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Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study.

Publication ,  Journal Article
Ullrich, SJ; Kakembo, N; Grabski, DF; Cheung, M; Kisa, P; Nabukenya, M; Tumukunde, J; Fitzgerald, TN; Langer, M; Situma, M; Sekabira, J; Ozgediz, D
Published in: J Surg Res
February 2020

BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS: A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS: For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS: Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.

Duke Scholars

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

February 2020

Volume

246

Start / End Page

93 / 99

Location

United States

Related Subject Headings

  • Uganda
  • Survival Rate
  • Surgical Procedures, Operative
  • Surgery
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Male
  • Infant, Newborn, Diseases
  • Infant, Newborn
  • Humans
 

Citation

APA
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ICMJE
MLA
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Ullrich, S. J., Kakembo, N., Grabski, D. F., Cheung, M., Kisa, P., Nabukenya, M., … Ozgediz, D. (2020). Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res, 246, 93–99. https://doi.org/10.1016/j.jss.2019.08.015
Ullrich, Sarah J., Nasser Kakembo, David F. Grabski, Maija Cheung, Phyllis Kisa, Mary Nabukenya, Janat Tumukunde, et al. “Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study.J Surg Res 246 (February 2020): 93–99. https://doi.org/10.1016/j.jss.2019.08.015.
Ullrich SJ, Kakembo N, Grabski DF, Cheung M, Kisa P, Nabukenya M, et al. Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res. 2020 Feb;246:93–9.
Ullrich, Sarah J., et al. “Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study.J Surg Res, vol. 246, Feb. 2020, pp. 93–99. Pubmed, doi:10.1016/j.jss.2019.08.015.
Ullrich SJ, Kakembo N, Grabski DF, Cheung M, Kisa P, Nabukenya M, Tumukunde J, Fitzgerald TN, Langer M, Situma M, Sekabira J, Ozgediz D. Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res. 2020 Feb;246:93–99.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

February 2020

Volume

246

Start / End Page

93 / 99

Location

United States

Related Subject Headings

  • Uganda
  • Survival Rate
  • Surgical Procedures, Operative
  • Surgery
  • Quality-Adjusted Life Years
  • Prospective Studies
  • Male
  • Infant, Newborn, Diseases
  • Infant, Newborn
  • Humans