A comparison of neonatal surgical admissions between two linked surgical departments in Africa and Europe

Abstract

Resources for neonatal surgery vary hugely between the developed countries and Africa. Due to the burden of other childhood diseases, neonatal surgery is of low priority to health-care budget holders in the developing countries. Admissions to two linked neonatal surgical institutions in Africa and Europe are compared to draw attention to the need of newborn care in developing countries. In a 3-year period, there have been 528 neonatal surgical admissions to the Kilimanjaro Christian Medical Centre (KCMC), Tanzania. During the same period, 707 surgical neonates were admitted to the John Radcliffe Hospital, UK (JRH). Conditions more commonly seen in the JRH include necrotising enterocolitis (NEC) (10.2 vs 0%), gastrochisis (5.5 vs 0.9%), congenital diaphragmatic hernia (2.4 vs 0.4%), congenital lung cysts (1.6 vs 0.4%), meconium ileus (2.4 vs 0%), malrotation (2.7 vs 0.6%) and abdominal/pelvic cysts (1.1 vs 0%). Conditions more commonly seen in KCMC include anorectal malformation (9.5 vs 4.7%), sacrococcygeal teratoma (2.3 vs 0.3%), Hirschsprung's disease (10.2 vs 4.5%), branchial fistula (0.9 vs 0%), haemangioma (2.1 vs 0%) and cystic hygroma (2.1 vs 1.0%). The spectrum of neonatal surgical admissions in our two institutions varied. We believe this is attributable to availability of antenatal diagnosis, primary health-care, transport facilities, genetics as well as survival of delayed presentation. This study demonstrates the extent and spectrum of neonatal surgical pathology in this part of Africa and highlights the need for newborn surgical care in developing countries.