Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh
Asian Journal of Pediatric Research,
Aims: While the developed world has significantly reduced mortality from surgical conditions in children, there is lack of adequate data on the outcome of children’s surgical conditions in the developing world. This study aims at assessing the spectrum of mortalities from children’s surgical conditions in a low-middle income country (LMIC).
Methods: Mortality data were collected for a period of 12 years (2008 to 2019) among 0 to12-year old children to analyse the diseases which had higher mortality trends, age -group specific mortality trends and categorize those according to body system.
Results: Among a total of 30,301 admitted children, 1228 (4.05%) patients died. Among them 53.01% were neonates, 20.28% were infants and 26.71% were children. Male to female ratio was 1.95:1. Mortality from neonatal surgical conditions was 24.21%. Infant mortality rate was 5.65% and child mortality rate was 1.41%. Neonatal surgical admission and mortality had a higher yearly trend. Anorectal malformation (ARM) was the most common cause of death (12.05%), followed by intestinal obstruction (11.40%) and gastroschisis (8.63%). Tracheo-oesophageal fistula/ oesophageal atresia (TOF/OA) had the highest mortality rate (83.33%), followed by gastroschisis (80.92%) and intestinal atresia (42.535) among the respective admissions. Other important causes of mortality were jejuno-ileal atresia (5.37%), trauma (5.05%), Hirschsprung disease (4.64%), intestinal perforation (4.48%), omphalocele (4.15%), burn (4.07%) and posterior urethral valves (PUV), 3.58%.
Conclusion: Overall mortality rate was much higher than developed countries and lower than some African countries. Neonatal mortality rate was very high and among them TOF/OA and gastroschisis had extremely high mortality rates.
- low-middle income countries
- global surgery
How to Cite
The Plos Medicine Editors. A Crucial Role for Surgery in Reaching the UN Millennium Development Goals. PLoS Medi. 2008;5:e 182. Available:https://doi.org/10.1371/journal.pmed.0050182
Ozgediz D, Poenaru D. The burden of pediatric surgical conditions in low- and middle- income countries: A call to action. J Pediatr Surg. 2012;47:2305–2311. Available:https://doi.org/10.1016/j.jpedsurg.2012.09.030
Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;340:829–835.
Dillon P, Hammermeister K, Morrato E, et al. Developing a NSQIP module to measure outcomes in children’s surgical care: Opportunity and challenge. 2008; 131–140. Available:https://doi.org/10.1053/j.sempedsurg.2008.02.009
Akbilgic O, Langham MR, Walter AI, et al. A novel risk classification system for 30-day mortality in children undergoing surgery. PLoS One. 2018;13:e0191176. Available:https://doi.org/dergoingsurgerhttps://doi.org/10.1371/journal. pone.0191176
Cheung M, Kakembo N, Rizgar N, et al. Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda. Pediatr Surg Int; 2019. Available:https://doi.org/10.1007/s00383-019-04520-2
UNICEF (2019) Levels & Trends in Child Mortality: Report; 2019. Available:https://www.unicef.org/sites/default/files/2019-10/UN-IGME-child-mortality-report-2019.pdf Accessed 5 August 2020.
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000 – 15: An updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;6736:1–9. Available:https://doi.org/10.1016/S0140-6736(16)31593-8
Ekenze SO, Ajuzieogu O V, Nwomeh BC. Challenges of management and outcome of neonatal surgery in Africa: A systematic review. Pediatr Surg Int. 2016;32:291–299. Available:https://doi.org/10.1007/s00383-016-3861-x
Tauro JK, Walker K, Halliday R, Jatana V TA. Trends in mortality in an Australian tertiary surgical neonatal intensive care unit. J Neonatal Surg. 2018;7. Available:https://doi.org/https://doi.org/10.21699/jns.v7i1.677
Yagi M, Asagiri MKK, Okada TIT. Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program. Pediatr Surg Int. 2015;31:955–962. Available:https://doi.org/10.1007/s00383-015-3775-z
Lee EJ CK. Mortality analysis of surgical neonates: A 20-year experience by a single surgeon. J Korean Assoc Pediatr Surg. 2012;12:137–146. Available:https://doi.org/10.13029/jkaps.2006.12.2.137
Abdul-mumin A, Anyomih TTK, Owusu SA, et al. Burden of neonatal surgical conditions in Northern Ghana. World J Surg. 2020;44:3–11. Available:https://doi.org/10.1007/s00268-019-05210-9
Ekenze SO, Modekwe VO, Ajuzieogu O V, et al. Neonatal surgery in a developing country: Outcome of co-ordinated interdisciplinary collaboration. J Paediatr Child Health. 2017;53:976–980. Available:https://doi.org/10.1111/jpc.13610
Livingston MH, Dcruz J, Pemberton J, et al. Mortality of pediatric surgical conditions in low-and middle- income countries in Africa. J Pediatr Surg. 2015;50:760–764. Available:https://doi.org/10.1016/j.jpedsurg.2015.02.031
Chirdan LB, Ucl DP, Ngiloi PJ, et al. Neonatal surgery in Africa. Semin Pediatr Surg. 2012;21:151–159. Available:https://doi.org/10.1053/j.sempedsurg.2012.01.007
NETS; 2020. Available:https://www.nets.org.au/ Accessed 6 Aug 2020.
Kozuki N, Guenther T, Vaz L, et al. A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia. BMC Public Health. 2015;989:1–9. Available:https://doi.org/10.1186/s12889-015-2330-0
Langford S, Field UKD, Deming DD, et al. Newborn transport around the world. Semin Neonatol. 1999;4. Available:https://doi.org/10.1053/siny.1999.0109
Bakker MK, Nassar N, Leoncini E, et al. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. Birth Defects Res. 2012;000:1–7. Available:https://doi.org/10.1002/bdra.23067
Islam MK. Experience of oesophageal atresia management in a tertiary Bangladeshi hospital. Acta Biomed. 2017; 88:445–449. Available:https://doi.org/10.23750/abm.v88i4.5743
Ford K, Poenaru D, Moulot O, et al. Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg; 2016. Available:https://doi.org/10.1016/j.jpedsurg.2016.02.090
Chang H, Chen J, Chang J, et al. Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis. PLoS One. 2017;12:1–14. Available:https://doi.org/10.1371/journal.pone.0171579
Bonasso PC, Dassinger MS, Ryan ML, et al. 24-hour and 30-day perioperative mortality in pediatric surgery Patrick. J Pediatr Surg; 2018. Available:https://doi.org/10.1016/j.jpedsurg.2018.06.026
Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries : The unborn child of global surgery. World J Surg. 2015;39: 36–40. Available:https://doi.org/10.1007/s00268-014-2714-9
Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development; 2015. Available:https://doi.org/10.1016/j.ijoa.2015.09.006
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