Global Health
The children who go uncounted: Quantifying the surgical disease burden of gastrointestinal congenital anomalies in low-, middle-, and high-income countries Kelsey R. Landrum* Kelsey R. Landrum Emily R. Smith Henry E. Rice Pamela Espinoza Brian W. Pence Jessie K. Edwards Mark G. Shrime Naomi J. Wright
Background
The birth prevalence of congenital gastrointestinal (GI) anomalies and outcomes in affected children remain poorly defined in most countries, and the number of children with untreated GI anomalies has not been adequately estimated at regional or global levels. Our aim is to estimate the global and regional birth prevalence of six major GI anomalies, the proportion of GI anomaly cases globally and regionally that receive and do not receive treatment, and the proportion of GI anomaly cases globally and regionally that survive and do not survive given their treatment status.
Methods
For congenital GI anomalies, we combined multiple data sources and a series of Monte Carlo simulation probability models to estimate 1) the birth prevalence of GI anomalies, 2) the proportion of children who are untreated, and 3) the proportion of children dying within 30 days of life or treatment initiation in 204 countries and territories in 2018 .
Findings
GI anomaly prevalence ranged from 1.30 to 4.22 children per 10,000 births depending on country income and anomaly type, resulting in 251,095 cases worldwide in 2018. We predicted the majority of children in low-income countries (LICs; 98%) and middle-income countries (MICs; 76%) and a smaller proportion of children in high-income countries (HICs; 15%) did not receive surgical treatment for GI anomalies globally in 2018 (n=186,131). Mortality among those treated was higher in LICs and MICs compared to HICs (as high as 96% in LICs, 41% in MICs, and 20% in HICs).
Interpretation
The burden of untreated disease and mortality from congenital GI anomalies is disproportionately high in LMICs compared to HICs. Access to surgical care and outcomes after receiving such care varied dramatically by country income level. This study provides a contemporary benchmark for birth prevalence, unmet need, and survival outcomes of children with major GI anomalies globally.
