A Pilot Study to Advance Task-Sharing of Gastroschisis Management in Uganda.

Introduction: Gastroschisis mortality in Africa is high partly due to delays in care. In Uganda, skilled birth attendants (SBAs) are the first point-of-contact for most babies, and with proper training, may be willing to participate in surgical task-sharing. Objective: Empower Ugandan skilled birth attendants with the knowledge and practical skills needed to care for babies with gastroschisis. Methods: Ugandan SBAs completed a one-day gastroschisis course, and resident physicians also requested to participate. A pre- and post-course test was administered to assess gastroschisis knowledge and confidence. Findings: A total of 69 SBAs (44 midwives, 25 nurses) and 17 residents participated. Participants were predominantly female (n = 64, 74%) with a median of 9 years of work experience. There was significant knowledge increase from pre- to post-course regarding differentiating gastroschisis from omphalocele (SBA 39% to 70%, p < 0.001; resident 48% to 77%, p < 0.001), gastroschisis incidence and outcomes (SBA 56% to 87%, p < 0.001; resident 65% to 89%, p < 0.001), risk factors (SBA 66% to 89%, p < 0.001; resident 67% to 86%, p < 0.0026), treatment (SBA 57% to 84%, p < 0.001; resident 63% to 79%, p < 0.001), and importance of community education (SBA 54% to 59%, p < 0.006; resident 56% to 65%, p < 0.0413). Only SBAs showed a significant increase in prenatal diagnosis (74% to 88%, p < 0.001). There was a significant boost in SBA clinical management confidence from 39% to 88%. Conclusion: A one-day training course can enable Ugandan SBAs to serve as task-sharers for babies with gastroschisis. While residents benefited, a future course should be developed for their learning needs. Continuing education is needed to ensure knowledge retention and clinical preparedness. Assessment of gastroschisis outcomes is necessary to determine if involving SBAs can improve survival.

Duke Scholars

Author Tamara Noel Fitzgerald Surgery, Pediatric General Surgery