Epidemiology of surgically correctable gastrointestinal disease among neonates in Cape Town, South Africa
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground/Purpose A large percentage of neonatal surgery involves gastrointestinal (GI) disease with high disability indexes, leaving opportunity for significant disability-adjusted life year (DALY) reduction in lowmiddle income countries (LMICs). We aimed to evaluate the impact individual neonatal GI diagnoses and their procedures have on LMIC health systems. Methods All neonates who presented with a surgical GI condition at 2 pediatric hospitals in Cape Town, South Africa from 2010-2011 were included and statistically analyzed by diagnosis, case numbers, and individual procedures. Results 118 neonates and 236 surgical procedures were analyzed. The most common overall diagnoses were anorectal malformations (ARM) (19.5%), necrotizing enterocolitis (NEC) (15.3%), and gastroschisis (9.3%). These same 3 diagnoses represented > 50% of overall total case load. Diagnoses of intestinal atresia, gastroschisis, and NEC were determined to have significantly higher mean number of procedures per patient (p = 0.002). Further, 35% of all procedures were related to stages of enterostomy/enterectomy and 18% of all procedures were determined minor in nature. Conclusions Our results demonstrate significant burden of congenital conditions with high risk of morbidity and mortality and provide evidence-basis for multi-level interventions. Additionally, our procedural results may improve resource allocation through proper referrals to higher levels of care and the opportunity for task-shifting minor procedures.