Surgical care of children born with birth defects in low and middle income countries [LMICs] using anorectal malformation [ARM] as a case study

Birth defects, also known as congenital anomalies, are one of the leading causes of infant mortality and lifelong disabilities worldwide. They disproportionately affect low and middle income countries [LMICs], where limited healthcare services, financial hardship, and societal stigma further increase the burden of these conditions. The thesis aims to investigate the impact of surgical intervention in managing birth defects, using Anorectal Malformations [ARM] as a case study, to highlight the challenges, innovations, and potential solutions in countries with low- resource settings like Bangladesh. This thesis utilizes five of my published works, including a hospital-based retrospective study in Bangladesh, a multicenter study across four countries [Bangladesh, Iran, Papua New Guinea, and the UK] on ARM, and several studies on low-cost innovation to bring surgery to rural areas and major neonatal surgery under local anesthesia. The hospital-based study provided critical insights into the prevalence of common patterns of birth defects like gastrointestinal and urogenital anomalies, as well as lack of medical documentation. Intervention studies that introduced innovative approaches, such as betel leaf for stoma care and major neonatal surgery under local anesthesia, proved to be culturally acceptable, cost-effective, and safe alternatives. Furthermore, outreach programs by taking specialized services to rural patients’ doorsteps successfully provided surgical services in underserved rural areas and addressed the challenges of underused logistics. The multicenter study examined the distribution of ARM subtypes and associated anomalies by using the Krickenbeck classification, differences in disease diagnosis and management system between LMICs and high income countries [HICs]. Collectively, this thesis showed how timely surgery for birth defects can significantly improve patient outcomes, reduce the financial burden of affected families, and strengthen the health system. It also advocates for including surgical management of birth defects into national health policies and focuses on the necessity of a ‘whole of society approach’ for equitable healthcare development.

Grantor dc:publisher

Oxford Brookes University

Author dc:creator

• Banu, Tahmina

Contributors dc:contributor

• Carding, Paul

Statement dc:rights

• All rights reserved

Language dc:language

en

DOI dc:identifier

https://doi.org/10.24384/1s71-kj29

OAI identifier oai:identifier

tle:c0d20793-de82-4d8c-8d22-4a3e82c26852:d6bd9758-527a-46cd-bfe2-c433766e8fca:1