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Background Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival. Objective The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda. Methodology Children’s treatment charts and files diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confirmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities. Results One-year overall survival was found to be 59.3% (95% CI: 40.7–73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. Conclusion Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavorable histology and tumor size greater than 115 cm.

BackgroundEmergency abdominal surgeries (EASs) in children are often necessary to address life-threatening congenital and acquired conditions. This study aimed to determine short-term outcomes and predictors of in-hospital mortality after EAS in children at Mbarara Regional Referral Hospital (MRRH), South-Western Uganda.MethodsThis prospective study was conducted from June to September 2024 and included children aged 0–17 years who underwent EAS at MRRH. Outcomes measured were 30-day in-hospital mortality, complications, and length of hospital stay. Overall survival after EAS was plotted using Kaplan-Meier curves. Cox regression analysis was used to determine predictors of in-hospital mortality after EAS.ResultsThe 30-day mortality rate for all pediatric abdominal surgery was 152 per 10 000 person-days of hospitalization. Among 96children who required EAS at MRRH, the risk of death was significantly increased in those who had hypoxemia (adjusted hazard ratio (aHR) 12.4, p=0.011) and hypokalemia (aHR 5.02, p=0.044). Forty-one patients (42.7%) developed postoperative complications, the most common being surgical site infection (14.58%) and pneumonia (5.2%).ConclusionThe 30-day mortality rate after pediatric EAS in our setting is high and children who present with hypokalemia and hypoxemia are at increased risk of mortality after EAS.

[...]we feel that there is an urgent need to clearly define the term to standardize care for ARM across the globe and minimize morbidity and mortality. Consensus about the definition(s) of delayed presentation of this congenital condition would facilitate more reliable metrics of health system performance in managing the condition and provide a foundation for interventions to reduce delays, morbidity, and mortality. Newborn perineal examinations should be incorporated into all newborn guidelines/protocols for birth personnel and documented in postnatal charts. Late Presentation of Anorectal Malformations - A Dilemma in Modern World: Cross-sectional Analysis from a Tertiary Care Hospital, Pakistan.

Background Teenage and late presentation of anorectal malformations are not uncommon in developing world. Some of the reasons for late presentation include but not limited to illiteracy, poverty, lack of awareness, and limited trained pediatric surgeons. In rural areas, neonates with ARMs are considered cursed and are marginalized. Case 15-Year-old African girl (a munyankole by tribe in Uganda) from western Uganda presented at 15 years of life with colostomy and uncorrected anorectal malformation. Never went to school due to social stigma. Conclusion Due to limited number of trained pediatric surgeons in most of African Countries, many children in addition to living with a colostomy or untreated malformation, may also be undiagnosed with chronic constipation. Improved awareness and advocacy would promote early presentation and treatment.

IntroductionGastroschisis mortality is disproportionately high in Africa due in part to delayed presentation and limited surgical capacity. Skilled birth attendants (SBAs) are often the first to encounter these babies and can be an important part of their stabilisation. We assessed baseline Ugandan SBA knowledge of gastroschisis and interest in a training course.MethodsSouthwestern Ugandan SBAs were surveyed regarding practice patterns, common beliefs and training course interest. Data were analysed with descriptive statistics.ResultsWe recruited 121 participants (70 midwives, 51 nurses). Most had a certificate or diploma (n=117, 97%) and 85% had more than 3 years of experience (n=103). Eighty-seven (72%) SBAs had cared for babies with gastroschisis. Most reported that communities stigmatised families (n=67, 55%), saw the child as cursed (n=74, 61%), blamed the mother (n=69, 57%) and advised parents to kill (n=30, 24%) or abandon the child (n=55, 45%). Barriers to families seeking care included healthcare mistrust (n=3, 2%), hopelessness (n=37, 31%), lack of knowledge (n=51, 42%), transportation difficulties (n=54, 45%) and fear of impoverishment (n=84, 69%). Most SBAs were unsure of the cause of gastroschisis and only 6% (n=8) recognised fetal vascular interruption as the cause. While 57% (n=69) prioritised intestinal coverage, only 7% (n=9) and 5% (n=6) would place a nasogastric tube or fast the baby. Three midwives encouraged immediate breastfeeding. Antibiotics (n=22, 18%) and fluid resuscitation (n=19, 16%) were sometimes recommended. Most participants (n=119, 98%) desired a course on gastroschisis management, but 41% (n=50) reported time constraints as a barrier.ConclusionsSouthwestern Ugandan SBAs encounter gastroschisis babies, have limited training in its management and desire a training course. Engaging SBAs into a task-sharing role on delivery is a promising next step. Additional studies will be needed to determine if this can improve gastroschisis survival by reducing delays in care and improving community awareness.

