title: Morbidity and Mortality following Traditional Uvulectomy among Children Presenting to the Muhimbili National Hospital Emergency Department in Dar es Salaam, Tanzania.
abstract: Background. Traditional uvulectomy is performed as a cultural ritual or purported medical remedy. We describe the associated emergency department (ED) presentations and outcomes. Methods. This was a subgroup analysis of a retrospective review of all pediatric visits to our ED in 2012. Trained abstracters recorded demographics, clinical presentations, and outcomes. Results. Complete data were available for 5540/5774 (96%) visits and 56 (1.0%, 95% CI: 0.7-1.3%) were related to recent uvulectomy, median age 1.3 years (interquartile range: 7 months-2 years) and 30 (54%) were male. Presenting complaints included cough (82%), fever (46%), and hematemesis (38%). Clinical findings included fever (54%), tachypnea (30%), and tachycardia (25%). 35 patients (63%, 95% CI: 49-75%) received intravenous antibiotics, 11 (20%, 95% CI: 10-32%) required blood transfusion, and 3 (5%, 95% CI: 1-15%) had surgical intervention. All were admitted to the hospital and 12 (21%, 95% CI: 12-34%) died. By comparison, 498 (9.1%, 95% CI: 8-10%) of the 5484 children presenting for reasons unrelated to uvulectomy died (p = 0.003). Conclusion. In our cohort, traditional uvulectomy was associated with significant morbidity and mortality. Emergency care providers should advocate for legal and public health interventions to eliminate this dangerous practice.
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: H R
authors.initials: HR
authors.lastname: Sawe
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: J A
authors.initials: JA
authors.lastname: Mfinanga
authors.affiliation: Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: F H
authors.initials: FH
authors.lastname: Ringo
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: V
authors.initials: V
authors.lastname: Mwafongo
authors.affiliation: Muhimbili National Hospital, Dar es Salaam, Tanzania ; University of California, San Francisco, CA, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Reynolds
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ; Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Runyon