A new study by scientists across 74 countries of the world has shown that survival for babies born with a birth defect is dependent on where they are born. Even as Nigerian scientists involved in the study urged the three tiers of government in Nigeria to prioritise surgical needs of children, especially considering the fact that the country has a young population.
The study just published in The Lancet examined the risk of mortality for nearly 4000 babies born with birth defects also known as a congenital anomaly – in 264 hospitals around the world.
The study found that babies born with birth defects involving the intestinal tract have a one in 20 chance of dying in a high-income country compared to one in five in a middle-income country and two in five in a low-income country.
Gastroschisis, a birth defect where the baby is born with their intestines protruding through a hole by the umbilicus has the greatest difference in mortality with 90% of babies dying in low-income countries compared with 1 per cent in high-income countries. In high-income countries, most of these babies will be able to live a full life without disabilities.
According to the Principal Investigator, Dr Naomi Wright, they devoted the last four years to studying these disparities in outcome.
“Geography should not determine outcomes for babies who have correctable surgical conditions. The Sustainable Development Goal to ‘end preventable deaths in newborns and children under 5 years old by 2030’ is unachievable without urgent action to improve surgical care for babies in low- and middle-income countries, Wright said.
The scientists noted the need to focus on improving surgical care for newborns in low- and middle-income countries.
Over the last 25 years, while there has been great success in reducing deaths in children under 5 years by preventing and treating infectious diseases, there has been little focus on improving surgical care for babies and children and indeed the proportion of deaths related to surgical diseases continue to rise. Birth defects are now the 5th leading cause of death in children under 5 years of age globally, with most deaths occurring in the newborn period.
Birth defects involving the intestinal tract have a particularly high mortality in low- and middle-income countries as many are not compatible with life without emergency surgical care after birth.
The study also highlighted the importance of care received before or after the corrective operation at the surgical centre. Babies treated at hospitals without access to ventilation and intravenous nutrition when needed had a higher chance of dying.
Furthermore, not having skilled anaesthetic support and not using a surgical safety checklist at the time of operation were associated with a higher chance of death.
Global Project Steering Committee Member, Professor Emmanuel Ameh, Chief Consultant Paediatric Surgeon at the National Hospital, Abuja, Nigeria, is coordinating a massive international project to have countries roll out National Surgical, Obstetric and Anaesthesia plans, which will incorporate many elements of the missing pieces.
Ameh, who also leads the Global Initiative for Children’s surgery said: “Improving survival from these conditions in low- and middle-income countries involve three key elements: enhancing antenatal diagnosis and delivery at a hospital with children’s surgical care; improving care for babies born at primary and secondary care facilities, with a safe and quick transfer to a tertiary surgical centre; and improved care for babies at the surgical centre. “
Chief of Paediatric Surgery at the Lagos University Teaching Hospital, Professor Adesoji Ademuyiwa while reviewing the import of the publication challenged leaders at the Federal, State and Local Government levels to prioritise surgical needs of children, especially considering the fact that Nigeria, a lower-middle-income country, has a young population.
“Alongside local initiatives, surgical care for newborns and children need to be integrated into a national and international child health policy and should no longer be neglected within global child health.”
Also, the National Lead for the study, Dr Taiwo Lawal from the University College Hospital, UCH, Ibadan. emphasized the need for stakeholders and policy drivers to use this opportunity to dodge the global bullet of widening the gap between the global north and south and reduce unmet surgical needs in children.