Improving Surgical Care for Babies in sub-Saharan Africa
The story so far:
Naomi Wright, the Paediatric Surgery Registrar and RCS Research Fellow leading on this initiative was awarded funding by the Wellcome Trust for an interventional study in seven paediatric surgery centres across four countries, with the aim of improving the survival of babies born with gastroschisis.
Currently more than 90% of babies with gastroschisis at these centres die. One of the centres provides solely palliative care to all newborns with this condition, because trying to save them is deemed futile.
Thanks to the generosity of our supporters the 2017 Christmas Appeal raised £17,238 funding neonatal surgical specialists to travel to assist with the implementation of Naomi's care bundle that will improve surgical care for babies with gastroschisis.
What was our 2017 appeal?
A report in 2015 highlighted that 5 billion people do not have access to safe, affordable, timely surgical care. Most of these people live in low and middle income countries where up to half of the population are children.
Many improvements during recent decades have reduced the number of childhood deaths globally through the prevention and treatment of infectious diseases such as malaria, TB and HIV. Nowadays, more children die of preventable and/or treatable surgical conditions than all three diseases combined, yet the majority of global funding still goes towards the latter. It is estimated that up to a third of childhood deaths in regions of sub-Saharan Africa are a result of a surgical condition – the majority of which could be treated successfully with adequate resources and facilities. Birth defects, which commonly require a surgical intervention, have risen to become the fifth leading cause of death in those under the age of five worldwide.
What is gastroschisis?
Gastroschisis is one of the commonest birth defects. It is a condition where the baby is born with the bowels protruding through a hole next to the tummy button. In well-resourced countries like ours, the bowels are reduced back inside the body and the baby is supported until feeding is established (approximately 3 weeks), resulting in more than 96% survival.
However, studies show that the overall death rate for babies with gastroschisis across sub-Saharan Africa is above 75%, with many specialised paediatric surgery centres having a death rate exceeding 95%.
Naomi Wright, a Paediatric Surgery Registrar and RCS Research Fellow, has been awarded funding by the Wellcome Trust for an interventional study in seven paediatric surgery centres across four countries, with the aim of improving the survival of babies born
with gastroschisis. Currently more than 90% of babies with gastroschisis at these centres die. One of the centres provides solely palliative care to all newborns with this condition, because trying to save them is deemed futile.
Naomi will spend the first 15 months working with teams and experts from around the world to produce an evidence-based care bundle to implement at each of the sites. Naomi will then travel to Africa for nine months to implement the care bundle (details below) at the seven sites.
What is Naomi's proposed care bundle?
Up to two-thirds of women in these countries are currently having an antenatal scan, but it’s unknown why the gastroschisis is not being detected or why the mothers are not informed if it is seen. Naomi will investigate this and try to improve the diagnosis and treatment phase. At present 95% of babies with gastroschisis are not diagnosed during pregnancy, are born outside of the hospital, and – by the time they arrive – are dehydrated, cold and septic.
Currently, most babies receiving treatment die within four days due to their poor condition and a lack of appropriate care at this critical stage. In the UK, many surgeons currently use a condom-like device to cover the bowels and reduce them back into the abdomen non-surgically over a number of days. Once the bowels are back in, the umbilical cord can be pulled across to cover the hole in the abdominal wall and a large dressing is applied for 10 days. As the cord naturally closes at this time of life, the hole can close and heal up without the need for stitches. This low-tech approach helps avoid a life-threatening anaesthetic and surgery in those first few days when the baby is so sick, and therefore has the potential to improve survival in sub-Saharan Africa.
For about three weeks after treatment, nutrition via a vein is required until the baby can be established on breastfeeding. The baby’s bowels take time to start working again after being exposed to the fluid in the womb and then the air at birth. Some centres in the study do have the set-up to provide this but it is currently only available for adults and older children. As most babies with gastroschisis die, it is deemed a poor use of resources to provide nutrition in this way for these cases. This study will give Naomi the opportunity to develop this life-saving and cost-effective service for newborns so they can go on to live a full, normal life.
2018 Christmas Appeal
Help us to Build the first High Dependency Unit in Eastern Uganda.