Browsing by Author "Ullrich, Sarah"

Now showing 1 - 4 of 4
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    Epidemiology and Mortality of Pediatric Surgical Conditions: Insights from aTertiary Center in Uganda
    (Pediatric Surgery International, 2019) Cheung, Maija; Kakembo, Nasser; Rizgar, Nensi; Grabski, David; Ullrich, Sarah; Muzira, Arlene; Kisa, Phyllis; Sekabira, John; Ozgediz, Doruk
    The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited.Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016.2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung’s, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%).There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.
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    Global children’s surgery: recent advances and future directions
    (Current opinion in pediatrics, 2019) Ullrich, Sarah; Kisa, Phyllis; Ozgediz, Doruk
    Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery.Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions. Surgery has continued to be identified as a cost-effective intervention in LMICs. There have also been substantial advances in research and advocacy for a number of childhood surgical conditions.Substantial global disparities persist in the care of childhood surgical conditions. Recent work has provided greater visibility to the challenges and solutions for children's surgery in LMICs. Capacity-building and scale up of children's surgical care, more robust implementation research and ongoing advocacy are needed to increase access to children's surgical care worldwide.
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    Implementation of a Contextually Appropriate Pediatric Emergency Surgical Care Course in Uganda
    (Journal of Pediatric Surgery, 2021) Ullrich, Sarah; Kisa, Phyllis; Ruzgar, Nensi; Okello, Innocent; Oyania, Felix; Kayima, Peter; Kakembo, Nasser; Sekabira, John; Situma, Martin; Ozgediz, Doruk
    Low- and middle-income countries like Uganda face a severe shortage of pediatric surgeons. Most children with a surgical emergency are treated by nonspecialist rural providers. We describe the design and implementation of a locally driven, pilot pediatric emergency surgical care course to strengthen skills of these providers. This is the first description of such a course in the current literature.The course was delivered three times from 2018 to 2019. Modules include perioperative management, neonatal emergencies, intestinal emergencies, and trauma. A baseline needs assessment survey was administered. Participants in the second and third courses also took pre and postcourse knowledge-based tests.Forty-five providers representing multiple cadres participated. Participants most commonly perform hernia/hydrocele repair (17% adjusted rating) in their current practice and are least comfortable managing cleft lip and palate (mean Likert score 1.4 ± 0.9). Equipment shortage was identified as the most significant challenge to delivering pediatric surgical care (24%). Scores on the knowledge tests improved significantly from pre- (55.4% ± 22.4%) to postcourse (71.9% ± 14.0%, p < 0.0001).Nonspecialist clinicians are essential to the pediatric surgical workforce in LMICs. Short, targeted training courses can increase provider knowledge about the management of surgical emergencies. The course has spurred local surgical outreach initiatives. Further implementation studies are needed to evaluate the impact of the training.
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    Pyloric Stenosis at a Tertiary Hospital in Uganda
    (Annals of Pediatric Surgery, 2020) Okello, Innocent; Naluyimbazi, Rovine; Massenga, Alicia; Ullrich, Sarah; Kakembo, Nasser; Kisa, Phyllis; Sekabira, John; Nimanya, Stella
    Worldwide, infantile hypertrophic pyloric stenosis has an incidence of 3 in 1000 livebirths, with an unknown etiology. Even when babies present with characteristic symptoms, it is often misdiagnosed leading to late referral for appropriate surgical care. The purpose of this study was to document our experience in management of pyloric stenosis within our setting.A total of 33 patient records were reviewed. All the patients presented with non-bilious vomiting. The ratio of males to females was 4.5:1. Of these patients, 76% had electrolyte imbalance with low chloride count in the majority of patients. All the patients underwent an open Ramstedt pyloromyotomy, and 91% had a good outcome.Management of IHPS has very good outcomes in our setting. Earlier referral of patients leads to improved outcomes.