https://doi.org/10.4081/pmc.2024.329
The hidden burden of Pediatric urology in Sub-Saharan Africa: an analysis of hospital admission data from three East African Health Centres
Submitted: 20 September 2023
Accepted: 9 January 2024
Published: 23 January 2024
Accepted: 9 January 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.
Lacombe A. Screening of urinary tract's malformations in child. Rev Méd Tours 1981;15:653-4.
deVries CR. A global view of pediatric urology. J Pediatr Urol 2022;18:271-9.
DOI: https://doi.org/10.1016/j.jpurol.2022.02.002
UNICEF. Children in Africa: Key statistics on child survival, protection, and development. 11;2015. Available from: https://data.unicef.org/wp-content/uploads/2015/12/Children-in-Africa-Brochure-Nov-23-HR_245.pdf
Van Batavia JP, Shukla AR, Joshi RS, Reddy PP. Pediatric urology and global health: why now and how to build a successful global outreach program. Urol Clin North Am 2018;45:623e31.
DOI: https://doi.org/10.1016/j.ucl.2018.06.009
Kakembo N, Godier-Furnemont A, Nabirye A, et al. Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda. Surg Res 2019;242:193-9.
DOI: https://doi.org/10.1016/j.jss.2019.03.058
Younoussa K, Aliou T, Fatou SN, et al. Congenital Abnormalities of Kidneys and Urinary Tract in Children at the Dakar University Hospital. Open J Ped 2022;12:529-37.
DOI: https://doi.org/10.4236/ojped.2022.123056
Odzébé AWS, Mandavo CM, Ondima PL, Bouya PA. Congenital Urinary Tract Anomalies: About Cases 80 Cases at the University Hospital of Brazzaville. Open J Urol 2020;10:8-15.
DOI: https://doi.org/10.4236/oju.2020.101002
Peiris HD, Lakshminarayanan B, Osifo OD, Lakhoo K, Management of undescended testes: a comparative study in England and Africa. Ann Pediatric Surg 2014;10:115-8.
DOI: https://doi.org/10.1097/01.XPS.0000452367.03459.bf
Ameh EA, Mbibu HN. Management of undescended testes in children in Zaria, Nigeria. East Afr Med J 2000;77:485–7.
DOI: https://doi.org/10.4314/eamj.v77i9.46694
Ekwunife OH, Ugwu JO, Onwurah C, et al. Undescended Testes: Contemporary Factors Accounting for Late Presentation Afr J Urol 2018;24:206-11.
DOI: https://doi.org/10.1016/j.afju.2018.05.007
Okeke A, Okonkwo C, Osegbe D. Frequency of hypospadias, abdominal and penoscrotal abnormalities among primary schoolboys in a Nigerian community. Afr J Urol 2003;9:56-64.
Ogundoyin OO, Olulana DI, Lawal TA, Ademola SA. Management of Hypospadias in a resource-poor setting: The Ibadan experience. Nigerian J Plast Surg 2017;13:40-4.
DOI: https://doi.org/10.4103/njps.njps_5_17
Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anaesthesia. American Academy of Pediatrics. Pediatrics 1996;97:590-4.
DOI: https://doi.org/10.1542/peds.97.4.590
Goodstein TA, Cost NG, Campbell JB, et al. A Contemporary Analysis of Pediatric Urology Surgical Volume at a Tertiary Care Centre. Urology 2019;125:179-83
DOI: https://doi.org/10.1016/j.urology.2018.12.030
Weber DM, Schonbucher VB, Gobet R, Gerber A, Landolt MA. Is there an ideal age for hypospadias repair? A pilot study. J Pediatr Urol 2009;5:345-50.
DOI: https://doi.org/10.1016/j.jpurol.2008.12.008
Aisuodionoe-Shadrach OI, Atim T, Eniola BS, Ohemu AA. Hypospadias repair and outcome in Abuja, Nigeria: A 5-year single-centre experience. Afr J Paediatr Surg 2015;12:41-4.
DOI: https://doi.org/10.4103/0189-6725.150977
Angwafo FF 3rd, Daudon M, Wonkam A, Kuwong PM, Kropp KA. Pediatric urolithiasis in sub-Saharan Africa: a comparative study in two regions of Cameroon. Eur Urol 2000;37:106-11.
DOI: https://doi.org/10.1159/000020109
Rizvi SA, Naqvi SA, Hussain Z, et al. Pediatric urolithiasis: developing nation perspectives. Urol 2002;168:1522-5.
DOI: https://doi.org/10.1097/00005392-200210010-00073
Mohammed S, Yohannes B, Tegegne A, Abebe K. Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia. Res Rep Urol 2020;12:623-31.
DOI: https://doi.org/10.2147/RRU.S284706
Hounnasso PP, Avakoudjo JD, Paré AK, et al. Symptomatic urinary lithiasis: epidemiology and management at the urology department of the university hospital of Cotonou. Open J Urol 2015;5:7-12.
DOI: https://doi.org/10.4236/oju.2015.52002
Mbonu O, Attah C, Ikeakor I. Urolithiasis in an African population. Int Urol Nephrol 1984;16:291-6.
DOI: https://doi.org/10.1007/BF02081863
Achila O, Araya M, Simel LL, et al. An assessment of kidney stone composition and risk factors: Matched case-control study at Orotta referral hospital in Asmara, Eritrea. Int J Adv Comm Med 2018;1:7-14.
DOI: https://doi.org/10.33545/comed.2018.v1.i2a.12
Rodgers A. The riddle of kidney stone disease: lessons from Africa. Urol Res 2006;34:92-5.
