Prevalence of intestinal stoma complications and associated factors among children at Mulago National Referral Hospital, a cross sectional study

Abstract

Background: Intestinal stomas are a common procedure performed in children with over 165 stomas placed annually at Mulago hospital. Associated complications range from 28-81% in countries like Nigeria, Tanzania and India and common complications like dermatitis, prolapse, stenosis and retraction affect the child`s health and increases both family and hospital resource utilization. The prevalence of intestinal stoma complications at MNRH has not been studied as well as the associated factors yet these are fundamental in formulating preventive policies. Objective: To determine the prevalence of intestinal stoma complications among children with stomas placed at Mulago National Referral Hospital and the associated factors. Methods: This was a cross-sectional study carried out at the paediatric surgery unit of MNRH over a period of one and a half months. It included 131 children with intestinal stomas whose caretakers were interviewed using a structured questionnaire and children physically assessed for presence of intestinal stoma complications after obtaining informed consent from caretakers and assent from children 8 years and above. Nutritional assessment and theater book review were also done to complete the required data for the study. Outcome variable included intestinal stoma complications. Data were cleaned and entered in Excel and analysed using STATA version 17.0. Bivariate and multivariate logistic regression were used to assess for association. Results: The mean age of participants was 2 years (SD±1) with a male to female ratio of 1.3:1. Anorectal malformation 77 (58.8%) was the most common indication for stoma formation followed by Hirschsprung disease 25 (19.1%) then intussusception 19 (14.5%). Sigmoid colon was the most exteriorised part 104 (79.4%) followed by ileum 27 (20.6%). Children with intestinal stomas who developed complications were 83 (63.4%) with peristomal dermatitis being the most common complication 54 (41.1%) followed by stoma prolapse 5 (3.8%). The factors associated with intestinal stoma complications were increasing age at the time of stoma placement, above 12 months (OR 10.7) and exteriolisation of the ileum. Conclusion and recommendation: The prevalence of intestinal stoma complications is high at MNRH (63.4%). Stoma placement after the age of one year and having an ileostomy are associated with an increased risk of getting stoma complications. Sigmoid divided colostomies where indicated, prioritization of children with ileostomies for stoma reversal, further analysis of the factors associated with peristomal dermatitis and giving children regular periodic reviews will help to significantly reduce intestinal stoma complications. Keywords: Intestinal stomas, children, complications, factors associated, Mulago national referral hospital.