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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
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2016 (English)In: BMJ Global Health, ISSN 2059-7908, Vol. 1, no 4, article id e000091Article in journal (Refereed) Published
Abstract [en]

Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.

Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.

Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.

Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016. Vol. 1, no 4, article id e000091
National Category
Surgery Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:umu:diva-151313DOI: 10.1136/bmjgh-2016-000091ISI: 000408718800002OAI: oai:DiVA.org:umu-151313DiVA, id: diva2:1245650
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-09-05Bibliographically approved

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Sund, MalinAndersson, LindaGunnarsson, Ulf

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Chapman, Stephen J.Pata, FrancescoRoslani, April CamillaLawani, IsmailMihanovic, JakovSalma, MahmoudHammad, Ali MohamedElfeki, HossamNouh, ThamerHassanain, MazenSund, MalinAndersson, LindaGunnarsson, UlfOzkan, Bahar BusraMannu, Gurdeep SinghLabib, PeterVan Duren, BernardShah, RohiAber, AhmedTham, Ji ChungBoshnaq, MohamedRabie, MohamedDaniels, IanKennedy, Ewan D.Giuliani, StefanoLoughran, Dafydd
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Department of Surgical and Perioperative Sciences
SurgeryPublic Health, Global Health, Social Medicine and Epidemiology

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CiteExportLink to record
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