Gastroschisis in Uganda: Opportunities for improved survival

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Study Justification:
The study aimed to investigate the high neonatal mortality rate from gastroschisis in Uganda, compared to the low mortality rate in high-income countries. By understanding the maternal and neonatal characteristics of gastroschisis in Uganda, the study sought to identify opportunities for intervention and improve survival rates.
Highlights:
– The study found that the mortality rate for babies with gastroschisis in Uganda was 98%.
– Maternal characteristics revealed a young average age of 21.8 years, with 40% being primiparous.
– Few mothers reported a history of alcohol use, smoking, or NSAID use.
– Despite a high percentage of mothers receiving prenatal care and ultrasounds, correct prenatal diagnosis was only 2%.
– Most deliveries occurred in a health facility, but many babies arrived at Mulago Hospital within 12 hours of birth.
– Challenges in postnatal care were identified, including a lack of breastfeeding, intravenous access, and adequate bowel protection.
– Only one patient survived, with an average time to death of 4.8 days.
Recommendations:
– Improve prenatal diagnosis of gastroschisis to ensure early detection and appropriate management.
– Enhance postnatal care in tertiary centers, focusing on breastfeeding support, intravenous access, and adequate bowel protection.
– Strengthen healthcare provider training to improve knowledge and skills in managing gastroschisis cases.
– Develop and implement protocols for the management of gangrenous bowel in gastroschisis patients.
– Increase awareness among policy makers and stakeholders about the high mortality rate of gastroschisis in Uganda and the need for intervention.
Key Role Players:
– Obstetricians and gynecologists
– Neonatologists
– Pediatric surgeons
– Nurses and midwives
– Ultrasound technicians
– Health educators
– Policy makers and government officials
– Non-governmental organizations (NGOs) working in maternal and child health
Cost Items for Planning Recommendations:
– Training programs for healthcare providers
– Equipment and supplies for prenatal diagnosis and postnatal care
– Development and dissemination of educational materials
– Implementation of protocols and guidelines
– Research and data collection
– Advocacy and awareness campaigns

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a prospective cohort study conducted over a one-year period, which provides valuable data. The sample size is relatively small with 42 babies, but it provides insights into the maternal and neonatal characteristics of gastroschisis in Uganda. The high mortality rate of 98% is a significant finding. The study also identifies opportunities for intervention, such as improving prenatal diagnosis and postnatal care in a tertiary center. To improve the strength of the evidence, future studies could consider increasing the sample size and conducting a longer-term study to gather more comprehensive data.

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 presenting with gastroschisis in Mulago Hospital in Kampala, Uganda were enrolled and followed up to 30 days. Univariate 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, correct 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 < 1 to 14 days]. Conclusion The mortality of gastroschisis in Uganda is alarmingly high. Improving prenatal diagnosis and postnatal care of babies in a tertiary center may improve outcome.

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Innovation 1: Development of a mobile prenatal screening app

Description: Develop a mobile application that provides pregnant women with access to prenatal screening information and resources. The app can include educational materials on gastroschisis, as well as a tool for healthcare providers to accurately identify the condition during routine ultrasounds. This app can also provide reminders for prenatal care appointments and offer a platform for pregnant women to ask questions and receive support from healthcare professionals.

Innovation 2: Telemedicine consultations for prenatal care

Description: Implement telemedicine consultations for pregnant women in remote areas of Uganda. This innovation would allow pregnant women to have virtual appointments with healthcare providers, reducing the need for long-distance travel and increasing access to prenatal care. During these consultations, healthcare providers can discuss prenatal screening options, including ultrasounds for gastroschisis, and provide guidance on healthy pregnancy practices.

Innovation 3: Training programs for healthcare providers

Description: Develop specialized training programs for healthcare providers in Uganda, focusing on prenatal diagnosis and postnatal care for babies with gastroschisis. These programs can include workshops, seminars, and hands-on training sessions to enhance the knowledge and skills of healthcare professionals. By improving their understanding of gastroschisis and its management, healthcare providers can provide better care and support to pregnant women and newborns.

Innovation 4: Strengthening referral systems

Description: Strengthen the referral systems between primary healthcare centers and tertiary centers in Uganda. This can be achieved by establishing clear protocols for the immediate referral and transportation of newborns with gastroschisis to tertiary centers equipped to provide specialized care. This innovation would ensure that babies with gastroschisis receive timely and appropriate treatment, increasing their chances of survival.

These innovations aim to improve access to maternal health by enhancing prenatal screening, increasing access to prenatal care, improving postnatal care in tertiary centers, and strengthening the knowledge and skills of healthcare providers. By implementing these innovations, it is expected that the mortality rate of gastroschisis in Uganda will decrease, ultimately improving the overall access to maternal health and the survival rates of newborns with this condition.
AI Innovations Description
Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Recommendation: Implement a comprehensive prenatal screening program for gastroschisis in Uganda, coupled with improved postnatal care in tertiary centers.

Explanation: The study highlights the high mortality rate of gastroschisis in Uganda, indicating a need for intervention. To address this issue, a comprehensive prenatal screening program should be established to improve the prenatal diagnosis of gastroschisis. This program should include routine prenatal ultrasounds and education for healthcare providers to accurately identify the condition. Additionally, efforts should be made to increase access to prenatal care for pregnant women, ensuring that a higher percentage of mothers receive proper care during pregnancy.

Furthermore, postnatal care in tertiary centers should be improved to enhance the survival chances of babies with gastroschisis. This can be achieved by implementing protocols for immediate referral and transportation of newborns with gastroschisis to these centers. Additionally, healthcare providers in tertiary centers should receive specialized training to provide appropriate care for babies with gastroschisis, including ensuring adequate bowel protection and intravenous access.

By implementing this recommendation, it is expected that the mortality rate of gastroschisis in Uganda will decrease, improving the overall access to maternal health and the survival rates of newborns with this condition.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Study Design: Conduct a prospective cohort study over a defined period, similar to the original study. Obtain ethical approval for the study design.

2. Sample Selection: Enroll all babies presenting with gastroschisis in Mulago Hospital in Kampala, Uganda, similar to the original study. Ensure that the sample size is sufficient to provide statistically significant results.

3. Intervention Implementation: Implement the recommended interventions, including the comprehensive prenatal screening program for gastroschisis and improved postnatal care in tertiary centers. Ensure that healthcare providers receive appropriate training and education on prenatal diagnosis and postnatal care for babies with gastroschisis.

4. Data Collection: Collect demographic, maternal, perinatal, and clinical outcome data for all enrolled babies. This includes information on maternal age, parity, prenatal care received, prenatal ultrasound, correct prenatal diagnosis, delivery location, time of arrival at the tertiary center, breastfeeding status, intravenous access, bowel protection, and any complications.

5. Data Analysis: Perform univariate and descriptive statistical analyses on the collected data. Compare the outcomes and characteristics of the babies before and after the implementation of the interventions. Calculate mortality rates, average time to death, and any other relevant outcome measures.

6. Interpretation of Results: Analyze the data to determine the impact of the recommended interventions on improving access to maternal health. Assess the changes in mortality rates, correct prenatal diagnosis rates, and the availability of postnatal care in tertiary centers.

7. Conclusion: Based on the results, draw conclusions about the effectiveness of the interventions in improving access to maternal health and reducing mortality rates for babies with gastroschisis in Uganda.

8. Publication: Publish the findings in a reputable journal, similar to the original study, to contribute to the existing body of knowledge on improving access to maternal health in resource-limited settings.

By following this methodology, researchers can assess the impact of the recommended interventions on improving access to maternal health and make evidence-based recommendations for future interventions.

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