Malaria infection linked to poor surgical outcomes among pediatric patients in rural Ghana – Penn State Health News
An international team of researchers studying pediatric surgery outcomes found that malaria infection may increase a child’s risk of 90-day hospital readmission. The researchers said the study is the first of its kind to investigate factors associated with prolonged hospital stays, hospital readmission and deaths among pediatric patients in rural Ghana.
The team included Penn State College of Medicine alumna Dr. Sarah Peiffer, Epidemiology PhD student Dr. Paddy Ssentongo and Dr. John Oh. They examined medical records of 468 children who underwent surgery between January 2015 and December 2017 at Eastern Regional Hospital in Ghana. The children’s ages ranged from newborns to 17 years old.
Most patients studied underwent gastrointestinal surgery to repair a hernia (19%) or had their appendix removed (15%). On average, patients were hospitalized for three days. The researchers found that surgical trauma, infection and lack of insurance resulted in longer hospitalization. Overall, 5% of children were back in the hospital within 90 days. Younger patients and those with malaria before and during surgery had an increased risk of being readmitted. The researchers found that younger patients and female patients had a higher risk of dying while hospitalized and that 38% of the mortalities occurred in infants.
“A global surgery needs assessment begins with identifying determinants of postoperative outcomes in low- and middle-income countries. When surgical interventions that work well in high-income countries are applied in these countries without first understanding the needs unique to these regions, most often the interventions are not effective,” said Ssentongo, research assistant professor at the Center for Neural Engineering in the Department of Engineering Science and Mechanics. “Therefore, the Department of Surgery at Penn State Health Milton S. Hershey Medical Center, in collaboration with Ghana’s Eastern Regional Hospital, conducted the study to fill in the knowledge gaps about what drives poor postoperative outcomes among pediatric surgery patients in Rural Ghana.”
Ssentongo and coauthors found that younger patients had an increased risk of death, due to a lack of specialized care and specialized care teams for pediatric surgical patients. They said that investing in improved medical equipment and training for pediatric surgeons could improve outcomes for patients.
The research team also uncovered that preoperative malaria infections posed a significant danger to pediatric patients and led to patients returning to the hospital with surgical complications, such as failed surgical wound healing. The reasons for higher rates of readmission in surgical patients with malaria included high fevers and weakened immune systems, which increases susceptibility to other postsurgical bacterial infections and longer recovery times.
“Factors driving surgical outcomes in sub-Saharan Africa are different from those of high-income countries. Therefore, global surgery trainees and collaborators should consider these factors when they design plans to improve surgical outcomes in this region,” Ssentongo said. “Due to the high burden of malaria infections in this region, its assessment and treatment perioperatively has a potential to prevent readmissions and mitigate postoperative complications.”
Anna Ssentongo, Laura Keeney and Anthony Tsai of Penn State College of Medicine; Forster Amponsah-Manu, Richard Yeboako, Richard Ofosu-Akromah, Temitope Ebenezer Arkorful and Eric Agyemang of Ghana’s Eastern Regional Hospital also contributed to this research.
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