Abstracts of the College of Surgeons of East, Central and Southern Africa (COSECSA) 25th Annual Scientific Conference: 4th to 5th December 2025: Bujumbura, Burundi

GENERAL SURGERY

Managing Acute on Chronic Colonic Pseudo-Obstruction in a Duchenne Muscular Dystrophy Patient: A Case Report from tertiary facility in Kenya

Ibrahim Mohamed Dahir, Daniel Kibicho, Alex Muturi

Kenyatta University Teaching, Referral and Research Hospital.

Correspondence: ibrahim.dahir@kutrrh.go.ke

Abstract ID: 426

Background: Duchenne Muscular Dystrophy (DMD), an X-linked genetic disorder, causes progressive muscle weakness, including gastrointestinal smooth muscle dysfunction. Acute on Chronic colonic pseudo-obstruction (CIPO), a rare complication, mimics bowel obstruction without a mechanical cause, posing diagnostic and therapeutic challenges, especially in resource-limited settings.

Case Presentation: A 17-year-old male with known DMD, wheelchair-bound since age 12 with recurrent constipation, presented with 3 weeks of progressive abdominal distension, nausea, and vomiting, and complete inability to pass stool or flatus for 5 days. Examination revealed a distended, tympanic abdomen with hypoactive bowel sounds. Abdominal X-ray and CT showed massive colonic dilatation without transition point, consistent with acute on chronic CIPO secondary to DMD. Conservative management with bowel rest, nasogastric decompression, IV fluids, electrolyte correction, polyethylene glycol, and enemas failed. Intravenous neostigmine (2 mg) was administered under cardiac monitoring, resulting in significant stool and flatus passage within 30 minutes. A low-residue diet and structured bowel regimen were instituted. Multidisciplinary input from neurology, nutrition, physiotherapy, and palliative care facilitated recovery. The patient was discharged after 8 days with outpatient follow-up.

Conclusion: This case highlights successful conservative management of CIPO in DMD using neostigmine in a low-resource setting. Early recognition and multidisciplinary care are crucial to avoid unnecessary surgery and improve outcomes.

Keywords: Duchenne Muscular Dystrophy, Acute on Chronic Colonic Pseudo-Obstruction, Neostigmine,

Surgical Management of Phimosis Following M-Pox Virus Infection: A Case Report

Barendegere Venerand, Mubamba Hubert

Kamenge Military Hospital

Correspondence: mubambahubert10@gmail.com

Abstract ID: 414

Background: The M-POX virus, previously known as monkeypox is a zoonotic viral disease that has gained global attention due to its atypical presentation and potential complications. It has emerged as a significant public health concern. While cutaneous manifestations are common, genital involvement remains underreported. This case report discusses and highlights a rare evolution of M-POX induced preputial lesions culminating in phimosis and ultimately requiring surgical intervention.

Case Presentation: a 42-year-old male patient was admitted to Kamenge Military Hospital after being diagnosed with M-POX virus. During his isolation period, he developed painful prepucial phlyctenoid lesions, which progressively worsened despite the supportive care consisting of painkillers (paracetamol and tramadol) and antibiotic(cloxacillin). He is the only one who has developed such lesions in 357 cases of P-POX positive patients who have been admitted to Kamenge Military Hospital so far. Over the course of several days, the lesions led to fibrotic changes and narrowing of the preputial opening, clinically diagnosed as phimosis. The patient reported increasing discomfort, hygiene difficulties and urinary stream alteration. Due to the progression of the condition and the patient’s discomfort, he was admitted to surgical ward on August 4^th, 2025, where surgical circumcision was performed. The procedure aimed to alleviate the phimosis and prevent further complications associated with the lesions and were uneventful with a rapid post-operative recovery plus the resolution of the symptoms. Post-circumcision, the patient was monitored for recovery and any potential complications. Follow-up evaluations indicated successful healing of the surgical site with no recurrence of lesions.

Conclusion: M-POX can present with rare but significant genital complications. Surgical circumcision remains a definitive treatment for post-infectious phimosis. This case contributes to growing body of evidence on M-POX’s evolving spectrum and reinforces the need for vigilance in urogenital manifestations. Therefore, surgical management, such as circumcision, can be an effective treatment for phimosis resulting from M-POX-related lesions. Further research is needed to understand the long-term implications of viral infections on urogenital health.

Keywords: M-pox, Phismosis, Case Report

Factors Associated with Conversion from Laparoscopic to Open Cholecystectomy at Muhimbili National Hospital, Tanzania

Esra Mohamed

University of Medical Science and Technology, Sudan

Muhimbili National Hospital, Tanzania

Aswan Teaching Hospital, Egypt

Correspondence: esraadam424@gmail.com

Abstract ID: 409

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstone disease. However, conversion to open cholecystectomy (OC) is occasionally required, particularly in low- and middle-income country (LMIC) settings, where resources and surgeon experience vary. This study aimed to evaluate factors associated with conversion from LC to OC among patients at Muhimbili National Hospital (MNH), Tanzania.

Methods: A retrospective cross-sectional study was conducted in the Department of Surgery at MNH, Dar es Salaam, Tanzania. A total of 230 patient records of individuals who underwent LC between 2023 and 2024 were reviewed. Data on demographics, comorbidities, operative indications, preoperative imaging, intraoperative findings, surgeon experience, and outcomes were collected and analyzed.

Results: Of 230 patients, 77.8% were female, with a mean age of 47.8 years. Hypertension was the most common comorbidity. Cholelithiasis accounted for 89.1% of operative indications. Preoperative imaging included ultrasonography (62.1%) and MRCP (18.1%). Intraoperative findings matched preoperative gallbladder descriptions in 40.4% of cases, while extensive adhesions were observed in 29.6%. The overall conversion rate was 9.2%. Factors significantly associated with conversion included patient body weight (p = 0.04), surgeon experience (p = 0.02), and intraoperative findings (p = 0.001).

Conclusion: Conversion from LC to OC at MNH was influenced by patient weight, surgeon experience, and intraoperative pathology. More experienced surgeons demonstrated lower conversion rates, while adhesions, inflammation, and contracted gallbladders increased conversion risk. Strengthening surgical training and preoperative risk stratification may reduce conversion rates in LMIC settings.

Keywords: Laparoscopic cholecystectomy, Tanzania, conversion to open cholecystectomy

Assessment Of Response to Neoadjuvant Therapy in Breast Cancer Patients Treated at A Faith-Based Referral Hospital in Kenya

Michelle Obat

AIC Kijabe Hospital, Kenya

Correspondence: mitchelle.obat93@gmail.com

Abstract ID: 408

Background: Breast cancer is the second leading cause of cancer-related deaths among women in Kenya, with most patients presenting at advanced stages. Neoadjuvant systemic therapy (NST) is a cornerstone of treatment for locally advanced breast cancer globally, but limited data exist on its use in Kenya.

Methods: We conducted a retrospective cohort study of 135 patients with biopsy-confirmed breast cancer treated at AIC Kijabe Hospital. Demographic and clinical data, including age, stage, histology, receptor status, treatment, and response were analyzed. Clinical and pathological staging were compared to assess tumor downstaging, with outcomes evaluated by age and receptor subtype.

Results: The mean age was 47 years. Most patients presented with locally advanced disease (52.7% T4; 69.4% node-positive; 55.5% stage III). After NST, 13.3% achieved complete pathologic response in the breast, and 10.1% were down staged to stage 0. Stage III disease decreased from 55.5% clinically to 33.0% pathologically. Receptor distribution was 43.7% HR+/HER2−, 15.6% HR+/HER2+, 10.3% HR−/HER2+, and 21.5% triple-negative. Response varied significantly by subtype (p=0.03): 80% of HR−/HER2+ and 42.3% of triple-negative patients showed no response. Only 48.3% of triple-negative patients received platinum-based therapy, while 54.3% of HER2-positive patients accessed trastuzumab. Axillary surgery was almost exclusively full dissection (97.5%), as sentinel lymph node biopsy was unavailable.

Conclusion: NST improved operability and down staged a subset of tumors, but responses were limited by restricted access to receptor-specific therapies and modern surgical techniques. Poor outcomes in triple-negative and HER2-positive patients highlight the need to expand access to platinum-based regimens, HER2-targeted therapy, and sentinel lymph node biopsy. Strengthening diagnostic capacity and adapting treatment guidelines to local contexts are essential for improving outcomes in resource-limited settings.

Keywords: Breast cancer Neoadjuvant systemic therapy Receptor subtype Resource-limited settings

Mortality Predictive Accuracy of Pulp Versus Boey in Patients Undergone Laparotomy Due To Perforated Peptic Ulcer at Muhimbili National Hospital

Novath Julius Ngowi

Muhimbili University of Health and Allied Sciences, Tanzania

Correspondence: novathngowi@yahoo.com

Abstract ID: 407

Background: Perforated peptic ulcer (PPU) is a common surgical emergency with variable morbidity and mortality in Tanzania. There are significant negative post-operative outcomes after a PPU. Identify patients needing additional resources for better outcomes in limited resources. This study aimed to identify a better predictive tool for morbidity and mortality between PULP and Boey among patients who underwent laparotomy repair for perforated peptic ulcers in local settings.

Methods: Combined retrospective and prospective cross-sectional study recruited adult patients with perforated peptic ulcers from 1stJanuary 2021 to 31st December 2022. PULP and Boey variables were collected from each patient through structured checklist. A sample size of 100 patients was considered sufficient to provide a study power of 80%. Main outcome was major complications occurring within the 30 days post-operative. Receiver Operator curves were used to compare the predictive accuracy of the two tools.

Results: We recruited 100 patients aged 18 years and older, with a 6:1 male-to-female ratio. 30-days mortality was 13%. Male sex, presence of preoperative shock and comorbidities, high serum creatinine and ASA class were found to significantly predict mortality. PULP had a good predictive ability, with an AUROC of 0.7505, sensitivity of 57.14% and specificity of 88.2%, compared to Boey’s score of 0.6629 sensitivity and specificity of 51.02% and 78.4%, respectively with p-value < 0.05.

Conclusion: Peptic ulcer perforation is common with poor postoperative prognosis. PULP and BOEY score can predict morbidity and mortality, with PULP being more accurate, aiding in allocating resources for individual patient care.

Keywords: Perforated peptic ulcer disease, mortality predictive score, PULP score, Boey Score

Traffic in Theatre as a Risk for Surgical Site Infection at Three Tertiary Hospitals in the Copperbelt Province, Zambia

Seke Manase Ephraim Kazuma

Kitwe Teaching Hospital, Kitwe

Correspondence: sekekazuma@gmail.com

Abstract ID: 406

Background: The rate of operating-theatre room nosocomial infections is estimated at 10% of surgical site infections (SSI) in postoperative wounds. Earlier studies have suggested that restricting traffic by head count and reducing the number of door openings of the operating room could reduce the development of SSI. This study was done to determine whether traffic in theatre by head count or door-openings was a risk for the development of SSI.

Methods: This was a prospective observational cross-section study conducted at 3 tertiary hospitals in the Copperbelt Province of Zambia.

Results: A total of 1122 participants were included. Of the total study population, 468 were females and 654 were males. A total of 218 participants, representing 19.4%, developed surgical site infection proven by pus results. This study showed no correlation between the number of people by head count in the operating theatre and the development of SSIs. All p-values for head counts were not significant. However, the number of door-openings was significant as a risk for development of SSI.

Conclusion: The prevalence of SSI at the 3 tertiary institutions was 19.4%. The risk of developing SSI was significant for an increased number of door-openings, but not for the head count in theatre, at the 3 tertiary institutions. Therefore, the number of door-openings was a significant risk for developing SSI.

Keywords: traffic in theatre as risk of SSI, prevalence of SSI, surgical site infection

Clinical Audit of Venous Thromboembolism (VTE) Risk Assessment and Guideline Compliance in Surgical Practice

Noha Abdelhalim, Siddig Rikabi

Correspondence: nuharikabi@gmail.com

Abstract ID: 390

Background: Venous thromboembolism (VTE) remains a major cause of preventable morbidity and mortality among surgical inpatients. Despite established international guidelines, adherence to prophylaxis protocols is often suboptimal in clinical practice. This study aimed to evaluate and improve adherence to VTE risk assessment and prophylaxis guidelines among surgical patients at Port Sudan Doctors Hospital through a structured clinical audit.

Methods: A two-cycle prospective clinical audit was conducted. The first cycle (September 2024) involved a retrospective review of 50 surgical inpatient records and a gap analysis through staff interviews and observations. A two-month intervention followed, introducing a standardized VTE risk assessment tool, staff training, and integration of clinical workflows. The second cycle (January-April 2025) included a prospective review of 41 patient records and qualitative staff feedback. Data were analyzed descriptively and thematically.

Results: Compliance with VTE prophylaxis guidelines improved significantly from 6% in the first cycle to 85.4% in the second. Patient education increased from 4% to 95.1%, and proper documentation of prophylaxis duration improved from 6% to 95.1%. The use of structured risk assessment tools (e.g., Caprini score) increased from 7.1% to 50%, while inappropriate pharmacological prophylaxis for low-risk patients was eliminated. Staff engagement and usability of tools were also enhanced.

Conclusion: Targeted interventions, including standardized risk assessment and focused staff education, significantly improved VTE prophylaxis practices. Sustained improvements will require continued auditing, digital integration of tools, and institutional support to promote long-term adherence and patient safety.

Keywords: Caprini score, patient education, prophylaxis, quality improvement

Assessment of Venous Thromboembolism (VTE) Risk Evaluation and Compliance with Guidelines in Surgical Patients: A Clinical Audit at the Prince Osman Digna Referral Hospital

Abdulrahman Abbas Yusuf Mohammed¹, Mohamed Salah Ibrahim Ahmed², Awad Abdalla Widaa Mohamed³, Abubakr Muhammed⁴, Ashraf H. Hassan⁵, Ahmed Khalid Mohamed Ahmed⁶, Ahmed N. Mohamed⁷, Mohammed Osman Ahmed Osman⁸, Soudad A. Shila⁹, Mohamed Hamza Mohamed Bakheet¹⁰, Abdulrahman Mohammed¹¹, Mohey Aldien Ahmed Elamin Elnour¹², Alnazeer Y. Abdelbag¹³, Elaf Osama Elsamani Altayb¹⁰, Amal A. Fadl¹⁴, Matab Abdalla Ahmed Abdalla², Mustafa Mohamed C¹⁵, Marwa Elaziz¹⁶, Suliman Saadeldeen¹⁷

1. University of Gezira

2. Prince Osman Digna Referral Hospital

3. Port Sudan Teaching Hospital

4. University of Cape Town

5. Emergency Department, Dr. Sulaimar Al Habib Hospital, Riyadh, SAU

6. Internal Medicine, Dongola Specialized Hospital, Dongola, SDN EDIT

7. Critical Care Medicine, SEHA Salma Rehabilitation Hospital, Abu EDIT Dhabi, ARE

8. Internal Medicine, The National Ribat University, Khartoum EDIT, SDN

9. Medical Education, Hamad Medical Corporation

10. General Surgery, Prince Digna Referral Hospital, Khartoum, SDN

11. General and Colorectal Surgery, Royal Oldham Hospital, Manchester, GBR

12. Neurosurgery, University Hospitals O Coventry and Warwickshire NHS EDIT Trust, Coventry, GBR

13. Department of Anatomy, University of Khartoum, Khartoum, SDN

14. Cardiology, Rashid Hospital, Dubai, ARE

15. Internal Medicine, Prince Othman Digna Teaching Hospital, Port Sudan, SDN

16. Ahfad University for Women

17. Managil Teaching Hospital

Correspondence: abdulrahmanabbas625@gmail.com

Abstract ID: 388

Background: Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of avoidable hospital-acquired morbidity and mortality. Despite clear international guidelines from bodies such as the American College of Chest Physicians (ACCP) and the National Institute for Health and Care Excellence (NICE), compliance in surgical settings remains suboptimal. This audit aimed to evaluate and improve the documentation and implementation of VTE risk assessment and prophylaxis among surgical patients.

Methods: A closed-loop clinical audit was conducted at Prince Osman Digna Referral Hospital, Port Sudan, Sudan. The study included retrospective and prospective data collection across two audit cycles, the first involving 50, and the second cycle, 47 randomly selected surgical inpatient records. Data were gathered using a standardized tool aligned with international guidelines. Interventions between the cycles included educational workshops, implementation of standardized assessment forms, visual aids, and feedback sessions. Data were analyzed using descriptive statistics and the Chi-square test to determine changes in compliance.

Results: In the first cycle (N = 50), compliance was poor: (0%) had Caprini scores documented, and 49 (98%) received no prophylaxis. Following targeted interventions, the second cycle (N = 47) showed significant improvement. Caprini score documentation increased to 39 (83%), early mobilization to 30 (63.8%), and LMWH administration to nine (19.1%). Use of TED stockings rose to eight (17%), while those receiving no prophylaxis dropped to seven (14.9%). Documentation of prophylaxis duration improved to 37 (78.7%), compared to one (2%) in the first cycle. All improvements were statistically significant (p < 0.05).

Conclusion: Targeted interventions led to substantial improvements in VTE risk assessment and prophylaxis practices. Standardized tools, clinician education, and systematic feedback proved effective in promoting adherence to evidence-based guidelines. Sustained efforts are essential to maintain compliance and enhance patient safety.

Keywords: General Surgery, Clinical Audit

Postoperative Intra-abdominal Abscess Following General Surgery: A Systematic Review of Risk Factors, Prevention, and the Role of Laparotomy

Mawada Taha

The National Ribat University

Correspondence: dr.mawada1992@gmail.com

Abstract ID: 386

Background: Postoperative intra-abdominal abscess (PIAA) is a significant complication following general abdominal surgery, contributing to increased morbidity and mortality.

Methods: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, with a comprehensive search of multiple databases including PubMed, Embase, Scopus, and the Cochrane Library up to July 2025. Studies were selected based on predefined PICO (Population, Intervention, Comparison, Outcome) criteria, focusing on adult patients undergoing abdominal surgery and assessing risk factors, prevention, and management strategies for PIAA.

Results: Five eligible studies involving 3,537 patients were included and analyzed. Key risk factors identified included perforated appendicitis, intraoperative contamination, elevated National Nosocomial Infections Surveillance (NNIS) scores, preoperative radiation, and splenectomy. Preventive measures such as targeted perioperative antibiotic prophylaxis and selective surgical drainage have demonstrated efficacy in reducing abscess incidence. Percutaneous drainage is generally preferred as the initial intervention due to its minimally invasive nature and favorable outcomes, while laparotomy remains necessary for complex abscesses involving multiloculated collections or anastomotic leaks. The routine use of prophylactic drains remains controversial and may increase postoperative complications.

Conclusion: Effective management of PIAA requires careful risk assessment, individualized preventive strategies, and prompt source control. Further well-designed randomized controlled trials are needed to establish standardized treatment protocols and optimize patient outcomes.

Keywords: Postoperative intra-abdominal abscess; Risk factors; Prevention; Management

Evaluating and Improving the Quality of Surgical Operative Notes at the Port Sudan Teaching Hospital: A Two-Cycle Clinical Audit

Mohey Aldien Ahmed Elamin Elnour¹, Alnazeer Y. Abdelbagi², Abubakr Muhammed³, Mustafa Mohamed⁴, Amir Alamin Ahmed Altyeb¹, Alaa Osman Sir Alkhatim Ali¹, Mohamed Khalid Hassan Abdelkarim¹, Fatima Aladdin Elssayed Osman¹, Elbokhari Mohamed Elbashir Hassan¹, Mahmoud Ali Mohamed Abdalrahman¹, Galaleldin Mohamed Abdeljalil Mohamed⁵, Etigad Salahuddin Elzubier Suliman1, Khalid Ahmed Noureldaim Ahmed¹, Awad Abdalla Widaa Mohamed¹

1. General Surgery, Port Sudan Teaching Hospital, Port Sudan, Sudan (SDN)

2. Anatomy, University of Khartoum, Khartoum, Sudan (SDN)

3. Surgery, University of Gezira, Madani, Sudan (SDN)

4. Internal Medicine, Al-Neelain University, Khartoum, Sudan (SDN)

5. General Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia (SAU)

Correspondence: moheyaldein@gmail.com

Abstract ID: 385

Background: Thorough and standardized documentation of operative notes is essential for effective communication, patient safety, legal protection, and the continuity of care. However, in many hospitals in Sudan, surgeons often use non-standardized methods, resulting in inconsistent and incomplete records. This study evaluates the quality of operative notes at the Port Sudan Teaching Hospital using the Royal College of Surgeons of England (RCSEng) guidelines, aiming to improve compliance and documentation practices.

Methods: A clinical audit was conducted in two cycles at the General Surgery Department. The first cycle, a retrospective review of 50 surgical notes, was carried out over one week in July 2024. The second cycle conducted prospectively on another 50 notes throughout September 2024, involved the implementation of an improved proforma and staff training. Data were collected using a standardized checklist aligned with Royal College of Surgeons of England (RCSEng) guidelines, covering 18 documentation criteria. Results were analyzed using Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington, United States) to assess improvements in compliance.

Results: Compliance with documentation standards increased significantly from 51.9% in the first cycle to 82.1% in the second cycle. Notable improvements were observed in recording operative findings (17, 34%), complications (34, 68%), and deep vein thrombosis (DVT) prophylaxis (47, 94%). Despite the overall progress, modest improvements were noted in documenting the anesthetist’s name (2.5, 5%) and the surgeon’s signature (3, 6%). These findings underscore the positive impact of structured proformas and targeted staff training.

Conclusion: The implementation of standardized documentation tools and staff training significantly improved the quality of surgical operative notes at the Port Sudan Teaching Hospital. While notable progress was achieved, continued efforts, including digital solutions and regular audits, are needed to sustain these improvements and promote patient safety.

Keywords: general surgery, operative notes, quality improvement, Royal College of Surgeons

The Ethiopian Surgical Outcome Study (Ethio-SOS): A 7-day Multicenter National Prospective Observational Cohort study

Atalel Fentahun

Debre Tabor University

Correspondence: fentahunatalel27@gmail.com

Abstract ID: 375

Background: Safe surgical care is a cost-effective intervention for addressing a wide range of conditions, yet postoperative complications remain a leading global cause of disability, mortality, and economic loss, disproportionately affecting low- and middle-income countries (LMICs). This study aims to generate robust epidemiological data on postoperative outcomes for surgical patients in Ethiopia.

Methods: This 7-day national observational cohort study included adult patients undergoing elective and non-elective surgeries, using a convenience sampling method to recruit as many hospital sites as possible from the twelve regions of Ethiopia. The primary outcomes measured were 7-day in-hospital mortality and postoperative complications. Statistical analysis included descriptive statistics and logistic regression models to identify risk factors for mortality and complications.

Results: A total of 4412 surgical patients across 46 Ethiopian hospitals were included in this study. The median patient age was 30 years (IQR: 25-42), with a predominance of female participants 2772/4412(62.8%) and American Society of Anesthesiologists classification class I-II classifications. The overall complication rate was 19.8% (873/4412), with 4.2% (184/4412) experiencing severe complications (Clavien-Dindo grades III-IV) necessitating reoperation. The overall mortality rate was 0.4% (17/4412), with a median age at death of 40 years (IQR=29-49). Our findings suggest that the key drivers of perioperative mortality and postoperative complications were higher ASA class, comorbidities, cancer surgery, infections, and emergency surgical procedures.

Conclusion: One in five surgical patients in Ethiopia experiences postoperative complications and a high rate of reoperation, despite exhibiting a low-risk profile, young age, and a low rate of high-risk surgical procedures. This suggests a need for more evidence-based interventions to strengthen the foundations, care processes, and quality of the surgical system to achieve safe and effective care and improve overall surgical outcomes in the country.

Keywords: Surgery, Mortality, Complication, Ethiopia

Implementation of a workplace-based assessment tool at a COSECSA Program at a Public Referral Hospital in Eastern Uganda

Justine Broecker

University of California, San Francisco

Correspondence: justinebroecker@gmail.com

Abstract ID: 368

Background: The workplace-based assessment and feedback tool Society for Improving Medical Professional Learning (SIMPL) is frequently used to assess operative autonomy, performance, and complexity in residency training in the United States. Limited data about its feasibility and usefulness in the COSECSA region is available. The aim of this study was to evaluate the usefulness and feasibility of SIMPL at a public COSECSA program in Uganda.

Methods: Usage of SIMPL was evaluated among residents and faculty between Jan 2024-July 2024 at Mbale Hospital, a public COSECSA general surgery residency training program. User perspectives were elicited through a survey. Descriptive analysis and fisher’s exact tests were performed.

Results: A total of 78 evaluations were completed for 49 distinct case IDs (out of 1033 total cases) among 8/10 trainees ranging from PGY 1-3 and 5/6 faculty. Residents and faculty had differing responses regarding usefulness of SIMPL. Residents overwhelmingly felt the dictated feedback was useful (90% very useful, 10% moderately useful) compared to faculty (0% very useful, 40% moderately useful, 20% slightly useful, 40% not at all useful) (p=0.007). Both residents and faculty believed that SIMPL had a positive impact on frequency and quality of feedback, found it a valuable learning tool, and appreciated that it allowed a way to track a resident’s progress. Barriers included technical challenges, 72-hour time limit, and forgetting to use it. Both residents and faculty believed senior residents should be able to evaluate junior residents.

Conclusion: Though residents and faculty feel that SIMPL is a valuable learning tool, they only use SIMPL for a fraction of their logged cases. Barriers to use include technical challenges, time-limit for evaluation submission, and forgetting to use it. This study does show that it is feasible to use SIMPL in a public COSECSA hospital, though measures to increase usage are necessary.

Keywords: surgical education, operative learning

Kibuye Surgical Residency Program: Advantages of Partnerships

Sadock Irankunda

Kibuye Hope Hospital, PAACS, Mercy Surgeons Research Department

Correspondence: sadockirankunda@gmail.com

Abstract ID: 346

Background: Burundi’s surgeon to patient ratio is 0.4/100000. Training more surgical providers is essential and urgent in Burundi. We describe lessons learnt from strategic collaboration between Hope Africa University, Kibuye District Hospital, the pan African academy of Christian Surgeons (PAACS) and the College of Surgeons of East Central and Southern Africa (COSECSA) in establishing a rural hospital based general surgery residency. Establishing a fully hospital based surgical residency program in rural Burundi is difficult because of challenges with local accreditation, underfunding, shortage of accredited surgical educators, and inadequate surgical facilities. Setting up such a residency program therefore requires innovative strategic partnerships.

Case Study: Kibuye Hope Hospital’s residency was launched in 2022. This was the first program to be affiliated to both universities and to be fully hospital based in rural Burundi, delivered in English, with full access to learning platforms and systems preestablished by PAACS and COSECSA.

Several lessons can be learnt from this collaboration:

1. Training of skilled surgeons is a shared need and goal in Burundi and other African nations.

2. Surgical educators should lead the way in establishing strategic surgical education partnerships to establish locally endorsed strong, sustainable surgical training programs.

3. The collaborative program creates safe working conditions, excellent academic and clinical learning environment supported by local and international volunteers surgical educators and academic oversight, as well as accreditation by Hope African University (Ministry of Education), PAACS, and COSECSA (Ministry of Health)

4. The impact and growth of a surgical residency program relies on the strength and determination of its partners.

Conclusion: Training and educating surgeons in a rural district hospital is achievable. Relationships, mutual respect and clear written agreements are also key to success. Such a partnership is paramount and combines the strengths of each partner to build a strong surgical residency program to address the urgent need for surgeons in Burundi and other LMICs.

Keywords: Residency, Education, Partnerships

Learning how to improve surgical patient safety in African hospitals: lessons from the 5Rs to Rescue quality improvement initiative.

Richard Gamubaka

Mbale Regional Referral Hospital, Busitema university

Correspondence: chard701@gmail.com

Abstract ID: 320

Background: Africa faces a surgical mortality rate twice the global average. This is primarily due to failure-to-rescue (FTR), deaths following post-operative complications. Despite evidence that enhanced monitoring reduces FTR, implementation remains inconsistent. We explore the challenges and successes of implementing a multi-country pilot quality improvement project (QIP), 5Rs to Rescue’, and describe a novel improvement mentorship model.

Methods: After co-producing a complex intervention with stakeholders across nine hospitals in Ethiopia, South Africa, Tanzania, and Uganda, we interviewed 24 professionals, including surgeons, nurses, anesthesiologists and improvement advisors. Semi-structured interviews explored experiences with implementing five key strategies to improve post-operative monitoring. Data were analyzed using thematic analysis, guided by the Consolidated Framework for Implementation Research.

Results: Relational work is critical for QIP success: Implementation required extensive engagement across professional hierarchies. Surgeons emphasized the need for early, multi-level communication to secure buy-in. Strong collaboration between senior surgeons and nurses improved adoption, while empowering nurses to escalate concerns was vital—yet time-intensive. Hierarchical divides between surgical and nursing teams posed challenges, highlighting the need for interprofessional leadership. Complex interventions in resource-constrained systems: Introducing tools like Early Warning Scores faced barriers, including unfamiliarity among nurses, frequent staff rotations, and unclear task delegation. Despite initial resistance, structured coaching and iterative training improved adherence. The reflection component fostered a blame-free learning culture but required cultural shifts led by senior staff. Multinational improvement mentorship: Despite high expectations that surgical teams continuously improve patient care, formal training in improvement methods is limited. We implemented a remote mentoring model involving rapid improvement events, improvement advisors and routine feedback.

Conclusion: The 5Rs to Rescue initiative underscores the importance of relational leadership, adaptive, context-sensitive interventions and improvement mentorship in reducing FTR. These findings provide a roadmap for scaling post-operative care improvements across African hospitals, ultimately saving lives through sustainable quality improvement.

Keywords: 5R, R-risk assessment with ASOS tool, R- recognize with NEWS observation charts, R-respond, R-reassess, R-reflect

Building Rural Surgical Capacity in DR Congo through the Diploma in SOTA Care

Neil Robert Wetzig, Jacques Fadhili Bake, Justin Tsandiraki, Muller Mudenga, Jean_Pierre Kigayi, Justin Paluku Lussy, Medard Jean Kakule Kubuyaya, Barthelemy Aksanti, Cathy Kassi, Nelson Kambale, Simplice Vuhaka, John Musubao, Benjamin Kambale

HEAL Africa

Correspondence: wetzigng@gmail.com

Abstract ID: 316

Background: Access to safe surgical care remains critically limited in many low-resource settings, particularly in the Democratic Republic of Congo (DRC), where Bellwether procedures are inconsistently available and quality concerns deter care-seeking. To address this gap, the DISC Course (Diploma In SOTA Care - Surgical, Obstetric, Trauma and Anaesthesia) was developed and implemented over two years, training 45 rural doctors across DRC.

