A. Yap2, A. Muzira3, D. Ozgediz2, T. N. Fitzgerald1 1Duke University Medical Center,Surgery,Durham, NC, USA 2Yale University School Of Medicine,Surgery,New Haven, CT, USA 3Mulago Hospital,Pediatric Surgery,Kampala, KAMPALA, Uganda
Introduction: Children in sub-Saharan Africa lack access to surgical care and few studies have documented the state of congenital colorectal surgery in low-income countries. Delay in diagnosis and treatment of these conditions is associated with significant morbidity and mortality.
Methods: A retrospective chart review was completed for children with anorectal malformations (ARM) and Hirschsprung’s Disease (HD) presenting to Mulago Hospital in Kampala, Uganda. Primary outcomes were prevalence of disease, presentation delay and surgical delay. These conditions are treated in 3 stages in this setting (colostomy formation, definitive surgery and colostomy takedown) and Mulago Hospital was the sole provider of definitive surgery in Uganda during this time frame. Definitive surgery was defined as receiving a PSARP or anorectal pull-through procedure and surgical completion was achieved with colostomy takedown.
Results: 92 patients were included over a 2-year period. 54 patients (59%) were male. Most patients came from the tribes of Ganda (n=32, 35%) and Soga (n=18, 20%), while these tribes make up only 16% and 9% of the population, respectively. 81 (88%) patients presented initially to a pediatric surgery referral center for colostomy placement, while the remainder presented to local hospitals. There were 20 (22%) patients with HD and 72 (78%) patients with ARM. Patients with ARM presented late for colostomy (median 5 days, [1 day – 1 year]), but late presentation for HD was more severe (median 1 year, [4 days – 7.6 years]). The median wait time for definitive surgery was 37 weeks [0 days – 7 year]). The median wait time for surgical completion was 2 years [23 weeks to 13 years]. 40 (43%) children are still waiting for definitive surgery and 59 (64%) waiting for surgical completion. The most common complication was neo-anal or anastomotic stenosis, occurring in 8 patients (9%).
Conclusion: Children with HD and ARM lack access to timely surgical care in Uganda. When accounting for misplaced medical records and children who do not present for care, this study likely represents a fraction of the burden of congenital colorectal disease in Uganda.
