Neonatal surgery in Africa

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The management of neonatal surgical problems continues to pose considerable challenges, particularly in low-resource settings. The burden of neonatal surgical diseases in Africa is not well documented. The characteristics of some neonatal surgical problems are highlighted. Late presentation coupled with poor understanding of the milieu interior of the neonates by incompetent health care providers and poorly equipped hospitals combine to give rise to the unacceptable high morbidity and mortality in most parts of Africa. Proper training of all staff involved in neonatal health care coupled with community awareness must be vigorously pursued by all stakeholders. Various governments throughout the continent of Africa, in conjunction with international donor agencies, must not only provide an adequate budget for health care services and improve infrastructures, but must also deliberately encourage and provide funding for neonatal surgical care and research across the continent. The well-established pediatric surgical training programs, particularly in North and South Africa, should hold the moral responsibility of training all possible numbers of young surgeons from other African countries that do not have any existing pediatric surgical training programs or those countries suffering from remarkable shortage of trained pediatric surgeons.

Section snippets

The burden and spectrum of neonatal surgical diseases in Africa

The burden of neonatal surgical diseases in Africa is not precisely known. There is paucity of population-based research and publications. This lack of data has negatively affected the adequate planning and delivery of neonatal surgical services in the continent.

Few available statistics like fertility rate, infant mortality, and neonatal mortality rates indicate that the problem is enormous. The fertility rate in sub-Saharan Africa is estimated to be 4%-6%. This higher fertility rate is

Problems of neonatal surgery in Africa

Neonatal surgical mortality in high-income countries have decreased from more than 50% in the 1950s to less than 5% in recent years.2 This is not the case in Africa, as the practice of neonatal surgery still faces multiple challenges and problems leading to high morbidity and mortality. Mortality figures have been reported to be between 16% and 40%.8, 47, 48 The main problems are discussed in the following section.

Improving neonatal surgical care in Africa

The problems mentioned previously lead to high morbidity and mortality after neonatal surgery in Africa. In a survey of pediatric surgeons across Africa, the average mortality from neonatal surgery in most centers is 20%-30%. Most of these neonatal surgical deaths are avoidable if necessary steps are taken by the care providers. These measures are given as follows:

Acknowledgments

The authors thank Mahmoud Marae (Cairo University), Mohamed Elbarabary (Cairo University), Ali Ismael, Amel Hashish (Tanta University, Egypt), and Ahmed Haseeb (Ain Shams University, Egypt) for providing patients data from 3 neonatal surgical units.

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