title: Epidemiology, management and outcome of gastroschisis in Sub-Saharan Africa: Results of an international survey.
abstract: BACKGROUND
  The aim was to compare gastroschisis (GS) epidemiology, management and outcome in low-income countries (LIC) in Sub-Saharan Africa (SSA) with middle- (MIC) and high-income countries (HIC).
  
  
  METHODS
  A 10-question survey was administered at the 2012 Pan-African Paediatric Surgery Association Congress. RESULTS are presented as median (range); differences were analysed using contingency tests.
  
  
  RESULTS
  A total of 82 delegates (28 countries [66 institutions]) were divided into LIC (n = 11), MIC (n = 6) and HIC (n = 11). In LIC, there were fewer surgeons and more patients. LIC reported 22 cases (1-184) GS/institution/year, compared to 12 cases (3-23)/institution/year in MICs and 15 cases (1-100)/institution/year in HICs. Antenatal screening was less readily available in LIC. Access to parenteral nutrition and neonatal intensive care in LIC was 36% and 19%, compared to 100% in HIC. Primary closure rates were similar in LIC and HIC at 58% and 54%, respectively; however, the majority of staged closure utilised custom silos in LIC and preformed silos in HIC. In LIC, mortality was reported as >75% by 61% delegates and 50-75% by 33%, compared to <25% by 100% of HIC delegates (P < 0.0001).
  
  
  CONCLUSIONS
  Gastroschisis is a problem encountered by surgeons in SSA. Mortality is high and resources in many centres inadequate. We propose the implementation of a combined epidemiological research, service delivery training and resource provision programme to help improve our understanding of GS in SSA whilst attempting to improve outcome.
authors: Naomi J
authors: NJ
authors: Wright
authors: Augusto
authors: A
authors: Zani
authors: Department of Paediatric Surgery, Kings College Hospital, London, United Kingdom.
authors: Niyi
authors: N
authors: Ade-Ajayi
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019468:Disease Management; D005260:Female; D020139:Gastroschisis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011795:Surveys and Questionnaires