Itinerary of children in the management of intussusception: the true reasons of delayed medical care in a west African country

Abstract

Background: The delayed medical care of intussusception is still the reason for morbidity and mortality in many developing countries. The objective of this study is to take stock of the itinerary of children treated for intussusception, in order to to reduce the delay of the treatment.

Methods: This is a cross-sectional study, carried over three years (from 1^st June 2016 to 31 May 2019), at a Paediatric Surgery department of Campus Teaching Hospital in Lomé (Togo). The medical record of 23 children whose median age was 12 months, were included. Symptoms, the average time before the first consultation, different health centres consulted and treatment received, and the average time before the admission in the specialised department were studied.

Results: In three years, 23 children were managed for intussusception. The average time before the first consultation from home in a health centre was 1.87 days. No patient was admitted to the Paediatric Surgery department directly from home. Twelve patients consulted one centre, eight patients 2 centres, and one patient 3 centres before admission. Before referral, these patients were misdiagnosis as gastro-enteritis in 8 cases (38.10%), malaria in 8 cases (38.10%), and digestive salmonellosis in 3 cases (14.29%). The time elapsed between the beginning of the disease and the admission in specialised service was on average 5.39 days and  3.52 days elapsed then between the first consultation from home and the admission to the Paediatric Surgery service.

Conclusion: Valuable time to manage intussusceptions is lost in other medical health services before admission to specialised services. Action on this route will have to be taken through an effective counter-referral system.