title: Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.
abstract: OBJECTIVE
  Pediatric neurosurgical cases have been identified as an important target for impacting health disparities in Uganda, with over 50% of the population being less than 15 years of age. The objective of the present study was to evaluate the effects of the Duke-Mulago collaboration on pediatric neurosurgical outcomes in Mulago National Referral Hospital.
  
  
  METHODS
  We performed retrospective analysis of all pediatric neurosurgical cases who presented at Mulago National Referral Hospital in Kampala, Uganda, to examine overall, preprogram (2005-2007), and postprogram (2008-2013) outcomes. We analyzed mortality, presurgical infections, postsurgical infections, length of stay, types of procedures, and significant predictors of mortality. Data on neurosurgical cases was collected from surgical logbooks, patient charts, and Mulago National Referral Hospital's yearly death registry.
  
  
  RESULTS
  Of 820 pediatric neurosurgical cases, outcome data were complete for 374 children. Among children who died within 30 days of a surgical procedure, the largest group was less than a year old (45%). Postinitiation of the Duke-Mulago collaboration, we identified an overall increase in procedures, with the greatest increase in cases with complex diagnoses. Although children ages 6-18 years of age were 6.66 times more likely to die than their younger counterparts preprogram, age was no longer a predictive variable postprogram. When comparing pre- and postprogram outcomes, mortality among pediatric patients within 30 days after a neurosurgical procedure increased from 4.3% to 10.0%, mortality after 30 days increased slightly from 4.9% to 5.0%, presurgical infections decreased by 4.6%, and postsurgery infections decreased slightly by 0.7%.
  
  
  CONCLUSIONS
  Our data show the provision of more complex neurological procedures does not necessitate improved outcomes. Rather, combining these higher-level procedures with essential pre- and postoperative care and continued efforts in health system strengthening for pediatric neurosurgical care throughout Uganda will help to address and decrease the burden throughout the country.
authors: Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA.
authors: Anthony T
authors: AT
authors: Fuller
authors: Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
authors: Michael M
authors: MM
authors: Haglund
authors: Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA.
authors: Stephanie
authors: S
authors: Lim
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: John
authors: J
authors: Mukasa
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Michael
authors: M
authors: Muhumuza
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Joel
authors: J
authors: Kiryabwire
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Hussein
authors: H
authors: Ssenyonjo
authors: Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA. Electronic address: emily.smith1@duke.edu.
authors: Emily R
authors: ER
authors: Smith
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000639:trends*; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D019635:Neurosurgical Procedures / Q000191:economics / Q000401:mortality* / Q000639:trends*; D010372:Pediatrics / Q000191:economics / Q000639:trends*; D062606:Tertiary Care Centers / Q000191:economics / Q000639:trends*; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
keywords: Health system strengthening; Mulago National Referral Hospital; Pediatric neurosurgery; Surgical outcomes