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Patterns of Congenital Malformations and Barriers to Care in Eastern Democratic Republic of Congo.

Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH - PLoS ONE (2015)

Bottom Line: Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment.We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa.Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair.

View Article: PubMed Central - PubMed

Affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.

ABSTRACT

Background: An increase of congenital anomalies in the eastern Democratic Republic of the Congo (DRC) has been reported. Congenital malformations (CMs) are not uncommon among newborns and, if left untreated, can contribute to increased neonate morbidity and mortality.

Methods: Medical records of all individuals admitted with a diagnosed CM to HEAL Africa Teaching Hospital (Goma, DRC) from 2002 to 2014 (n=1301) were reviewed. Data were analysed using descriptive statistics to summarize chart records, and inferential statistics to investigate significant barriers to earlier treatment.

Results: Since 2012, the number of patients treated each year for CMs has increased by over 200% compared to the average annual number of cases treated from 2002-2011. Though delayed presentation of patients to HEAL Hospital was very obvious, with an average age of 8.2 years. We find that patient age has been significantly decreasing (p=0.037) over time. The average distance separating patients from HEAL Hospital was 178 km, with approximately one third living 350 km or further from the treatment center. Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment. When controlling for an interaction between gender and the use of mercy funds, we also find that female patients are at a significant (p=1.04x10(-3)) disadvantage to undergo earlier corrective surgery. This disadvantage is further illustrated by our finding that 89% of women and girls, and over 81% of all patients, required mercy funds to cover the cost of surgery in 2014. Lastly, the mortality rate for surgery was low and averaged less than 1.0%.

Conclusion: Despite a formal end to the war in 2009, and an overall increase in individuals undergoing corrective surgery, distance, poverty, and gender are still massive barriers to CM care at HEAL Hospital, Goma, DRC. We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa. Thus, we advocate for further funding from the National Government and international health agencies to enable continued treatment of CMs in rural residents of the eastern DRC. Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair.

No MeSH data available.


Related in: MedlinePlus

Boxplots depicting the yearly age distributions of patients treated for congenital malformations at HEAL Africa Training Hospital from 2002–2014.The overall average age at time of presentation decreased significantly (p = 0.04) over time, even when controlling for distance from HEAL, payment type, diagnosis, and sex. Boxes indicate interquartile (IQR) variation in age each year; bold lines the median age. Whiskers demonstrate data within the third and quartile +/- 1.5 IQR respectively; dots indicate outliers. Number of individuals treated each year is indicated within parentheses.
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pone.0132362.g001: Boxplots depicting the yearly age distributions of patients treated for congenital malformations at HEAL Africa Training Hospital from 2002–2014.The overall average age at time of presentation decreased significantly (p = 0.04) over time, even when controlling for distance from HEAL, payment type, diagnosis, and sex. Boxes indicate interquartile (IQR) variation in age each year; bold lines the median age. Whiskers demonstrate data within the third and quartile +/- 1.5 IQR respectively; dots indicate outliers. Number of individuals treated each year is indicated within parentheses.

Mentions: We identified 1301 cases of CMs admitted to HEAL Africa Hospital between 2002 and 2014 (Table 1). Delayed presentation was apparent, as the mean patient age was 8.19 (+/- 9.44 SD) with a distribution ranging from 1 day to 65 years (Fig 1). Only 281 cases (21.6%) were corrected before the age of one year, while 419 individuals (32.2%) underwent corrective procedures between the age of 1 and 5 years, and 155 patients (11.9%) were corrected after the age of 17 years. Overall when controlling for all other predictors (barriers), there was a significant decrease in age of treatment over the 13-year study period (p = 0.037).


Patterns of Congenital Malformations and Barriers to Care in Eastern Democratic Republic of Congo.

Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH - PLoS ONE (2015)

Boxplots depicting the yearly age distributions of patients treated for congenital malformations at HEAL Africa Training Hospital from 2002–2014.The overall average age at time of presentation decreased significantly (p = 0.04) over time, even when controlling for distance from HEAL, payment type, diagnosis, and sex. Boxes indicate interquartile (IQR) variation in age each year; bold lines the median age. Whiskers demonstrate data within the third and quartile +/- 1.5 IQR respectively; dots indicate outliers. Number of individuals treated each year is indicated within parentheses.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493128&req=5

pone.0132362.g001: Boxplots depicting the yearly age distributions of patients treated for congenital malformations at HEAL Africa Training Hospital from 2002–2014.The overall average age at time of presentation decreased significantly (p = 0.04) over time, even when controlling for distance from HEAL, payment type, diagnosis, and sex. Boxes indicate interquartile (IQR) variation in age each year; bold lines the median age. Whiskers demonstrate data within the third and quartile +/- 1.5 IQR respectively; dots indicate outliers. Number of individuals treated each year is indicated within parentheses.
Mentions: We identified 1301 cases of CMs admitted to HEAL Africa Hospital between 2002 and 2014 (Table 1). Delayed presentation was apparent, as the mean patient age was 8.19 (+/- 9.44 SD) with a distribution ranging from 1 day to 65 years (Fig 1). Only 281 cases (21.6%) were corrected before the age of one year, while 419 individuals (32.2%) underwent corrective procedures between the age of 1 and 5 years, and 155 patients (11.9%) were corrected after the age of 17 years. Overall when controlling for all other predictors (barriers), there was a significant decrease in age of treatment over the 13-year study period (p = 0.037).

Bottom Line: Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment.We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa.Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair.

View Article: PubMed Central - PubMed

Affiliation: HEAL Africa, 111 Avenue des Ronds Points, Box 319, Goma, Nord Kivu, Democratic Republic of Congo.

ABSTRACT

Background: An increase of congenital anomalies in the eastern Democratic Republic of the Congo (DRC) has been reported. Congenital malformations (CMs) are not uncommon among newborns and, if left untreated, can contribute to increased neonate morbidity and mortality.

Methods: Medical records of all individuals admitted with a diagnosed CM to HEAL Africa Teaching Hospital (Goma, DRC) from 2002 to 2014 (n=1301) were reviewed. Data were analysed using descriptive statistics to summarize chart records, and inferential statistics to investigate significant barriers to earlier treatment.

Results: Since 2012, the number of patients treated each year for CMs has increased by over 200% compared to the average annual number of cases treated from 2002-2011. Though delayed presentation of patients to HEAL Hospital was very obvious, with an average age of 8.2 years. We find that patient age has been significantly decreasing (p=0.037) over time. The average distance separating patients from HEAL Hospital was 178 km, with approximately one third living 350 km or further from the treatment center. Distance is the most significant (p=3.33x10(-6)) barrier to earlier treatment. When controlling for an interaction between gender and the use of mercy funds, we also find that female patients are at a significant (p=1.04x10(-3)) disadvantage to undergo earlier corrective surgery. This disadvantage is further illustrated by our finding that 89% of women and girls, and over 81% of all patients, required mercy funds to cover the cost of surgery in 2014. Lastly, the mortality rate for surgery was low and averaged less than 1.0%.

Conclusion: Despite a formal end to the war in 2009, and an overall increase in individuals undergoing corrective surgery, distance, poverty, and gender are still massive barriers to CM care at HEAL Hospital, Goma, DRC. We find that patients have been successfully treated earlier by HEAL, although the average age of CM correction in 2014 (4.9 years) is still above average for Sub-Saharan Africa. Thus, we advocate for further funding from the National Government and international health agencies to enable continued treatment of CMs in rural residents of the eastern DRC. Distance, the most significant barrier to care can be mitigated by the implementation of additional mobile clinics and the construction of regional surgery centers along with the associated hiring of surgeons trained in CM repair.

No MeSH data available.


Related in: MedlinePlus