Methods: The course focused on practical skills in basic surgery and trauma management, using low-cost simulation models, alongside foundational knowledge in anatomy and physiology. Participants completed pre- and post-course knowledge assessments, self-rated confidence surveys (Likert score 0-10), and facility evaluations. 23 participants completed a 12-month assessment of skills retention and ongoing practice of SOTA care.

Results: Pre- and post-course assessments demonstrated significant improvements in knowledge (mean scores rising from 58%-75%) and self-rated procedural confidence, (5.4-8). Improvement was particularly noted in trauma interventions -cricothyroidotomy (1.3-8) and intercostal catheter insertion (3-8). Anatomy and physiology understanding improved (5-8). Twelve-month follow-up confirmed sustained skill retention across most procedures (8.5 overall), increased SOTA-related workload, and enhanced confidence in managing complex cases. Obstetric procedures (C-section and Hysterectomy) remained the most common performed post-training. Despite limited infrastructure only 24% of centers had reliable power and 32% consistent oxygen supply participants reported improved patient outcomes after 12 months and greater peer trust. Increased ongoing learning supported by a WhatsApp group Community of Practice was noted with 82% of the alumni group using online videos for procedural preparation.

Conclusion: This study highlights the feasibility and impact of targeted, context-specific surgical training in fragile settings. The DISC model demonstrates that short, intensive courses can sustainably build rural surgical capacity, even amid conflict and resource constraints. Future iterations will maintain longitudinal mentorship and use digital learning platforms, to further strengthen surgical systems in LMICs.

Keywords: Surgical training, OTA care, rural health, capacity building

Postgraduate Clinical Assessment in Africa: Are We Getting It Right, And at What Cost?

Lois Haruna-Cooper

UCL

Correspondence: l.haruna@ucl.ac.uk

Abstract ID: 313

Background: Quality can be defined as the degree to which something meets or exceeds established standards, specifications, or expectations. While there is a consensus on what constitutes high-quality assessment, these views predominantly originate from the global north. It is essential to consider the perspective of the global south, and whether the accepted definition is applicable and relevant in all contexts. While the Ottawa consensus statements provide valuable guidance on assessment quality, further exploration and consideration of diverse stakeholder views are necessary. By examining the views of different regions and educational stakeholders, it becomes possible to determine if there is agreement on what constitutes good quality assessment and whether these ideals are effectively implemented. This exploration helps bridge the gap between theoretical concepts of quality assessment and the practical realities experienced by institutions in different parts of the world. As many institutions seek to reform their assessment strategies, it is necessary to ensure these strategies align with the needs and aspirations of diverse educational systems. Perspectives from across Africa can contribute to creating assessment frameworks that are more equitable, culturally sensitive, and effective in preparing post-graduate trainees for their respective work environments.

Methods and expected outcomes: The workshop will begin by reflecting on challenges in post-graduate clinical assessment and discuss experiences from across Africa. Then, using the nominal group technique, participants will engage in reflective and discursive activities to identify key features of a good quality workplace-based assessment of clinical competence. These features will be used to formulate a thematic framework to guide existing and future initiatives, and policy development, as part of improving specialist certification in Africa.

Keywords: Assessment, Quality, workplace-based

Learning Curve of Laparoscopic Cholecystectomy in Low-Resource Setting: An Experience of a Junior Surgeon by Analysis the Cumulative Sum of Autonomy

Regis Bakunda, Raoul Mizero

Department of General and Visceral Surgery, Kira Hospital, Bujumbura, Burundi.

Correspondence: mizero929@gmail.com

Abstract ID: 292

Background: Laparoscopy is the gold standard technique of cholecystectomy. In surgery, learning curve is defined as time and or number of procedures to carry out a procedure with reasonable outcome. The aim of our study was to determine the moment of a safe laparoscopic cholecystectomy done independently by a junior surgeon under mentorship of an experienced surgeon.

Methods: Our study was a retrospective one single-center of 17 patients who underwent a laparoscopic cholecystectomy over a period of 6 months. The learning curve was evaluated by the cumulative sum analysis of the roles performed by the junior surgeon as assistant, under supervision and independently. The junior surgeon had assisted laparoscopic procedures during his residency and had done training at IRCAD AFRICA before.

Results: A total of 17 patients were included. The mean age was 39 years (21-57) with a sex ratio of 0.06. 5 patients (29.4 %) had history of cholecystitis. There were no per and post-operative complications. The average length of hospitalization was 1.06 days (1-2). The CUSUM analysis showed that the autonomy was achieved at 8^th ^procedure with consistent independence in performing the following procedures.

Conclusion: Laparoscopic cholecystectomy is the gold standard of care for symptomatic cholelithiasis. A safe laparoscopic cholecystectomy is feasible by training with mentorship and the CUSUM is a good tool for evaluation of surgical performance.

Keywords: cholecystectomy, learning curve, laparoscopy, cumulative sum analysis, general surgery training

Clinical Outcomes of Patients with Gangrenous Sigmoid Volvulus After Resection and Primary Anastomosis and Hartmann’s Procedure at The University Teaching Adult Hospital in Lusaka, Zambia

Clement Mwamba

University Teaching Adult Hospital, Lusaka, Zambia

Correspondence: ccmj.mwamba@yahoo.com

Abstract ID: 269

Background: Sigmoid volvulus, a condition in which the sigmoid colon twists around its mesentery, is the most common cause of intestinal obstruction in Zambia and can lead to gangrene if not treated promptly. The study aimed to address the limited data on clinical outcomes for gangrenous SV in the country.

Methods: A prospective cohort study was conducted on 40 patients at the University Teaching Hospitals in Lusaka, Zambia between May 2024 and April 2025. There were 15 patients in whom Hartman’s was done and 25 patients in whom RPA was done. Data was collected using a researcher-administered structured questionnaire. Patients were followed up for a minimum period of 30 days post-operatively. Univariate and Multivariate analysis were carried out using R. A p-value of <0.05 at 95% confidence interval was considered significant.

Results: The results showed no significant differences in baseline characteristics such as age, BMI, and blood pressure between the two groups. The median hospital stay was 9 days for the RPA group and 8 days for the Hartmann’s group, which was not a statistically significant difference (p=0.457). Postoperative complications occurred in 22.5% of all patients, with no significant difference between the RPA group (20%) and the Hartmann’s group (26.7%). Common complications included surgical site infections and stoma-related issues. Mortality was low and comparable between both groups (RPA: 8%; Hartmann’s: 6.7%).

Conclusion: RPA was the more frequently performed procedure and demonstrated similar outcomes to Hartmann’s in terms of complications, hospital stay, and mortality. These findings suggest that RPA can be safely performed in selected patients with gangrenous sigmoid volvulus, especially where adequate surgical expertise and perioperative care are available.

Keywords: Resection and primary anastomosis

Benign Breast Disease in Limited Resources- Part of A Curriculum

Herbert Cubasch

Wits University, South Africa

Correspondence: hcubasch@gmail.com

Abstract ID: 244

Benign Breast Disease (BBD) encompasses a range of non-cancerous conditions that account for a significant portion of breast clinic referrals worldwide. While breast symptoms are common and often benign, distinguishing these from malignancy remains a challenge, especially in the absence of effective screening systems. This paper explores the diagnostic and therapeutic approaches to BBD, focusing on common conditions such as mastalgia, fibrocystic changes, fibroadenomas, nipple discharge, and phyllodes tumours, among others.

BBD often presents with symptoms that mimic malignancy, such as lumps, pain, and discharge, which can be distressing for patients. The paper emphasizes the importance of a comprehensive diagnostic approach, including clinical evaluation, radiological assessments, and histopathological examination, collectively known as the “triple assessment.” Despite the benign nature of these diseases, some conditions require surgical intervention, especially in the case of significant breast deformity or complications like infection. It is essential to distinguish BBD from physiological changes in the breast, such as cyclical hormonal fluctuations, which do not fall under the classification of disease. These physiological changes, while common, are not considered pathological and generally do not require medical intervention, although they can lead to symptoms like discomfort or benign lumpiness. In contrast, BBD involves more persistent and distinct conditions that may require treatment or monitoring. The challenge of classifying BBD is highlighted, with two prominent systems—Dupont and Page’s histological classification and Hughes’ Aberrations of Normal Development and Involution (ANDI) framework—both offering distinct perspectives but often leading to confusion. This work also addresses the management of BBD in resource-limited settings, where delayed presentations often require oncoplastic surgical skills to prevent disfiguring procedures.

Keywords: breast, benign, curriculum, LMIC

Irreducible Primary Ventral Abdominal Hernia Containing Segment III of The Liver: A Case Report

Yoseph Solomon Bezabih¹, Shimelis Nigussie², Tages Hadish Degefu²

1. Haramaya University

2. Addis Ababa University

Correspondence: josephsol87@gmail.com

Abstract ID: 242

Background: Herniation of the liver through the anterior abdominal wall is extremely rare entity; majority of cases are from incisional hernia after upper abdominal or cardiac surgery.

Case presentation: A 42-year-old woman who is known to have asthma presented to our emergency unit with, vomiting, epigastric pain, and swelling of 12 h duration. Upon examination, we found a mildly tender and irreducible epigastric abdominal swelling. Clinically, SBO (small bowel obstruction) secondary to irreducible epigastric hernia was suspected and abdominal ultrasound and non-contrast CT scan was done. Both ultrasound and CT revealed an epigastric hernia containing segment III of the liver. She underwent an emergent abdominal exploration that included non-anatomic resection of segment III of the liver and tissue-based hernia repair.

Conclusion: Primary liver hernia through the anterior abdominal wall is extremely rare entity. To the best of our knowledge, only four cases of primary anterior liver hernia have been described in the literature. Diagnosis requires imaging studies such as abdominal ultrasound and CT scan. The management depends on the patient’s presentation, and the presence of any complications such as vascular compromise and injury to herniated liver.

Keywords: Ethiopia; segment III, case report, Ventral abdominal hernia

Perioperative Outcomes and Associated Factors among Adult Patients Undergoing Laparotomy for Non-Traumatic Acute Abdomen in Eastern Ethiopia: A Multi-Center Prospective Cohort Study

Yoseph Solomon Bezabih, Yaried Awoke

Haramaya University

Correspondence: josephsol87@gmail.com

Abstract ID: 241

Background: Acute abdomen refers to symptoms of intra-abdominal disease that often require surgical intervention. Timely decision-making is critical in managing non-traumatic acute abdominal pain, a common surgical emergency. Laparotomy remains a frequent procedure, yet data on perioperative morbidity and mortality in low-income settings like Ethiopia are scarce. This study investigates factors linked to adverse outcomes following laparotomy for non-traumatic acute abdomen in Eastern Ethiopia.

Methods: A prospective cohort study was conducted in two public hospitals in Eastern Ethiopia from July 1 to October 31, 2024. A total of 141 patients underwent laparotomy for non-traumatic acute abdomen. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-rank test was used to determine their statistical significance. A Cox regression analysis was conducted to identify factors associated with time to develop complications.

Results: The overall rate of unfavorable outcome was 13.5% and 29.08% of the cases developed postoperative complications. The hazard of developing unfavorable treatment outcomes among those with preoperative shock was 33.19 times higher than those without preoperative shock (AHR 33.191, 95% CI [1.376, 800.464]). Fever was another significant factor, with an AHR of 16.474, 95% CI [1.372, 197.756], indicating that patients with fever were sixteen times more likely to develop unfavorable treatment outcomes. Age above 50 years was also another factor with AHR of 13.950, 95% CI [1.551, 125.493]. The mortality rate in this study was 8.5%.

Conclusion: Shock, fever, and age above 50 are key predictors of adverse perioperative outcomes in patients undergoing laparotomy for non-traumatic acute abdomen. These findings highlight the need for heightened clinical attention and preoperative optimization in high-risk patients to reduce morbidity and mortality.

Keywords: Acute abdomen, Eastern Ethiopia, Laparotomy, Perioperative Outcome

Correlation Between Endoscopic and Histopathological Findings in Gastritis, A Single Center Retrospective Study

James Kariuki

The Karen Hospital

Correspondence: Karizjim@gmail.com

Abstract ID: 234

Background: The histological hallmark of gastritis is the presence of gastric mucosal inflammation. Although commonly diagnosed endoscopically, data on histopathological correlation is scarce in our region. We aim to highlight the discrepancy between endoscopically vs. histologically diagnosed gastritis in a major city hospital and potentially inappropriate prescribing of proton pump inhibitors.

Methods: A retrospective study was conducted on 141 gastroscopies performed at the Karen Hospital, over a 12-month period. Indications for the gastroscopy, endoscopic findings and histological findings were considered. Data was gathered via checklists, endoscopy records, and lab histological reports. Data was analyzed using SPSS.

Results: Of the 141, 97.9% (138/141) had endoscopic gastritis diagnosed, 99.2% (137/138) were biopsied, and 92% (127/138) had histological gastritis confirmed. Despite only 92% having histologically proven gastritis, 100% (138/138) of the cohort were prescribed a PPI on discharge. Notably, of 50 patients with findings of only gastritis on endoscopy, 100% were prescribed a PPI, but when biopsied, 12% (6/50) had histologically normal mucosa.

Conclusion: Our study highlights the potential poor correlation between endoscopic and histological diagnosis of gastritis, and the need for both to be used in concert.

While we recommend more widespread research into this area, ultimately, consideration must be given to routine biopsy on endoscopy and judicious administration of PPIs.

Keywords: Gastritis, Endoscopy, Histopathology, Correlation

Assessing Knowledge and Confidence of Surgical Residents in Inguinal Hernia Repair Using a Low-Cost Synthetic Model

Akinniyi Fadipe

College of Surgeons of East, Central and Southern Africa

Correspondence: akinnems@yahoo.com

Abstract ID: 212

Background: Open repair of groin hernia is an essential skill for the general surgeon. This study aimed to develop a low-cost hernia model based on a validated high-fidelity model and assess its effectiveness in teaching inguinal hernia repair to surgical trainees from many institutions throughout Africa.

Methods: Using inexpensive, locally available materials, a low-cost hernia model was created. Six models were constructed, and a workshop was conducted for surgical residents. Pre- and post-workshop surveys were administered to assess knowledge, confidence, and understanding. Statistical analyses were performed using paired t tests and the Wilcoxon signed-rank test.

Results: The low-cost hernia model consisted of various readily available materials and cost an average of $5.07. Sixty-eight trainees participated in the workshop, and 59 completed the post-workshop survey. Participants reported a significant increase in confidence for both mesh and non-mesh repairs and an improved understanding of hernia anatomy after the workshop. Trainees scored an average of 5.6 (SD 1.9) out of 10 questions on the pre-workshop quiz and 7.9 (SD 1.4) out of 10 on the post-workshop quiz (p < 0.001), indicating improved knowledge. All trainees supported the use of the model for education.

Conclusion: The low-cost hernia model demonstrated its effectiveness in enhancing trainees’ understanding of hernia anatomy and increasing their confidence in hernia repair. Integrating low-cost hernia models into training programs can help improve trainees’ knowledge and confidence in a safe and affordable environment.

Keywords: Surgical education, hernia, simulation

Comparative Effectiveness of Platelet-Rich Plasma Versus Honey in Diabetic Wound Healing: A Clinical and Patient-Reported Outcome Evaluation

Faraja Magwesela¹, Doreen Msemakweli²

1. Nkinga Referral Hospital

2. KCMC University

Correspondence: fm3magwesela@gmail.com

Abstract ID: 210

Background: Chronic diabetic wounds pose a significant clinical and psychosocial burden, particularly in low-resource settings. Platelet-Rich Plasma (PRP) and honey have emerged as affordable alternatives for wound management. However, comparative data evaluating both clinical outcomes and patient-reported experiences are limited. This study aimed to compare the effectiveness of PRP and honey in diabetic wound healing and assess patient satisfaction using the validated WOUND-Q tool over an 8-week treatment period.

Methods: We conducted a prospective comparative study involving 38 patients with diabetic foot wounds—20 treated with PRP and 18 with honey. Three additional patients were lost to follow-up after initial dressing. Clinical parameters included fasting blood sugar, HbA1c, wound dimensions, Texas Wound Classification, and complications (infection, ischemia). WOUND-Q domains—including pain, drainage, appearance, psychological and social impact, and satisfaction—were evaluated weekly.

Results: PRP-treated wounds showed a significantly greater reduction in wound dimensions at weeks 4 and 8 (p<0.05). Both groups reported similar overall patient satisfaction; however, honey-treated patients reported higher WOUND-Q drainage scores (mean 61 vs 74, p=0.03). Texas Class 1D and 2D were associated with higher complication rates. Smokers had significantly worse scores across clinical and WOUND-Q domains. No cases of ischemia were observed.

Conclusion: PRP is more effective than honey in accelerating diabetic wound healing without compromising patient-reported experience. WOUND-Q proved valuable in capturing nuanced perceptions of treatment, particularly in areas like drainage and appearance. Integrating patient-reported outcomes into wound care trials enriches the clinical narrative and supports holistic care.

Keywords: Diabetic wounds, PRP, WOUND-Q, Patient-Reported Outcomes

Comparison Of the Laparoscopic Appendectomy and Open Appendectomy in Limited Resource Settings: A Systematic Review and Meta-Analysis

Jean Luc Mwizerwa

University of Rwanda

Correspondence: jeanlucmwizerwa@gmail.com

Abstract ID: 203

Background: Surgery is a cornerstone in the management of acute appendicitis. The two main approaches to appendectomy are: laparoscopic and open. This study aimed to conduct a systematic review and meta-analysis comparing both approaches in low and middle-low-income countries.

Methods: Systematic search in PubMed, Google scholar, Scopus, Embase, the Cochrane clinical trial, the WHO Global Index Medicus, African Journal online. We included clinical trials, observational studies (cohort, cross-sectional). Registration in PROSPERO ID: CRD42024600883.

Results: A total of 14 studies (6 RCTs and 8 observational studies) with 1,897 participants were included. Of these, 873 underwent laparoscopic appendectomy and 1,024 underwent open appendectomy (male: 754, female: 1,091). Laparoscopic appendectomy was associated with a shorter operative time compared to open appendectomy (Cohen’s d: -0.2, 95% CI: -2.06 to1.64, p=0.92). Surgical site infection (SSI) was lower in laparoscopic appendectomy than in open appendectomy (OR:0.50, 95% CI: 0.19-1.92, p=0.16), Hospital stay was shorter in the laparoscopic group (Cohen’s d -0.79, 95% CI: -1.92 to 0.34, p=0.17). Return to normal activity was significantly faster after laparoscopic appendectomy (Cohen’s d: -2.09, 95% CI: -3.33 to -0.05, p=0.00). There was no significant difference in postoperative pain scores (Cohen’s d: -0.52 95% CI: -0.85 to -0.19, p<0.01). Only one RCT reported cost, showed higher expense for laparoscopic appendectomy (Mean/SD $142±1.7 USD) compared to open appendectomy ($110.8±3.1 USD). A meta-analysis of observation studies also indicated higher costs for laparoscopic appendectomy (Cohen’s d:1.60, 95% CI: 0.21- 2.98, p=0.02).

Conclusion: Laparoscopic appendectomy demonstrated advantages over open appendectomy in terms of shorter operating time, reduced hospital stay, earlier return to normal activity and lower rates of surgical site infection. However, it was associated with higher costs. While laparoscopic appendectomy should be considered the gold standard in LMICs, further research is necessary to better understand its health economic implications in these settings.

Keywords: appendicitis, laparoscopic appendectomy, open appendectomy, low and middle-low-income countries

Train 2 Transform: A Quality Improvement Initiative for Educator Development in Medical Education

Athar Ali, Mariam Noorani

Aga Khan Hospital and Aga Khan University

Correspondence: athar.ali@akhst.org
Abstract ID: 201

Background: Quality teaching and learning in medical education are crucial for improving clinical practice and patient care outcomes over time. Medical education at postgraduate level must meet evolving expectations and competent faculty is essential to achieve this. Despite their clinical expertise, many physicians have received little to no formal training in teaching, highlighting need for a tailored approach to faculty development. The aim is to build health professional education capacity by helping faculty members develop teaching and learning skills relevant to their roles.

Methods: A mixed-methods approach was used, including a needs assessment survey and learner-focused discussions, to inform the design of a faculty development (FD) program at AKU Dar. Faculty satisfaction was assessed through a post-intervention survey.
Results: Learners prioritized innovative teaching strategies, effective assessment, and self-directed learning, while faculty emphasized pedagogical skills, assessment and feedback, technology use, interviewing, leadership, and research for curriculum design. Faculty preferred face-to-face weekend workshops, teaching rewards, and protected academic time. A competency-based FD curriculum was implemented, resulting in high post-intervention faculty satisfaction.

Conclusion: The alignment between learners’ and faculty’s priorities played a critical role in shaping a responsive, faculty development curriculum. Faculty preferences of weekend face-to-face workshops and teaching rewards facilitated successful implementation. Recommendations are to conduct iterative evaluations, refine the faculty development intervention, and incorporate objective measures and learner outcomes into program evaluation.

Keywords: Medical education, Faculty development, PGME, Quality teaching and learning

Development and Validation of the GASP Score: A Predictive Tool for 60-Day Mortality in Geriatric Abdominal Surgery Patients in Resource-Limited Settings

Lele Mutombo Fabrice

NSK Hospital Ltd

Correspondence: fabricelele@gmail.com

Abstract ID: 191

Background: Geriatric surgical patients face elevated perioperative mortality risks due to physiological vulnerabilities and comorbidities, with mortality rates in low-income countries (LICs) doubling the global average. Existing risk-stratification tools lack both LIC feasibility and geriatric specificity, creating a critical gap in prognostication capabilities for this vulnerable population. This study aimed to identify independent predictors of 60-day mortality and develop/validate the Geriatric Abdominal Surgery Predictive (GASP) score, an adapted risk stratification tool for LIC settings.

Methods: we conducted an analytical cross-sectional study, 594 geriatric patients (≥60 years) undergoing abdominal surgery at KCMC Hospital, Tanzania (2019–2023). Multivariate Cox regression with time-dependent covariate analysis derived the mortality risk score, with validation metrics including discrimination (AUC) and calibration.

Results: The 60-day mortality rate was 14.8%. Four independent predictors were identified: shock (HR=4.7, p=0.001), moderate/severe comorbidity (Charlson Index ≥3; HR=3.4, p=0.008), infectious diagnosis (HR=4.0, p<0.001), and tachypnea exhibiting profound time-dependency (HR=133.5 immediately postoperative, decaying to HR=2.3 at 72 hours). The resulting GASP score (0–5 points) demonstrated: (1) a robust mortality gradient from 2.1% (score 0) to 100% (score 5); (2) acceptable discrimination (AUC=0.72, 95% CI 0.67–0.78); and (3) clinically actionable risk stratification: low-risk (0–1 points, 2.1–8.5% mortality) → ward care; intermediate-risk (2–3 points, 23.8–40.0% mortality) → comorbidity optimization; high-risk (4–5 points, 60–100% mortality) → ICU/palliative focus.

Conclusion: The GASP score represents the first mortality risk tool integrating time-dependent physiological decline with universally assessable parameters (shock, comorbidity, infection, tachypnea). Its discrimination matches complex models (POSSUM AUC 0.70–0.85) while overcoming LIC barriers through independence from laboratory/imaging dependencies. Implementation can accelerate triage, guide resource allocation, and reduce preventable deaths via protocolized shock resuscitation bundles, infection time-to-antibiotic initiatives, and oxygen conservation strategies. External validation across heterogeneous African settings is prioritized.

Keywords: Geriatric surgery, mortality prediction, resource-limited settings, risk stratification

Optimal Timing of Percutaneous Transhepatic Gallbladder Drainage in High-Risk Acute Cholecystitis Patients and Its Impact on Elective Laparoscopic Cholecystectomy

Sakarie Mustafe Hidig

Research Center Hargeisa Group Hospital

Correspondence: hidig2015@icloud.com

Abstract ID: 187

Background: To compare the effect of the timing of Percutaneous Transhepatic Gallbladder Drainage (PTGBD) intervention on the difficulty of elective Laparoscopic cholecystectomy (LC) in high-risk patients with acute cholecystitis.

Methods: A retrospective analysis was used to collect data from the First Affiliated Hospital of Xinjiang Medical University. Clinical data of patients treated for acute cholestatic PTGBD between 2017 and 2022 was collected. Thirty cases were included in the early intervention group (≤2 days) and 36 cases in the late intervention group (>2 days). The reasons for tube placement, tube placement-related complications, surgical difficulty, and postoperative pathological findings were compared between the two groups.

Results: There were no statistically significant differences between the two groups in terms of age at admission or comorbidities. However, significant differences were observed in complications related to time (P=0.001), intraoperative blood loss (P=0.017), severe adhesions (P=0.001) and the conversion rate to open surgery (P=0.042). The Spearman’s correlation coefficient between the interval time from onset and conversion was 0.25 (P=0.043).

Conclusion: PTGBD performed within two days of symptom onset may reduce the difficulty of surgery. The conversion in performing LC after PTGBD in patients with acute cholecystitis is positively correlated with the time between performing PTGBD.

Keywords: Acute cholecystitis, Percutaneous transhepatic gallbladder drainage, Laparoscopic cholecystectomy

PAEDIATRIC SURGERY

Turning off the Tap: Successful Conservative Therapy of Tuberculosis-Associated Chylous Ascites

Ian Simel, Kathleen Kabeu, Daniel Tamirat

AGC Tenwek Hospital

Correspondence: kiansimel@gmail.com

Abstract ID: 411

Background: Chylous ascites is a rare complication of constrictive pericarditis, particularly in tuberculosis (TB)-endemic regions. Elevated central venous pressure impairs lymphatic drainage, causing triglyceride-rich chyle to accumulate within the peritoneal cavity. Management requires treating the underlying pathology with anti-tuberculous therapy, while the ascites itself is addressed conservatively through dietary modification with medium-chain triglycerides, total parenteral nutrition (TPN), somatostatin analogues such as octreotide, and therapeutic paracentesis. Surgical or interventional approaches are reserved for refractory cases.

Case Presentation: A 16-year-old male with a year-long history of abdominal distension, edema, and exertional dyspnea was diagnosed with constrictive pericarditis complicated by massive chylous ascites and bilateral pleural effusions. He underwent pericardiectomy, paracentesis, and bilateral pleurodesis for persistent effusions. Despite prior anti-tuberculous therapy, he developed high-output chylous ascites requiring repeated large-volume taps. Initial conservative therapy with a fat-modified diet and octreotide over two weeks was unsuccessful. Subsequently, he was managed with six weeks of bowel rest, TPN, and octreotide, alongside re-initiation of anti-tuberculous therapy and temporary peritoneal drainage. After completing TPN, he transitioned to a fat-free diet. Ascitic drainage gradually resolved, allowing removal of drains approximately three months after therapy initiation.

Conclusion: This case underscores the value of sustained conservative management—including TPN, octreotide, bowel rest, dietary modification, and peritoneal drainage—integrated with anti-tuberculous therapy in achieving resolution of TB-associated chylous ascites while avoiding invasive interventions.

Keywords: Chylous ascites, Conservative therapy

Association Between Social Determinants of Health and Loss to Follow-Up Among Children with Anorectal Malformations Treated in Southwestern Uganda

Marissa Ray¹, Kara Faktor², Sarah Ullrich³, Emmanuel Bua⁴, Denis Oluka⁴, Meera Kotagal¹, Felix Oyania⁴

1. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

2. University of California, San Francisco, San Francisco, CA, USA

3. Yale New Haven Children\s Hospital, New Haven, CT, USA

4. Mbarara University of Science & Technology, Mbarara, Uganda

Correspondence: marissa.ray@cchmc.org

Abstract ID: 399

Background: Anorectal malformation (ARM) repair in resource-constrained settings often utilizes a three-stage approach due to delayed patient presentation and a paucity of pediatric surgeons. These stages include temporary colostomy formation (stage I), ARM repair (stage II), and colostomy closure (stage III). The influence of social determinants of health (SDOH) on surgical outcomes is well-documented and may impact outcomes in this population. This study sought to examine which SDOH are associated with loss to follow-up during surgical management of ARMs.

Methods: A cross-sectional survey was administered to caregivers of patients with ARMs who underwent stage I (June 2021 - July 2023) at <redacted for review>. Patients who did not return for stage II or III were considered lost to follow up. Categorical variables were compared using chi-squared analysis; continuous variables were compared with Welch’s t-test.

Results: Of 157 caregivers surveyed, 14.6% (n=23) were lost to follow-up prior to completing stage III (Figure 1). Respondents lost to follow-up had a lower average monthly income (48.92 USD vs 81.08 USD, p=0.007) (Table 1) and attended fewer pre-operative appointments (3.2 vs 4.9, p=0.01). Distance from the hospital, the primary caregiver’s relationship to the patient and highest level of education, and the need to sell possessions or borrow money for care were not associated with loss to follow-up.

Conclusion: Loss to follow-up among children undergoing ARM repair is significantly associated with lower monthly income of caregivers, possibly due to the prohibitive cost of multiple surgeries and clinic visits to achieve complete repair. Interventions to improve follow-up rate should prioritize mitigating costs.

Keywords: social determinants of health, congenital colorectal conditions, pediatric surgery

Establishing Paediatric Colorectal Clinics in LMICs

Precious GT. Mutambanengwe¹, Fareeda Galley², Omolara Modupe Williams³,

1. Sally Mugabe Central Hospital

2. Komfo Anokye Teaching Hospital, Kumasi Ghana

3. Lagos State University College of Medicine, Ikeja, Lagos

Correspondence: gamchi86@gmail.com

Abstract ID: 370

Background: Paediatric colorectal conditions, including anorectal malformations and Hirschsprung’s disease, represent a significant burden in low- and middle-income countries (LMICs), where access to timely and specialized care is limited. To address these challenges, paediatric surgical units in Nigeria, Zimbabwe, and Ghana independently piloted dedicated paediatric colorectal clinics. This combined report synthesizes their experiences, highlighting the impact, challenges, and successes of these initiatives.

