Improving care and survival of newborns with surgical conditions in Tanzania (TINY Tanzania): a focus on gastroschisis

• Published in: Pediatric surgery international 2024-09, Vol.40 (1), p.250, Article 250
• Main Authors: Philipo, Godfrey Sama, Bokhary, Zaitun Mohamed, Kapapa, Melanie, Bayyo, Neema Lala, Nyamuryekung’e, Massawa Klint, Salim, Mohamed, Mboma, Lazaro, Massenga, Alicia, Michael, Langa, Mashara, Meshack, Mgaya, Baraka Edward, Mwita, Raphael, Desta, Aron, Lodhia, Jay, Gwahela, Neema L., Sindani, Suba Martin, Sudai, Frank Martin, Lindert, Judith
• Format: Article
• Language: English
• Subjects: Decentralization; Female; Gastroschisis - mortality; Gastroschisis - surgery; Humans; Infant, Newborn; Male; Medicine; Medicine & Public Health; Original Article; Patient Care Bundles - methods; Patients; Pediatric Surgery; Pediatrics; Quality Improvement; Surgery; Survival Rate; Tanzania - epidemiology
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-024-05828-4

Purpose Gastroschisis is associated with over 90% mortality in many sub-Saharan African countries. The introduction of the Gastroschisis Care Bundle at Muhimbili National Hospital (MNH) increased survival up to 60%. We aim to explain the impact of using implementation science methods to decentralize the care of babies with gastroschisis to other parts of Tanzania. Methods We used a Step-Wedge Implementation Science design to scale up gastroschisis care through training of providers, dissemination and current revision of evidence-based care protocols, advocacy, and engagement with stakeholders. We used mixed methods for data collection. Anonymous patient and provider evaluation data were collected using a nationwide Gastroschisis Database via REDCap. We evaluated the implementation and effectiveness of the care bundle in different hospitals in Tanzania. Results Decentralizing care nationally was feasible, acceptable, and adaptable. A total of nine trainings have been conducted training 420 providers (14 Master Trainers) reaching seven regions of Tanzania. The three advocacy national campaigns have ensured community reach and patient engagement. A countrywide gastroschisis database was developed to collect data on patients with gastroschisis, hosted locally at MNH with 332 patients’ data entered in 1 year. The majority (90.2%) were treated using preformed silo bags with an overall survival of 28.5% in all centers. Late presentation and infection remain to be the main challenge. Conclusion To achieve quality and sustainable surgical care, there is a need to design, implement, evaluate, and continuously improve context-relevant strategies to achieve and sustain the survival of neonates with congenital anomalies. Decentralization enables clear connectedness of hospitals, bringing care closer to patients.