Society of Black Academic SurgeonsPediatric intestinal obstruction in Malawi: characteristics and outcomes
Section snippets
Methods
This is a retrospective analysis of a pediatric surgery database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi.14 The data for the pediatric surgery database were collected between February 2012 and June 2014. The database consists of all admitted patients age less than or equal to 18 years with a surgical diagnosis and admitted to a pediatric surgical ward, or having surgical consultation. Patients were deemed to have an IO based on either admission or final diagnosis.
KCH is a 600-bed
Results
A total of 3,407 children met inclusion criteria into the pediatric surgery database during the study period. Of these, 130 (3.8%) children were found to have a diagnosis of IO, based on admission or final diagnosis. Of the patients with a diagnosis of IO, 74 (57%) patients were male with a mean age of 3.5 ± 4.1 years, and the mean hospital LOS was 13 ± 13.7 days. Mortality rate for patients with and without IO in the database was 3% and .4%, respectively (Table 1).
The leading causes of IO were
Comments
IO is a large contributor to pediatric surgical disease in SSA, and patterns of IO differ by region. In West Africa, several studies, particularly from Nigeria, reveal the varying etiopathogenesis of IO in this region where leading causes of IO include intussusception and typhoid perforation.8, 15, 16 This differs from our study population where congenital causes were highest. The proportion of congenital causes in our study is similar to other regions, but we observed a higher rate of
Conclusions
IO continues to be a rampant source of morbidity and mortality in pediatric patients in Malawi. To address the burden of pediatric surgical diseases, attention must be paid to increasing the surgical workforce by increasing the numbers of physician and nonphysician providers in SSA. It is clear that increasing the number of pediatric surgeons in this resource poor region is unlikely. Therefore, efforts must be made to fully incorporate pediatric surgical training into general surgical training.
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There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.