Impact: The introduction of dedicated clinics improved clinical outcomes by reducing overcrowding in general outpatient clinics, enabling structured follow-up, and enhancing the detection and management of complications. Multidisciplinary collaboration was strengthened, with input from urology, gynaecology, gastroenterology, psychiatry, nursing, and stoma therapy. Notably, Zimbabwe pioneered the development of a reusable colostomy bag prototype, while Ghana initiated a dedicated colorectal registry and plans for a transition care program linking paediatric and adult colorectal services. Nigeria in addition, now have timely delivery of stages of care and a follow up care protocol. Across all sites, family empowerment emerged as a cornerstone: Nigeria explored structured support groups, Zimbabwe facilitated peer learning through focus groups, and Ghana leveraged a WhatsApp platform for caregiver engagement. Challenges included staff shortages, financial barriers, stigma, documentation gaps, and occasional resistance to change within surgical teams. Families often struggled with the high cost of stoma supplies and the social and economic consequences of long-term stoma care. Despite these barriers, each project achieved measurable successes in improving patient satisfaction, staff morale, and multidisciplinary training.

Conclusion: These experiences underscore the transformative potential of dedicated paediatric colorectal clinics in LMICs. By institutionalizing such models, embedding data systems, and fostering caregiver support, these initiatives can inform regional policy, attract partnerships, and ensure equitable, sustainable surgical care for children with colorectal conditions.

Keywords: Paediatric surgery, Colorectal clinic, LMICs

Pan-African Paediatric Surgery E-Learning Programme: Collaborative Development, Implementation, and Outcomes Over Four Years

Nina Capo-Chichi¹, George Youngson¹, Eric O’Flynn², Ines Perić², Emmanuel Ameh³, Eric Borgstein⁴

1. Kids Operating Room

2. Royal College of Surgeons in Ireland

3. West African College of Surgeons

4. College of Surgeons of East, Central and Southern Africa

Correspondence: nina.capo-chichi@kidsor.org

Abstract ID: 358

Background: In Sub-Saharan Africa, the paediatric surgical workforce remains critically below population needs, limiting access to timely, safe surgical care for children. To address the challenge of delivering high-quality, context-appropriate education across a geographically dispersed trainee population, Kids Operating Room and the RCSI Institute of Global Surgery partnered with the College of Surgeons of East, Central and Southern Africa (COSECSA) and the West African College of Surgeons (WACS) to launch PAPSEP - the first Pan-African Paediatric Surgery E-Learning Programme.

Methods: Launched in May 2021, PAPSEP delivers a structured, curriculum-aligned self-directed online academic programme, supplemented by monthly live Zoom case discussions. Data on user registration, country of origin, module completion, and live session participation were collected over a four-year period via Moodle site and Google forms. Feedback was obtained via post-module ratings. Descriptive statistics summarized engagement and satisfaction.

Results: The programme consists of 81 self-guided modules, developed by 57 paediatric surgeons from 17 countries, covering clinical topics, case studies and professional competencies. As of August 2025, 258 trainees from 22 countries have enrolled in the programme. Engagement has consistently been higher among COSECSA trainees than WACS trainees, with Francophone users showing the lowest participation. The modules have received an average rating of 4.6 out of 5, with learners particularly appreciating their relevance to the African context.

Conclusions: PAPSEP demonstrates that a distributed, inter-collegiate e-learning model can provide sustainable, context-specific surgical education across Sub-Saharan Africa. The collaborative authorship model ensures relevance, while sustained engagement and positive feedback highlights its potential to strengthen the paediatric surgical workforce and foster a connected learning community. Future plans include translating content into French to better serve West African Francophone trainees, using AI to create interactive scenarios and podcasts for microlearning, and making the Programme open-access to expand reach.

Keywords: Paediatric Surgery, E-Learning, Sub-Saharan Africa, Workforce Development

Addressing The Silent Crisis: Advancing Pediatric Surgical Services in Northern Uganda

Odongo Charles Newton

Lira Hospital

Correspondence: cnodongo@gmail.com

Abstract ID: 341

Background: Northern Uganda remains one of the most underserved regions, with children’s surgical needs largely addressed through occasional outreach camps. The absence of dedicated pediatric surgeons and appropriate infrastructure results in many children going untreated or facing delayed care, often with severe consequences. This study aimed to improve timely access to pediatric surgical services by establishing a dedicated pediatric surgical unit at Lira Regional Referral Hospital.

Methods: Institutional approval was obtained and an operational team formed. Outpatient clinics and surgeries began in May 2024. Demographic and clinical data were prospectively collected and analyzed using Microsoft Excel and STATA.

Results: Between May and December 2024, 843 children aged 1 day to 17 years were screened; 590 (70%) were male and 253 (30%) females. A total of 319 (37.8%) children underwent surgery—220 (69%) elective and 99 (31%) emergency cases. Anorectal malformation was the most common elective condition (44 cases, 20%), followed by inguinal hernia (27 cases, 12.3%). Intussusception accounted for the most emergencies (20%), followed by gastroschisis.

Conclusions: The data reflect a high unmet need for pediatric surgical care in Northern Uganda. The establishment of this unit offers a long-term solution and represents a foundational step for pediatric surgery in Uganda. Sustained support, including mentorship from local and international partners, is essential for its growth.

Keywords: silent crisis, pediatric surgery

Early Impact of the World Health Organization Surgical Antibiotic Prophylaxis Protocol at a Kenyan Referral Hospital

Musau Brian¹, Alexa Engel², Faith Mukwanja³, Moses Odhiambo³, Britney Grayson^1,2,3

1. AIC Kijabe Hospital

2. Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

3. Bethany Kids Kijabe Hospital

Correspondence: drmusaubrian@gmail.com

Abstract ID: 326

Background: Preoperative antibiotics reduce postoperative infection risk in contaminated surgical cases. Withholding preoperative antibiotics in cases without a wound or designated wound class “clean” does not increase infection risk. Preoperative antibiotic prophylaxis patterns were unknown prior to standardization. This study describes antibiotic prophylaxis practices and investigates the difference in postoperative surgical site infection (SSI) before and after implementation of the WHO Surgical Antibiotic Prophylaxis (SAP) Protocol.

Methods: The WHO SAP protocol was implemented in the pediatric surgical department of a Kenyan referral hospital in July 2021. The required sample size was calculated using a 0.05 significance level and 80% power using baseline SSI rate and a two-proportion comparison formula. Pediatric surgical operations were reviewed retrospectively from November 2020 through March 2022. Groups were separated into pre- and post-protocols to compare SSI rates. Data was analyzed using Fisher’s Exact Test and T-test.

Results: Data was collected for 844 pediatric patients. There was no difference in age or sex. There was a significant decrease in preoperative antibiotic administration for clean cases post SAP protocol implementation, although antibiotics were still given 38% of the time. There was no significant difference in total SSI rate post protocol implementation. A significant decrease in SSI rate for clean-contaminated cases was seen. Both pre and post SAP protocol implementation, higher rates of SSI were seen in urgent/emergent cases compared to elective cases although not significant.

Conclusion: There was no significant difference in surgical site infection rates before and after WHO SAP protocol implementation. Even with a significant decrease in antibiotic use in clean cases, overall protocol adherence was low. This study only included antibiotics that were given in the operating room. Including scheduled antibiotics from the ward and further education for adherence will be important in future studies.

Keywords: SSI, SAP, Preoperative, Antibiotics

Early Detection of Birth Defects through Screening: A Practical Approach to Improve the surgical outcome of newborns in Low-Resourced Settings

Hana Abebe Gebreselassie¹, Kokila Lakhoo²

1. Saint Paul’s Hospital Millennium Medical College

2. University of Oxford

Correspondence: hanaabebe23@gmail.com

Abstract ID: 322

Background: Congenital anomalies are among the common health problems faced by children in low and middle-income countries, contributing substantially to infant mortality rates. Due to limited access to newborn screening programs in most of the resource-limited settings, many congenital anomalies go undiagnosed and untreated, leading to adverse outcomes. This study aimed to develop and validate a newborn screening tool for congenital anomalies to be used in resource-limited settings.

Methods: A draft screening tool that uses clinical examination findings only was developed through a literature review and underwent two rounds of Delphi consensus. Tool validation was conducted by applying it to a representative sample of neonates who were delivered and/or admitted to the neonatal intensive care unit at St. Paul’s Hospital Millennium Medical College. Data was collected using Kobo Collect and then exported to Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 26 for analysis. The sensitivity and specificity of the screening tool were calculated to assess its validity.

Results: A total of 1160 neonates were screened for congenital anomalies, of which 673(58%) were males. The mean age of the newborns was 26.9±33 hours. The prevalence of congenital anomalies in our series was 5.7%. The central nervous system was the most frequently involved body system (33.7%), followed by genitourinary (18.5%), gastrointestinal (10%), and musculoskeletal (10%) systems. More than one anomaly was diagnosed in 11(13.6%) neonates. The sensitivity and specificity of the screening tool were 86.4% and 97.6% respectively. Furthermore, the positive and negative predictive values of the screening tool were found to be 70.4% and 97.6%, respectively.

Conclusion: Congenital anomalies are not rare findings in our hospital. The newly developed neonatal screening tool in this study has demonstrated significant validity and is both cost-effective and easily deployable, including in rural environments.

Keywords: structural birth defects, screening tool, newborn, validated

Intussusception Presentation, Management, and Outcomes at a Kenyan Referral Hospital: A 5-year Retrospective Review

Marlene Ishimwe¹, Alexa A. Engel², Britney L. Grayson^1,2

1. Department of Pediatric Surgery, Bethany Kids Kijabe Hospital

2. Department of Pediatric Surgery, Indiana University School of Medicine

Correspondence: alexa.a.engel@gmail.com

Abstract ID: 298

Background: In the pediatric population, ileocolic intussusception is a frequent cause of abdominal surgical emergencies. Acute intussusception is the second most common cause of acute abdomen in children and the most common cause of small bowel obstruction in infants. In low-and middle-income countries (LMICs), delayed diagnosis, limited access to advanced imaging, and a lack of timely medical intervention often contribute to worse outcomes. Ability to perform pneumatic reductions is limited. We aim to understand the unique management and outcomes of this condition at a Kenyan Referral Hospital to inform strategies to reduce morbidity and mortality related to intussusception.

Methods: A retrospective review was performed on pediatric patients who presented between January 2020 through December 2024. Eighteen patients were identified with ileocolic intussusception. Patients were categorized into groups: successful pneumatic reduction (sPR), attempted pneumatic reduction (aPR), and no pneumatic reduction (noPR). Demographics, presentation, and outcomes were analyzed using descriptive statistics, Mann-Whitney U Test, and Fisher’s Exact Test.

Results: When comparing sPR and aPR, no difference was seen in age, sex, or z-score.  A significant difference was seen in days of symptoms (p=0.03), days in HDU/PICU (p=0.03), and days in hospital (p<0.01). When comparing rates, a significant difference was seen in rate of bowel resection, 1 in sPR and 4 in aPR (p=0.01).

Conclusion: Successful pneumatic reduction of intussusception was performed in patients with symptoms up to 6 days and in patients less than 2 years of age.  Performing a pneumatic reduction requires specialized equipment and trained personnel which is not always available in LMICs. Continued education can help reduce morbidity and mortality in LMIC pediatric populations.

Keywords: intussusception, pneumatic reduction, LMIC

Value and Impact of a Multidisciplinary Pediatric Colorectal Surgical Course in Eastern Africa

Marissa Ray¹, Sarah Ullrich², Kara Faktor³, Phyllis Kisa⁴, Randi Wittenberg¹, Allison Linden⁵, Jason Frischer¹, Meera Kotagal¹, Felix Oyania⁶, Stella Alice Nimanya⁴

1. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

2. Yale New Haven Children’s Hospital, New Haven, CT, USA

3. University of California San Francisco, San Francisco, CA, USA

4. Mulago National Referral Hospital, Kampala, Uganda

5. Children’s Healthcare of Atlanta, Atlanta, GA, USA

6. Mbarara University of Science and Technology, Mbarara, Uganda

Correspondence: marissa.ray@cchmc.org

Abstract ID: 294

Background: To improve knowledge about pediatric colorectal (CR) conditions and build a community of practice, a multi-disciplinary course was designed and implemented in May 2025.

Methods: Providers from across eastern Africa attended a 3-day in-person course consisting of group didactics plus surgeon and nursing-specific breakout sessions. A pre-course survey was administered to all participants; responses were stratified by experience level and compared using one-way ANOVA. Surgeon knowledge was assessed before and after the course with an identical test and compared with Wilcoxon signed-rank test.

Results: Pediatric surgeons (n=21) and nurses (n=11) participated in the course, 87.5% had completed survey data. Surgeons perform 8 (IQR 5-10) CR procedures monthly and 88% see CR patients daily or a few times per week. All surgeons felt very comfortable performing colostomy formation and takedown. Compared to surgeons in practice 1-5 years (n=9) or 5+ years (n=5), surgical fellows (n=4) reported lower confidence in their ability to complete ARM repairs (low, high, and primary), Soave pull-through, Malone, and cloaca repair (Table 1) but no differences in comfort with medical management. Knowledge scores did not differ by training level and improved (11.59 vs 12.21, p=0.08), although not significantly. Of nurses, 90.9% see CR patients daily but only 54.5% have a bowel management program. Nurses were least comfortable with adjusting enema components, identifying ostomy complications, and implementing pre-cautions after anoplasty.

Conclusion: Surgeons and nurses in LMICs see a significant burden of congenital CR disease. All participants regardless of experience reported the information was relevant and applicable but surgical fellows may benefit most from this training course. Nursing responses demonstrated that tools for establishing a BM program may be a valuable intervention. Participant feedback highlighted the value of the multidisciplinary format and the opportunity to develop a network of professionals committed to advancing pediatric surgical care.

Keywords: Training, colorectal, pediatric surgery

REACH ON Plus: Referral and Education to Advance Care and Health Outcomes for Neonatal Surgical Emergencies

Alexa Engel¹, Mercy Gakii², Cara Liebert³, Dana Lin³, Jason Axt^1,4, Brian Gray¹, Peter Saula²

1. Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

2. Department of Pediatric Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya

3. Department of General Surgery, Stanford University, Sanford, CA, USA

4. Department of Pediatric Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya

Correspondence: alexa.a.engel@gmail.com

Abstract ID: 279

Background: According to the Kenya Demographic and Health Survey 2022, the neonatal mortality rate is around 21 per 1,000 live births. Neonatal surgical emergencies such as gastroschisis, omphalocele, anorectal malformation, tracheoesophageal fistula, intestinal atresia, and Hirschsprung’s disease represent a significant burden of disease due to delayed diagnosis, inadequate resuscitation, and unsafe transport contributing to mortality within the first month of life. A recent cluster randomized control trial by Saula et al. demonstrated timely referral and structured pre-transfer stabilization can reduce neonatal surgical mortality by 25% (2021). REACH ON Plus aims to expand on the developed protocols and increase education sessions to include 15 community hospitals in western Kenya to further reduce neonatal mortality.

Methods: We will perform a staged implementation study. Initially, delayed neonatal surgical diagnoses will be verified using a Delphi process through a Kenya Academy of Pediatric Surgeons survey. Teaching sessions will be refined and approved by local pediatric surgeons. Day long interactive education sessions will include in-person examples and simulations of initial assessment, stabilization, diagnosis, and transportation preparation for each diagnosis. Initial impact will be assessed using pre and post surveys while 3-month retention will utilize ENTRUST, a virtual patient simulation platform developed to assess decision-making through case-based scenarios. Data will additionally be collected on transferred neonates’ arrival status, transport interventions, and outcomes.

Preliminary findings and anticipated results: We hope to further decrease neonatal mortality with continued expansion of education in newborn units at surrounding community hospitals. The primary outcome is reduction in pre-surgical neonatal mortality, while secondary outcomes include reducing referral time, increased adherence to stabilization techniques, and improved clinician knowledge at 3 months.

Significance and implications: We anticipate that expanding education sessions through community hospital newborn units will further reduce mortality for neonates with surgical diseases transferred from these community hospitals.

Keywords: surgical neonates, referral, education

Outcomes And Management of Patients with Anorectal Malformations One Year Post-Definitive Surgery at Children’s Surgical Hospital, Entebbe, Uganda.

John Yiga, Hans Menghistab, Daisy Akurete, Luisa Napolitano, Andrea Franchella

Children Surgical. Hospital Entebbe Uganda

Correspondence: yigajohn2000@gmail.com

Abstract ID: 266

Background: In low- and middle-income countries (LMICs), anorectal malformations (ARMs) are often managed in stages due to delayed presentation. Long-term follow-up and bowel management are crucial for achieving optimal functional outcomes.

Methods: A retrospective descriptive review was conducted on 114 ARM patients (November 2024–February 2025), evaluated one-year post-definitive surgery. Data collected included demographics, anomaly types, associated conditions, surgical procedures, complications, follow-up patterns, and functional outcomes.

Results: At evaluation, 70% of patients were over four years old; the male-to-female ratio was 1:1.3. The most common anomalies were recto-vestibular fistula (70.3% of females) and rectourethral fistula (44% of males). Other anomalies included blind pouch (M=5, F=1), cloaca (6), rectoperineal fistula (M=17, F=10), rectovaginal fistula (1), and H-type fistula (1). Associated anomalies occurred in 30.1% of cases, predominantly genitourinary (17.5%); six patients were syndromic. Stomas persisted for more than three years in 39% of patients, although nearly half were created within the first week of life. Posterior sagittal anorectoplasty (PSARP) was performed in 80% as the definitive procedure; others included redo PSARP (4), PSARP pull-through (10), vaginoplasty (2), and fistulectomy (1). Perineal wound complications occurred in 43.9% (50% minor), and stoma closure complications occurred in 38% (78.4% minor). Of those with follow-up data (91.2%), 97.4% had voluntary bowel movements; 57% experienced soiling (7% grade 3), and 15.8% had constipation. Regular follow-up was maintained by 44.7%, while 42.1% were lost to follow-up. Bowel management and physiotherapy were effective in 87.5% of patients; 8.4% required surgical revision.

Conclusion: Surgical outcomes were generally favourable; however, functional complications and poor follow-up remain significant challenges. Strengthening follow-up systems and bowel management programmes is essential for improving outcomes.

Keywords: anorectal malformation, outcomes, post-surgery

Building Pediatric Surgical Training in Uganda: Lessons from Managing Hirschsprung’s Disease at Children’s Surgical Hospital of Emergency

John Yiga, Carlotta Ardenghi

Children Surgical Hospital Entebbe Uganda

Correspondence: yigajohn2000@gmail.com

Abstract ID: 264

Background: In low- and middle-income countries (LMICs), specialized pediatric surgery is limited by a lack of trained pediatric surgeons, late presentations, and poor follow-up systems. The Children’s Surgical Hospital (CSH) of Emergency in Entebbe, Uganda, combines high-quality care with a structured training model involving international and national pediatric surgeons with Ugandan COSECSA fellows and international residents. This collaborative framework aims to build long-term surgical capacity.

Methods: We reviewed the management of Hirschsprung’s Disease (HD) as a tracer condition to illustrate the CSH training model. A retrospective case series included all patients undergoing pull-through between April 2021 and December 2024 with ≥ 6 months follow-up. Clinical outcomes were collected alongside observations on training and clinical care. Follow-up protocols were standardized, enabling functional outcome assessment via the Krickenbeck score. Since 2024, laparoscopic equipment has allowed minimally invasive biopsies and abdominal dissections, enriching trainee exposure.

Results: Sixty-seven patients (M:F ratio 5.1:1) were treated; mean age at first visit was 3.16 years, with 62.7% arriving with a colostomy. Definitive surgery occurred at a mean age of 3.88 years. Techniques: Swenson (68%), Soave (31%), Duhamel (1%). Complications included enterocolitis (28.4%) and strictures (13.4%); 29.9% required reoperation. Functional follow-up (n=49) showed complete voluntary bowel movements in 64.7%, though 43% required enemas. Regular follow-up allowed early identification and management of functional issues, a rarity in many LMIC settings.

Conclusion: The CSH model demonstrates that sustainable surgical training programs in LMICs can be built through structured international–local partnerships, standardized care pathways, and investment in technology such as laparoscopy. Integrating well-established follow-up into training not only improves patient outcomes but also equips future surgeons with the skills and systems knowledge needed for long-term impact in resource-limited settings.

Keywords: Hirschsprung’s Disease, Surgical Training, Follow-up

Epidemiology, Management Practices and Outcomes of Patients with Gastroschisis: Experience from A Regional Referral Hospital in Uganda

Richard Gamubaka

Mbale Regional Referral Hospital

Busitema University

Correspondence: chard701@gmail.com

Abstract ID: 255

Background: Gastroschisis, an abdominal wall defect affecting 3% of babies with congenital anomalies, has survival rates exceeding 90% in high-income countries due to advanced care. In Uganda, however, survival rates are as low as 2% because of limited resources. This study evaluated a novel, low-cost management approach using a female condom as a silo for gravitational reduction of exposed bowel in neonates at Mbale Regional Referral Hospital (RRH).

Methods: A retrospective service evaluation was conducted on 72 neonates admitted between January 2023 and December 2024. Most (88.9%) were born outside Mbale RRH, with a median weight of 2.1 kg. Management included broad-spectrum antibiotics, oxygen, IV fluids, and the female condom silo technique, allowing gradual bowel reduction over 2–7 days before surgical closure.

Results: Of the 72 neonates, 45.8% (33/72) survived to discharge, while 6.9% (5/72) were discharged due to poor prognosis. Mortality rates were 30.6% (22/72) before surgery and 11.1% (8/72) post-surgery. Outcomes for 5.6% (4/72) were unknown. The study demonstrated that the female condom silo technique is a safe, affordable, and effective alternative in resource-limited settings, reducing inpatient mortality by nearly half compared to previous reports.

Conclusion: This approach offers a practical solution for improving gastroschisis outcomes in low-resource environments where specialized neonatal care is unavailable. Further implementation and scaling of this technique could significantly enhance survival rates for gastroschisis patients in similar settings.

Key words: Gastroschisis, female condom silo, low-resource setting, neonatal mortality, Uganda

Outcomes of Implementing Paediatric Daycase Surgery at A Teaching Hospital in Kenya

Bethleen Waisiko¹, David Limo², John Kennedy¹, Nyagetuba Muma¹

1. AIC Kijabe Hospital, Kenya

2. Actuarial Society of Kenya

Correspondence: waisikoleen@gmail.com

Abstract ID: 250

Background: Up to 80% of elective paediatric surgical case load is suitable for day-case surgery (DCS). However, its uptake in Sub-Saharan Africa (SSA) lags due to patient, institutional and socioeconomic factors. A contextualized implementation of DCS within pre-existing hospital operational framework has the potential to address these barriers to the benefit of the patient and healthcare systems involved.

Methods: A retrospective two-arm study was conducted (pre- and post-adoption of a DCS protocol). DCS was introduced in May 2021. The post-DCS adoption period was from June 2021 to May 2022. The pre-DCS adoption period of June 2020 to May 2021 was used as the comparator.

Results: Each arm had 253 cases. Overall, the median patient age was 4 years. Orchidopexy was the most common surgery performed overall, followed by hypospadias in the pre-DCS arm and gastrointestinal-related procedures in the post-DCS arm. The majority of cases were done under general anaesthesia. The median waiting time for elective surgery was similar in both groups.

The median duration of stay in the post anaesthesia care unit (PACU) was lower in the post-DCS adoption group (95 minutes) compared to the pre-DCS adoption group (141 minutes) (p= 0.0008). The unplanned admission rate was 9.1% (n=23), with 65% of these being due to social reasons. The 30-day post-operative complication rate was similar in both arms (p=0.1441). The median cost of care was lower in the post-DCS adoption group (£ 425.2) compared to the pre-DCS adoption group (£ 473.4) (p=0.004).

Conclusion: Contextualized paediatric DCS in SSA is feasible, lowering costs to patients without adverse clinical outcomes. Addressing social concerns is likely to improve the quality of DCS offered.

Keywords: paediatric surgery, day-case surgery

A Prospective Observational Study of Postoperative Outcomes of Neonates with Congenital Anomalies of The Gastrointestinal Tract and Abdominal Wall Defects at The University Teaching Hospitals (UTHs) in Lusaka, Zambia

Vincent Mulenga

University of Zambia, School of Medicine

Correspondence: vbmulenga@gmail.com

Abstract ID: 246

Background: Neonatal surgery for congenital GIT anomalies and AWDs is associated with high mortality in LMICs. Limited critical care infrastructure, delayed interventions, and postoperative complications worsen outcomes. This study evaluated postoperative outcomes and predictors of mortality among neonates undergoing surgery at the UTHs in Lusaka, Zambia.

Methods: A prospective observational longitudinal study was conducted over one year, enrolling 180 neonates with congenital GIT and AWDs who underwent surgery. The primary outcome was 30-day postoperative mortality. KM survival curves, Cox regression, and logistic regression analyses were performed to identify predictors of mortality.

Results: Overall, 30-day mortality was 42.22%. Mortality was highest among neonates with gastroschisis (89.5%), JIA (70.7%), and OA/TOF (61.1%). Significant predictors of mortality included low birth weight (<2.5 kg) (aHR: 1.77; 95% CI: 1.01–3.08; p = 0.040), sepsis (aHR: 6.00; 95% CI: 3.10–11.60; p = 0.023), anastomotic leak (aHR: 11.01; 95% CI: 5.42–22.34; p = 0.038), and outborn referral status (aHR: 2.42; 95% CI: 1.02–5.75; p = 0.040). Delays in admission (>48 hours) and prolonged operative time (>90 minutes) were also associated with worse outcomes.

Conclusion: High neonatal surgical mortality at UTH is driven by modifiable factors such as delayed admission, low birth weight, sepsis, and postoperative complications. Strengthening critical care infrastructure and promoting early intervention are essential to improving surgical outcomes in Zambia.

Keywords: Neonatal surgery, gastrointestinal anomalies and abdominal wall defects, mortality, postoperative outcomes

Adult Hirschsprung’s Disease; A Case Report Of 27-Year-Old Female Patient

Wondmagegn Gizaw, Murtii Teressa Obolu, Kibrom Legesse, Eyerusalem Fissehatsion, Dereje Berhenu, Gebril Ahmed, Mishame Damtew, Fekade Yerakly

Hawassa University College of Medicine and Health science

Correspondence: murtyko1984@gmail.com

Abstract ID: 226

Background: Adult Hirschsprung’s disease is a functional intestinal obstruction whenever it’s diagnosed in adolescents older than ten years and adult age. The primary pathology of Hirschsprung’s disease is a congenital gut motor neuron development disorder. The disease usually diagnosed in over 94% of cases before the age of five years. However, beyond children age the disease is often overlooked and misdiagnosed as refractory functional constipation, which delay diagnosis and management.

Case presentation: In this study, we report the case of a 27-year-old female patient presented with prolonged difficulty of defecation, progressive abdominal distension, intermittent vomiting and appetite loss. She had received frequent laxatives and rectal enema for temporary relief of her symptoms. Subsequently, from clinical and imaging evidence, with an impression Adult Hirschsprung’s disease, Rectal biopsy was taken and the biopsy result confirmed Hirschsprung’s disease.

Result: Initially, diversion of the sigmoid loop colostomy was done. Which resulted in a significant reduction in colonic calibre and patient was improved from secondary malnutrition morbidity. Despite, some difficulties from anatomic change and deep female pelvis, Swenson pull through technique was successful applied for definitive management. Subsequently, the post-operative outcome was satisfactory.

Conclusion: Thus, adults with refractory functional constipation, Adult Hirschsprung’s disease should be considered as a differential diagnosis. Those patients need a gold standard diagnostic histopathologic study. Even though the management sequence and choice of surgical techniques depend on different factors, Swenson’s pull-through technique is the most convenient to apply with or without modification.

Keywords: Adult Hirschsprung’s disease, Refractory constipation, Swenson’s pull through technique

Pattern And Factors Affecting Surgical Outcomes of Infantile Hypertrophic Pyloric Stenosis; A Six -Year Retrospective Cohort Study in Hawassa, Ethiopia

Wondmagegn Gizaw, Murtii Teressa Obolu, Ermias Tadesse, Dereje Berhanu, Kibrom Legesse Abrha

Hawassa University College of Medicine and Health Science

Correspondence: murtyko1984@gmail.com

Abstract ID: 222

Background: Infantile Hypertrophic Pyloric Stenosis is a frequent cause of gastric outlet obstruction in early infancy, classically presenting with progressive, projectile, non-bilious vomiting and requiring timely surgical intervention. This study evaluates the six-year surgical experience at Hawassa university comprehensive specialized hospital, focusing on patient demographics, clinical presentation, diagnostic findings, perioperative details and post-operative course and factors affecting surgical outcomes.

Methods: A descriptive six-year retrospective cohort study was conducted on 103 Infantile Hypertrophic Pyloric Stenosis patients in Hawassa university comprehensive specialized hospital from January 2018 to December 2024 in G.C. Data were collected on demographics, clinical presentation, radiological findings, preoperative and intraoperative details and postoperative course. The collected data entered into Kobo Toolbox, with subsequent descriptive analysis and bivariate and multivariate logistic regression analyses were done using SPSS version 26.3 to identify factors affecting long-term surgical outcomes.

Results: Among 103 infants treated for Infantile Hypertrophic Pyloric Stenosis at Hawassa university comprehensive specialized hospital, the majority were male, aged 3–8 weeks, and firstborn. Most presented with classic symptoms, the study identified reoperation rate and prolonged hospital stays were an independent predicting factors of poor outcomes, However, prolonged durations of symptoms, Severe malnutrition and electrolyte imbalances were negatively correlated with unsatisfactory outcomes. Despite these challenges, the use of standardized surgical protocols resulted in 93.2% (n=96) favourable outcomes, and 6.8% (n=7) unfavourable outcomes of Infantile Hypertrophic Pyloric Stenosis treated at HUCSH.

Conclusion: This six-year surgical experience shows Infantile Hypertrophic Pyloric Stenosis is effectively managed at Hawassa university comprehensive specialized hospital with low complications even in a training setup. While outcomes are strong compared to local and regional data, delayed presentation, severe range multiple electrolyte derangement and severe malnutrition, reoperation rate, prolonged hospital remain key areas for improvement.

Keywords: Gastric outlet obstruction, reoperation rate, long term surgical outcome, pyloromyotomy

The Untold Story: The Life of Parents with Children Having Congenital Anomalies in Ethiopia, A Hermeneutic Phenomenological Study

Temesgen Nane

Wolaita Sodo University, Ethiopia

Correspondence: mtemenane16@gmail.com

Abstract ID: 216

Background: Congenital anomalies are structural abnormalities that occur during intrauterine life and are prenatally or postnatally identifiable. They are major contributors to neonatal and under-5 mortality. Childbirth is a pleasant phase of life for parents who birth healthy newborns. However, this would mean something different for parents who give birth to children with congenital anomalies. Even though these anomalies can be treated surgically, parents experience physical, psychological, and economic difficulties. Most of the literature on parental experiences originates from high-income countries, making their context less applicable to low and middle-income countries (LMICs) such as Ethiopia. This study aimed to explore the firsthand experiences of Ethiopian parents raising children with congenital anomalies.