Background: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda. Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files. Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%). Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes. Keywords: Uganda, malignant obstructive jaundice, benign obstructive jaundice

Introduction: Gastroschisis mortality in Africa is high partly due to delays in care. In Uganda, skilled birth attendants (SBAs) are the first point‑of‑contact for most babies, and with proper training, may be willing to participate in surgical task‑sharing. Objective: Empower Ugandan skilled birth attendants with the knowledge and practical skills needed to care for babies with gastroschisis. Methods: Ugandan SBAs completed a one‑day gastroschisis course, and resident physicians also requested to participate. A pre‑ and post‑course test was administered to assess gastroschisis knowledge and confidence. Findings: A total of 69 SBAs (44 midwives, 25 nurses) and 17 residents participated. Participants were predominantly female (n = 64, 74%) with a median of 9 years of work experience. There was significant knowledge increase from pre‑ to post‑course regarding differentiating gastroschisis from omphalocele (SBA 39% to 70%, p < 0.001; resident 48% to 77%, p < 0.001), gastroschisis incidence and outcomes (SBA 56% to 87%, p < 0.001; resident 65% to 89%, p < 0.001), risk factors (SBA 66% to 89%, p < 0.001; resident 67% to 86%, p < 0.0026), treatment (SBA 57% to 84%, p < 0.001; resident 63% to 79%, p < 0.001), and importance of community education (SBA 54% to 59%, p < 0.006; resident 56% to 65%, p < 0.0413). Only SBAs showed a significant increase in prenatal diagnosis (74% to 88%, p < 0.001). There was a significant boost in SBA clinical management confidence from 39% to 88%. Conclusion: A one‑day training course can enable Ugandan SBAs to serve as task‑sharers for babies with gastroschisis. While residents benefited, a future course should be developed for their learning needs. Continuing education is needed to ensure knowledge retention and clinical preparedness. Assessment of gastroschisis outcomes is necessary to determine if involving SBAs can improve survival.

Background Anorectal malformations (ARMs) are common congenital anomalies in low-and middle-income countries (LMICs), and they are often repaired in a staged manner. High out-of-pocket (OOP) payment for surgical care in many LMICs makes households vulnerable to catastrophic health expenditures (CHE). ARM patients often require multiple operations and hospitalizations, which may make them vulnerable to CHE. In this study, we sought to determine the prevalence of CHE and the factors driving these costs among families of children with ARMs in southwestern Uganda. Methods This was a combined retrospective and prospective cohort study of the OOP and CHE among families of children with ARMs at a Regional Referral Hospital between June 2021 and July 2023. CHE was defined as a cost exceeding 10% of annual income. Patient characteristics were compared, and multivariable modeling with best subset analysis was used to determine which factors were significantly associated with CHE and total OOP expenditure. Results There were 236 study participants with a median age at diagnosis of 6 days, 51% were male, 71% lived in rural areas, and the median distance traveled was 175 km. 64% of patients experienced CHE, with almost all families incurring travel costs (99%). Following best subset analysis, distance traveled (OR 1.06, 95% CI: 1.03–1.08) and rurality (OR 1.83, 95% CI: 0.96–3.48) were significantly associated with CHE, suggesting that for every additional 10 km, a patient traveled for care, there were 6% higher odds of incurring CHE. In examining total cost, patients who had a two-stage repair incurred more than twice the costs compared to those who had a single-stage repair, and education level and repair type were also significantly associated. Conclusion Identifying methods to provide financial protection from CHE is essential for all children. ARM patients are at particularly high risk for CHE and high OPP expenditures, especially those living far from healthcare services and in rural areas.

Aim: To evaluate the anorectal malformation-stoma social challenges experienced by families of children with anorectal malformation in southwestern Uganda. Methods: Using a mixed-methods approach, a descriptive observational quantitative study with structured interview-based data collection was performed. The link between ARMs-stoma-related social challenges faced by families in southwestern Uganda from June 2021 to July 2023 was examined. Results: 157 participants were enrolled, and 74.3% of caregivers reported social challenges. Among those surveyed about the specific nature of these social difficulties, 66.7% reported facing discrimination from the community. 17.9% of patients experienced abandonment by their relatives. 72.1% reported being unable to attend public functions, while 21.4% felt compelled to keep their children indoors. 27.6% reported experiencing social restrictions. Conclusion: Caregivers face social challenges and restrictions due to stomas related to anorectal malformations in their communities. Healthcare providers should tailor care to address the urgent needs associated with these stoma challenges.

BackgroundIn Uganda, only two public hospitals provide pediatric surgery services. With less than 10 pediatric surgeons serving approximately 20 million children in Uganda, most patients with anorectal malformations (ARMs) must make several trips to the hospital before undergoing surgery. As a result, households borrow money, sell assets, or solicit contributions from friends and relatives to meet healthcare expenses. We used a cross-sectional study to examine methods families use to raise funds for the treatment of ARMs at a single institution in Southwestern Uganda.MethodsThis cross-sectional study was conducted in the pediatric surgery unit at a Regional Referral Hospital/University Teaching Hospital in Southwestern Uganda from June 2021 to July 2023. Participants included caretakers of children presenting with ARMs for treatment at our referral hospital.ResultsA total of 157 participants were enrolled. Mothers were the main caregivers (77.9%) present at the hospital. Out of a median monthly household income of UGX200 000 (US$51.68), families spent a median of UGX50 000 (US$12.92) to travel to the hospital. To raise funds for healthcare expenses, 68% of households reported selling assets.ConclusionFamilies sell household assets to afford ARMs treatment in Southwestern Uganda. Financial protection by the government through a national child health insurance policy would shield families from substantial health-related expenditures and decrease this burden. In addition, targeted policy to strengthen pediatric surgical capacity through workforce expansion and skills training such as the Pediatric Emergency Surgery Course, may minimize costs, improve timeliness of care, and prevent case cancellations.