Aetiologic profile, outcomes and associated factors for Infantile obstructive jaundice cases managed at a tertiary hospital in Uganda: A retrospective study

Abstract

Background: The care for children with infantile obstructive jaundice (IOJ) remains a significant challenge in low-resource settings such as in Uganda. These patients often present late with significant complications of prolonged cholestasis. However, aetiologies, management outcomes and the associated factors for IOJ cases in Uganda remain largely unknown. This study investigated the aetiologies, short-term outcomes and associated factors, among infants with obstructive jaundice managed at Mulago National Referral Hospital (MNRH). Methodology: A retrospective study on children with the diagnosis of IOJ managed at MNRH for a period of 10 years, from January 2014 to December 2023. Demographic and clinical data from medical records were extracted and analysed. Aetiology and outcome were expressed as percentage proportions of total cases evaluated. A logistic regression model was used to identify independent factors associated with short-term outcomes of IOJ. The approval to conduct this study and waiver of informed consent was granted by the School of Medicine Research and Ethics Committee of Makerere University. Results: A total of 109 cases of IOJ were evaluated. M:F ratio= 1.32:1. The median duration of symptoms prior to admission was 90 days (IQR: 29– 179 days). Biliary atresia was the commonest cause of IOJ; 82 (75.2%) cases followed by Biliary cyst, 14 cases (12.8%) and inspissated bile plug syndrome, 9 cases (8.3%). Thirteen cases (11.9%) died, 84 cases (77.1%) were on palliative care and 12 cases (11.0%) showed clinical improvement at the time of assessment. Most of the outcomes were poor (Mortality, or on palliative care) at 84.4% and the most common specific among these was palliation at 80.4%. Significant factors for poor outcomes were: IOJ caused by biliary atresia (adjusted OR= 6.24, (95% CI: 1.5 – 23.6)) and prolonged duration of symptoms prior to admission (adjusted OR=1.01, 95% CI: 1.00 – 1.02)). Conclusion: Infantile obstructive jaundice at MNRH is predominantly caused by biliary atresia, and is associated with an unacceptably high rate of poor outcomes (Mortality, or on palliative care) with the most common specific being palliation because of late presentation. Outcomes are particularly poor for those with longer duration of symptoms prior to admission to care and for those with biliary atresia as the underlying cause.