Methods: A phenomenological study was conducted to explore the lived experiences of parents of children with congenital anomalies at two tertiary hospitals in South Ethiopia. Eighteen parents were purposively selected for the in-depth interviews. The interviews were audio recorded, transcribed, and translated. The rigor of the study was ensured by establishing its credibility, transferability, dependability, and conformability. Thematic analysis was performed using Open Code v4.03.

Results: Five overarching themes emerged. The themes include ‘prior awareness, perception and discovery,’ ‘parental emotional reaction,’ ‘burden,’ ‘support system,’ and ‘impact of the anomaly.’

Conclusion: Parents of children with congenital anomalies face challenges in obtaining healthcare services and experience financial and hygiene-related burdens because of their children’s condition. They experience emotional distress and social difficulties, while relying on their limited community and familial support.

Keywords: Congenital anomaly, Pediatric surgery, Lived experience, Qualitative study

Patterns and Outcomes of Anorectal Malformations Among Children in a Missions Teaching Hospital Niger Republic

Louisa Nneka Nwachukwu, Yves Mpongo, Yacoubou Sannoussi

Pan-African Academy of Christian Surgeons (PAACS)

Correspondence: drlouisann@gmail.com

Abstract ID: 189

Background: This retrospective study aimed to describe the sociodemographic profile, clinical presentation, management approaches, and outcomes of Anorectal Malformations (ARM) patients treated at SIM Galmi Hospital, Niger.

Methods: We analyzed medical records of 24 ARM patients out of 40 treated between January 1, 2021, and June 30, 2024.

Results: Female predominance was observed (male-to-female ratio 1:1.5). Rectoperineal fistula was the most common anomaly (67%) among males and females. Delayed presentation (>48 hours) occurred in 72.3% of patients. The median age at diagnosis was 9 months, and the median distance from patients’ homes to the hospital was 90 km. Co-existing congenital abnormalities were prevalent (25%). Morbidity was observed in 29.1% of patients, mostly wound-related. The mortality rate was 12.5%, attributed to delayed presentation and associated anomalies. Additionally, 20.8% of patients required financial assistance.

Conclusion: This study highlights challenges in managing ARM in a developing country context. Early diagnosis and timely surgical intervention are crucial for improving outcomes. Addressing barriers to early presentation, improving healthcare access, and enhancing primary care providers’ ability to recognize and refer these conditions promptly are essential.

Keywords: ARM Anorectal malformations

ORTHOPEDIC SURGERY

Demographics and clinical outcomes of Latarjet at Muhimbili Orthopedic Institute.

Mohamed Muhamedhussein, Felix Mrita, Joseph Sabas, Kitugi Nungu,

Muhimbili University of Health and Allied Sciences

Correspondence: fmirtta@yahoo.com

Abstract ID: 364

Background: Recurrent shoulder dislocation is common amongst young adults following shoulder trauma which often requires surgical intervention. Amongst the most common procedures is a coracoid bone block technique known as latarjet procedure. This study was done to find the demographics and outcomes of patients undergoing this procedure.

Methods: A retrospective analysis of all adult patients who underwent Latarjet procedure from January 2023 to December 2024 at Muhimbili Orthopedic Institute. A standard questionnaire was used to extract demographic data. Clinical, functional and overall outcomes were assessed.

Results: There was a total of 78 patients included in this study, with 40(51.3%) males. A quarter of the patients were between 36-45 years. Fifty-five patients had the procedure on the right shoulder. All patients had reported pain before surgery whilst 87.2% reported instability. Thirteen of the patients had co-morbid conditions including hypertension and diabetes mellitus. There was significant improvement in shoulder stability, decrease in pain and significant functional improvement 3 months post-surgery (P<0.05). Complications were seen in 6 (7.7%) of the patients.

Conclusion: Latarjet is a common procedure done for correcting shoulder instability and found to significantly improve clinical and functional outcomes.

Keywords: Latarjet, Shoulder instability, Outcomes

Impact Of an Integrated Quality Improvement Program in Perioperative Team Training in Open Fracture Management in Malawi

Damiano Chaula

Queen Elizabeth Central Hospital, Malawi

Correspondence: damianochaula1@gmail.com

Abstract ID: 348

Background: Malawi experiences a high burden of road traffic related mortality (31/100,000/year), with open fractures increasingly contributing to major morbidity. Reported outcomes for these injuries include ~15% amputations, 18% infections and 15% non-unions. Effective management of open fractures might require multiple surgeries, meticulous surgical site preparation and adherence to specific antibiotics protocols. However, gaps in perioperative processes contribute to high rates of surgical site infections and poor outcomes. Clean cut, a Lifebox quality improvement program demonstrated reduced surgical site infection across different surgical specialties. Clean cut intervenes in six perioperative processes: WHO checklist use, gauze counting, antibiotic prophylaxis administration, skin and hand preparation, linen sterility and instrument retreatment. Integrating this approach into orthopaedic trauma care may address preventable complications and improve patient outcomes in Malawi. This study aimed to evaluate the impact of integrating a quality improvement program in perioperative team training, adherence to infection prevention measures and reduction of SSI during open fractures management.

Methods: A prospective, mixed method, quasi-experimental study conducted at two tertiary hospitals; Queen Elizabeth and Mzuzu Central and one district hospital; Ntcheu.

Results: A total of 241 patients with open fractures were enrolled at baseline and intervention. The majority were ASA I (86.1% vs 82.4%) and presented as emergency cases (75.4% vs 70.6%). Compliance with preoperative infection prevention processes improved significantly with a global compliance increase from 2.6 to 5.4 (p< 0.001). Correspondingly, SSI rate declined by 10% (p < 0.028)

Conclusion: The integration of quality improvement in perioperative team training through the clean-cut program significantly enhanced adherence to infection prevention measures and reduced SSI in open fracture management, highlighting the potential of structured quality improvement initiative to improve orthopaedic trauma care outcomes in resource limited settings.

Keywords: team training, SSI

Innovating Gait Assessment in Resource-Limited Settings: Smartphone Vid⁠eo Analysis to Guide Surgical Care‍ of Children with Musculoskeletal Deformities at CU‌RE Kenya

Samson Bedada Kassa

AIC CURE/ Kijabe Hospital

Correspondence: samsonkassa4@gmail.com

Abstract ID: 328

Background: Comprehensive gait analysis and physical examination are critical tools in surgical planning for children with musculoskeletal deformities.‍ However, traditional mo‌tion analysis laborator‌ies a‍re co‍stly and inaccessible in most low‍-resou⁠rce sett‌ings. There is a pres⁠sing need f⁠or a⁠ffordable‌, reproducible alternatives that can enhance su‌rgical d⁠ecision-ma⁠king in Africa.

Metho‌ds: T⁠his study explores the feasibility of using a⁠ smartphone-b‍as‌ed vide‌o⁠ analysis method to record a standardised physical examination, as well as the patient’s gait pattern. We also explored the practicality of using freeware software (Kinovea) to calculate joint angles. The method was trialled on 12 children with various musculoskeletal deformities at CURE Kenya.

Results: Preliminary findings demonstrate that smartphone video‍ analysi‍s was quick and easy to implement. Clinicians were able to obtain data with minimal training. The advantages of obtaining this data include having a permanent record of the patient’s status, which allows tracking of progress over time. It also provides the opportunity for discussing the patient within a multi-disciplinary context. Finally, this data has the potential to permit accumulation of data to facilitate generation of evidence-based treatment. Its⁠ low cost, ease o‍f use, and adaptability make it particularly valuable in high-volume, resource-constrained envir⁠onments‌.

Con⁠clusi‌on: Smartphone-based gai⁠t video anal‍ysi‍s is a feasible,‌ low-cos‌t innovat‍ion‍ with the potential to enhance surgical assessment and d‍ecision-maki‍ng for children⁠ with mu‌s⁠cu⁠loskeletal deformities in resource-⁠li‌m‍ited settings. Adoption⁠ of this method‌ at CURE Kenya highlights⁠ it⁠s‍ po‌ten‌tia‌l fo‍r wider integration acro⁠ss‌ COSECSA‌ training cente‌rs t⁠o im‍prove surgical outcomes and strengthen c‍l‍inical‌ educati‍o⁠n.

Keywords: Gai⁠t an⁠al⁠ysis, mu⁠scul⁠oskeletal deformity,⁠ smartph⁠one in‌novati‌on, resource limited center

Tanzanian Tibia Fractures: Microbiome and Antibiotic Resistance

Billy Haonga, Kelechi Nwachuku, Shravya Kakulamarri, Francisco Gomez-Alvarado, Patricia Rodarte, Charlotte Wahle, Saam Morshed, David Shearer

Muhimbili University of Health and Allied Sciences

Correspondence: bhaonga@gmail.com

Abstract ID: 312

Background: This study investigated the microbiome and antibiotic resistance profiles of open tibia fractures in Tanzania, addressing a gap in data regarding wound cultures at the time of debridement. Open tibia fractures are common, associated with high infection rates, and contribute significantly to morbidity and mortality. Despite advancements, infection rates have remained consistently high.

Methods: The research was conducted at a large government hospital in the Dar es Salaam Region, Tanzania, including skeletally mature patients (over 18 years old) with Gustilo Anderson Type I, II, or IIIA open tibial shaft fractures. Exclusion criteria included presentation more than 48 hours after injury, severe burns, or kidney disease, among others. Tissue samples were collected from 100 consecutive patients prior to debridement, and both anaerobic and aerobic cultures were performed.

Results: From these cultures, 243 bacterial isolates were identified, with 155 originating from deep cultures of 74 patients. Staphylococcus aureus was the most frequently identified species from deep cultures (n=66), followed by unspecified gram-negative rods (n=28) and coagulase-negative Staphylococcus (n=18). Antibiotic sensitivity testing revealed high sensitivity rates to ciprofloxacin (74.5%), piperacillin (85.7%), and meropenem (82.8%). Conversely, resistance was most pronounced against penicillin (82.2%), erythromycin (68.5%), and ceftazidime (66.1%). Notably, ceftriaxone, a widely used empiric prophylactic antibiotic, also exhibited higher resistance rates than sensitivity. A significant difference was observed in the time from injury to debridement between deep culture-positive and deep culture-negative groups.

Conclusion: The study concluded with a high culture positivity rate of 74%, underscoring the predominance of Staphylococcus aureus and significant antibiotic resistance. The high resistance to ceftriaxone is a particular concern given its common use.

Keywords: Open fracture, Antibiotics resistance, Culture positivity

Musculoskeletal injury research in Sub-Saharan Africa: A 10-year bibliometric analysis of research outputs from Malawi, South Africa and Tanzania

Robyn Waters¹, Shahd Osman², Linda Chokotho³, Maritz Laubscher¹, Sithombo Maqungo¹, Nyengo Mkandawire⁴, Billy Haonga⁵, George Njambilo⁵, Matt L Costa⁶, Simon Matthew Graham⁶

1. Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town

2. Federal Ministry of Health, Sudan

3. Malawi University of Science and Technology

4. Kamuzu University of Health Sciences, Blantyre, Malawi

5. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

6. Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford

Correspondence: lchokotho@must.ac.mw

Abstract ID: 291

Background: Musculoskeletal (MSK) injuries pose a significant health burden across Sub-Saharan Africa (SSA). Despite this, regional research output is limited, constrained by insufficient infrastructure, limited funding, and underdeveloped research capacity. This bibliometric analysis examined research outputs and collaboration patterns in MSK injury research across three SSA countries.

Methods: MSK injury research articles from Malawi (MLW), South Africa (SA), and Tanzania (TZN), published between January 2014 and April 2024, were identified using Web of Science and Scopus databases, and cross-referenced with ResearchGate. Data were analyzed descriptively in Excel and institutional co-authorship and collaboration networks were mapped using VOSviewer.

Results: A total of 329 articles were published across MLW (n=98), SA (n=141), and TZN (n=90) between January 2014 and April 2024. We report a steady increase in the number of publications from 2014, with a research focus on fracture management, outcomes, and lower limb injuries. Majority of research was published in partnership with high-income countries (HICs) (SA: 51%, MLW: 98%, TZN: 87%), with HIC institutions dominating first and last authorship in MLW (68 and 61%) and TZN (59 and 69%) publications. Most studies were descriptive and based on secondary records. Institutional networks showed strong regional collaboration in SA, international focus in MLW, and limited connectivity in TZN.

Conclusion: MSK injury research is increasing across MLW, SA, and TZN, but remains largely HIC-led and descriptive. Strengthening local leadership, regional collaboration, and research capacity is essential for more sustainable and context-specific evidence generation.

Keywords: Bibliometric analysis, Low-income countries, Musculoskeletal, Orthopaedic

Educational Impact of High-Fidelity Simulation on Open Fracture Management Skills in Senior Medical Students

JC Allen Ingabire^1,3, Innocent Kwizera², Jean Luc Niyonsaba³, Guido Migezo⁴, Eric Muvunyi⁵, Stephen Kwesiga⁶, Eugene Kanyemera⁷, Claudine Uwera⁸, Olivier Kubwimana⁵

1. University Teaching Hospital of Kigali

2. Inkurunziza Orthopedic Center, Rwanda

3. University of Rwanda

4. Kibagabaga Hospital, Rwanda

5. University Teaching Hospital of Butare, Rwanda

6. King Faycal Hospital, Rwanda

7. Rwanda Military Hospital, Rwanda

8. Ruhengeri Hospital, Rwanda

Correspondence: ijea2000@gmail.com

Abstract ID: 284

Background: Open fractures pose a significant management challenge in trauma care, particularly in low- and middle-income countries (LMICs) where surgical training opportunities are constrained. High-fidelity simulation offers a structured, risk-free platform to teach procedural and decision-making skills. This study assessed the impact of simulation-based education on the knowledge, technical proficiency, and confidence of senior medical students managing open fractures in Rwanda.

Methods: A quasi-experimental, non-randomized pre-post study was conducted among 71 final-year medical students from two Rwandan teaching hospitals. Based on clinical rotation schedules, students were allocated to a simulation group (n = 36) or a control group (n = 35). Both groups received standardized lectures; only the intervention group participated in additional high-fidelity simulation training covering open fracture assessment, irrigation and debridement, casting, and external fixation. Outcomes were measured pre- and post-intervention using a validated 25-item MCQ exam, OSCEs with a Modified DOPS checklist, and a 10-item Likert-scale survey on confidence and preparedness. Data were analyzed using Wilcoxon signed-rank and Mann-Whitney U tests, with effect sizes calculated using Cohen’s d.

Results: Both groups demonstrated significant within-group improvements in knowledge scores post-intervention (simulation: p < 0.001; control: p < 0.001), but between-group differences were not statistically significant (p = 0.397).In contrast, simulation group participants achieved significantly higher post-test scores in all practical domains: debridement and irrigation (mean gain = 2.28 vs. 0.29), cast application (6.61 vs. 1.51), and external fixation (7.86 vs. 3.80), all p < 0.001, with large effect sizes (d = 1.55–2.09). Subgroup analysis revealed greater gains among students with no prior orthopedic simulation or fracture management experience. Post-intervention OSCE reliability improved (Cronbach’s α = 0.970), and regression analysis confirmed simulation exposure as the strongest predictor of OSCE performance.

Conclusion: High-fidelity simulation significantly improves procedural competence and confidence in managing open fractures, supporting its integration into surgical education in LMICs.

Keywords: High-fidelity simulation, Open fractures, Medical education, Surgical skills

Acetabular Reconstruction Using Acetabular Cage in A 23-Year-Old Female Following Acetabulum Fracture and AVN Of Femoral Head

Geoffrey Rotich, Kibor Lelei, Warimi Mungai, Janet Tibakanya Kanyange, Abigail Yator,

St. Luke’s Orthopaedics and Trauma Hospital, Eldoret, Kenya

Correspondence: rotichdoc@yahoo.com

Abstract ID: 277

Background: THR reconstruction is relatively rare in young adults. Implant survival, aseptic loosening and potential for future revision are key considerations in this population.

Case Presentation: A 23-year-old female presented with right hip pain and inability to bear weight. She had sustained fracture acetabulum and hip dislocation following a road traffic accident in July 2023 and had delay is seeking the appropriate medical assistance. When she managed, open reduction internal fixation of the acetabulum was done; subsequently she developed avascular necrosis of the head of femur. This was confirmed radiologically. We did THR with acetabular cage reconstruction in August 2024. Post operatively the patient reported pain relief and regained independent ambulation.

Conclusion: This case highlights Total Hip Replacement with acetabular cage reconstruction as a viable choice in young adults with complex post-traumatic hip pathology being made possible to good health management funding sources.

Keywords: Acetabular reconstruction, Acetabular cage, Acetabulum fracture

Ankle Fusion by Arthroscopy: A Case Report

Abigail Yator, Kibor Lelei, Geoffrey Rotich, Marvin Simiyu, Janet Tibakanya Kanyange

St. Luke’s Orthopaedics and Trauma Hospital, Eldoret, Kenya

Correspondence: abigailyator@gmail.com

Abstract ID: 276

Background: Ankle arthritis is a physically disabling condition. It’s challenging to treat both for the patient and the doctor. The biomechanical aspects of the ankle make it particularly suitable for arthrodesis. This can be achieved using either open or arthroscopic techniques.

Case Presentation: This is a case of a 73-year-old male who presented with chronic right ankle pain, worsening over a 3-month duration. Imaging showed severe right ankle post traumatic arthritis. He underwent arthroscopic ankle fusion with screws. The patient was positioned in the supine position, and the surgical site was prepared. Medial & lateral ankle arthroscopic portals were made. The ankle was debrided & the articular cartilage removed using burr. Tripod configuration compression of the joint done with 7mm percutaneous cannulated screws x 3 (2 lateral, 1 medial). Screw position was confirmed to be adequate with fluoroscopy. A circular cast was applied. Post-operatively, the patient was put on medications & strict non-weight bearing rehab protocol with crutches. Postop x-ray showed good ankle alignment. The patient was followed closely with regular imaging and has been ambulating pain-free without support.

Conclusion: This case demonstrates the efficacy of arthroscopic arthrodesis in the treatment of posttraumatic ankle arthritis. The results show a minimally invasive way to provide a stable, pain free joint for improved patient outcomes in all age groups even in low resource centers.

Keywords: Ankle arthritis, Arthroscopic, Fluoroscopy

Bilateral Knee Flexion Contracture Deformities Correction Using a Specialized Taylor Spatial Frame Software: Case Report.

Warimi Mungai, Janet Tibakanya Kanyange, Kibor Lelei

St. Luke’s Orthopaedics and Trauma Hospital, Eldoret, Kenya

Correspondence: drwarimimungai@gmail.com

Abstract ID: 275

Background: Taylor Spatial Frame (TSF) is a specialized external fixation device used to adjust joint and bone deformities using multiplanar dimensions. Six telescoping struts connect to at least two whole or partial rings in multiple planes making up the TSF. Changing the strut length daily permits the simultaneous correction of abnormalities in any conceivable plane without frame alteration.

Case summary: 39-year-old male involved in a road traffic accident in 2018, sustained polytrauma including severe head injury and fractures to the right humerus shaft, femur neck, and acetabulum. On presentation in 2024, he had flexion contractures of both knees, right hip stiffness and right lower limb shortening of about 10cm compared to the contralateral side.

Bilateral knee x-rays were uploaded into the specialized TSF software program whereby measurements for each strut were designed into the joint deformity and it calculated how much adjustment needed to be made to achieve full extension (1mm = 1° per day). In prone position, under standard aseptic techniques posterior knee Z incisions were made bilaterally. The heterotrophic ossifications excised under fluoroscopy, with care due to the surrounding fibrotic tissues and the neurovascular structures in the popliteal region. The knee frames were placed using a 155mm 2/3^rd ring proximally and 155mm full ring distally for the right and 130mm full ring distally for the left. Adjustments were then made over the next 57days (right) and 72 days (left). It was well tolerated and he was able to achieve near full extension with no neuropathy.

Conclusion: This system proved its effectiveness in correcting joint deformities without complications, although it took meticulous follow up over a long duration to achieve the desired alignment and angulation.

Keywords: Taylor Spatial Frame, Heterotrophic ossifications, Knee flexion contracture, Multiplanar dimensions

Post Sign Nailing Foot Drop: Do Tendon Transfer: A Case Report

Kibor Lelei, Geoffrey Rotich, Janet Kanyange Tibakanya, Warimi Mungai, Abigail Yator

St. Luke’s Orthopaedics and Trauma Hospital, Eldoret, Kenya

Correspondence: kiborlelei@gmail.com

Abstract ID: 272

Background: Foot drop is a debilitating condition characterized by the inability to dorsiflex the foot, commonly resulting from peroneal nerve injury or dysfunction of the dorsiflexion muscles. It can significantly impair mobility and quality of life. Tendon transfer surgery is an established treatment for foot drop.

Case Presentation: We report the case of a 51-year-old female patient who developed foot drop following a sign nailing procedure. Despite initial conservative management, the condition persisted and was worsening. Surgical intervention was performed using tendon transfer, involving the peroneus longus and posterior tibialis tendons. The peroneus longus was rerouted to the tibialis anterior to restore dorsiflexion, and the posterior tibialis tendon was lengthened and transferred to further support foot alignment. Postoperatively, the patient demonstrated a significant improvement in foot positioning, achieving a neutral 90-degree angle. Gait analysis revealed enhanced dorsiflexion and functional mobility. The patient showed no signs of infection or other complications, and follow-up evaluations indicated successful recovery.

Conclusion: This case illustrates the effectiveness of tendon transfer surgery for the management of foot drop resulting from peroneal nerve dysfunction. The use of the peroneus longus and posterior tibialis tendon transfer provided significant functional restoration, supporting its application as a reliable treatment option for foot drop in similar clinical scenarios.

Keywords: Foot drop, Tendon transfer

Limb Salvage for Chondrosarcoma in Low Resource Settings: A Case Report

Kibor Lelei, Marvin Simiyu, Geoffrey Rotich, Janet Kanyange Tibakanya, Warimi Mungai, Abigail. Yator

St. Luke’s Orthopedics and Trauma Hospital, Eldoret, Kenya

Correspondence: marvigles@gmail.com

Abstract ID: 271

Background: Proximal femur chondrosarcomas are rare but aggressive malignancies causing challenges in both oncological management and joint preservation. Surgical resection with limb salvage is often required, and in cases of extensive local invasion, prosthetic joint reconstruction is done to avoid amputation.

Case Presentation: A 20-year-old male diagnosed with a large left proximal femur sarcoma 12 months from the onset of symptoms due to financial constraints. At presentation, there was no marked local invasion and the acetabulum was found intact. Soon after diagnosis, in March 2024, the patient underwent tumor excision and left proximal femur replacement. Using standard sterile techniques, in right lateral decubitus position, the tumor was exposed through a modified Hardinge approach. It was excised with margins and then a hybrid prosthesis (cemented femoral stem and non-cemented acetabular cup) was inserted. The hip joint was then reduced and found to be stable throughout its full range of motion. Postoperatively, the patient showed no complications such as infection, dislocation, or deep venous thrombosis. Rehabilitative protocols were initiated promptly, and histological examination confirmed the diagnosis of conventional chondrosarcoma. In June 2024, the patient had a prosthesis dislocation. Intraoperatively, no tumor recurrence was noted. To improve joint stability, and offset, the femoral stem length was increased by 20 mm (from 60 mm to 80 mm), and the femoral head size increased. This was successful as no dislocations thereafter were reported.

Conclusion: The benefits of early diagnosis and early intervention are evident especially in low resource settings whereby amputation which would result from delayed diagnosis and intervention. Limb salvage preserves one’s functionality and avoids amputation stigma.

Keywords: Limb Salvage, Chondrosarcoma

Reversed Miniaci Method for Varus Deformity Correction in Adolescence: A Case Report

Janet Kanyange Tibakanya, Kibor Lelei, Warimi Mungai, Abigail Yator, Makokha Paul

St. Luke’s Orthopaedics and Trauma Hospital, Eldoret, Kenya

Correspondence: janetkanyange29@gmail.com

Abstract ID: 270

Background: Athletes, particularly adolescents, are more susceptible to developing genu Varum compared to their non-athletic peers due to repetitive stress on the lower limbs during sports and also due to Salter Harris dysplasia because of its late presentation (less likely). The Reversed Miniaci procedure is an effective method for correcting the mechanical axis of the lower limb, ultimately improving knee alignment, reducing pain and enhancing function.

Case Presentation: A 21-year-old football player presented with knee pain, gait disturbance and leg length discrepancy of 2 cm for 2 years post trauma 4 years prior. Full lower limb length x-ray showed right Varus deformity. With an altered right lower limb anatomical axis: lateral distal femur angle (97.2°) and medial proximal tibia angle (88.7°) and mechanical axis; lateral distal femur angle (101.8°) and medial proximal tibia angle (88.7°); noting the deformity to be on the femur. At the distal femur metaphysis parallel to the articular surface, an isosceles triangle of 19.90° was measured correlating to the 2cm defect (1 mm = 1°). Under standard aseptic technique, via medial distal femoral subvastus approach on the metaphysis, osteotomy was made through the medial, anterior and posterior cortices, sparing the lateral. Using a High Tibia Osteotomy ruler medial cortex was opened achieving 20° Isosceles triangle. A 20mm cortical bone block was harvested from the ipsilateral iliac crest and grafted into the wedge osteotomy defect at the distal femur then buttressed with T plate. Mechanical axis and length were thereafter restored making the lateral distal femur mechanical axis angle now 90.2°.

Conclusion: The Miniaci method used at the proximal tibia metaphysis has proved effective when revered to the distal femur metaphysis giving good results due to its robust blood supply.

Keywords: Reversed Miniaci method, Varus deformity, Adolescence

Honey Dressings for Open Tibia Fractures: A Randomized Trial of Healing and Quality of Life

JC Allen Ingabire, Faustin Ntirenganya, Anette Uwineza, Carine Uwakunda, Emile Musoni, Claude M. Mambo

University Teaching Hospital of Kigali, University of Rwanda

Correspondence: ijea2000@gmail.com

Abstract ID: 260

Background: Open tibia fractures are debilitating injuries with high risks of delayed healing and infection, leading to significant morbidity and reduced quality of life. Honey dressings, with antibacterial and wound-healing properties, may provide a cost-effective alternative to standard saline dressings, particularly in resource-limited settings. This study compared honey dressings with saline dressings in improving quality of life and clinical outcomes among patients with Gustilo IIIA open tibia fractures.

Methods: A randomized controlled trial was conducted at the University Teaching Hospital of Kigali (CHUK) between August 2022 and June 2023. A hundred adults were randomized to honey dressings (n=50) or saline dressings (n=50). Quality of life was assessed using the Visual Analog Scale (VAS) and EQ-5D-5L at baseline, Day 30, and six months. Secondary outcomes included wound and bone healing, infection rates, functional recovery, and hospital stay.

Results: Groups were similar at baseline, although the honey group had more males (94% vs. 79%, p=0.03) and simpler fractures (54% vs. 33%, p=0.039). Honey dressings led to faster wound healing at Day 30 (86% vs. 37.5%, p<0.001), fewer surgical site infections (14% vs. 31.3%, p=0.041), and shorter hospital stays, with 86% discharged within seven days compared to 58% in controls (p=0.002). VAS scores improved more rapidly with honey, rising from 36.3 at baseline to 58.3 at Day 30 and 79.1 at six months, compared with 36.3, 52.9, and 71.7 in controls (p<0.05). Multivariate analysis identified early wound healing (Wilks’ Lambda=0.84, p<0.05) and socioeconomic status (Ubudehe III, coefficient 3.46, p=0.047) as predictors of long-term recovery.

Conclusion: Honey dressings accelerated wound healing, reduced infection, and improved both short- and long-term quality of life in open tibia fractures. Their effectiveness, affordability, and accessibility support integration into standard fracture care, particularly in low-resource settings.

Keywords: Open tibia fracture; Honey dressing; Quality of life; Wound healing

Incidence Of Surgical Site Infection and Its Associated Factors After Intramedullary Nailing of Open Femur Fracture Using Surgical Implant Generation Network (SIGN) Nail at Tibebe Ghion Specialized Hospital, Northwest Ethiopia in 2024: A Cross-Sectional Study.

Yonatan Abie Tesgaye

Debretabor University

Correspondence: yonatanabie2119@gmail.com

Abstract ID: 200

Background: Surgical site infection is disastrous in orthopedic practice. Despite its preventable complications, surgical site infections continue to threaten public health with significant impacts on human and financial resources. The number of patients with open femur fractures increased in our hospital due to the war in the northern part of Ethiopia, but there was no study. This study aimed to assess the incidence of surgical site infection and its associated factors after intramedullary nailing of an open femur fracture using a Surgical Implant Generation Network nail.

Methods: A cross-sectional study was done on adult patients admitted with a diagnosis of open femur fracture and treated by intramedullary nailing using Surgical Implant Generation Network nail fulfilling the inclusion criteria at the Department of Orthopedic and Trauma Surgery, Tibebe Ghion Specialized Hospital from January 1/2022 to July 1/2024. The data were collected from the Surgical Implant Generation Network online database and patient charts. Data was entered and analyzed using SPSS 27.

Result: A total of 115 of 125 patients (92.0%) were included. Among them, 100 were males and 15 were females with a mean age of 29.83 ±10 years. The estimated incidence of surgical site infection was 12.2%. Patients who took antibiotics after 6 hours of injury are 4 times more likely to develop surgical site infection compared to those who took before 6 hours of injury (AOR =4.0; 95%CI 1.0 -15.3) and those who had one debridement were 4 times more likely to develop surgical site infection compared to those who had more than one debridement (AOR = 3.9; 95%CI 1.1-14.0).

Conclusion: The magnitude of Surgical site infection was lower in this study. The study also found that delayed timing of starting antibiotics of more than 6 hours and having only one debridement was statistically associated with increased prevalence of surgical site infection.

Keywords: Femur fracture, intramedullary nail, Open fracture, surgical site infection.

UROLOGIC SURGERY

Trends and Predictors of Incidence of Hypospadias in a Tertiary Hospital in South Africa

Daniel Udatinya

Charlotte Maxeke Johannesburg Academic Hospital

Correspondence: dandoctor22@gmail.com

Abstract ID: 396

Background: Hypospadias is one of the congenital abnormalities that require surgery. The aim of this study was to determine the trends and predictors of hypospadias.

