high neonatal mortality in Ghana. The highest burden in terms of both caseload and mortality is attributed to congenital anomalies involving the digestive system, which should be targeted to improve outcomes.

Electronic supplementary material

The online version of this article (10.1007/s00268-019-05210-9) contains supplementary material, which is available to authorized users.

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Congenital Anomalies in Low- and Middle-Income Countries: The Unborn Child of Global Surgery

Nicole A. Sitkin, Doruk Ozgediz, Peter Donkor … (2014)

Surgically correctable congenital anomalies cause a substantial burden of global morbidity and mortality. These anomalies disproportionately affect children in low- and middle-income countries (LMICs) due to sociocultural, economic, and structural factors that limit the accessibility and quality of pediatric surgery. While data from LMICs are sparse, available evidence suggests that the true human and financial cost of congenital anomalies is grossly underestimated and that pediatric surgery is a cost-effective intervention with the potential to avert significant premature mortality and lifelong disability.

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Epidemiology of pediatric surgical needs in low-income countries

Elissa K. Butler, Tu Tran, Neeraja Nagarajan … (2017)

Objective According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs. Methods A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering. Results A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0–18 years of age) with median age of 8 (Interquartile range [IQR]: 4–13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns. Conclusion Surgery has been elevated as an “indivisible, indispensable part of health care” in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.

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Surgical care in low and middle-income countries: burden and barriers.

Rele Ologunde, Mahiben Maruthappu, Kumaran Shanmugarajah … (2014)

Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. Currently, efforts to improve surgical care are mainly coordinated by academia and intuitions with strong surgical and global health interests. However, with the involvement of various international organisations, policy makers, healthcare managers and other stakeholders, a collaborative approach can be achieved in order to accelerate progress towards improved and sustainable surgical care. In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally.

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Author and article information

Contributors

Naomi Wright: naomiwright@doctors.org.uk

Journal

Journal ID (nlm-ta): World J Surg

Journal ID (iso-abbrev): World J Surg

Title: World Journal of Surgery

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0364-2313

ISSN (Electronic): 1432-2323

Publication date (Electronic): 3 October 2019

Publication date PMC-release: 3 October 2019

Publication date (Print): 2020

Volume: 44

Issue: 1

Pages: 3-11

Affiliations

[1 ]GRID grid.442305.4, School of Medicine and Health Sciences, , University for Development Studies, ; Tamale, Ghana

[2 ]GRID grid.460777.5, ISNI 0000 0004 0374 4427, Tamale Teaching Hospital, ; Salaga Road, Tamale, Ghana

[3 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, , King’s College London, ; London, SE5 9RJ UK

[4 ]GRID grid.252890.4, ISNI 0000 0001 2111 2894, Department of Public Health, , Baylor University, ; 1301 S University Parks Dr, Waco, TX 76706 USA

[5 ]GRID grid.26009.3d, ISNI 0000 0004 1936 7961, Duke Global Health Institute, , Duke University, ; 310 Trent Dr, Durham, NC 27710 USA

Article

Publisher ID: 5210

DOI: 10.1007/s00268-019-05210-9

PMC ID: 6925064

PubMed ID: 31583459

SO-VID: d4270b9c-56ef-41f2-ad2f-893295b001d8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: 203905/Z/16/Z

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Burden of Neonatal Surgical Conditions in Northern Ghana

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Most cited references 30

Congenital Anomalies in Low- and Middle-Income Countries: The Unborn Child of Global Surgery

Epidemiology of pediatric surgical needs in low-income countries

Surgical care in low and middle-income countries: burden and barriers.

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