DOI: https://doi.org/10.1007/s00240-005-0017-1
Optimal Management of Congenital Anomalies of The Kidney and The Urinary Tract (CAKUT) In Africa: A Call for Action, Rasheed Gbadegesin. Afr J Ped Nephrol 2014;1:46-7.
Carrera JM. Obstetric ultrasound in Africa: Is it necessary to promote their appropriate use? Donald School J Ultrasound Obstet Gynecol 2011;5:289-96.
DOI: https://doi.org/10.5005/jp-journals-10009-1205
Anigilaje EA, Adesina TC. The pattern and outcomes of childhood renal diseases at the University of Abuja Teaching Hospital, Abuja, Nigeria: A 4-year retrospective review. Niger Postgrad Med J 2019;26:53-60.
DOI: https://doi.org/10.4103/npmj.npmj_174_18
Vd Merwe E, Cox S, Numanoglu A. Anorectal malformations, associated congenital anomalies and their investigation in a South African setting. Pediatr Surg Int 2017;33:875-82.
DOI: https://doi.org/10.1007/s00383-017-4109-0
Broadley P. The 4 Years Outcome Following the Demonstration of Bilateral Renal Pelvic Dilatation on Prenatal Ultrasound. Br J Radiol 1999;72:265-70.
DOI: https://doi.org/10.1259/bjr.72.855.10396216
Kané M, Keïta AD, Diallo M, et al. Imaging Congenital Malformations of the Child's Urinary System: about 32 Cases. Mali Médical 2006;21:5-9.
Abolarinwa AA, Ojewuyi OO, Solarin AU. Overview of paediatric urology practice in Lagos state university teaching hospital, Ikeja, Lagos, Nigeria. Niger Postgrad Med J 2020;27:132-5.
DOI: https://doi.org/10.4103/npmj.npmj_182_19
Esezobor CI, Ladapo TA, Osinaike B, Lesi FE. Paediatric acute kidney injury in a tertiary hospital in Nigeria: prevalence, causes and mortality rate. PLoS One 2012;7:e51229.
DOI: https://doi.org/10.1371/journal.pone.0051229
Chevalier, R.L. CAKUT: A Pediatric and Evolutionary Perspective on the Leading Cause of CKD in Childhood. Pediatr Rep 2023;15:143–53.
DOI: https://doi.org/10.3390/pediatric15010012
Ulasi II, Awobusuyi O, Nayak S, et al. Chronic Kidney Disease Burden in Low-Resource Settings: Regional Perspectives. Semin Nephrol 2023;42:151336.
DOI: https://doi.org/10.1016/j.semnephrol.2023.151336
El Imam M, Omran M, Nugud F, et al. Obstructive Uropathy in Sudanese Patients, Saudi J Kidney Dis Transplant 2006;17:415-9.
Breslow N, Olshan A, Beckwith JB, Green DM. Epidemiology of Wilms tumour. Med Pediatr Oncol 1993;21:172–81.
DOI: https://doi.org/10.1002/mpo.2950210305
Cunningham ME, Klug TD, Nuchtern JG, et al. Global Disparities in Wilms Tumor. J Surg Res 2020;247:34–51.
DOI: https://doi.org/10.1016/j.jss.2019.10.044
Abuidris DO, Elimam ME, Nugud FM, et al. Wilms tumour in Sudan. Pediatr Blood Cancer 2008;50:1135-7.
DOI: https://doi.org/10.1002/pbc.21547
Schroeder K, Saxton A, McDade J, et al. Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes. J Glob Oncol 2018;4:1-10.
DOI: https://doi.org/10.1200/JGO.2016.009027
Wiersma R. Overview of bladder exstrophy: a third world perspective. J Pediatr Surg 2008;43:1520-3.
DOI: https://doi.org/10.1016/j.jpedsurg.2007.11.005
Wilkinson J, Pope R, Kammann TJ, et al. The ethical and technical aspects of urinary diversions in low-resource settings: a commentary. BJOG 2016;123:1273-7.
DOI: https://doi.org/10.1111/1471-0528.13934
Nthumba PM, Carter LL Jr, Poenaru D. Ambiguous genitalia in rural Africa and the complexities of management: Which way forward? East Central Afr J Surg 2008;13:51-5.
Blackless M, Charuvastra A, Derryck A, et al. How sexually dimorphic are We? Review and Synthesis. Am J Hum Biol 2000;12:151–66.
DOI: https://doi.org/10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F
Hansen E, Irungu E, Nyagetuba J M, Mbogo J Management of Differences in Sexual Development: Evolution of an Approach for a Resource-Limited Setting Ann Afr Surg. 2022; 19: 186-192]
DOI: https://doi.org/10.4314/aas.v19i4.5
Warne GL, Raza J. Disorders of sex development (DSDs), their presentation and management in different cultures. Rev Endocr Metab Disord. 2008; 9: 227-36.
DOI: https://doi.org/10.1007/s11154-008-9084-2
Kisa P, Scotland K, Afshar K, MacNeily AE. Surveying unmet pediatric urological needs in low- and middle-income countries. J Pediatr Urol 2021;17:171.e1-9.
DOI: https://doi.org/10.1016/j.jpurol.2020.12.023
Coyle D, Nidaw E, Getachew H, Payne SR, Subramaniam R. Paediatric urology in Sub-Saharan Africa: challenges and opportunities. BJU Int 2022;130:277-84.
DOI: https://doi.org/10.1111/bju.15852
How to Cite
Calisti, A., Salman, D. Y., Belay, K., Mombo, A., Tresphory, B., Giuliani, G., … Parigi, G. B. (2024). The hidden burden of Pediatric urology in Sub-Saharan Africa: an analysis of hospital admission data from three East African Health Centres. La Pediatria Medica E Chirurgica, 46(1). https://doi.org/10.4081/pmc.2024.329
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