Methods: A case-control study compared boys with hypospadias and those without retrospectively. EpiData version 3.1 and STATA version 15.1 were used for statistical analysis. Mantel Haenszel determined combined odds ratios for the hypospadias outcome in boys whose mothers were exposed versus boys of unexposed mothers. Woolf’s computed confidence intervals of the odds ratios. Logistic regression analyzed maternal factors of risk of hypospadias.

Results: Records of 221 male babies were collected, of which 73 were cases and 148 controls in the ratio of 1:2. Hypospadias was more frequent in boys born by Caesarian Section (p < 0.001), those with low birth weight (p < 0.001), and those small for gestational age (p < 0.002). Alcohol use (Odds Ratio 3.1), smoking (Odds Ratio 1.54), herbal use (Odds Ratio 2.05), medical history (Odds Ratio 2.8), multiple pregnancies (Odds Ratio 1.69) and maternal congenital abnormalities (Odds Ratio 3.03) indicated an increased risk of hypospadias. Surgical history (Odds Ratio 1.29), prenatal vaccination (Odds Ratio 0.92), employment (Odds Ratio 0.85), and education (Odds Ratio 0.48) were not associated with the risk of hypospadias.

Conclusion: Mothers’ age above 36 years presented a stratifying effect on disease outcome. Our findings did not indicate major changes in trends of incidence of hypospadias.

Keywords: Hypospadias, Congenital abnormalities, Birth defects, Developmental disabilities

Clinical And Pathological Characteristics of Urinary Bladder Cancer at A Tertiary Institution (A.I.C Kijabe Mission Hospital). Kijabe, Kenya

Brian Odhiambo Ooro, Beryl Akinyi, Jack Barasa

Pan-African Academy of Christian Surgeons (PAACS), Kijabe Hospital

Correspondence: oorobrian@gmail.com

Abstract ID: 333

Background: Bladder cancer ranks as the 9th and 19th leading cause of cancer related deaths for males and females respectively worldwide. There is a significant paucity of data in Africa describing the epidemiology of urinary bladder cancer. This study aims to highlight the clinical and pathological characteristics of urinary bladder cancer in a tertiary institution in Kenya. This study aimed to determine the clinical and pathological characteristics of urinary bladder cancer in a tertiary institution in Kenya.

Methods: We conducted a retrospective cohort study of patients with biopsy confirmed bladder cancer treated at AIC Kijabe hospital from 1st January 2019 to December 31st, 2021. Demographic and clinical data including age, clinical presentation, tumor location and histology subtype were collected. Analysis was performed to evaluate all these.

Results: A total of 54 patients were included in the study, majority being male at 75.9%. The median age was 61 years (29 -90 years range). Eighteen of the patients had an associated risk factor of smoking. The most common presenting symptom was haematuria at 91.5% followed by lower urinary tract symptoms at 44.7%, dysuria (36.2%), anemia (12.8%) and pain (17%). The main histopathology was transitional cell carcinoma (TCC) at 90.4%, followed by squamous cell carcinoma (SCC) at 5.8% and adenocarcinoma (3.8%). For TCC high grade presentation was 61.7% with low grade at 38.3 % with noninvasive papillary carcinoma at 53.2% and muscle invasion at 44.7 % one patient had TCC just invading the lamina propria. The most common site of presentation was the left lateral bladder wall bladder (46.2%) followed by bladder trigone (38.5%), right lateral wall (34.6%), posterior wall (32.7%), anterior wall (15.4 %) and bladder dome (7.7%)

Conclusion: TCC still remains the most common histopathological type of bladder cancer. Hematuria as a symptom should be evaluated further to pick bladder cancer early.

Keywords: bladder cancer, haematuria, transitional cell carcinoma

Low Yield of Pathological Lymph Node Metastasis Among Patients with Clinically Palpable Inguinal Lymph Nodes in Penile Squamous Cell Carcinoma in The Context of High HIV Burden: Evidence from A Prospective Cohort Study in Zambia

Victor Mapulanga

University of Zambia

Correspondence: vmapulanga@yahoo.com

Abstract ID: 295

Background: Penile Squamous cell carcinoma PSCC) is common in developing countries such as those in sub-Saharan Africa (SSA) which has been attributed to a high prevalence of human papilloma virus (HPV). Additionally, since the prevalence of human immunodeficiency virus (HIV) is high in SSA and considering that HIV affects lymph nodes, this may potentially affect the clinical manifestation and staging of inguinal lymph nodes. Data on surgical staging via inguinal lymph node dissection (ILND) in penile cancer patients from areas of high HIV burden are scanty. We evaluated the use of ILND as staging tool of inguinal lymph nodes in PSCC patients in the context of a high HIV burden.

Methods: This was a prospective cross-sectional study of participants recruited between November 2022 and January 2024 at the University Teaching Hospital in Lusaka, Zambia. Patients with surgically resectable PSCC that underwent surgery for both primary tumor and inguinal lymph nodes simultaneously were recruited into the study. The dissected lymph nodes were pathologically analyzed for lymph node number, size and the presence of lymph node metastasis (LNM).

Results: Forty patients were enrolled in the study with the mean age of 53 years. Thirty-five patients (87.5%) were HIV seropositive with most patients being virologically suppressed at the time of surgery. Thirty-two patients (80%) presented with clinically palpable inguinal lymph nodes (cN+). The yield of pathological lymph node metastasis (LNM) from surgical staging was 37.5% (12/32) in patients with clinically palpable (cN+) inguinal lymph nodes.

Conclusion: The study demonstrates a low yield of pathological inguinal lymph node metastasis in patients with clinically palpable nodes in the context of a high HIV burden of 87.5% HIV prevalence.

Keywords: PSCC, LNM, HIV

Does Intravesical Povidone-Iodine Reduce Risk of Surgical Site Infection in Patients with Chronic Urinary Catheters? Results of a Prospective Randomized Controlled Trial

Kyobe Emmanuel

PAACS/COSECSA Malamulo Adventist Hospital, Malawi

Correspondence: kemmanuel.kyobe@gmail.com

Abstract ID: 207

Background: Patients with prolonged catheterization are at higher risk of postoperative surgical site infection (SSI) because they often have bacterial contamination of their catheters and chronic bacteriuria. The use of povidone-iodine (PI) as a bladder irrigant prior to urologic surgery has been shown in some studies to be effective in reducing postoperative bacteriuria and SSI. We conducted a randomized trial to evaluate the effectiveness of preoperative bladder irrigation with PI in reducing the incidence of SSI for chronically catheterized patients undergoing surgical treatment for benign prostatic hyperplasia (BPH) or urethral stricture.

Methods: The study prospectively randomized patients to 200 ml of intravesical 5% PI (Group A) and 200 ml intravesical normal saline (Group B) for a minimal contact time of 15 minutes. The primary endpoint was clinical evidence of SSI. A chronic catheter was defined as an indwelling urinary catheter for ≥ one month duration.

Results: A total of 140 patients accrued to the study including 70 patients who received intravesical PI in Group A and 70 patients who received normal saline in Group B. Most of the surgeries done, 85% were open transvesical prostatectomy-(TVP) and urethroplasties, 18%. The overall incidence of SSI was 29.3% for the entire study cohort, but more patients in the saline irrigation group B developed SSI, 23 patients 16.4% compared to 18 patients 12.9% with PI irrigation Group A. However, the lower incidence of SSI noted in PI Group A did not reach statistical significance.

Conclusions: A single preoperative instillation of 5% povidone-iodine failed to significantly reduce surgical site infection in patients with chronic urinary catheters undergoing corrective open urological surgery.

Keywords: Povidone-Iodine, Surgical Site infection, Transvesical Prostatectomy

Current Practice of Onco-Urology in Africa: Current Realities and Future Prospects

Nedjim Saleh

Université d’Adam Barka, Abéché / Tchad, Modern Urology For Africa

Correspondence: nedjimsaleh@gmail.com

Abstract ID: 206

Background: Uro-oncology focuses on diagnosing and treating cancers of the genitourinary system. While global advances have improved care, little is known about the burden and management of these cancers in Africa. A continental, multicenter survey is urgently needed to map current practices and identify key areas for intervention and improvement across the continent.

Methods: This multicenter continental survey, led by Modern Urology for Africa (MUFA), aimed to improve urologic surgical care in Africa. It was conducted through a web-based questionnaire emailed to urologists across 32 African countries. The collected data was presented using text, tables, graphs, and charts.

Results: Urologists from 76 centers across 32 African countries were contacted, with responses from 56 centers in 28 countries (response rates: 73.6% for centers, 87.1% for countries). West Africa was the most represented region, notably Nigeria (17.3% of respondents). While 59% of countries had national cancer registries, only 13.9% had specific uro-oncology treatment protocols. Monthly multidisciplinary team (MDT) meetings were held in 73.1% of centers. Prostate cancer was the most common tumor, followed by bladder and kidney cancers. In 90.4% of centers, patients presented over three months after symptom onset. PSA was the only universally available tumor marker, and CT scans were the main imaging tool (88.4%). Common diagnostic procedures included prostate biopsy (88.4%), bladder biopsy via cystoscopy (84.6%), and renal biopsy (53.8%). Most centers (78.8%) reported performing fewer than 15 urogenital cancer surgeries per month. More than two-thirds of the centers (n=41, 78.8%) reported performing fewer than 15 urogenital cancer surgeries monthly.

Conclusion: Uro-oncology in Africa faces major challenges, but training, collaboration, and regional guidelines offer hope for progress.

Keywords: Urological cancers, Cancer care, Africa

Landscape Of Urology Training in Sub-Saharan Africa

Nedjim Abdelkerim Saleh

Université d’Adam Barka, Abéché / Tchad, Modern Urology For Africa

Correspondence: nedjimsaleh@gmail.com

Abstract ID: 205

Background: Urology is one of the most rapidly evolving and technologically advanced surgical specialties. However, training programs in Sub-Saharan Africa (SSA) face unique challenges. This study aimed to assess the current status of urology training in SSA and identify areas for improvement, providing crucial insights into the strengths and limitations of these programs.

Methods: A 24-discrete items online survey was developed with “Google Forms” in English and French. The questionnaire was composed of two parts. The first part assessed general information about urology training, and the second part evaluated the consultant’s or department head’s ability to perform and teach endourology procedures.

Result: A total of 25 responses were received from 18 countries. The oldest training center is the University of Cape Town, South Africa; the program started in 1950. The number of consultants in the department ranges from 1 to 12, with an average of 4.79. Twenty of the training sites have a compulsory general surgery clinical attachment in their program. Fourteen of the training sites stated that research is mandatory in their curriculum. Fourteen of the centers reported providing laparoscopic urology surgery. Cystoscopy is the most mastered procedure and percutaneous nephrolithotomy (PCNL) is the most difficult procedure to gain any experience with by residents.

Conclusion: Urology training in sub-Saharan Africa started late but is increasing in number through time. Urology training in Africa faces multiple challenges, including inadequate number of experts, limited availability of advanced equipment and simulation-based training sites. Training institutions should be encouraged to facilitate research and basic urological skills training.

Keywords: Urology, Surgical Training, Sub-Saharan Africa, Workforce Development

NEUROSURGERY

Surgical Treatment Outcomes in Children with Hydrocephalus or Hydranencephaly at a Tertiary Teaching Hospital in Western Uganda

Franck Sikakulya, David Kitya, Teddy Achola

Neurosurgery Division, Mbarara Regional Referral Hospital, Mbarara, Uganda

Correspondence: francksikakulya@gmail.com

Abstract ID: 353

Background: This study aims to provide information to the community and clinicians and could influence policies in Uganda if it reveals comparable surgical treatment patterns and favorable outcomes in public health facilities with limited resources, such as Mbarara RRH.

Methods: A retrospective cohort study reviewing medical records of 234 children under 18 years of age, operated on for Hydrocephalus and Hydranencephaly at MRRH between January 2016 and April 2024. Data from inpatient charts, theatre registers, and outpatient neurosurgery clinic notes, including participants’ sociodemographic characteristics, intraoperative findings, and postoperative follow-up for up to 3 months, were extracted into a pre-designed data collection tool and analyzed using STATA 17.

Results: Among 234 medical records of children with hydrocephalus or hydranencephaly, the median age was 5 months, and the male proportion was n=121, 51.71%. Hydrocephalus alone accounted for 207 cases (88.46%), with post-infectious hydrocephalus (PIH) comprising 46 cases (22.22%). Hydrocephalus associated with spina bifida was present in n=42, 20.29%, among other conditions. The most common surgical treatment for hydrocephalus or hydranencephaly was ETV with or without CPC at 47.86%, followed by VP shunting at 34.19%. The primary outcome was postoperative mortality, occurring in n=10 patients, 4.27%, 95% CI (2.31, 7.78). The overall complication rate within 3 months postoperatively was n=59, 25.21%, 95% CI (20.04, 31.20), p=0.928, with CSF leakage being the most common complication in n=25 patients, 10.68%.

Conclusion: The most common cause of hydrocephalus was PIH.ETV, with or without CPC, is the most frequent surgical treatment. CSF leakage was the most common complication, occurring in 10.68%. The overall 3-month post-operative mortality rate was 4.27%.

Keywords: Hydrocephalus, surgical outcome, Western Uganda

Transtentorial Herniation in A Patient Shunted for Obstructive Hydrocephalus Secondary to A Posterior Cranial Fossa Tumor

Norbert Singine

COSECSA, Parirenyatwa hospital

Correspondence: nmsingine@gmail.com

Abstract ID: 345

Background: Neuro-oncology emergencies encompass a wide variety of presentations including complications that are treatment-related. The main aim of this case report was to share experience of responding to a neuro-oncology emergency in a low-resource environment. A 19-year-old male patient presented with a 2-day history of reduced consciousness and a 7-day history of poor feeding and projectile vomiting. He was being followed up for a posterior fossa tumour that had a cystic component with an intramural nodule. A ventriculoperitoneal shunt was inserted 3 months prior for an active triventricular obstructive hydrocephalus. The patient was doing well until 7 days prior to presentation when the above symptoms started. There was no history of trauma or convulsions.

Methods: On examination he was critically ill and in respiratory distress. His neck was hyperextended with decerebrate posturing. His airway and cervical spine were clear. LOC 7/15. Pupils 3mm with sluggish light response. He had generalized muscle hypertonia and hyperreflexia. A CT scan showed collapsed, slit supratentorial ventricles with a large infra-tentorial cyst containing an intramural nodule located in left cerebellar hemisphere. Significant brainstem compression plus supratentorial herniation.

Results: A suboccipital craniotomy was done within 2 hours and patient admitted in ICU for 4 days. He showed good recovery and was discharged on day 8 after regaining consciousness, and without obvious neurological deficits.

Discussion: Emergent neuro-oncology surgical intervention is an essential component of neurosurgical services which should be available even in low resourced settings. The application of ventriculoperitoneal shunt in the setting of posterior cranial fossa masses, even the high-pressure shunts, need to be done with caution as there is a real and eminent risk of upward transtentorial herniation.

Keywords: transtentorial herniation, suboccipital craniotomy

Microbiological And Clinical Outcomes Following Ventriculo-Peritoneal Shunt Removal: A Single Center Retrospective Analysis in Blantyre, Malawi

Leonard Chafewa

Queen Elizabeth Central Hospital, Blantyre, Malawi

Correspondence: leonardchafewa@gmail.com

Abstract ID: 248

Background: Ventriculoperitoneal (VP) shunt infections remain a leading complication of hydrocephalus treatment, with significant associated morbidity and mortality. This study analyzes the microbiological profiles and clinical outcomes of patients undergoing ventriculoperitoneal shunt removal at Queen Elizabeth Central Hospital in Blantyre, Malawi between 2020 and 2023.

Methods: We conducted a retrospective review of 60 consecutive patients who underwent VP shunt removal between 2020-2023 from a total of 453 shunted patients. During this period, a total of 758 patients were managed for hydrocephalus with either a ventriculoperitoneal shunt or an endoscopic third ventriculostomy. Data collected included demographic characteristics, microbiological culture results, and clinical outcomes.

Results: Among 60 patients; youngest being under 3 months and the oldest at 77, 48 (80%) had samples available for culture, with 16 (33.3%) showing positive growth. The most common organisms isolated were Klebsiella pneumoniae (n=3, 18.8%), Staphylococcus aureus (n=3, 18.8%), and Acinetobacter baumannii (n=2, 12.5%). The overall mortality rate was 23.3% (95% CI: 12.6–34.0; 14/60), significantly higher in culture-positive cases (43.8%, 95% CI: 19.5–68.1; 7/16) than culture-negative cases (15.6%, 95% CI: 3.0–28.2; 5/32; p=0.03). The overall positive culture rate was 3.5% (16/453), with a 13.2% infection rate (60/453). Pediatric patients (<16 years) comprised 75% (45/60) of removals.

Conclusion: The concerningly low culture positivity rate of 33.3%—leaving two-thirds of clinically suspected infections culture negative highlights fundamental limitations in conventional diagnostic approaches. These findings emphasize the need for early microbiological diagnosis, prompt initiation of targeted antimicrobial therapy, and consideration of local resistance patterns in empiric treatment regimens.

Keywords: Hydrocephalus, antimicrobial resistance, VP shunt

Spectrum And Risk Factors of Neurological Disorders in The Eastern Democratic Republic of Congo: A Cross-Sectional Study

Larrey Kasereka Kamabu, Franck Sikakulya

Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Catholic University of Graben, Butembo, DRC

Correspondence: francksikakulya@gmail.com

Abstract ID: 231

Background: In the Eastern Democratic Republic of the Congo (DRC), neurological conditions are worsened by limited access to qualified neurological staff and infrastructure, ongoing armed conflict, and financial shortages. This study examines the range and risk factors of neurological disorders in eastern DRC.

Methods: This cross-sectional study was conducted in New deal SARL hospital *Clinique Internationale de Médecine Avancée au Kivu *(CIMAK) located in Goma across the Eastern DRC. Data were collected from December 2024 to March 2025 using a structured questionnaire and clinical assessments. Descriptive statistics summarized prevalence, and logistic regression analyses were performed to identify factors associated with having a neurological disorder.

Results: A total of 596 participants were enrolled, representing diverse demographics. The average age was 41 years (SD = 20), and 53% were female. Most participants lived in urban areas (78%), and 65% had at least secondary education. Unemployment was reported by 24%. In total, 20.6% (n = 123) had a neurological diagnosis, most commonly epilepsy (35.8%), stroke (22.8%), and migraine or chronic headache (11.4%). Among those with epilepsy, 56.8% had the condition for more than five years. In multivariable logistic regression, tobacco use was significantly linked to higher odds of a neurological diagnosis (adjusted OR = 4.51; 95% CI: 1.32–14.9; p = 0.013). Participants who were married (adjusted OR = 0.43; 95% CI: 0.19–0.94; p = 0.034) or divorced (adjusted OR = 0.09; 95% CI: 0.00–0.61; p = 0.038) had notably lower odds of a neurological condition compared to those who were single.

Conclusion: These findings emphasize the importance of targeted public health initiatives, especially tobacco cessation programs and integrated neurological care within primary health systems. Further long-term and diagnostic studies are recommended to better understand causal relationships and enhance prevention strategies in similar low-resource environments.

Keywords: Neurological diagnosis, sociodemographic factors, Eastern DRC

Epidemiological Trends of Traumatic Brain and Spinal Cord Injury in Ndola District: Implications for Surgical Training in Low-Resource Settings

Ebenisha Choonya Majata

Ndola Teaching Hospital, Copperbelt University School of Medicine, Association of Future African Neurosurgeons, Zambia Medical Association

Correspondence: majataninshi@gmail.com

Abstract ID: 228

Background: Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) remain leading causes of morbidity and mortality globally, with significant social and economic implications. In Zambia’s Copperbelt Province, rapid industrialization, mining activity, and increased motorization have raised the burden of trauma-related neurosurgical conditions. Understanding the epidemiology of TBI and SCI is crucial to inform surgical training and resource allocation in low-resource settings. This study aimed to examine the epidemiological patterns of TBI and SCI at Ndola Teaching Hospital, identify high-risk demographic groups, and assess clinical factors associated with hospitalization and recovery outcomes.

Methods: This retrospective cohort study analyzed data from 83 patients presenting with traumatic CNS injuries. Descriptive statistics were used to summarize demographic and clinical characteristics. Bivariate and multivariate regression analyses were conducted to identify associations between injury characteristics and outcomes. Trends were assessed using linear regression.

Results: Among the 83 cases, 66.3% were male, with the majority (50.6%) aged 21–30 years. Most patients resided in urban areas (53.8%) and were married (51.8%). Non-penetrating TBIs accounted for 81.9% of cases, with 67.5% presenting with a GCS of 13–15. Road traffic accidents were the leading cause (38.7%). A significant association was found between GCS score and cause of injury with recovery outcomes (p < 0.05). Notably, 85.5% of patients achieved full recovery.

Conclusion: This study highlights a high incidence of TBI and SCI among young males in Ndola, primarily due to road traffic injuries. The findings underscore the need for enhanced surgical training in trauma care, particularly in managing neurotrauma in resource-limited settings. Incorporating epidemiological data into surgical curricula and workforce planning can improve outcomes and strengthen trauma systems across similar contexts in Africa.

Keywords: Neurotrauma, Surgical Education, Injury Epidemiology, Low-Resource Settings

Multiple Giant Cerebral Hydatid Cysts in Pediatrics

Dagnechew Yohannes, Murtii Teressa Obolu, Abdulaziz Abdellah Hussein, Yared Assefa Beyene, Tadesse Getachew Mulisa, Kibrom Legesse

Hawassa University College of Medicine and Health Science

Correspondence: murtyko1984@gmail.com

Abstract ID: 225

In Ethiopia, although multiple giant cerebral hydatid cysts are rare, rural children in close contact with dogs, remain at risk. Diagnosis requires clinical suspicion and advanced imaging. Dowling hydrodissection allows intact cyst removal. Preoperative anthelmintics minimize allergic risks. Early Surgical intervention better neurologic recovery, and follow-up is essential for potential recurrence.

Keywords: Cerebral hydatid cyst, Cystic Echinococcosis, Dowling technique, Neurologic recovery, Hydatid cyst rupture

Predicting Factors of Long-term Surgical Outcomes in None-Acute Subdural Hematoma at Hawassa University Comprehensive Specialized Hospital; A Two-year Prospective Cohort Study

Abdulaziz Abdellah Hussein, Murtii Teressa Obolu, Dagnachew Yohannes Gechera

Hawassa University College of Medicine and Health Science

Correspondence: murtyko1984@gmail.com

Abstract ID: 223

Background: Non-acute subdural hematomas are increasingly encountered in neurosurgical practice, particularly among the elderly. Despite their generally favorable prognosis following burr-hole and hematoma evacuation, a subset of patients experiences unfavorable outcomes. This study aimed to comprehensively evaluate clinical profile and predicting factors of long-term outcomes of patients treated surgically at HUCSH.

Methods: A prospective hospital-based cohort analysis was conducted on 161 patients with non-acute subdural hematoma who underwent surgical intervention at HUCSH from January 2022 to December 2024 G.C. Data were collected on demographics, clinical presentation, radiological findings, intraoperative details, postoperative course, and outcomes up to six months. Bivariate and multivariate logistic regression analyses were used to identify predictors of long-term neurologic outcomes.

Results: The majority of patients were older adults (74% aged ≥60), male (72.7%), and from rural settings (76.4%). Falls were the leading cause of trauma (50.9%), with most hematomas being unilateral (71.4%). Postoperative recovery was excellent in the majority (88.8%), with short hospital stays (78.3% discharged within 3 days). Multivariate analysis identified advanced age (AOR=8.16, p=0.001), initial body weakness (AOR=0.196, p=0.032), lower GCS on admission (AOR=0.374, p=0.017), midline shift on imaging (AOR=2.97, p=0.050), and longer hospital stay (AOR=5.04, p=0.039) as independent predictors of poor outcome.

Conclusion: This study strongly states the importance of early neurological assessment and radiological evaluation in predicting outcomes of non-acute subdural hematomas. Particularly, age, low GCS score, body weakness, midline shift, and long hospital stay are key prognostic indicators. Standard surgical management, effective postoperative protocols, and follow-up strategies contribute to the excellent recovery rates observed in this setting, despite resource limitations.

Keywords: Subdural hematoma, Burr hole, Glasgow outcome scale, Hematoma recurrence

Microneurosurgery Ethiopia: Leveraging Digital Video to Enhance Surgical Training in a Low-Resource Setting

Eyerusalem Bergene Banti, Samuel Equar Alem

St. Paul’s Hospital Millennium Medical College

Correspondence: monorovia@gmail.com

Abstract ID: 221

Background: Surgical trainees in low-resource settings often face limited access to high-quality operative teaching materials. Microneurosurgery Ethiopia is a free YouTube-based initiative launched in 2025 to provide real-time, high-resolution operative neurosurgical videos recorded in Ethiopia, aimed at junior surgeons, residents, and the broader medical community.

Methods: The creators designed and published a curated series of operative videos, including glioblastoma resections, meningioma removals, and skull base dissections. Each video includes annotations and voice-overs or subtitles where appropriate. Analytics from YouTube Studio were monitored for impact and audience engagement.

Results: Within the initial six weeks of launch, the educational neurosurgical video channel reached 478 subscribers and published 9 original, procedure-based videos. The most viewed content, titled Anteromedial Temporal Lobectomy, garnered 2054 views, 7200 impressions, and 194 likes, indicating high engagement. Over the last 28-day period, the channel accumulated 71.5 total watch hours. Viewer feedback, particularly from residents and junior neurosurgeons, was consistently positive, highlighting its perceived value in surgical training. All videos were produced in a manner that is age-restricted, HIPAA-compliant, and sensitive to patient confidentiality, ensuring ethical standards in digital surgical education were upheld.

Conclusion: Microneurosurgery Ethiopia demonstrates the potential of low-cost, open-access digital tools in surgical education within low-resource settings. This platform serves as both an educational archive and mentorship extension, fostering scalable knowledge sharing. Future directions include case-based modules, multilingual subtitles, and outcome-based learning analytics.

Keywords: Surgical Education, Global Neurosurgery, Video-based Training, Low-resource Innovation, COSECSA

Descriptive Epidemiology and Surgical Outcomes of Intracranial Tumors in Southwestern Uganda: A Cross-Sectional Study

Ssembatya Joseph Mary, Blessing Michael Taremwa

Mbarara regional referral hospital

Correspondence: ssembatyajosephmary@gmail.com

Abstract ID: 209

Background: There is a paucity of published data on intracranial tumors in Sub-Saharan Africa (SSA), leaving the true epidemiology of these lesions unclear. To address this gap, we conducted a descriptive epidemiological analysis at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda to characterize histological patterns, patient demographics, surgical management, and discharge outcomes.

Methods: This mixed-methods cross-sectional study contains retrospective (2016 - 2020) and prospective (2021 - 2024) descriptive components from clinical records of patients with intracranial tumors. Histology reports were sourced from the Histopathology Unit at MRRH and a private facility, Surgpath Medical Consultants.

Results: We included data from 364 patients with radiologically confirmed intracranial tumours between 2016 and 2024. The median age was 40 years (Interquartile range IQR: 24-54), and females were 51%. Overall, 92% of patients received Computed Tomography (CT) scans images, and tumors were predominantly supratentorial (87% adults; 61% pediatrics). The majority (69%) underwent surgical intervention, with meningiomas as the most common histological subtype (33%), followed by adult-type diffuse gliomas (24%) and sellar region tumors (15%). Female preponderance correlated with the high proportion of meningiomas. No regional variation in histology was noted. Survival at discharge was higher among meningioma and benign tumors, with no significant variation by histology.

Conclusion: This study demonstrates a high burden of intracranial tumors in Southwestern Uganda, with demographic and histological patterns broadly comparable to global literature. The findings highlight the need for enhanced neuro-oncology capacity in SSA and serve as a baseline for future studies to improve patient outcomes.

Keywords: Intracranial tumors, Epidemiology, Neuro-Oncology, Uganda

Neurosurgical Services at Mbarara Regional Referral Hospital, Uganda: The Burden, Spectrum and Outcomes

Ssembatya Joseph Mary, Blessing Michael Taremwa

Mbarara Regional Referral Hospital

Correspondence: michelkgb@yahoo.com

Abstract ID: 197

Background: Africa faces a significant gap in access to neurosurgical services, with only 1% of the global neurosurgical workforce available despite accounting for 15% of the unmet need. Uganda is experiencing a growing demand for neurosurgical care, but regional referral hospitals have not participated equitably in delivering these services. Mbarara Regional Referral Hospital (MRRH) has pioneered and played a pivotal role in providing and expanding neurosurgical services in Uganda since 2012. This study aimed at documenting the variety, volume and outcome of neurosurgical cases at MRRH.

Methods: This was a retrospective case series analysis of neurosurgical cases at MRRH from 2019 to 2023. Data was collected from a prospectively maintained neurosurgery database, focusing on admission patterns, types of procedures and discharge outcomes and outpatient attendance. We used frequency tables, pie and bar charts, and linear graphs. Appropriate regression models were used to analyze data.

Results: Total admissions from 2019 to 2023 were 5,602. Adults were 4207 (75.1%) and pediatric cases were 1,395 (24.9%) with a male predominance of 3371(60.2%). There was a preponderance of Traumatic brain injury (TBI) (4174, 74.5%) and the trend of TBI showed an increasing incidence over the years. Overall operated cases were 1,923, (34.3%). Common operated pediatric cases were MMC closure (220), VP Shunts (108), ETVs (121). CSDH cases operated were (429). Tumor surgeries were (235, 12.2%), Spine surgeries were (17, 0.9%). Overall mortality was 13.1%, mainly due to TBI. Total outpatients’ visits were 5189.

Conclusion: There was an overwhelming burden and diversity of neurosurgical cases at MRRH with results showing an increasing demand for services over the period of study. TBI dominated the picture in both admission and surgery. One third of the admitted cases were children. Majority of the patients were discharged alive.

Keywords: Neurosurgical services, Burden, Traumatic Brain Injury

Surgical Management of Meningioma in a Conflict-Affected, Resource-Limited Setting: A Case Report from Eastern Democratic Republic of Congo

Rugendabanga Karume Edouard

College of Surgeons of East, Central and Southern Africa

Correspondence: eddyspark@rocketmail.com

Abstract ID: 193

Background: Meningiomas represent the most prevalent primary intracranial neoplasms, comprising approximately 30% of all intracranial tumors, with 90% classified as benign (WHO Grade I). Surgical resection remains the primary therapeutic modality. However, in low-income and conflict-affected regions, timely diagnosis and surgical intervention are frequently constrained by limited access to neuroimaging and specialized neurosurgical care.

