The College of Surgeons of East Central and Southern Africa, Arusha, Tanzania.
The Branch for Global Surgical Care, UBC, Vancouver, Canada.
Pediatr Surg Int. 2024 Sep 6;40(1):250. doi: 10.1007/s00383-024-05828-4.
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.
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.
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.
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.
在许多撒哈拉以南非洲国家，先天性腹裂的死亡率超过 90%。在穆希比利国家医院（MNH）引入先天性腹裂护理包使存活率提高到 60%。我们旨在解释利用实施科学方法将先天性腹裂患儿的护理分散到坦桑尼亚其他地区的影响。
我们使用阶段式实施科学设计，通过培训提供者、传播和当前修订基于证据的护理方案、宣传和与利益相关者合作，扩大先天性腹裂的护理范围。我们使用混合方法收集数据。通过 REDCap 全国性先天性腹裂数据库匿名收集患者和提供者评估数据。我们评估了护理包在坦桑尼亚不同医院的实施情况和效果。
全国范围内分散护理是可行的、可接受的和可适应的。已经进行了九次培训，培训了 420 名提供者（14 名主培训师），覆盖了坦桑尼亚的七个地区。三次全国性宣传活动确保了社区的覆盖范围和患者的参与度。开发了一个全国性的先天性腹裂数据库，用于收集先天性腹裂患者的数据，该数据库在 MNH 本地托管，在 1 年内输入了 332 名患者的数据。大多数患者（90.2%）使用预制的沙堤袋进行治疗，所有中心的总体存活率为 28.5%。晚期就诊和感染仍然是主要挑战。
为了实现高质量和可持续的外科护理，需要设计、实施、评估和不断改进与背景相关的策略，以实现和维持先天性畸形新生儿的生存。分散护理使医院之间的联系更加清晰，使护理更加贴近患者。
