Congenital Diaphramatic Hernia Outcomes in East Africa: The Ethiopian Experience

Background: Despite advances in care leading to improved survival rate in high-income countries, congenital diaphragmatic hernia (CDH) continues to have a poor prognosis in sub-Saharan Africa. This retrospective analysis documents the demographics, presenting symptoms, initial diagnosis and outcomes of those CDH patients on whom operations are performed at TikurAnbessa Specialized Hospital (TASH), Ethiopia’s largest tertiary referral center, from September 2012 to August 2016.
Methods: The pediatric surgery database was reviewed for those patients who underwent CDH repair, and these cases were retrospectively analyzed. All work was performed in compliance with the Addis Ababa University institutional review board.
Results: Out of 15 patients who underwent operations, twelve cases were included in our study. Average age at presentation to TASH was 233 days. 83.3% of our study patients were initially misdiagnosed; 50% were initially diagnosed with pneumonia. The diaphragmatic defect was on the left in six (50%) of our patients and on the right in six (50%). Two patients died after surgery. The remaining ten survived. All patients underwent primary repair via lateral subcostal incision. Average length of stay was 24.5 days.
Conclusion: Misdiagnosis of CDH remains to be a major problem in sub-Saharan Africa, likely contributing to delay in diagnosis and early appropriate care. First line physicians and neonatal care units should consider the possible diagnosis of CDH when neonates and infants present with respiratory symptoms.