Case Presentation: We present the case of a 37-year-old male from Eastern Democratic Republic of Congo (DRC) who developed progressive neurological deterioration over six months. Clinical features included left-sided hemiparesis, aphasia, seizures, right eye blindness, and sphincter incontinence. Cranial computed tomography (CT) revealed a right fronto-parietal extra-axial mass with substantial peritumoral edema, subfalcine herniation, and probable transtentorial involvement. The patient underwent gross total resection of a 5 cm encapsulated tumor via craniotomy. Histopathological examination confirmed a WHO Grade I meningioma composed of epithelioid cells arranged in clusters, interspersed with fibroblast-like cells. Postoperative recovery was favorable, with partial neurological improvement and persistent visual impairment.

Conclusion: This case underscores the feasibility of performing life-saving neurosurgical procedures in resource-limited and conflict-affected regions. It highlights the urgent need for global health initiatives aimed at expanding access to neuroimaging, surgical expertise, and postoperative rehabilitation in low-resource settings.

Keywords: meningioma, resource-limited settings, WHO grade

PLASTIC SURGERY

From Classroom to OR: Co-designing a Simulation-Based Cleft Training for Surgical Trainees in Africa

Patrick Mwai

Smile Train

Correspondence: pmwai@smiletrain.org

Abstract ID: 398

Background: Cleft lip and palate repair requires highly specialized surgical expertise yet training opportunities in Africa remain limited. To address this gap, Smile Train integrated Simulare 3D-printed cleft simulators into its educational strategy. These simulators replicate lifelike anatomy, enabling hands-on practice in a safe environment. Regional workshops were developed to strengthen surgical confidence and skill acquisition through structured simulation-based learning.

Methods: Simulation workshops were embedded within surgical conferences and university-based programs. Trainees were provided with preparatory manuals and videos before participating in hands-on sessions using unilateral, bilateral, and cleft palate simulators under expert proctor guidance. Pre- and post-test surveys assessed confidence, technical comfort, and skill levels. Workshop evaluations captured trainee perceptions of realism, educational value, and challenges.

Results: At the University of Nairobi, pre-test data from 14 residents revealed only 21% with above-average skills; post-test findings showed 93% reporting comfort or higher in independently performing cleft repairs. Similarly, at the 2025 International Congress on Innovations for Global Surgery (ICIGS, Malawi), baseline surveys demonstrated ≤20% of participants were comfortable with repair; post-training, over 80% reported improved preparedness and confidence despite identifying challenges with model fragility. Qualitative feedback highlighted the workshops’ interactive, stepwise instruction as transformative, though trainees consistently requested extended practice time.

Conclusion: The integration of Simulare training has measurably improved surgical confidence and skill among early-career African trainees, bridging a critical educational gap. Strategic partnerships that embed simulation into fellowships and conferences demonstrate a scalable pathway to strengthen cleft surgery capacity in resource-limited regions. Further refinements in model durability and longitudinal curricula will enhance sustainability and impact.

Keywords: Simulare, simulation-based training, cleft surgery, surgical education, Africa, unilateral cleft lip, bilateral cleft lip, cleft palate.

Rethinking The Use of The Rule Of 10s for Cleft Lip Surgery in The African Context

Bethel Mulugeta Yaregal, Delage Barbara

Smile Train

Correspondence: bmulugeta@smiletrain.org

Abstract ID: 379

Background: Cleft lip operations are typically conducted from the age of 3 months, when anaesthesia is considered safer. The «rule of 10s» is often cited as providing minimum eligibility criteria for cleft lip surgery, suggesting readiness when patients are at least 10 weeks of age (≈ 3 months), weigh more than 10 pounds (≈ 4.5 kg), have a haemoglobin concentration above 10 g/dL, and white blood cell count exceeding 10,000 mm3 (Wilhelmsen and Musgrave, 1966). An analysis of Smile Train clinical database indicated that one-quarter of surgeries between 2008 and 2018 involved children presenting underweight (weight-for-age z score [WAZ] < -2 SD), highlighting the challenge of achieving an appropriate weight for age (Delage et al., 2022). This study aims to demonstrate the limitations of using the «rule of 10s», specifically the focus on weight-for-age.

Methods: Anthropometric data reported by Smile Train partners in Africa for cleft lip surgeries in children 5 years and younger were analyzed for the year 2023 (N=5,384).

Results: At the time of surgery, 22.4% (N=939) of patients with valid anthropometric data were underweight (WAZ<-2 SD). Among these underweight patients, 50.6% were stunted (chronic malnutrition; height-for-age z score <-2 SD), 33.8% were wasted (acute malnutrition; weight-for-height z score <-2 SD), and 9.7% were both wasted and stunted. Additionally, among patients with appropriate weight-for-age (N=4199), 17.7% were stunted and 6.9% were wasted.

Conclusions: Relying on a minimum weight-for-age to assess surgical readiness is inadequate in contexts with high burden of malnutrition and can create a misleading sense of safety. There is an urgent need to reconsider how nutritional fitness is assessed and start prioritizing growth status rather than solely focusing on nutritional status.

Keywords: rule of 10s; nutritional fitness; malnutrition; growth status

Exploring Cosmetic Surgery in Africa as a Strategy for Sustainable Reconstructive Care

Jessieka Knazze¹, Jasmine Craig², Michael Bentz², Metasebia Abebe³, Darius Balumuka⁴, Amanda Gosman⁵, Musunga Mulenga⁶, Okensama La-Anyane², Ian Shyaka⁷

1. Cooper University Hospital

2. University of Wisconsin

3. Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia

4. John Hopkins University

5. UC San Diego Health Plastic Surgery

6. University of Colorado

7. Chang-Gung Memorial Hospital

Correspondence: musunga.a.mulenga@gmail.com

Abstract ID: 366

Background: Disparities in surgical care across Africa contribute to premature mortality and disability. Plastic and reconstructive surgery can be pivotal in addressing this burden; however, it is constrained by limited resources, inadequate number of training programs, and a shortage of surgeons. This study surveyed plastic surgeons across Africa to assess involvement in cosmetic surgery, perceived barriers to its practice, and its potential to support reconstructive surgery through sustainable income generation.

Methods: A survey was developed in Research Electronic Data Capture with input from African and global leaders in plastic surgery. Surgeons were invited to complete the survey through email and professional organizations and given a 3-week window to respond. Data were analyzed with MATLAB and open-source Python software.

Results: Fifty-two responses were collected. Of the respondents, 64% (n=50) perform cosmetic surgery and 37% (n=49) perform cosmetic procedures. Most received cosmetic surgery training in residency and/or fellowship (73%, n=30). All surgeons not currently performing cosmetic surgery (n=18) agreed they would benefit from further training. The majority of respondents were male (67%, n=36), early in their careers (0-5 years, 69%, n=32), trained in Ethiopia (69%, n=36), and currently practicing in Eastern Africa (89%, n=36). Key patient barriers to cosmetic surgery included limited surgeon availability, low awareness, safety concerns, and social stigma. Surgeon barriers included lack of training and access to necessary products. Notably, 100% of surgeons not performing cosmetic surgery disagreed that it would detract from reconstructive care, and 96% (n=13) believed it could generate revenue to support care for underserved patients.

Conclusions: Attitudes towards cosmetic surgery and procedures are generally positive with perceived benefits amongst plastic surgeons in Eastern Africa. Strengthening cosmetic surgery infrastructure may offer a viable strategy to sustainably fund and expand access to reconstructive surgical care.

Keywords: Cosmetic, sustainable, revenue, reconstruction

Maffucci Syndrome with Malignant Transformation Presenting as Infected Hand Swelling: A Case Report

Simeon Mulugeta Mengistu

Addis Ababa University, ALERT comprehensive specialized Hospital

Correspondence: mulgeta.simon@gmail.com

Abstract ID: 356

Background: Maffucci syndrome is a rare, non-hereditary disorder characterized by multiple enchondromas and vascular anomalies, most commonly hemangiomas. The syndrome carries a significant risk of malignant transformation, particularly into chondrosarcoma.

Case Presentation: We report a case of a 7-year-old patient who presented with a painful, swollen right hand and signs of soft tissue infection. Imaging revealed multiple lytic lesions involving the hand. Biopsy of the lesion confirmed chondrosarcoma arising in the setting of Maffucci syndrome. Due to the extent of the lesion, presence of infection, and soft tissue compromise, transradial amputation was performed.

Discussion: Maffucci syndrome carries up to a 30% lifetime risk of chondrosarcoma. In this case, infection masked the underlying malignancy and contributed to rapid deterioration. Timely biopsy, histologic confirmation, and definitive surgical intervention were essential for both oncologic control and infection eradication.

Conclusion: This case highlights the diagnostic and management challenges in Maffucci syndrome, particularly when malignant transformation is complicated by soft tissue infection. Aggressive surgical treatment, including amputation, may be necessary in selected cases to achieve satisfactory outcomes.

Keywords: Maffucci syndrome, enchondroma, malignant transformation, transradial amputation

Recurrent Vulvar Dermatofibrosarcoma Protuberans: A Case Report and Reconstructive Approach Using Pedicled Tensor Fascia Lata (TFL) Flap

Simeon Mulugeta Mengistu

Addis Ababa University, ALERT comprehensive specialized Hospital

Correspondence: mulgeta.simon@gmail.com

Abstract ID: 355

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive malignant cutaneous soft tissue sarcoma, characterized by high recurrence potential but low metastatic risk. Vulvar involvement is extremely rare, and recurrent presentations are even more uncommon.

Case Presentation: We report the case of a 32-year-old woman with a recurrent vulvar mass, previously excised 4.5 years earlier. Clinical and radiologic features suggested DFSP. Wide local excision with 5 cm margins, including excision of the clitoris and superficial inguinal lymphadenectomy, was performed. Histopathology confirmed DFSP with negative margins and reactive lymphadenopathy. The large vulvar defect was reconstructed using a pedicled tensor fascia lata (TFL) flap and split-thickness skin graft (STSG). Postoperative recovery was uneventful, and the patient was discharged with good functional and cosmetic outcome. She was given follow up appointment and linked to oncology.

Conclusion: DFSP of the vulva, though rare, should be considered in the differential diagnosis of recurrent vulvar masses. Multidisciplinary surgical planning with adequate margin resection and appropriate reconstruction is essential for disease control and quality of life.

Keywords: Recurrent DFSP, Vulvar tumor, Soft tissue sarcoma, Tensor Fascia Lata (TFL) flap

Reconstruction of a Complex Epigastric Abdominal Wall Defect Following Wide Excision of Giant Fibrosarcoma Using Proline mesh and Modified Keystone Flap in a Resource-Limited Setting: A Case Report

Abdirahman Abdifatah Mohamed

College of Surgeons of East, Central and Southern Africa (COSECSA)

Correspondence: drabdirahman688@gmail.com

Abstract ID: 347

Background: Fibrosarcoma is a rare, slow-growing soft tissue sarcoma that accounts for less than 5% of all such tumors. Its global incidence is estimated at 0.8–4.5 cases per million population per year. Fibrosarcoma is characterized by indolent but aggressive local infiltration and a high recurrence rate following incomplete excision, although metastatic potential remains relatively low. In Africa, fibrosarcoma is infrequently reported, and data from Uganda are limited, reflecting challenges in awareness, diagnosis, and documentation of rare cancers.

Case Presentation: We report the case of a 71-year-old Ugandan male with a two-year history of a progressively enlarging anterior trunk lesion. The mass began as a small, firm nodule but gradually developed into a large, fungating tumour with ulceration, necrosis, and bleeding. On examination, a deeply invasive exophytic lesion was noted in the supraumbilical region, with overlying stretched and tense skin. A computed tomography scan of the abdomen demonstrated a heterogeneously enhancing mass measuring 78 × 100 × 63 mm involving the subcutaneous tissue and rectus abdominis muscle, without evidence of peritoneal, visceral, or bony invasion and no distant metastasis. Following multidisciplinary review, wide local excision with a 5 cm margin was performed. Abdominal wall reconstruction was achieved with Prolene mesh reinforcement and a modified keystone flap, supplemented by split-thickness skin grafting for residual coverage. The postoperative course was uneventful, with good flap viability and satisfactory wound healing. The patient remains on regular follow-up for recurrence surveillance and long-term functional outcome assessment.

Conclusion: This case highlights the occurrence of a rare, locally advanced Fibrosarcoma in an elderly Ugandan patient. It emphasizes the importance of early recognition, safe surgical margins, and the adaptation of reconstructive techniques to resource-limited settings. This report contributes to the sparse Ugandan literature on fibrosarcoma and underscores the need for documenting rare cancers to guide clinical care and health policy.

Keywords: fibrosarcoma, Soft tissue sarcoma, Abdominal wall tumor, Keystone flap

Tibialization of the Fibula in a Pediatric Patient Following Post-Infectious Tibial Bone Loss: A Case Report

Hanna Atlabachew, Endale Kefale

College of Surgeons of East, Central and Southern Africa (COSECSA)

Correspondence: hannaatlabachew@gmail.com

Abstract ID: 343

Background: Extensive tibial bone loss in children, particularly following infection, presents a major reconstructive challenge. In resource-limited settings, tibialization of the fibula provides a simple and reliable alternative to advanced microsurgical techniques. We report a case of pediatric tibial reconstruction using ipsilateral fibular transfer following post-infectious bone loss.

Case Presentation: A 4-year-old boy presented with a right leg deformity of three years’ duration. At the age of 1 year, he developed pyomyositis complicated by chronic osteomyelitis in the setting of severe acute malnutrition. Initial treatment involved multiple staged incision and drainage procedures and tibial sequestrectomy, resulting in a large distal tibial defect. On current examination, the child had visible bowing of the leg, shortening, and ankle angulation. A palpable tibial gap was noted, with preserved ankle flexion, extension, and internal rotation, but restricted external rotation. Laboratory investigations were within normal limits. Definitive management consisted of tibialization of the ipsilateral fibula to bridge the defect and restore limb stability.

Results: The postoperative course was uneventful. Serial radiographs demonstrated progressive union between the tibia and the transposed fibula. At the latest follow-up, the child was ambulatory, with improved stability, preserved ankle motion, and no significant functional limitation. Long-term follow-up was planned to monitor potential limb-length discrepancy and angular deformity.

Conclusion: Tibialization of the fibula is a cost-effective and durable option for managing large tibial defects in pediatric patients, particularly in cases following post-infectious complications. With meticulous surgical technique and structured long-term follow-up, this method can achieve satisfactory structural and functional outcomes. It represents an invaluable solution in resource-constrained settings where advanced microsurgical reconstruction may not be feasible.

Keywords: osteomyelitis, mega bone loss, reconstruction

Surgical Research in Sub-Saharan Africa: Challenges and Opportunities Through the Eyes of Plastic Surgery Residents

Tesfahun Ali Said, Imraan Shuaib Sherman

College of Surgeons of Eastern, Central, and Southern Africa (COSECSA)

Correspondence: Tesfuali240@gmail.com

Abstract ID: 335

Background: Despite having about 17% of the world’s population and about a quarter of the global burden of disease, Africa has less than 3% of the world’s healthcare professionals, and barely 1% of global research output. Locally led surgical research is critical to solving the burden of surgical disease in sub-Saharan Africa (SSA). There is an urgent need for investment in research training for surgical residents in sub-Saharan Africa (SSA). Herein, we report the challenges faced by plastic surgery residents of the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA) in engaging in research.

Methods: Participants attending a COSECSA-Operation Smile didactic cleft lip and palate, and basic research methodology workshop engaged in a brainstorming session on the challenges they faced engaging in research; these were then discussed by focus groups. Thematic analysis was used to identify recurring themes, along with potential solutions posed by the participants.

Results: Seventeen participants from nine SSA countries, aged between 29 and 36 years, identified challenges themed into six groups: absence of a research culture, financial constraints compounded by limited scholarships, time limitations due to demanding clinical workloads, inadequate institutional support, poorly organized medical records, and insufficient funding and skills for research. Participants also proposed potential solutions for these challenges.

Conclusion: Overall, the findings highlight the urgent need for targeted interventions, resources, and support to empower surgical residents and address systemic barriers that deprioritize surgical research engagement and negatively affect capacity building in the region.

Keywords: research; plastic surgery resident; sub-Saharan Africa; challenges

Superficial Variance of Ulnar Artery Unique Course in The Forearm: A Case Report

Tesfahun Ali Said

College of Surgeons of Eastern, Central, and Southern Africa (COSECSA)

Correspondence: Tesfuali240@gmail.com

Abstract ID: 334

Background: Anatomical variations of the upper limb vasculature, while often asymptomatic, pose significant challenges during trauma management and surgical procedures including flap elevation. The superficial Variant of the ulnar artery (SVUA), a rare condition where the ulnar artery follows a course superficial to the forearm’s flexor muscles, is particularly vulnerable to injury. It is critical to differentiate this variant from a persistent median artery (PMA), which typically accompanies the median nerve through the carpal tunnel. This case report details a unique presentation of a traumatic laceration of an SVUA and discusses the diagnostic and surgical implications of this vascular anomaly.

Case Presentation: A 26-year-old male carpenter presented to the emergency department approximately six hours after sustaining a grinder machine cut injury to his distal right forearm. Initial assessment revealed a previously sutured wound with active bleeding. Intraoperative exploration uncovered complete transection of the ulnar nerve and eight flexor tendons at the distal forearm. A crucial finding was the abnormal, superficial course of the ulnar artery, which was also severed. This anomalous vessel coursed deep to the skin but superficial to the forearm muscles, and distally it entered the hand via Guyon’s canal alongside the ulnar nerve, confirming its identity as an SVUA rather than a PMA. The patient underwent meticulous surgical repair, including a 4-core strand cruciate repair for the transected tendons, direct coaptation of the ulnar nerve, and microsurgical repair of the anomalous superficial ulnar artery.

Conclusion: This case highlights the heightened vulnerability of a superficially located ulnar artery to trauma and underscores the importance of intraoperative vigilance for such anatomical variations. Awareness of these anomalies is paramount for clinicians and surgeons to ensure accurate planning of flaps, prevent iatrogenic injury, and perform appropriate surgical management of trauma, ultimately contributing to successful limb salvage and preservation of hand function.

Keywords: superficial, ulnar artery, variance

Psychosocial Effects of Cleft Lip and Palate on Adolescents at Yekatit 12 Medical College in Ethiopia: A Phenomenological Study

Tigist Zewude, Mekonen Eshete, Getaw Alemne

AAU Yekatit 12 hospital

Correspondence: tigistzawudes@gmail.com

Abstract ID: 329

Background: Cleft lip and palate (CLP) are among the most common congenital anomalies globally, profoundly affecting the physical, emotional, and social well-being of those affected. In Ethiopia, adolescents with CLP often face unique challenges, including stigma, low self-esteem, and social isolation, which can significantly impact their quality of life and academic performance. This study aims to explore the psychosocial effects of living with CLP among adolescents in Ethiopia.

Methods: A qualitative descriptive study design will be employed, utilizing in-depth interviews to capture the lived experiences of participants. The sample consists of 13 adolescents with CLP, selected through purposive sampling to ensure a diverse representation of experiences related to their condition. This approach allows for a comprehensive understanding of the psychosocial challenges faced by these individuals. The research will take place at Yekatit 12 Medical College in Addis Ababa, a prominent institution known for its specialized care in plastic and reconstructive surgery. This setting provides a unique opportunity to engage with adolescents who have received varying levels of medical intervention for CLP. Data collection is scheduled from December 2024 to June 2025. This timeframe allowed for thorough engagement with participants and in-depth analysis of the qualitative data gathered.

Preliminary findings: Participants experience significant psychosocial difficulties, including low self-esteem and limited peer interactions, which adversely affect their academic performance and overall quality of life. This study underscores the urgent need for targeted interventions to enhance self-esteem and foster supportive environments for adolescents with CLP in Ethiopia, ultimately contributing to improved social integration and academic outcomes.

Keywords: CLP, adolescents, psychosocial impact

Hand Function after Surgery for Dupuytren Contracture: A Multi-Center Prospective Cohort Study

Abraham Gebreegziabher, Tigist Zewude

AAU Alert Specialized Hospital

Correspondence: tigistzawudes@gmail.com

Abstract ID: 327

Background: Dupuytren’s disease is a common, benign fibroproliferative disorder affecting the palmar and digital fascia of the hand. This condition can lead to significant disability, morbidity, and economic loss due to impaired hand function, impacting individuals’ quality of life and work capacity. This study aimed to evaluate the effectiveness of surgical intervention in improving hand function for patients diagnosed with Dupuytren’s disease at ALERT and Yekatit Medical College Plastic Surgery Treatment Centers in Addis Ababa, Ethiopia, during the year 2024.

Methods: A multi-center prospective cohort study was conducted, including patients who underwent surgical procedures for Dupuytren’s disease from January to September 2024. Hand function was assessed using the validated Southampton Patient Outcome Reporting Tool. Data analysis was performed using SPSS version 25, with normality assessed through histograms and the Shapiro-Wilk test. Paired t-tests and Wilcoxon signed-rank tests were utilized for comparing parametric and non-parametric data, respectively.

Results: The study analyzed outcomes for 32 patients, predominantly male (93.8%) with a mean age of 56.1 years. Pre-surgical hand function scores averaged 14 (SD=2). Postoperative complications included hematoma (9.4%) and infection (9.4%), which were relatively minor. Notably, surgical intervention led to a statistically significant mean reduction in the Southampton score of 9.2 (95% CI 8.2, 10.2; p<0.0001), indicating substantial improvement in hand function.

Conclusion: The findings of this study demonstrate that surgical intervention for Dupuytren’s disease significantly enhances hand function and overall quality of life. This improvement allows affected individuals to return to work and engage in daily activities more effectively. The results underscore the effectiveness of surgical treatment in alleviating the disability associated with Dupuytren’s disease.

Keywords: hand function; Dupuytren’s contracture

The Use of Plastic Wrap for Burn Wound Management in Resource Constrained Setting, Rural Zambia

Richard Miti

College of Surgeons of East, Central and Southern Africa (COSECSA)

Correspondence: rmmithi.rm@gmail.com

Abstract ID: 297

Background: Burn injuries pose a significant public health challenge in low-resource settings like rural Zambia, where access to advanced wound care is limited. This study evaluated the implementation of domestic plastic wrap as a primary burn dressing at St. Francis Mission Hospital, a regional referral center.

Methods: A retrospective cohort study was conducted by reviewing files of burn patients admitted between February 2021 and February 2025. Patients were stratified into two groups: a historical cohort managed with traditional gauze dressings and an intervention cohort managed with plastic wrap. Data on demographics, burn characteristics and clinical outcomes were collected. Multivariate logistic regression and survival analysis were used to compare outcomes between groups, controlling for confounders like TBSA burned and presence of SIRS.

Results: Analysis of 361 patient records revealed that plastic wrap use was independently associated with a 51.9% higher hazard of discharge (aHR=1.52, p<0.05), indicating a significantly shorter hospital stay of 11 days. Larger TBSA (aOR 1.05 per 1% increase), need for debridement (aOR 2.00), and antibiotic administration (aOR 3.67) were significant factors in the care for these patients. The plastic wrap group also demonstrated a lower incidence of wound infections acquired during hospitalization. A clear gradient in time to discharge was established: Plastic → Gauze → Mixed approach.

Conclusion: The use of plastic cling wrap for burn wound management in a resource-constrained setting is associated with a significantly reduced length of hospital stay and may contribute to lower rates of nosocomial wound infection. Its adoption represents a safe, effective, and economically viable strategy for improving burn care outcomes in similar low-resource environments. These findings support the integration of plastic wrap protocols into national burn management guidelines.

Keywords: Burn, plastic, wound, infection

Local Partnership for Sustainable and Impactful Access to Cleft Care: A Best Practice from Ethiopia

Getaneh A. Siyum, Bethel Mulugeta

Smile Train

Correspondence: gsiyum@smiletrain.org

Abstract ID: 293

Background: Cleft lip and/or palate (CLP) affects 1 in 700 births globally and 1 in 1,200 births in Africa and is the second most common congenital anomaly in Ethiopia. It causes serious functional, psychosocial, and economic challenges. In 2021, the number of CLP cases in Ethiopia was estimated at 59,666, with a prevalence of 52.3 per 100,000 and 5,182 new cases. Incidence is projected to exceed 5,200 by 2030, highlighting the urgent need for strengthened national cleft care and prevention efforts.

Methods: Smile Train, guided by its “Teach a Man to Fish” implementation model, partnered with the Ethiopian Ministry of Health, local healthcare institutions, and other development partners to strengthen national capacity for sustainable, high-quality, and comprehensive cleft care. A comprehensive and critical evaluation of the partnership cycle was conducted to assess its strategic implementation, operational outcomes, and systemic impacts.

Results: The partnership improved access to cleft care by delivering surgeries to over 41,000 patients and non-surgical comprehensive cleft care to more than 600. Key determinants of success included trust-building, effective communication, and clearly defined roles. Strategic partnership with the Ministry of Health proved pivotal for institutionalizing cleft care within national systems. The initiative contributed to a 91% reduction in the median age at primary surgery between 2006/07 and 2024/25. Furthermore, an estimated 246,971 disability-adjusted life years (DALYs) were averted, translating to an economic contribution of $377.9 million.

Conclusions: Sustainable and impactful access to cleft care in Ethiopia has been significantly advanced through strong operational partnerships with local institutions and a strategic partnership with the Ministry of Health.

Keywords: Partnership, cleft care, cleft lip, cleft palate, Ethiopia, sustainability

Burden, Trend and Quality of Care Index of Orofacial Cleft in Africa 1990-2021 and Forecast Till 2030; Analysis of Global Burden of Disease 2021

Atalel Fentahun¹, Mekonnen Eshete², Lealem Tilahun³, Getaneh Asefa⁴, Bethel Mulugeta⁴, Nkeiruka Obi⁴

1. Debre Tabor University

2. Addis Ababa University

3. Jimma University

4. Smile Train

Correspondence: fentahunatalel27@gmail.com

Abstract ID: 278

Background: Orofacial clefts represent a significant public health concern, ranking among the top congenital anomalies.

Method: This study utilized the established GBD 2021 methodology and a suite of advanced analytic tools to comprehensively assess orofacial cleft incidence, prevalence, death, and disability-adjusted life-years (DALYs).

Results: In 2021, the Quality-of-Care Index (QCI) for orofacial clefts in Africa was 70%, with scores ranging from a low in Burkina Faso, Chad, and Somalia to a high of 100% in Ghana. In 2021, an estimated 799,200 (95%UI: 646,250-974,340) prevalent cases, 827 (143-3311) deaths, and 123,360 (95%UI: 56,160-347,136) DALYs of OFC in Africa. The age-standardized DALYs rate ranged from 7.7 (4.9-11.4) per 100,000 in Southern Sub-Saharan Africa to 4.8 (2.2-12.1) per 100,000 in Central Sub-Saharan Africa in 2021. A significant decline in the age-standardized DALYs rate was observed in Eastern Sub-Saharan Africa (50.1% [-70.2 to -8.7]), while other regions also experienced possible declines, including Western Sub-Saharan Africa (33.3% [-61.5 to 10.4%]), Central Sub-Saharan Africa (43.8% [-69.3 to 1%]), Northern Africa (33.3% [-61.4 to 3.8%]), and Southern Sub-Saharan Africa (-30.2% [-52.1 to 4.6%]). The age-standardized DALYs rate ranged from 2.8 (1.6-4.7) per 100,000 in Gabon to 14.4 (3 to 56.8) per 100,000 in Burkina Faso in 2021.

Conclusion: While a decline in age-standardized incidence, death, and DALYs rates for oral facial cleft (OFC) in Africa with significant heterogeneity across regions and nations points to the effectiveness of preventative strategies and improved surgical interventions, the persistent high burden of this condition underscores the urgent need for sustained investment and commitment to comprehensive care. Africa requires enhanced preventative measures, advanced therapeutic approaches, and robust rehabilitation programs to effectively address the ongoing challenges posed by OFC.

Keywords: Africa, orofacial cleft, cleft lip, cleft palate

Exploring Parental and Care Providers’ Experiences and Challenges in Providing Nutritional Care to Infants with Cleft Lip and/or Palate in Ethiopia

Misha Abayneh Lemma

St. Paul’s Hospital Millenium Medical College

Correspondence: mishaabay2@gmail.com

Abstract ID: 267

Background: Infants born with cleft lip and/or palate (CL/P) face severe feeding challenges that place them at risk of malnutrition, delayed surgery, and psychosocial strain. In Ethiopia, limited awareness, fragmented health services, and financial constraints compound these challenges, yet few studies explore caregivers’ lived experiences.

Methods: This qualitative study explored the experiences and challenges of mothers and healthcare providers in providing nutritional care for infants with Cleft lip and or palate in Ethiopia. In-depth interviews were conducted with nine mothers across four hospitals (Yekatit 12, Cure, Alatyon, and Saglan Waji) and four key informants (nutritionists and care providers). Data were analyzed thematically.

Results: Feeding difficulties including choking, nasal regurgitation, and prolonged feeding merged as universal and distressing. Mothers often improvised unsafe feeding methods amid inconsistent professional guidance. Financial strain was a pervasive theme, with formula and feeding equipment often unaffordable. Additional medical conditions such as anemia and infections compounded growth setbacks and delayed surgeries. Stigma, abandonment, and psychosocial stress further burdened families, though many demonstrated resilience through faith and peer solidarity. Key informants reinforced these findings, emphasizing systemic gaps such as misinformation, resource shortages, and weak referral systems.

Conclusion: Infants with CL/P in Ethiopia face intersecting nutritional, financial, and psychosocial vulnerabilities. While specialized centers provide critical support, strengthening community awareness, breastfeeding counselling, and sustainable resource allocation is essential to improve outcomes. Integrating nutritional and psychosocial support into cleft care pathways can reduce delays, enhance growth, and mitigate stigma.

Keywords: Cleft lip and palate, infant feeding, Ethiopia, nutrition, stigma, maternal experiences

Epidemiology and Predictors of In-Hospital Mortality Among Burn Patients in Ethiopia

Rahel Kassa Bayou

Saint Paul’s Hospital Millenium Medical College

Correspondence: rahelkbt@gmail.com

Abstract ID: 263

Background: Burns are a leading cause of morbidity and mortality in low-resource settings. Data on outcomes and risk factors in Ethiopia are limited.

Methods: A retrospective study of 800 burn patients admitted to AaBET and Yekatit 12 Hospitals (Sep 2021–Nov 2023). Binary logistic regression identified predictors of in-hospital mortality.

