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Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.

Publication ,  Journal Article
Fuller, AT; Haglund, MM; Lim, S; Mukasa, J; Muhumuza, M; Kiryabwire, J; Ssenyonjo, H; Smith, ER
Published in: World Neurosurg
November 2016

OBJECTIVE: Pediatric neurosurgical cases have been identified as an important target for impacting health disparities in Uganda, with over 50% of the population being less than 15 years of age. The objective of the present study was to evaluate the effects of the Duke-Mulago collaboration on pediatric neurosurgical outcomes in Mulago National Referral Hospital. METHODS: We performed retrospective analysis of all pediatric neurosurgical cases who presented at Mulago National Referral Hospital in Kampala, Uganda, to examine overall, preprogram (2005-2007), and postprogram (2008-2013) outcomes. We analyzed mortality, presurgical infections, postsurgical infections, length of stay, types of procedures, and significant predictors of mortality. Data on neurosurgical cases was collected from surgical logbooks, patient charts, and Mulago National Referral Hospital's yearly death registry. RESULTS: Of 820 pediatric neurosurgical cases, outcome data were complete for 374 children. Among children who died within 30 days of a surgical procedure, the largest group was less than a year old (45%). Postinitiation of the Duke-Mulago collaboration, we identified an overall increase in procedures, with the greatest increase in cases with complex diagnoses. Although children ages 6-18 years of age were 6.66 times more likely to die than their younger counterparts preprogram, age was no longer a predictive variable postprogram. When comparing pre- and postprogram outcomes, mortality among pediatric patients within 30 days after a neurosurgical procedure increased from 4.3% to 10.0%, mortality after 30 days increased slightly from 4.9% to 5.0%, presurgical infections decreased by 4.6%, and postsurgery infections decreased slightly by 0.7%. CONCLUSIONS: Our data show the provision of more complex neurological procedures does not necessitate improved outcomes. Rather, combining these higher-level procedures with essential pre- and postoperative care and continued efforts in health system strengthening for pediatric neurosurgical care throughout Uganda will help to address and decrease the burden throughout the country.

Duke Scholars

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2016

Volume

95

Start / End Page

309 / 314

Location

United States

Related Subject Headings

  • Uganda
  • Treatment Outcome
  • Tertiary Care Centers
  • Pediatrics
  • Neurosurgical Procedures
  • Mortality
  • Male
  • Humans
  • Healthcare Disparities
  • Female
 

Citation

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Fuller, A. T., Haglund, M. M., Lim, S., Mukasa, J., Muhumuza, M., Kiryabwire, J., … Smith, E. R. (2016). Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda. World Neurosurg, 95, 309–314. https://doi.org/10.1016/j.wneu.2016.07.090
Fuller, Anthony T., Michael M. Haglund, Stephanie Lim, John Mukasa, Michael Muhumuza, Joel Kiryabwire, Hussein Ssenyonjo, and Emily R. Smith. “Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.World Neurosurg 95 (November 2016): 309–14. https://doi.org/10.1016/j.wneu.2016.07.090.
Fuller AT, Haglund MM, Lim S, Mukasa J, Muhumuza M, Kiryabwire J, et al. Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda. World Neurosurg. 2016 Nov;95:309–14.
Fuller, Anthony T., et al. “Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.World Neurosurg, vol. 95, Nov. 2016, pp. 309–14. Pubmed, doi:10.1016/j.wneu.2016.07.090.
Fuller AT, Haglund MM, Lim S, Mukasa J, Muhumuza M, Kiryabwire J, Ssenyonjo H, Smith ER. Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda. World Neurosurg. 2016 Nov;95:309–314.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

November 2016

Volume

95

Start / End Page

309 / 314

Location

United States

Related Subject Headings

  • Uganda
  • Treatment Outcome
  • Tertiary Care Centers
  • Pediatrics
  • Neurosurgical Procedures
  • Mortality
  • Male
  • Humans
  • Healthcare Disparities
  • Female