TITLE:
Management of Congenital Disorders in a Resource-Limited Country: Organizational Model of a Specialized Working Group within a Perinatal Network
AUTHORS:
Mame Diarra Ndiaye, Lissoune Cisse, Daouda Ndour, Yaye Joor Dieng, Hélène Chami, Mamadou Mour Traore, Maguette Mbaye, Pape Moctar Faye
KEYWORDS:
Congenital Disorders, Perinatal Network, Resource-Limited Country, Antenatal Diagnosis, Care Centralization
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.1,
January
6,
2025
ABSTRACT: Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.