Results: Median age: 18 years; 57% female; >80% were children and young adults. Most common burn: scald (46.5%). In-hospital mortality: 8.5% (95% CI: 6.5–10.5%). Key predictors were Inhalation injury AOR 10.9 (95% CI: 6.2–19.2), TBSA ≥15%: AOR 5.0 (95% CI: 2.3–11.0), Deep/full-thickness burns: AOR 0.43 (95% CI: 0.24–0.77)

Conclusion: Burn mortality in Ethiopia is driven by inhalation injury, larger TBSA, and burn depth. Children and young adults are the most affected. Urgent improvements in critical care, triage, and prevention are needed.

Keywords: Burn injury, Mortality, Inhalation injury, Ethiopia

Aetiology, Factors Associated with Injury Severity, And Bacterial Susceptibility Patterns Among Burn Patients in Six Selected Hospitals in Uganda.

Byamungu Pahari Kagenderezo

College of Surgeons of East, Central and Southern Africa

Correspondence: byamungupk@yahoo.fr

Abstract ID: 258

Background: Globally burn injury is of public health concern, it is a significant health problem in both children and older adult populations. In Africa and specially in Uganda burn injuries remain a major cause of prolonged hospital stays, disability and death. Bacterial microorganisms take short hours to invade the burn wound and can be identified in the burn wounds less than 24 hours old. Bacterial infection is still a serious complication which might compromise with the patient’s life after the early phase of management.

Methods: We determined the most common etiology, the factors associated with injury severity and the bacterial susceptibility patterns of burn patients in six selected hospitals in Uganda.

Results: Around 76 patients admitted to those hospitals with burns during our study period were included. Those who were very severe without care takers eligible to consent for them were excluded. The average age was 17.7 years. There were slightly more males with a male to female ratio of 1.05. Majority were from the rural areas, accounting for 76.3%. The common etiology was thermal accounting for 80.8%, dominated by scalds 60.5%. Patients with bun wounds at the sites mandating admission were 22 times more likely to have a severe injury. The commonest organism isolated was staphylococcus aureus accounting for 45.2% followed by pseudomonas accounting for 15.5% and were resistant to most of the antibiotics used in our study. Despite that identified bacteria were resistant to most antibiotics, good number of them were sensitive to imipenem, amikacin, ciprofloxacin and cloxacillin.

Conclusion: Implementation of burn infection control policies is needed. There is a need to include sites mandating admission in the parameters of the score to assess the severity "ABSI score’'. Based on microorganisms isolated, empirical treatment with ciprofloxacin or cloxacillin should be considered.

Keywords: Burn, factors associated with severity; etiology; bacterial susceptibility patterns

Improving Microsurgery Foundational Skills Acquisition Through Short Simulation Courses in Rwanda: A Pre- and Post- Training Survey

Victoire Mukamitari, Danielle H. Rochlin, Bahar Bassiri Gharb, Michelle Coriddi, Paolo Sassu, Samuel Poore, Andrea Pusic, Faustin Ntirenganya

College of Surgeons of East, Central and Southern Africa

Correspondence: mvictoire15@gmail.com

Abstract ID: 213

Background: Microsurgery is increasingly becoming the cornerstone of reconstructive surgical practice, yet training opportunities remain scarce in sub-Saharan Africa. To address this gap, a two-day simulation-based microsurgery course was held in Kigali as part of the pre-conference activities of the Pan-African Conference in February 2025. This study aimed to evaluate the impact of the course on participants’ microsurgical skills.

Methods: Pre- and post-training surveys were administered to course participants, assessing comfort and confidence across six core skill domains: microscope handling, instrument manipulation, needle control, vessel preparation, end-to-end anastomosis, and judging the patency of an anastomosis as well as anxiety related to performing microsurgery. Responses were recorded on a Likert-type scale using a 0-100 format. Paired analysis was performed using Wilcoxon rank sum tests. Qualitative feedback was also collected to assess the perceived value and suggested improvements for future sessions.

Results: 18 participants completed pre- and/or post-training surveys (14 completed both). Statistically meaningful improvements were observed in participants’ comfort and confidence across all skill domains (p<0.05). Participants reported a significant decrease in anxiety (p<0.02). Qualitative responses emphasized high satisfaction with the course, with many requesting more frequent sessions and earlier integration of microsurgical skills into training.

Conclusion: Short-duration, simulation-based microsurgery training had a positive, measurable impact on technical confidence and psychological readiness among surgical trainees in Rwanda. These findings highlight the feasibility and importance of expanding access to structured microsurgical education across sub-Saharan Africa and support efforts to integrate such training into national surgical training frameworks.

Keywords: Microsurgery, Microscope, Surgical Education, Simulation-Based Learning

Assessment of Training Environment of Plastic, Reconstructive and Hand Surgery in Ethiopia

Misha A. Lemma, Bereket A. Worku, Rahel K. Bayou, Peter M. Nthumba, Moses O. Osoo, Onesmus O. Onyango, Don Elliso Prisno

St. Paul’s Hospital Millenium Medical College

Correspondence: mishaabay2@gmail.com

Abstract ID: 202

Background: A supportive clinical learning environment is critical for effective surgical training, promoting professional growth and problem-solving skills. Despite global use of tools like the Postgraduate Hospital Educational Environment Measure (PHEEM), Ethiopia lacks data on the training environment for plastic and reconstructive surgery, limiting efforts toward educational quality improvement. This study aimed to explore and assess the perceptions and experiences of trainees and educators in Ethiopia’s plastic, reconstructive and hand surgery programs regarding the training environment.

Methods: A mixed methods design was employed at Addis Ababa University and St. Paul’s Hospital Millennium Medical College. Quantitative data were collected using the validated PHEEM questionnaire, while qualitative data were gathered through in-depth interviews and focus group discussions. Purposeful sampling was used, and data collection continued until thematic saturation. Thematic analysis was conducted using NVivo software.

Results: Forty-eight residents participated (56.3% male), with a mean age of 28. The average PHEEM score was 85/160 (53% satisfaction). Subscale scores indicated moderate satisfaction across domains: autonomy (51.9%), teaching (55.3%), and social support (51.8%). Teaching received the highest score, while social support was the lowest. Qualitative analysis identified four key themes: poor training environment, the importance of collaboration and networking, the role of resilience, and the need to move from general to specialized plastic surgery practice.

Conclusion: While residents appreciated aspects of teaching, there is a clear need to strengthen social support and overall training quality. Findings highlight opportunities for targeted improvements in Ethiopia’s surgical education system.

Keywords: Medical education; training environment; Plastic, and Reconstructive Surgery, Ethiopia

Popliteal Pterygium Syndrome: Innovations in Managing a Rare Congenital Anomaly in Resource-Limited Settings

Nagasa Wirtu Shanko, Abraham Gebreegziabher, Mekonen Eshete, Reyad Adem Hussen, Eyob Zergaw, Senayad Banti

ALERT Comprehensive Specialized Hospital

Correspondence: sweetnws@gmail.com

Abstract ID: 195

Background: Popliteal Pterygium Syndrome (PPS) is a rare congenital disorder with an estimated incidence of 1 in 300,000 live births. It manifests through orofacial anomalies, musculoskeletal deformities, and genitourinary abnormalities. Managing PPS in low-resource environments poses clinical and logistical challenges. This study reports a successful multidisciplinary intervention for a child with classic PPS features.

Methods: We describe a 4-year-old male presenting with bilateral popliteal webbing, cleft palate, and genital anomalies. Initial evaluation involved comprehensive physical examination, imaging, and multidisciplinary consultation. A phased surgical approach was employed. The first procedure involved a modified “jumping man” Z-plasty for web release. Cleft palate repair and genital reconstruction followed in subsequent stages. Postoperative care included splinting, rehabilitation, and long-term follow-up.

Results: The initial Z-plasty achieved excellent soft tissue release, and postoperative immobilization allowed full extension at the knee. Cleft palate correction significantly improved speech and feeding. Genital reconstruction addressed both form and function. The patient achieved full mobility and normal urination, with the family reporting high satisfaction. No major complications were observed, and early rehabilitation contributed to sustained functional improvement.

Conclusion: This case illustrates that PPS can be effectively managed in resource-limited settings through well-planned surgical staging, innovative flap design, and a coordinated care model. Despite being rare, early recognition and multidisciplinary management of PPS are critical for achieving good outcomes. The use of adaptable techniques like the jumping man Z-plasty provides practical solutions where high-tech resources are unavailable. This study highlights the need for increased awareness, early parental counseling, and investment in reconstructive services for congenital anomalies in low-income countries.

Keywords: Popliteal Pterygium Syndrome, popliteal webbing

Revolutionizing Limb Salvage: Exceptional Outcomes of Tibialization of Fibula for Tibial Bone Defects in Ethiopia

Nagasa Wirtu, Abraham Gebreegziabher, Senayad Benti, Endale Kefale

ALERT Comprehensive Specialized Hospital

Correspondence: sweetnws@gmail.com

Abstract ID: 194

Background: Tibial bone defects represent a significant surgical challenge, particularly in resource-limited settings where limb amputation is often the only option. Tibialization of the fibula, involving transposition of the fibula to function as a tibia, is emerging as a highly effective solution. This study examines its outcomes in Ethiopia, offering hope for patients with large tibial defects.

Methods: We conducted a retrospective cross-sectional analysis of 12 patients treated with fibular tibialization at ALERT Comprehensive Specialized Hospital from January 2014 to March 2024. Patient demographics, etiology, radiological union, and functional outcomes were assessed using ASAMI criteria. Complications and overall satisfaction were recorded.

Results: The cohort had a mean age of 21.83 years (3–34), with trauma being the predominant cause (91.7%). Bone union was achieved in 91.7% of patients, with a mean consolidation time of 10.36 months. Despite complications in 25%—including infection and nonunion—all were successfully managed. Functionally, 66.7% scored excellent or good, while 72.7% expressed satisfaction with the outcome and quality of life.

Conclusion: Tibialization of the fibula proves to be an effective, durable, and affordable limb salvage technique for severe tibial bone defects. Especially valuable in low-resource settings, it offers a viable alternative to amputation and expensive reconstructive options. This study supports the integration of tibialization in standard orthopedic and reconstructive protocols and encourages further prospective research to refine surgical technique and post-op rehabilitation strategies. Its success lies in combining surgical innovation with patient-centered care.

Keywords: Tibialization, resource-limited settings, Functional recovery

GLOBAL SURGERY

Primary Trauma Care Implementation Outcomes on Emergency Response Personnel’s Competencies: A Prince Regent Hospital Quasi-Experimental Study

Gilles Eloi Rwibuka

School of Anaesthesia and Critical Care

Correspondence: rwibahgilel31@gmail.com

Abstract ID: 427

Background: Trauma is a significant global health issue, particularly in low and middle-income countries with limited resources. Annually, trauma causes approximately 6 million deaths and countless disabilities, burdening healthcare systems, especially in low and middle-income countries. Yet, structured trauma training for emergency response personnel remains scarce in countries like Burundi. This study aimed to evaluate the outcomes of implementing the Life & Limb Primary Trauma Care training program on Emergency Response Personnel’s competencies from Prince Regent Hospital in Burundi.

Methods: A before-and-after quasi-experimental design was used in this study. This study involved 50 subjects. Training was implemented over a period of 12 months. A pretest and posttest assessment were done to measure subjects’ knowledge, skills, and attitudes about Life & Limb Primary Trauma Care training program. Testing was done before and immediately after Life & Limb Primary Trauma Care training program implementation, and after 1 month.

Results: Findings demonstrated significant improvement in subjects’ competencies following Life & Limb Primary Trauma Care training program implementation. Knowledge scores increased from a mean of 11.24 pretest to 15.30. Skills assessment showed substantial gains, with primary survey skills rising from 25.32 to 34.78 and secondary survey skills from 42.28 to 61.72. Attitude scores also improved markedly, with confidence levels increasing from 22.72 pretest to 33.68.

Conclusion: The Life & Limb Primary Trauma Care training program proved effective in enhancing Emergency Response Personnel’s competencies from Prince Regent Hospital in Burundi. Recommendations include integrating Life & Limb Primary Trauma Care training program into academic curricula. Further research should include conducting longitudinal studies to assess long-term retention, training sustainability and the impact on patients’ care related outcomes.

Keywords: Competencies, Emergency Response Personnel, Life & Limb Primary Trauma Care, Low-Resource Settings

Timing of Urinary Catheter Removal After Elective C-Section at the University Teaching Hospital of Butare, Rwanda

Rugabira Silas¹, Rugambwa Jean Paul², Mutabazi Jean De la Croix¹, Gasakure Miguel³, Mpirimbanyi Christophe⁴, Jennifer Rickard⁵, Ahsan Khan⁶

1. Department of Obstetrics and Gynecology, University Teaching Hospital of Butare

2. Department of Surgery, University Teaching Hospital of Butare

3. Department of Surgery, University Teaching Hospital of Kigali

4. Department of Surgery, Kibagabaga Level II Teaching Hospital

5. Department of Surgery, University of Minnesota

6. Department of Surgery, Emory University

Correspondence: silasrugabira@gmail.com

Abstract ID: 425

Background: Indwelling urinary catheterization is routinely performed for cesarean delivery (c-section) to reduce bladder injury and monitor urine output. Prolonged catheter use is associated with delayed ambulation, discomfort, and catheter associated urinary tract infections (CAUTI). The rationale of our study is to have baseline information about how long the urethral catheterization lasts after c-section, and its impact on elective cesarean section patients, and to design policies regarding urethral catheterization in elective cesarean section patients.

Methods: We will conduct a prospective cross-sectional study enrolling term pregnant women undergoing elective cesarean section at the University Teaching Hospital of Butare (CHUB). Exclusion criteria include pre-existing urinary tract infection, significant medical comorbidities, prior cesarean delivery, or gynecologic complications. Using a structured questionnaire, we will record demographics, duration of catheterization, operative time, type of anesthesia, time to ambulation, first voiding time, postoperative urinary retention, and hospital length of stay. We will perform statistical analyses to evaluate the timing of foley catheter insertion with urinary retention, length of stay, and time to ambulation afterwards amongst other characteristics. This study is being conducted at the CHUB, in the Department of Gynecology and Obstetrics. The study population consists of pregnant women at term undergoing elective C-section without other significant comorbidities. Approximately 384 patients were enrolled in the study.

Results: We hypothesize that a substantial proportion of women will retain the catheter beyond 12 hours post-surgery and that longer catheterization will correlate with delayed ambulation, increased discomfort, and higher rates of postoperative urinary retention.

Conclusions: This study will provide the first local data on urinary catheter management after elective cesarean section at CHUB. Findings will guide evidence-based recommendations on optimal catheter removal timing to minimize CAUTI risk, enhance patient comfort, and promote earlier mobilization and discharge.

Keywords: obstetrics, catheter, cesarean, gynecology

From Injury to Intervention: Exploring Trauma and Prehospital Care in Ethiopia

Assefa Tesfaye Menerba, Tihitena Negussie Mammo

Stanford University, St Peter Specialized Hospital, Lifebox Foundation

Correspondence: assefa.tesfaye@lifebox.org

Abstract ID: 419

Background: Trauma causes 10% of global DALYs and over 4 million deaths yearly, disproportionately affecting LMICs with emergency capacity gaps. In Ethiopia, trauma is common, but centers and data are lacking. We evaluated trauma epidemiology for a larger economic study. This study aimed to describe the epidemiology, prehospital care, and discharge outcomes of trauma patients in five urban Ethiopian hospitals.

Methods: We conducted a prospective cohort study (Nov 2024–June 2025) in five tertiary hospitals (four in Addis Ababa, one in Hawassa) serving ~25 million people. Adults ≥18 years with an inpatient admission (>24-hour hospitalization) for traumatic injury were included. Prehospital care data was collected by asking patients directly or their caretakers when they were not able. Data was collected in REDCap and analyzed using STATA 19.

Results: A total of 576 trauma patients were analyzed prospectively; 75.5% were male with a mean age of 35.7 years (range: 18–90); the majority (94.2%) were under 65. Motor vehicle collisions were the leading mechanism of injury (37.7%), most commonly leading to injuries of the lower extremities (37.6%). While 65.1% reached any type of facility within one hour, only 12.8% arrived by ambulance and 12.9% received prehospital care—primarily from bystanders. Most required multiple transfers (60.9% visited two facilities; 21.7% three) before receiving definitive care and travelling an average of 28.6 km to the first facility. Emergency department stays averaged 36.7 hours before admission. In-hospital mortality was 1% (6 deaths).

Conclusion: Trauma in Ethiopia primarily affects young adults and was most often due to motor vehicle collisions. Critical gaps to receipt of life saving trauma care in the golden hour include limited ambulance use, lack of organized prehospital services, and multiple hospital transfers. Increasing ambulance availability, timely triage and referral coordination are essential to strengthening Ethiopia’s trauma system and reducing preventable morbidity and mortality.

Keywords: Trauma care, epidemiology, Ethiopia

Bridging The Language Gap in Surgical Education: A French Language Adaptation of The COSECSA Surgical Foundations Course

Andrea Parker¹, Robert K. Parker¹, Madison Parker², Yves Yankunze³

1. Brown University/Tenwek Hospital

2. Indiana University

3. COSECSA/PAACS

Correspondence: yankyves@gmail.com

Abstract ID: 252

Background: The Surgical Foundations Course, developed by the College of Surgeons of East, Central, and Southern Africa (COSECSA) and hosted on the open-access SURGhub platform, is a broad-based, 38-topic, 80-module curriculum for Membership of the College of Surgeons trainees, designed to reflect the surgical realities and resource context of the COSECSA region. While widely accessed in African countries where English is the primary language of surgical training, participation from countries where French is the primary language of medical education has been limited by linguistic barriers, which adversely impact comprehension, training quality, and patient communication.

Methods: To quantify this need, we modeled potential demand for a French-language version using SURGhub user data and engagement tracking, applying uptake rates equivalent to those observed in English-medium training countries in the region.

Results: Demographic data from 2,314 learners with known details (73% of total SURGhub users enrolled in the Surgical Foundations Course) and United Nations mid-year 2025 population estimates were used to calculate a learner-to-population ratio of 1.68 learners per million in English-medium countries. Applying this ratio to 395.6 million people living in African countries where French is the primary language of medical education yielded an estimated 665 potential learners after adjusting for incomplete demographic data. The translation and adaptation process, led in partnership with Francophone surgeons and surgical educators, is in its final stages. A structured, multi-step workflow incorporated artificial intelligence–assisted translation (ChatGPT, Amazon Web Services with Hero Translate, and the localization function within Articulate 360) followed by iterative, expert clinical review to ensure terminological accuracy, linguistic precision, and preservation of educational intent within the regional context. This initiative will deliver a linguistically inclusive, contextually grounded surgical curriculum that strengthens regionally defined training priorities, promotes equity in surgical education, and advances the goal of building surgical capacity through collaboration.

Keywords : COSECSA, French translation, SURGhub, Surgical education.

Moving Towards Equity: Leveraging Academic Partnerships in Surgical Education

Gatwiri Murithi¹, Naol Belema Gemechu¹, Derbew Fikadu Berhe¹, Betel Amdeslassie Fenta¹, Geoffrey A. Anderson², Robert Riviello², Abebe Bekele¹, Barnabas Alayande¹

1. University of Global Health Equity

2. Harvard University

Correspondence: gmurithi@ughe.org

Abstract ID: 401

Background: Low-and middle-income countries experience significant faculty deficits, which limit the delivery of quality surgical education and research. Academic partnerships have been established to address this by supporting faculty development, resource mobilization, and improvement of training infrastructure. We evaluate an African attempt at partnership-based surgical education at the University of Global Health Equity (UGHE).

Methods: A convergent mixed-methods study was conducted to collect data using a quantitative survey, qualitative Key Informant Interviews, In-depth interviews, and a desk review of all surgical education and partnership documents at UGHE. Data was obtained from faculty, partners, and students who undertook surgical education programs at the university. Analysis was performed using descriptive and inductive thematic analysis.

Results: UGHE had built a strong partnership network with diverse geographical backgrounds and expertise; 33% were from Rwanda (Fig. 1). More than half (58%; n=24) of UGHE’s partners had formal MOUs and were involved in curriculum development (42%), didactic training (33%), clinical and medical simulation training (13%), student assessment (29%), faculty development (4%), and research (13%). UGHE adopted the partnership-based model to fill in critical gaps in the surgical education workforce and financing. Eighty-one percent (n=26) of undergraduate students strongly agreed that the visiting faculty improved their overall learning experience. Qualitative results showed that respondents valued access to shared resources, diversity of experiences, and the opportunity to learn from surgical sub-specialty experts. Emergent themes included the impact of resource limitations at local partner teaching hospitals on the learners’ clinical experience.

Conclusion: The study found that the partnership model improved access to essential resources and opportunities for the stakeholders. This model of surgical education can achieve demonstrable academic improvements that benefit both learners and faculty. To ensure balanced collaboration, regular evaluation is essential to nurture sustainable partnerships and inform the co-creation of interventions required to further advance equity.

Keywords : Academic partnerships, Collaboration, Global Surgery Education

Strengthening Surgical Education in LMICS: Harnessing Ethiopia’s National Perioperative Quality Improvement Network as A Platform for Capacity Building

Megbar Dessalegn¹, Fitsum Kifle², NaPQIN Collaborators³

1. Debre Markos University

2. Network for Perioperative and Critical Care (N4PCC, Ethiopia)

3. Network for Perioperative Quality Improvement

Correspondence: megbardessalegn@yahoo.com

Abstract ID: 332

Background: Surgical education in LMICs is based mainly on evidence generated from studies in developed nations. Moreover, only few can trace perioperative status of patients limiting specific epidemiologic and clinical data and undermining the practicality of training and translation of evidence to policies. This article aimed to present the ongoing efforts put forth and lessons learned in generating local evidence by establishing perioperative registry to support academics and perioperative care improvement in Ethiopia.

Methods: National Perioperative Quality Improvement Network (NaPQIN) represents a locally designed, nationally aligned, collaborative data collection, research, and learning platform. NaPQIN captures data across the full surgical care continuum using standard metrics by supporting facilities to implement registries, contribute to a federated national system while maintaining local ownership and data security. Timely recognition of trends, patient outcomes, and system gaps are enabled through real-time data analysis and intuitive dashboards.

Results: The ongoing NaPQIN registry has so far tracked more than 50,000 surgical cases in its platform in five regional states across Ethiopia. NaPQIN has trained more than 250 healthcare professionals, initiated & assisted the implementation of over 15 Quality Improvement projects. Moreover, this has enabled real-time monitoring of surgical outcomes, nationwide surgical outcome study (Ethio-SOS), enabled patient rescue systems in Hospitals, and enabled implementation research.

Conclusion: The perioperative registry enables capturing patient-level outcomes data generating essential KPIs in Hospitals. The ongoing implementation outcome from NaPQIN underscores the role of peri-operative registry in supporting contextualized training, improving data literacy, continuous measurement of trainee competence, and surgical care.

Keywords : NaPQIN, Peri-operative, registry

Comparing Operative Exposure of Paediatric Surgery Trainees Across the COSECSA Region Using The E-Logbook

Takondwa Malamba

College of Surgeons of East, Central and Southern Africa (COSECSA)

Correspondence: takomalamba@gmail.com

Abstract ID: 412

Background: COSECSA offers a fellowship program in paediatric surgery, where the volume and range of surgical procedures performed by trainees are crucial assessment components. Eighteen accredited hospitals provide this fellowship, with variations in resources such as laparoscopic facilities and paediatric intensive care units. Despite these differences, previous analyses of logbook data show substantial experience in common paediatric surgical procedures among trainees. However, it remains unclear whether exposure to various procedures is equitable among trainees at different centers. This research seeks to determine if paediatric surgery trainees at different COSECSA training hospitals receive equitable exposure during their training.

Methods: It was a retrospective descriptive study that analyzed 11 accredited training hospitals that in the COSECSA regions and logbook entries that were complete and filled between 2015-2024 were included. The study calculated the total number of cases logged by trainees at each training center, identified patterns in the different types of cases logged by trainees at each center and quantified to what extent trainees from different training hospitals gain exposure to procedures as required by COSECSA’s curriculum.

Results: The preliminary findings showed that 26,732 procedures were logged by 47 paediatric surgery trainees across 11 hospitals across COSESCA. The highest number of procedures were recorded at Tikur Anbessa Hospital in Ethiopia representing 19.37%. While the lowest record was at Harare Children’s hospital in Zimbabwe contributing only 0.05%. On the other hand, Queen Elizabeth Central Hospital in Malawi offered the highest procedural exposure to trainees throughout their training, with an average of 937 cases per trainee.

Conclusion: These results show that there are differences in the total number of procedures performed by trainees at different training centers, hence affecting the exposure of trainees through the fellowship program. This brings the need to consider setting standardized exchange programs to allow trainees to get an equitable exposure to surgical experience.

Keywords: E-logbook, operative exposure, paediatric surgery fellowship

Virtual Reality for Surgical Training in Burundi

Mugisha Innocent¹, Alliance Niyukuri¹, Vijna Boodhoo²

1. Mercy Surgeons Research Department, Olivia University

2. University of Glasgow, UK, Mercy Surgeons Research Department

Correspondence: mugishinnocent@gmail.com

Abstract ID: 387

Background: Burundi faces a severe shortage of physicians (0.1 per 1,000 people). This scarcity is compounded by difficulties in training healthcare professionals, due to insufficient infrastructure, urban concentration of doctors, limited funding, and brain drain. Innovative approaches to medical education are crucial to addressing these challenges. We describe a relatively novel tool for surgical training in Burundi- the use of virtual reality (VR) in surgical training. This was the first initiative of its kind in the country.

Methods: A series of half-day VR-based surgical training workshops were conducted for medical learners and educators, including medical students, postgraduate doctors, senior physicians, and faculty. A total of 41 participants attended the workshops. Each session began with a presentation, followed by hands-on engagement with VR headsets displaying pre-recorded cadaveric dissections and surgical procedures. Audio explanations were delivered through the headsets either via pre-recorded commentary or live narration from the workshop facilitator. Post-session feedback was collected using questionnaires.

Results: Among the 41 attendees, 25 participants (response rate: 61%) completed the feedback questionnaire. This cohort comprised medical students (36%), resident doctors (40%), and senior physicians or consultants (24%). Only 12% had prior experience with VR. Participants reported VR technology as very easy (44%) or somewhat easy (52%) to use. The majority (96%) believed that VR could be a valuable addition to their standard medical training. Key perceived benefits included enhanced understanding of anatomy, procedural knowledge, and surgical skill acquisition. Identified barriers to implementation included infrastructure limitations, cost, internet connectivity, and digital literacy.

Conclusion: This study shows that the use of VR is feasible in our setting and is acceptable to learners. VR could be integrated into surgical education. To achieve sustainable implementation, future efforts should focus on developing long-term partnerships, evaluating the technology and assessing the impact of VR on surgical skill acquisition.

Keywords: Virtual Reality Burundi

Implementation of the ENTRUST Learning and Assessment Platform for Undergraduate Medical Education: Multidisciplinary Curriculum Integration at the University of Global Health Equity, Rwanda

Anteneh Gadisa Belachew¹, Malerie Pratt², Anam N. Ehsan², Barnabas Alayande², Tyler Wilson³, Martin Bronk², Zelalem Mengistu Gashaw⁴, Birhanu Abera Ayana⁴, Biniam Ewnte Zelelew¹, Solomon Nega⁵, Brooke Cotter⁶, Savannah Karmen-Tuohy⁶, Jason Tsai², Edward Melcer⁷, Daniel Logan⁸, Katherine Arnow⁸, Abebe Bekele¹, Dana T. Lin², Cara A. Liebert²

1. Department of Surgery, University of Global Health Equity, School of Medicine, Rwanda

2. Department of Surgery, Stanford University School of Medicine, USA

3. Los Robles Regional Medical Center, USA

4. Department of Obstetrics/Gynecology, University of Global Health Equity, School of Medicine, Rwanda

5. Department of Medicine, University of Global Health Equity, School of Medicine, Rwanda

6. Department of Medicine, Stanford University School of Medicine, USA

7. Department of Computational Media, School of Computer Science, Carleton University, Canada

8. Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), USA

Correspondence: malerie.s.pratt@gmail.com

Abstract ID: 363

Background: Robust and accessible evidence-based tools are critical for advancing competency-based medical education globally. ENTRUST is an online, case-based virtual patient simulation platform to teach and assess clinical decision-making. This study describes multidisciplinary longitudinal ENTRUST integration across surgery, internal medicine (IM), and obstetrics and gynecology clerkships at the University of Global Health Equity in Rwanda.

Methods: Following a successful pilot in 2023, ENTRUST was integrated into the Senior Surgery Clerkship for case-based learning, formative assessment (Mid-Clerkship Assessment), and summative assessment (End-of-Clerkship Assessment) in November 2023. A similar model was implemented in the Senior OBGYN Clerkship April 2024 for case-based learning and summative assessment (End-of-Clerkship Assessment). The platform has been piloted in Internal Medicine and Pediatric Clerkships with case development ongoing. ENTRUST cases were integrated in the Medical School Exit Examination July 2024 and 2025 (n=30 and n=36, respectively). Usability and validity evidence were evaluated by platform utilization, System Usability Scale (SUS), and correlation to OSCE performance.

Results: From 2023–2025, 66 medical students participated in the curriculum integration in one or more clerkships (Figure 1). Usability was high [Surgery: 77.9 (2.3); IM: 87.0 (14.6)]. Surgery Clerkship students completed median 14 learning case attempts (IQR:12–17) and 115 minutes (IQR:80–147) independent learning; in OBGYN, median 4 learning cases (IQR 1–8) and 30 minutes (IQR 0–81); and in IM, 1 case and 15 minutes (IQR 12–16). ENTRUST performance correlated positively with OSCE scores for Surgery End-of-Clerkship Assessment (r=0.45, p=0.01) and Exit Examination (r=0.37, p=0.04).

Conclusion: ENTRUST is being successfully integrated in a multidisciplinary longitudinal fashion across surgery, OBGYN, and internal medicine clerkships for learning and assessment. Usability and acceptance of the platform is high, supporting its promise as a scalable multidisciplinary platform for competency-based undergraduate medical education.

