title: Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe.
abstract: BACKGROUND
  Survival for infants with gastroschisis in developed countries has improved dramatically in recent decades with reported mortality rates of 4-7%. Conversely, mortality rates for gastroschisis in sub-Saharan Africa remain as great as 60% in contemporary series. This study describes the burden of gastroschisis at the major pediatric hospital in Zimbabwe with the goal of identifying modifiable factors influencing gastroschisis-related infant mortality.
  
  
  METHODS
  We performed a retrospective cohort study of all cases of gastroschisis admitted to Harare Children's Hospital in 2013. Univariate and multivariate analyses were performed to describe infant, maternal, and geographic factors influencing survival.
  
  
  RESULTS
  A total of 5,585 neonatal unit admissions were identified including 95 (1.7%) infants born with gastroschisis. Gastroschisis-related mortality was 84% (n = 80). Of infants with gastroschisis, 96% (n = 91) were born outside Harare Hospital, 82% (n = 78) were born outside Harare Province, and 23% (n = 25) were home births. The unadjusted odds of survival for these neonates with gastroschisis were decreased for low birth weight infants (<2,500 grams; odds ratio [OR], 0.15; 95% CI, 0.05-0.51), preterm births (<37 weeks gestational age; OR, 0.06; 95% CI, 0.01-0.50), and for those born to teenage mothers (<20 years of age; OR, 0.05; 95% CI, 0.01-0.46). There was also a trend toward decreased odds of survival for home births (OR, 0.16; 95% CI, 0.02-1.34) and for those born outside Harare Province (OR, 0.35; 95% CI, 0.10-1.22).
  
  
  CONCLUSIONS
  Gastroschisis-related infant mortality in Zimbabwe is associated with well-known risk factors, including low birth weight, prematurity, and teenage mothers. However, modifiable factors identified in this study signify potential opportunities for developing innovative approaches to perinatal care in such a resource-constrained environment.
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Jordan C
authors.initials: JC
authors.lastname: Apfeld
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
authors.affiliation: Harare Children's Hospital, Harare, Zimbabwe.
authors.forename: Nyasha
authors.initials: N
authors.lastname: Macheka
authors.affiliation: Harare Children's Hospital, Harare, Zimbabwe.
authors.forename: Bothwell A
authors.initials: BA
authors.lastname: Mbuwayesango
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Karl G
authors.initials: KG
authors.lastname: Sylvester
authors.affiliation: Stanford University School of Medicine, Stanford, CA. Electronic address: zjk1@stanford.edu.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Kastenberg
mesh_terms: D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D020139:Gastroschisis / Q000453:epidemiology* / Q000401:mortality*; D005865:Gestational Age; D006700:Home Childbirth; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D047928:Premature Birth; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology