title: Gastroschisis in Uganda: Opportunities for improved survival.
abstract: OBJECTIVE
  Neonatal mortality from gastroschisis in sub-Saharan Africa is high, while in high-income countries, mortality is less than 5%. The purpose of this study was to describe the maternal and neonatal characteristics of gastroschisis in Uganda, estimate the mortality and elucidate opportunities for intervention.
  
  
  METHODS
  An ethics-approved, prospective cohort study was conducted over a one-year period. All babies presenting with gastroschisis in Mulago Hospital in Kampala, Uganda were enrolled and followed up to 30days. Univariate and descriptive statistical analyses were performed on demographic, maternal, perinatal, and clinical outcome data.
  
  
  RESULTS
  42 babies with gastroschisis presented during the study period. Mortality was 98% (n=41). Maternal characteristics demonstrate a mean maternal age of 21.8 (±3.9) years, 40% (n=15) were primiparous, and fewer than 10% (n=4) of mothers reported a history of alcohol use, and all denied cigarette smoking and NSAID use. Despite 93% (n=39) of mothers receiving prenatal care and 24% (n=10) a prenatal ultrasound, correct prenatal diagnosis was 2% (n=1). Perinatal data show that 81% of deliveries occurred in a health facility. The majority of babies (58%) arrived at Mulago Hospital within 12h of birth, however 52% were breastfeeding, 53% did not have intravenous access and only 19% had adequate bowel protection in place. Four patients (9%) arrived with gangrenous bowel. One patient, the only survivor, had primary closure. Average time to death was 4.8days [range<1 to 14days].
  
  
  CONCLUSIONS
  The mortality of gastroschisis in Uganda is alarmingly high. Improving prenatal diagnosis and postnatal care of babies in a tertiary center may improve outcome.
authors: Makerere University School of Medicine, Kampala, Uganda.
authors: Anne S
authors: AS
authors: Wesonga
authors: Paul L. Foster School of Medicine, Texas Tech University, EI Paso, TX, United States. Electronic address: tnfitz@hotmail.com.
authors: Tamara N
authors: TN
authors: Fitzgerald
authors: Makerere University School of Medicine, Kampala, Uganda.
authors: Ronald
authors: R
authors: Kabuye
authors: Makerere University School of Medicine, Kampala, Uganda.
authors: Samuel
authors: S
authors: Kirunda
authors: Tufts University School of Medicine and Maine Medical Center, Portland, ME, United States.
authors: Monica
authors: M
authors: Langer
authors: Makerere University School of Medicine, Kampala, Uganda.
authors: Nasser
authors: N
authors: Kakembo
authors: Yale University School of Medicine, New Haven, CT, United States.
authors: Doruk
authors: D
authors: Ozgediz
authors: Makerere University School of Medicine, Kampala, Uganda.
authors: John
authors: J
authors: Sekabira
mesh_terms: D000328:Adult; D003906:Developing Countries; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D020139:Gastroschisis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care; D011181:Postnatal Care; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: Gastroschisis; Global health; Neonatal surgery in Africa