Open AccessDelays in presentation of intussusception and development of gangrene in Zimbabwe
Author(s) -
Dennis Mazingi,
Eleanor Burnett,
Hilda Mujuru,
Kusum Nathoo,
Jacqueline E. Tate,
Jason M. Mwenda,
Goitom Weldegebriel,
Portia Manangazira,
Arnold Mukaratirwa,
Umesh D. Parashar,
Taurai Zimunhu,
Bothwell Mbuwayesango
Publication year - 2021
Publication title -
the pan african medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.287
H-Index - 30
ISSN - 1937-8688
DOI - 10.11604/pamj.supp.2021.39.1.21301
Subject(s) - medicine , intussusception (medical disorder) , referral , presentation (obstetrics) , gangrene , pediatrics , surgery , family medicine
prompt diagnosis and treatment are considered key to successful management of intussusception. We examined pre-treatment delay among intussusception cases in Zimbabwe and conducted an exploratory analysis of factors associated with intraoperative finding of gangrene. Methods data were prospectively collected as part of the African Intussusception Network using a questionnaire administered on consecutive patients with intussusception managed at Harare Children´s Hospital. Delays were classified using the Three-Delays-Model: care-seeking delay (time from onset of symptoms to first presentation for health care), health-system delay (referral time from presentation to first facility to treatment facility) and treatment delay (time from presentation at treatment facility to treatment). Results ninety-two patients were enrolled from August 2014 to December 2016. The mean care-seeking interval was 1.9 days, the mean health-system interval was 1.5 days, and the mean treatment interval was 1.1 days. Mean total time from symptom onset to treatment was 4.4 days. Being transferred from another institution added 1.4 days to the patient journey. Gangrene was found in 2 (25%) of children who received treatment within 1 day, 13 (41%) of children who received treatment 2-3 days, and 26 (50%) of children who received treatment more than 3 days after symptom onset (p = 0.34). Conclusion significant care-seeking and health-system delays are encountered by intussusception patients in Zimbabwe. Our findings highlight the need to explore approaches to improve the early diagnosis of intussusception and prompt referral of patients for treatment.