title: Mortality of pediatric surgical conditions in low and middle income countries in Africa.
abstract: BACKGROUND
  There are ongoing efforts to improve the quality of surgical care for children in low and middle-income countries (LMICs) in Africa. The purpose of this study was to review the recent literature and estimate the mortality associated with pediatric surgical conditions in this setting.
  
  
  METHODS
  We completed a comprehensive search for studies that: (1) reported outcomes associated with pediatric surgical conditions; (2) were conducted in LMICs in Africa; and (3) were published between 2007 and 2012. Abstract screening, full-text review, and data abstraction were completed in duplicate. Mortality rates were pooled using a random effects model.
  
  
  RESULTS
  Out of 2085 abstracts, 292 were selected for textual review, and 107 underwent complete data abstraction. Only 74 (68%) of these reported mortality explicitly. The highest pooled mortality rates were seen with esophageal atresia (72%), midgut volvulus (36%), and jejunoileal atresia (35%). Pooled mortality was 17% for congenital conditions and 9% for acquired disease. The overall mortality rate for all conditions was 12%.
  
  
  CONCLUSIONS
  Mortality following pediatric surgical conditions in LMICs in Africa remains high, especially for congenital conditions in neonates. Future studies should report mortality explicitly and provide accurate follow-up data whenever possible.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinician Investigator Program, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Western University, London, Ontario, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: DCruz
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.affiliation: Division of Pediatric Surgery, Yale-New Haven Children's Hospital, New Haven, CT, USA.
authors.forename: Doruk
authors.initials: D
authors.lastname: Ozgediz
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; BethanyKids at Myung Sung Christian Medical Center, Addis Ababa, Ethiopia. Electronic address: dpoenaru@gmail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Poenaru
mesh_terms: D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D011203:Poverty; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate / Q000639:trends
keywords: Africa; Global health; Mortality; Outcomes; Pediatric surgery