title: Pediatric intestinal obstruction in Malawi: characteristics and outcomes.
abstract: BACKGROUND
  Intestinal obstruction (IO) is a common pediatric surgical emergency in sub-Saharan Africa with high morbidity and mortality, but little is known about its etiopathogenesis in Malawi.
  
  
  METHODS
  Retrospective analysis of patients seen from February 2012 to June 2014 at Kamuzu Central Hospital in Lilongwe, Malawi (n = 3,407). Pediatric patients with IO were analyzed (n = 130).
  
  
  RESULTS
  Overall, 57% of patients were male with a mean age of 3.5 ± 4.1 years. A total of 52% of patients underwent operative intervention. The overall mortality rate was 3%. Leading causes of IO were Hirschprung's 29%, anorectal malformation 18%, and intussusception 4%. Neonates and patients with congenital causes of IO underwent surgery less frequently than infants and/or children and patients with acquired causes, respectively. These groups also demonstrated increased number of days from admission to surgery.
  
  
  CONCLUSIONS
  Increasing pediatric-specific surgical education and/or training and expanding access to resources may improve mortality after IO in poor medical communities within sub-Saharan Africa.
authors.affiliation: Department of Surgery, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA.
authors.forename: Mansi
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Surgery, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Gallaher
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Nelson
authors.initials: N
authors.lastname: Msiska
authors.affiliation: Department of Surgery, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA.
authors.forename: Sean E
authors.initials: SE
authors.lastname: McLean
authors.affiliation: Department of Surgery, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA. Electronic address: anthchar@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008295:Malawi / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hirschprung's disease; Imperforate anus; Intussusception; Malawi; Obstruction; Pediatric surgery
references.citation: Niger J Clin Pract. 2008 Dec;11(4):347-50
references.pmid: 19320408
references.citation: West Afr J Med. 2008 Apr;27(2):101-5
references.pmid: 19025024
references.citation: J Trop Pediatr. 2014 Oct;60(5):352-7
references.pmid: 24771355
references.citation: S Afr J Surg. 2005 May;43(2):34, 36
references.pmid: 16035380
references.citation: Afr J Paediatr Surg. 2011 Jan-Apr;8(1):15-8
references.pmid: 21478580
references.citation: Afr J Paediatr Surg. 2009 Jul-Dec;6(2):98-101
references.pmid: 19661639
references.citation: Pediatr Surg Int. 2001 Jul;17(5-6):442-7
references.pmid: 11527185
references.citation: East Afr Med J. 2006 Jun;83(6):333-6
references.pmid: 16989379
references.citation: Semin Pediatr Surg. 2003 Nov;12(4):241-53
references.pmid: 14655163
references.citation: Afr J Med Med Sci. 2001 Mar-Jun;30(1-2):17-21
references.pmid: 14510143
references.citation: Trop Gastroenterol. 1989 Jan-Mar;10(1):33-40
references.pmid: 2718254
references.citation: Afr Health Sci. 2009 Sep;9(3):170-3
references.pmid: 20589146
references.citation: West Afr J Med. 2004 Oct-Dec;23(4):314-8
references.pmid: 15730090
references.citation: J Pediatr Surg. 1976 Apr;11(2):195-204
references.pmid: 1263057