Gastroschisis in Uganda: Opportunities for improved survival Anne S. Wesonga a , Tamara N. Fitzgerald b, ⁎, Ronald Kabuye a , Samuel Kirunda a , Monica Langer c , Nasser Kakembo a , Doruk Ozgediz d , John Sekabira a a Makerere University School of Medicine, Kampala, Uganda b Paul L. Foster School of Medicine, Texas Tech University, EI Paso, TX, United States c Tufts University School of Medicine and Maine Medical Center, Portland, ME, United States d Yale University School of Medicine, New Haven, CT, United States abstract article info Article history: Received 25 March 2016 Received in revised form 9 June 2016 Accepted 15 July 2016 Available online xxxx Key words: Gastroschisis Global health Neonatal surgery in Africa Purpose: Neonatal mortality from gastroschisis in sub-Saharan Africa is high, while in high-income countries, mortality is less than 5%. The purpose of this study was to describe the maternal and neonatal characteristics of gastroschisis in Uganda, estimate the mortality and elucidate opportunities for intervention. Methods: An ethics-approved, prospective cohort study was conducted over a one-year period. All babies pre- senting with gastroschisis in Mulago Hospital in Kampala, Uganda were enrolled and followed up to 30 days. Uni- variate and descriptive statistical analyses were performed on demographic, maternal, perinatal, and clinical outcome data. Results: 42 babies with gastroschisis presented during the study period. Mortality was 98% (n = 41). Maternal characteristics demonstrate a mean maternal age of 21.8 (±3.9) years, 40% (n = 15) were primiparous, and fewer than 10% (n = 4) of mothers reported a history of alcohol use, and all denied cigarette smoking and NSAID use. Despite 93% (n = 39) of mothers receiving prenatal care and 24% (n = 10) a prenatal ultrasound, cor- rect prenatal diagnosis was 2% (n = 1). Perinatal data show that 81% of deliveries occurred in a health facility. The majority of babies (58%) arrived at Mulago Hospital within 12 h of birth, however 52% were breastfeeding, 53% did not have intravenous access and only 19% had adequate bowel protection in place. Four patients (9%) arrived with gangrenous bowel. One patient, the only survivor, had primary closure. Average time to death was 4.8 days [range b 1 to 14 days]. Conclusion: The mortality of gastroschisis in Uganda is alarmingly high. Improving prenatal diagnosis and post- natal care of babies in a tertiary center may improve outcome. © 2016 Elsevier Inc. All rights reserved. 1. Background Gastroschisis is a congenital anomaly in which abdominal organs, primarily the small and large intestine, protrude through an uncovered defect in the anterior abdominal wall. Newborns with this defect re- quire emergent surgical intervention in the early neonatal period, ne- cessitating treatment in a tertiary care hospital with pediatric surgical services. The need for in-hospital delivery or emergent neonatal transfer highlights the importance of prenatal diagnosis in helping locate and plan perinatal care [1]. Gastroschisis is increasing throughout the world for unknown rea- sons [2–4]. As with several other congenital abnormalities, gastroschisis is diagnosed in the antenatal period more frequently because of the widespread use of maternal serum α-fetoprotein screening and obstet- ric ultrasonography [5]. In Uganda outcomes have been poor, with only rare survivors. There are reports of low-income countries with better outcomes, but available studies reveal consistently high mortality, rang- ing from 33% to 100% across sub-Saharan Africa [1,6,7]. With modern treatment, survival exceeds 90% in high-income countries [8]. The goal of this study was to describe the epidemiology of babies born with gastroschisis in Uganda. Understanding this condition begins with understanding maternal care and delivery conditions, with the aim of making an accurate prenatal diagnosis. Early diagnosis and maternal preparation for delivery at a tertiary center may improve outcomes in Uganda. 2. Methods A prospective cohort study was performed at Mulago Hospital in Kampala, Uganda. This is the only tertiary hospital in Uganda offering pediatric surgical services and also receives referrals from surrounding countries. All babies who presented with gastroschisis and their mothers were enrolled consecutively between February 2014 and Feb- ruary 2015. Approval for this study was obtained by the institutional re- view board at Makerere University School of Medicine. Informed Journal of Pediatric Surgery xxx (2016) xxx–xxx ⁎ Corresponding author at: Paul L. Foster School of Medicine, Texas Tech UHSC, 4800 Al- berta Avenue, El Paso, TX 79905, United States. E-mail address: tnfitz@hotmail.com (T.N. Fitzgerald). http://dx.doi.org/10.1016/j.jpedsurg.2016.07.011 0022-3468/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Wesonga AS, et al, Gastroschisis in Uganda: Opportunities for improved survival, J Pediatr Surg (2016), http://dx.doi.org/ 10.1016/j.jpedsurg.2016.07.011