Prevalence of gastroschisis and its neonatal mortality in the Eastern Cape Province tertiary institutions.

Context: Gastroschisis is a common abdominal wall defect faced by paediatric surgeons worldwide. Early gastroschisis detection, access to improved neonatal intensive care, parenteral nutrition and surgical techniques have led to a reported improvement in mortality of between 4% and 8% in high-income countries. In low to middle income countries, such as in Southern Africa, however, there is as much as 84% mortality among patients with gastroschisis. This is thought to be due to factors such as lack of antenatal screening, access to neonatal intensive care services and parenteral nutrition. Aims: The purpose of this study was to calculate the prevalence of gastroschisis and report on its neonatal mortality in the Eastern Cape Province of South Africa. Settings and Design: A retrospective observational study on all neonates with gastroschisis, presenting to a tertiary facility offering paediatric surgical services within the Eastern Cape Province from 1 January 2016 to 31 December 2018. Subjects and Methods: A convenience sampling method was used in retrieving patient files for the study period. Statistical analysis used: Stata version 13. Results: Thirty-seven neonates were included in the study. The prevalence of gastroschisis ranged from 0.07% to 0.18% throughout the 3-year study. The majority (81%) of the neonates were outborn and delivered by mode of caesarean section. Nearly 60% (n = 22) were female. 54% (n = 20) of neonates died within the neonatal period. Conclusions: The majority of the neonates in this study were outborn and female. Although their mortality rate was higher than reported in high-income countries, it was much improved from what is reported in the low to middle income countries.

Clinical presentation and management of childhood intussusception in South Africa.

PURPOSE: We assessed management and outcomes for intussusception at nine academic hospitals in South Africa. METHODS: Patients ≤ 3 years presenting with intussusception between September 2013 and December 2017 were prospectively enrolled at all sites. Additionally, patients presenting between July 2012 and August 2013 were retrospectively enrolled at one site. Demographics, clinical information, diagnostic modality, reduction methods, surgical intervention and outcomes were reviewed. RESULTS: Four hundred seventy-six patients were enrolled, [54% males, median age 6.5 months (IQR 2.6-32.6)]. Vomiting (92%), bloody stool (91%), abdominal mass (57%), fever (32%) and a rectal mass (29%) represented advanced disease: median symptom duration was 3 days (IQR 1-4). Initial reduction attempts included pneumatic reduction (66%) and upfront surgery (32%). The overall non-surgical reduction rate was 28% and enema perforation rate was 4%. Surgery occurred in 334 (70%), 68 (20%) patients had perforated bowel, bowel resection was required in 61%. Complications included recurrence (2%) and nosocomial sepsis (4%). Length of stay (LOS) was significantly longer in patients who developed complications. Six patients died-a mortality rate of 1%. There was a significant difference in reduction rates, upfront surgery, bowel resection, LOS and mortality between centres with shorter symptom duration compared longer symptom duration. CONCLUSION: Delayed presentation was common and associated with low success for enema reduction, higher operative rates, higher rates of bowel resection and increased LOS. Improved primary health-care worker education and streamlining referral pathways might facilitate timely management.