Keywords: undergraduate medical education, competency-based medical education, multidisciplinary, virtual patient simulation

Enhancing Usability of the ENTRUST Assessment Platform: Comparative Analysis of the 2023 and 2024 Membership Examinations of the College of Surgeons of East, Central, and Southern Africa

Anam N. Ehsan¹, Malerie Pratt¹, Ivan Seno Saruni², Hanna Getachew³, Michael Mwachiro³, Andrea Parker⁴, Edward Melcer⁵, Jason Tsai¹, Daniel Logan⁶, Katherine Arnow⁶, Payton Miller⁷, Lye-Yeng Wong⁸, Melissa Lee¹, Connie Y. Gan¹, Fatyma Camacho⁹, Kimutai R. Sylvester¹⁰, Abebe Bekele¹¹, Dana T. Lin¹, Cara A. Liebert¹

1. Stanford University School of Medicine, USA

2. Aga Khan University Hospital, Kenya

3. College of Surgeons of East, Central, and Southern Africa (COSECSA), Tanzania

4. Tenwek Hospital, Kenya; Brown University, USA

5. Carleton University, Canada

6. Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), USA

7. Indiana University School of Medicine, USA

8. Oregon Health and Science University, USA

9. University of California-Santa Cruz, Baskin School of Engineering, USA

10. College of Surgeons of East, Central, and Southern Africa (COSECSA), Tanzania; Tenwek Hospital, Kenya

11. College of Surgeons of East, Central, and Southern Africa (COSECSA), Tanzania; University of Global Health Equity, School of Medicine, Rwanda

Correspondence: anamne1@stanford.edu

Abstract ID: 362

Background: ENTRUST Learning and Assessment Platform is an online, case-based virtual patient simulation platform to evaluate surgical trainees’ decision-making competence. The platform was piloted by COSECSA in the Membership of the College of Surgeons (MCS) Examination in 2021 and has since been formally integrated. This study compared usability between the 2023 and 2024 MCS examinations and factors influencing user experience.

Methods: Each MCS Examination comprised eight Objective Structured Clinical Examination (OSCE) stations and eight ENTRUST cases. Between 2023 and 2024, platform upgrades included extended access to practice cases and MCS ENTRUST Practice Exam and ability to securely continue examination offline if internet connection is disrupted or unstable. Post-exam surveys measured usability using the System Usability Scale (SUS), technical reliability, and test perceptions on 5-point Likert scales. Univariate and bivariate analysis was performed.

Results: A total of 254 examinees (2023, n=132; 2024, n=122) from 17 sub-Saharan countries completed the post-examination survey. Median ENTRUST SUS scores increased significantly from 60.0 (IQR:50–70) in 2023 to 75.0 (IQR:65–85) in 2024 (p<0.001; Figure 1) with fewer examinees reporting technical issues in 2024 (p<0.001). In 2023, there were no significant differences in test perceptions between OSCE and ENTRUST format. In 2024, examinees reported significantly higher ease of login, internet stability, reduced internet disruption, objectivity, reduced bias, and fairness with ENTRUST compared to OSCE format (all p≤0.01; Table 1). Regarding exam format, examinees preferred ENTRUST alone (47%) or a combination of ENTRUST/OSCE (45%) over OSCE alone (7%).

Conclusion: ENTRUST demonstrated significant usability gains between 2023 and 2024 following iterative platform refinements. In 2024, examinees perceived higher objectivity, fairness, and reduced internet disruption with ENTRUST compared to traditional OSCE format. Examinees expressed a desire for continued implementation of the platform in the MCS Exam, underscoring the promise of regionally tailored, innovative digital platforms for surgical assessment.

Keywords: surgical education, simulation-based assessment, system usability scale, sub-Saharan Africa

Building Research Capacity in the Global South: Insights from a Scientific Writing Workshop

Pierrette Ngutete Mukundwa

University of Global Health Equity

Correspondence: pmukundwa@ughe.org

Abstract ID: 361

Background: Health researchers in the Global South face many barriers to scientific publication, including language limitations, lack of access to mentorship, and minimal training opportunities. Scientific writing workshops offer an affordable and effective method for building research capacity. We aimed to evaluate the design, implementation, and effectiveness of a scientific writing workshop implemented by the University of Global Health Equity (UGHE) in Rwanda and the Duke Global Health Institute (DGHI) for early-career researchers in Rwanda and surrounding regions.

Methods: We conducted a mixed-methods program evaluation of a contextualized scientific writing workshop co-designed by UGHE and DGHI from 2023 to 2025 using Glatthorn’s and Smith’s curriculum frameworks and Fair-Trade Learning principles and delivered three times pre-and post-workshop surveys assessed participant perceptions (Kirkpatrick Level 1). Quantitative data were analyzed using descriptive statistics and Wilcoxon signed-rank tests (p<0.05); qualitative responses underwent thematic analysis.

Results: A total of 203 participants attended (129 online, 94 in person). Pre-workshop data (n=178) showed that 57.3% had a good understanding of scientific writing, and 34.2% felt comfortable preparing a manuscript. Post-workshop surveys (n=195) data showed 87.6% reported having a strong understanding of adapting skills to resource-limited settings, and 88.2% had a good understanding of the manuscript components. Emerging themes included increased confidence, skill enhancement, motivation, and the need for more practice. Participants recommended extending workshop time, adding practical components, and providing mentorship.

Conclusions: This collaborative workshop enhanced the scientific writing skills and confidence among early-career health researchers in Rwanda and surrounding regions. Grounded in equity and contextual relevance, the workshop addresses barriers in scientific publishing and offers a scalable model for research capacity strengthening in resource-limited settings.

Keywords: Scientific writing, research capacity, Global South, manuscript preparation

Building Surgical Capacity in Burundi: Competency-Based Training, Partnerships, and Patient Impact

Chrystina Russell

Village Health Works Kigutu Hospital, Rural Burundi

Correspondence: chrystina.russell@gmail.com

Abstract ID: 357

Background: Burundi faces significant surgical workforce shortages, making sustainable training models essential.

Case Study: At Village Health Works (VHW), we have developed a competency-based model that integrates service delivery with surgical education, allowing general practitioners to progressively gain surgical skills in the operating theatre and then train others. This builds a sustainable cascade of knowledge transfer tailored to Burundi’s rural context. Currently, six GP’s are in surgical training through this model, supported by partnerships with international institutions including ReSurge International and independent surgeons. We have worked in collaboration with ReSurge for plastic and reconstructive surgery teaching campaigns that combine high patient volumes with hands-on training. In addition, VHW collaborates with independent surgeons in specialties such as orthopedics and plastic surgery to further expand training opportunities. VHW admitted 1,777 patients across wards in the beginning of 2025, creating opportunities to align patient care with structured learning. Successes include creating reliable pathways for surgical training, attracting international expertise, embedding philanthropy into program design to sustain teaching visits, and developing partnerships that extend teaching capacity. Challenges include ensuring consistent patient case mix and volume across specialties, retention, balancing service delivery with structured mentorship, limited infrastructure for simulation/digital learning, and the need for additional policy support to integrate competency-based training for non-specialist providers into the national framework.

Conclusion: This presentation will outline VHW’s experience in advancing surgical training in Burundi, highlighting the role of competency-based teaching, partnerships with institutions, independent surgeons, and philanthropy in strengthening local surgical capacity. We argue that this combined approach—training through service while embedding sustainability offers a rural replicable model for low-resource contexts aligned with COSECSA’s mission.

Keywords: Burundi, rural surgery, competency-based, partnerships

Evaluation Of Problem Based Learning as A Training Method and Its Role in Production of Future Doctors.

Haddasah Ngina, Nelima Faith

Moi university, School of Medicine, Eldoret, Kenya

Correspondence: haddasahngina@gmail.com

Abstract ID: 336

Background: Problem-Based Learning (PBL), introduced in 1969 by Dr. Howard Barrows at McMaster University, is a student-centered educational approach that emphasizes active learning through small group discussions and clinical case analysis. Unlike traditional lecture-based methods, PBL encourages students to identify learning objectives and independently seek solutions. This approach fosters self-directed learning, critical thinking, creativity, and teamwork, skills essential for future medical professionals. As PBL continues to replace conventional teaching methods in many medical schools, it is vital to evaluate its effectiveness. Understanding how students, educators, and practicing doctors perceive PBL helps identify its strengths and weaknesses, ensuring continuous improvement and relevance in clinical training. This study aims to assess the impact of transitioning from traditional lecture-based instruction to PBL, gather the perspectives of students, lecturers, and alumni, and explore how well PBL prepares doctors for real-world clinical practice.

Methods: Focus Group Discussions (FGDs) will be used as the primary method of qualitative data collection. FGDs will facilitate open, interactive conversations that allow participants to share in-depth insights and lived experiences; information that might not emerge through quantitative methods alone.

Expected findings: initial challenges in adapting to PBL, as well as insights into how it has positively and negatively influenced learning and teaching experiences. Participants are likely to highlight key strengths such as increased engagement and integration of knowledge, along with challenges like inconsistent facilitation or resource demands.

Conclusion: Regular evaluation of PBL is necessary to maintain its relevance and effectiveness in training competent, adaptable, and practice-ready doctors. This study will provide valuable feedback from all stakeholders involved, informing future improvements in medical education and helping align teaching methods with modern healthcare demands.

Keywords: Problem based learning

Propelling the Future of Surgical Care Through a Roadmap for African National, Sub-Regional, and Continental Action to Build Resilient Surgical Systems: A Modified Nominal Group Qualitative Consensus of African Ministries of Health

Barnabas Alayande, Naol Belema Gemechu

University of Global Health Equity

Correspondence: nbelema@ughe.org

Abstract ID: 330

Background: The Pan African Surgical Healthcare Forum (PASHeF) is a coalition of African Member States with a vision equitable access to safe and affordable surgical and anesthesia care. It was created to provide a platform for leaders of surgical healthcare across the continent to share best practices and innovative approaches to ensuring equitable surgical and anesthesia care. The 2023 forum used consensus methodology to identify 12 thematic areas and 50 statements for advancing surgical care. The second (2024) forum was aimed at creating and adopting a governance framework and a roadmap for implementing this African consensus to build resilient surgical systems.

Methods: African Ministries of Health (MoH) met from September 16-17, 2024, in Kigali, Rwanda. Using a modified nominal group qualitative consensus methodology, a practical roadmap for the implementation of improved surgical healthcare at national, sub-regional, and continental levels was iteratively designed and adapted with 100% consensus. Discussions were guided by a 7-person expert technical committee, and observations compiled using rapid qualitative analysis with purposeful data reduction activities, and a constant comparative method to itemize delegates’ recommendations, with member checking. A peer-monitoring governance structure was also decided through a combination of consensus-building and open voting by senior technocrats.

Results: Forty of 55 (73%) African Union Member States were represented by technocrats from the MOH and representatives. Building on shared best practices on national surgical healthcare policy and planning, workforce retention, and financing, a practical roadmap to implementation of the 50-point consensus and a PASHeF governance structure were generated with consensus on a 3-part roadmap, which included (1)National Governance, (2)Sub-regional Collaboration, and 3)Continental Prioritization by Community Awareness.

Conclusion: Clear national, regional, and continental action informed by governance is essential for propelling the future of surgical care in Africa. African nations have embraced surgical healthcare policy as an imperative on their journey towards Universal Health Coverage through PASHeF

Keywords: Global surgery, Pan African surgical Healthcare forum (PASHeF), Workforce retention, High level advocacy

Harnessing Artificial Intelligence in the Development of Virtual Patient Simulation Cases for Surgical Trainee Education in East, Central, and Southern Africa

Colleen Witty¹, Abebe Bekele², Michael Mwachiro³, Ivan Seno⁴, Robert Parker⁵, Andrea Parker⁵, Dana Lin⁶, Cara Liebert⁶, Kimutai R. Sylvester⁵

1. Department of Surgery, Washington University in St Louis

2. University of Global Health Equity (UGHE)

3. College of Surgeons of East, Central and Southern Africa

4. Department of Surgery, Aga Khan University

5. Department of Surgery, Tenwek Hospital

6. Department of Surgery, Stanford University

Correspondence: witty@wustl.edu

Abstract ID: 315

Background: Artificial Intelligence (AI) is being rapidly integrated into professional workstreams, including surgical education. AI-generated virtual patient case scenarios have been shown to improve trainee knowledge and clinical judgement. In June 2025, the College of Surgeons of East, Central, and Southern Africa (COSECSA) partnered with ENTRUST, an online virtual patient simulation platform, to develop practice cases in alignment with the Membership of the College of Surgeons (MCS) trainee curriculum. This study evaluates the feasibility, efficiency, and accuracy of using AI to develop virtual patient simulation cases.

Methods: Using iterative prompt engineering with Abacus AI, a platform that integrates collections of large language models, a case template was developed in the ENTRUST platform format. Each case consisted of a simulation phase (diagnostic work-up and initial stabilization and management) followed by multiple-choice questions (MCQs) assessing perioperative care and procedural knowledge. Faculty leaders selected clinical topics, and AI-generated cases underwent expert review by surgeons. A quality improvement framework captured generation time, review duration, and identified errors. Descriptive statistics and thematic analysis were performed in Excel.

Results: From June 2025 to August 2025, 116 cases generated by Abacus AI underwent faculty review. The average duration for AI generation and faculty review was 7.6 and 52 minutes per case, respectively. A total of 32 (31.7%) AI-generated cases had an error identified by reviewers, most commonly attributed to treatment inconsistent with clinical guidelines, omission of a physical exam component, or discordancy between history, physical exam and diagnostic work-up.

Conclusions: AI is a feasible and efficient tool for generating virtual patient simulation cases. The rapid production of cases can reduce faculty workload and support consistent trainee learning opportunities. However, errors in multiple domains highlight the necessity of expert faculty oversight. Continued scrutiny and refinement of AI-generated content is required to ensure safety, reliability, and educational validity.

Keywords: Artificial Intelligence, Surgical Education, Patient Simulation, Clinical Competence

Inside the OR: Exploring Surgical Teaching Experiences of Medical Students in Rwanda

Biniam Ewnte Zelelew¹, Anteneh Gadisa Belachew¹, Abebe Bekele¹, Kristin Long²

1. University of Global Health Equity

2. University of Wisconsin

Correspondence: longk@surgery.wisc.edu

Abstract ID: 288

Background: The operating room provides a dynamic and intense learning environment for medical students, and while a core component of surgical education, the experience is often challenging for trainees. We sought to better understand the experiences and perceived outcomes of medical students in the operating room in Rwanda, and to determine if this influences their career trajectory.

Methods: Final-year medical students in surgical rotations were surveyed to assess their knowledge, level of engagement, and perceived value of the experience. Surveys included standard Likert scale responses as well as opportunities for free-text commentary and were sent to students after completion of surgical rotations at 6 different rotations sites across Rwanda used by the University of Global Health Equity as training sites.

Results: 36 students responded to the survey. 24 were female. The majority felt that they received adequate orientation to OR protocols (27/36 agree/strongly agree, 75%) and that their roles in the procedure were explicitly defined (27/36 agree/strongly agree, 75%). Students noted a deficit of post-procedure debriefings (11/36 agree/strongly agree, 25%). Students felt safe in the operating room and engaged in patient care. Qualitative responses included requests for teaching beyond surgical anatomy, encouraging questions, and more teaching faculty on-site. 9 respondents indicated they envisioned a career in surgery, along with 2 in orthopedics, 2 in ophthalmology, and 1 in otolaryngology.

Conclusions: Students were engaged and interested in both the technical components of surgical care and the complex pre- and post-operative management of patients with surgical diseases. Experiences varied based on faculty and rotation sites, but this data suggests that ensuring medical students are involved in all aspects of surgical care is critical and could influence future career choices. Overall, while the current experience provides a solid foundation, targeted improvements in structured debriefing and faculty teaching engagement could significantly strengthen surgical education.

Keywords: surgical education, medical student, surgery clerkship

Non-Technical Skills for Surgeons in Low- and Middle-Income Countries, A Scoping Review

Samuel Lyness

University of Edinburgh

Correspondence: causewaysammy@gmail.com

Abstract ID: 281

Background: Perioperative morbidity and mortality rates are significantly higher in Low- and Middle-Income Countries (LMICs) than in High-Income Countries (HICs). Although technical expertise is paramount, non-technical skills (NTS) such as teamwork, communication, leadership, and situational awareness are increasingly recognized as essential for surgical patient safety. Synthesis of evidence regarding interventions designed to improve NTS within perioperative teams in LMICs has been limited. This scoping review aimed to describe interventions used to improve the NTS of surgical teams in LMICs and evaluate their effectiveness on NTS behaviours and patient outcomes.

Methods: A comprehensive search of nine databases, including MEDLINE, PubMed, and Global Index Medicus was performed. Two independent reviewers screened titles and abstracts, followed by full-text review of 83 articles. A total of 33 studies published after 2015 were included. Data from included studies were extracted and mapped to the Kirkpatrick Model for evaluating training programs.

Results: Most of the included studies originated from Sub-Saharan Africa. NTS interventions used a multifaceted approach, with adapted NTS training curricula, such as non-technical skills for surgeons for variable resource context (NOTSS-VRC), integrated technical and non-technical training programs, simulation, and multimodal interventions. Participants’ reactions to NTS interventions were positive (Kirkpatrick Level 1). NTS interventions led to knowledge acquisition (Level 2), improved team dynamics, communication, and leadership confidence (Level 3 outcomes). Only one study described that NTS led to a reduction in maternal sepsis rates and better adherence to checklists. (Level 4 outcomes).

Conclusion: There is a significant increase in NTS interventions in LMICs. However, there is a paucity of robust quantitative data directly linking NTS training to patient outcomes. Future research should use more rigorous study designs to investigate the long-term effectiveness of NTS interventions on patient outcomes.

Keywords: Non-Technical Skills, Low- and Middle-Income Countries, Training Interventions, Surgical Outcomes.

Bridging the Language Gap in Surgical Education: A French-Language Adaptation of the COSECSA Surgical Foundations Course

Andrea Parker¹, Robert K. Parker¹, Madison Parker², Yves Yankunze³

1. Brown University/Tenwek Hospital

2. Indiana University

3. COSECSA/PAACS

Correspondence: yankyves@gmail.com

Abstract ID: 252

Background: The Surgical Foundations Course, developed by the College of Surgeons of East, Central, and Southern Africa (COSECSA) and hosted on the open-access SURGhub platform, is a broad-based, 38-topic, 80-module curriculum for Membership of the College of Surgeons trainees, designed to reflect the surgical realities and resource context of the COSECSA region. While widely accessed in African countries where English is the primary language of surgical training, participation from countries where French is the primary language of medical education has been limited by linguistic barriers, which adversely impact comprehension, training quality, and patient communication. To quantify this need, we modeled potential demand for a French-language version using SURGhub user data and engagement tracking, applying uptake rates equivalent to those observed in English-medium training countries in the region.

Methods: Demographic data from 2,314 learners with known details (73% of total SURGhub users enrolled in the Surgical Foundations Course) and United Nations mid-year 2025 population estimates were used to calculate a learner-to-population ratio of 1.68 learners per million in English-medium countries. Applying this ratio to 395.6 million people living in African countries where French is the primary language of medical education yielded an estimated 665 potential learners after adjusting for incomplete demographic data.
The translation and adaptation process, led in partnership with Francophone surgeons and surgical educators, is in its final stages. A structured, multi-step workflow incorporated artificial intelligence–assisted translation (ChatGPT, Amazon Web Services with Hero Translate, and the localization function within Articulate 360) followed by iterative, expert clinical review to ensure terminological accuracy, linguistic precision, and preservation of educational intent within the regional context.

Expected outcomes: This initiative will deliver a linguistically inclusive, contextually grounded surgical curriculum that strengthens regionally defined training priorities, promotes equity in surgical education, and advances the goal of building surgical capacity through collaboration.

Keywords: Surgical education, COSECSA, French translation, SURGhub

Advancing Breast Cancer Diagnosis in Kisumu (Kenya): Bridging Histopathological Gaps Towards Global Breast Cancer Initiative (GBCI) Goals

Albert Odhiambo Ng’ong’a¹, Joy Ogingo¹, Caesar Bitta¹, Rhiana Menen²

1. Jaramogi Oginga Odinga Teaching & Referral Hospital, Kisumu

2. Tiba Foundation; St Luke’s Hospital

Correspondence: albert.odhiambo@gmail.com

Abstract ID: 251

Background: Breast cancer is the leading cause of cancer-related mortality among women worldwide, with disproportionate impacts in LMICs such as Kenya. In Kisumu, over 75% of cases present with advanced disease, where survival is poor. Barriers to timely diagnosis include high diagnostic costs, limited-service access, low awareness, and systemic delays. The WHO Global Breast Cancer Initiative targets diagnosis within 60 days; Kenya’s National Cancer Control Strategy (2023–2028) emphasizes equitable diagnostic access. We are implementing an accelerated histopathological breast diagnostic project to reduce delays and improve access to subsidized, timely histopathological diagnosis at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) through subsidized breast core biopsy, histopathology, and immunohistochemistry (IHC) testing, with active patient navigation.

Implementation: A collaboration between JOOTRH, Africa Cancer Foundation, and Tiba Foundation (Jan–Aug 2025) provided 61 patients with subsidized on-site biopsies, histology, and outsourced IHC, alongside active navigation. Diagnostic turn-around-times (TAT) and patient-level data were tracked; interim results are reported.

Results: Core biopsies were performed in 61 suspected cases of breast cancer; contact-to-biopsy TAT averaged 0.22 days (100% met <2-day target). Histopathology TAT averaged 19.10 days (18.33% met 10-day target). IHC TAT averaged 11.69 days (100% met 6-week target; 78.26% met 10-day target). Of the 61, 46 were malignant (75.41%): HR+ 63.21%, HER2-enriched 22.31%, triple-negative 14.48%. Mean age was 51.79 years; most were rural (84.2%), unemployed/informally employed (82.40%), faced a median 8-month pre-diagnostic delays, visited multiple hospitals pre-diagnosis (mean 3.79), and reported financial barriers (75%).

Conclusion: The project improved biopsy and IHC timeliness and generated vital baseline data for breast cancer management in Kisumu; the main challenge was slow histopathology TAT. Pre-hospital delays and socioeconomic barriers persist. This project improved diagnostic access in Kisumu but highlights the need to shorten histopathology TAT, strengthen referral pathways, and secure sustainable financing for diagnostic services and infrastructure.

Keywords: Breast Neoplasms/diagnosis, Time-to-Treatment, Patient Navigation, Health Services Accessibility

Breast Cancer in Western Kenya: Characteristics and Treatment Outcomes Among Patients on Follow-Up at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya 2016 – 2023

Albert Odhiambo Ng’ong’a¹, Rhiana Menen²

1. Jaramogi Oginga Odinga Teaching & Referral Hospital, Kisumu

2. Tiba Foundation; St Luke’s Hospital

Correspondence: albert.odhiambo@gmail.com

Abstract ID: 249

Background: Breast cancer in Western Kenya presents a significant public health burden due to late-stage diagnoses and limited data. This study aimed to describe sociodemographic, clinical characteristics, and treatment outcomes among breast cancer patients at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), informing care aligned with WHO and national cancer control strategies.

Methods: We conducted a retrospective cohort study of 188 female breast cancer patients managed at JOOTRH between 2016 and 2023. Sociodemographic factors, clinical attributes, tumor biology, and treatment outcomes were analyzed using descriptive and analytical methods. T-tests assessed continuous variables, while chi-square tests examined categorical variables. Kaplan–Meier survival analysis and Cox proportional hazards regression evaluated survival probabilities and independent predictors between premenopausal and postmenopausal women (<50 vs. ≥50 years). We report log-rank tests, adjusted hazard ratios (aHRs), 95% confidence intervals (CIs), and p-values. Statistical significance was set at p<0.05.

Results: Mean patient age was 60.64 years; most were rural (71.28%), had limited education (81.91%), were unemployed (71.28%), and uninsured (49.47%). Patients averaged 4.2 facility visits, with a mean symptom-to-diagnosis time of 10.76 months; 68.09% were diagnosed after six months. Advanced-stage disease (Stage III/IV) was common (71.81%), with invasive ductal carcinoma (69.15%) and Luminal A subtype (53.72%) most frequent. Mastectomy (59.04%) and chemotherapy (84.04%) were common treatments; radiotherapy use was low (14.36%). Overall mortality was 37.77%, significantly lower in women <50 years (25.57%) than ≥50 years (44.92%) (p=0.0125). Luminal A (aHR 0.07, p=0.002) and mastectomy (aHR 0.22, p=0.04) predicted reduced mortality. Median survival for ≥50 years was 26 months; unreached for <50 years.

Conclusion: Breast cancer at JOOTRH is marked by late presentation, delays, and socioeconomic barriers. Targeted community awareness, early detection, and improved treatment access are urgently needed to reduce mortality.

Keywords: Breast Cancer; Community awareness; Outcomes; Late Presentation

Assessing Burn First Aid Knowledge, and Information Sources among Burn Caregivers in Rwanda

Thierry Cyuzuzo¹, Tuyisenge Emmanuel¹, Jean Paul Abigorora¹, Didace Mushimiyimana², Jean de Dieu Hategekimana¹, Miguel Gasakure¹, Jennifer Rickard³, Debra Reilly⁴, Faustin Ntirenganya¹

1. University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda

2. Kigali University Teaching Hospital

3. Department of Surgery, University of Minnesota, Minneapolis, Minnesota

4. Department of Surgery, University of Nebraska Medical Center

Correspondence: cyuzutsi95@gmail.com

Abstract ID: 243

Background: Burn injuries are a major public health issue, especially in low- and middle-income countries (LMICs). This study assessed burn first-aid knowledge and information sources among caregivers at the University Teaching Hospital of Kigali, Rwanda (CHUK).

Methods: A cross-sectional study involving 75 caregivers (next of kin) was conducted between October 2023 and April 2024. Data were collected using a structured questionnaire covering demographics, first aid knowledge, and sources of information. Knowledge was assessed using ten multiple-choice questions (scored from 0 to 10), classified as poor (<5), intermediate (5-7) and good (>7). Data analysis was performed using JMP software.

Results: The median age of the caregivers was 33 years (IQR: 27-43), with the majority being female (80%; n=60) and married (60%; n=60). Among the caregivers, 67%(n=50) had intermediate knowledge, 25%(n=19) had poor knowledge, and 8%(n=6) had good knowledge, with a mean score of 5.36 (SD: 1.6). Friends and family members were the primary information sources (95%, n=71), whereas healthcare providers contributed minimally (8%, n=6). Misconceptions included the use of sugar and cooking oil for burns. Despite 93% (n = 70) lacking prior training, 96%(n=72) expressed willingness to learn, preferring books (69%, n=50), and classroom training (39%, n=28). Significant associations were found between demographics and improved knowledge: rural caregivers better understood escaping building fires (32 [58%], p=0.0292), and females had superior knowledge of handling burn blisters (52 [85%], p=0.0270).

Conclusion: Significant gaps in burn first-aid knowledge among caregivers at CHUK have been identified, highlighting the urgent need for educational interventions.

Keywords: Burn injuries, first aid knowledge, caregivers, educational interventions, University Teaching Hospital of Kigali.

Minimally Invasive Surgery Training in Sudan: Insights from a National Survey of Surgical Residents

Swsan A. M. Elsharif¹, Mustafa A. Elamin², Esra Ali¹, Elaf M. H. Abdelraheem¹, Ahmed Rafei³, Arwa Nasr¹, Noon Mohamed¹, Mugahid M. Khair¹

1. Faculty of Medicine, University of Khartoum

2. Faculty of Medicine, Al-Neelain University

3. Department of Research, National Centre for Gastrointestinal and Liver Diseases

Correspondence: swsanelsharif@gmail.com

Abstract ID: 239

Background: Minimally invasive surgery (MIS) is now considered the standard practice in many countries. Despite that, accessibility of laparoscopic surgery in low-income settings such as Sudan is limited, and the required targeted training is missing from the surgical training programs. Exposure to laparoscopy training in Sudan is not well established, thus this study aims to describe the access, barriers, and residents’ experiences with laparoscopy training in Sudan.

Methods: We performed a national survey study among urology, general surgery and paediatric surgery residents using a structured questionnaire. It included questions on sociodemographic characteristics, access to laparoscopy training, experience, and barriers to laparoscopy training.

Results: A total of 164 surgery residents participated in the study, 64% were males, and 63.4% were general surgery residents. The median self-reported knowledge score of laparoscopy was 2 (1-3), and the factors that influence it were: Male gender, higher training level, access to training, access to laparoscopic surgery instructions, increased practice time and frequency and participation in laparoscopic surgery (p value <0.05). Nearly two-thirds of the participants reported disruption of their training due to the ongoing war. Most frequent barriers to laparoscopy utilization were access to training equipment and materials (67.7%), and access to trainers (64.6%), whereas most frequent barriers to the sustainability of training programs were lack of institutional support (64%), availability of training equipment (56.7%), and availability of skill labs (56.7%).

Conclusion: The study highlights several gaps in MIS training in Sudan. Attention is needed to strengthen surgical training through curriculum development, improving infrastructure and governmental investment.

Keywords: Laparoscopy training; simulation-based training; medical education; surgical curriculum

Overcoming The Barriers Between Resource Constraints and Healthcare Quality, A Multi-Center Experience From 3 Tertiary Hospitals in East Africa

James Kariuki

The Karen Hospital

Correspondence: Karizjim@gmail.com

Abstract ID: 238

Background: Healthcare quality & resource constraints are often mutually exclusive, a significant challenge in the field of Global Surgery. Our aim was to examine the various efforts being made by 3 tertiary institutions in East Africa to address the challenge of resource constraints while promoting access to quality & accessible surgical health service.

Methods: We examined 3 innovations currently employed in 3 tertiary health facilities in East Africa with a focus on their feasibility, scalability and role in expanding access to quality, affordable surgical healthcare to the community.

1. WALANT use for surgery at the Karen Hospital, Kenya

2. Surgical infection prevention programs and safety checklists at St. Mary’s Rift Valley Mission Hospital, Kenya

3. Engagement of patients in the design, delivery, evaluation of health services and service delivery redesign with development of innovative solutions and optimization of networks of care at Kerugoya level 5 hospital, Kenya

Results: All 3 of the above innovations have resulted in a significant improvement in access to safe, affordable and accessible surgical healthcare in their respective facilities of implementation.

The above innovations demonstrate that unless Peri-operative care interventions are co-designed with local health-care staff, their sustainable adoption and successful implementation cannot be ensured and anticipated benefits may well not be seen even with the best of intentions.

Conclusion: Our study demonstrates that it is possible to improve the quality of surgical care with the help of affordable low-cost surgical innovations, especially when they are ‘locally developed’ by front-line health workers in search of simple, safe and ethical solutions for their unique challenges.

Keywords: Barriers, Resources, Quality

The Ethics of Equitable Authorship: Teaching Surgery in Humanitarian and Low-Resource Contexts.

Margaret J. Tarpley

University Of Botswana, Vanderbilt University

Correspondence: margaret.tarpley@vanderbilt.edu

Abstract ID: 214

Background: International and Global North institutions and NGOs seek research collaborations with faculty and hospitals of the College of Surgeons of East, Central and Southern Africa (COSECSA)/Pan-African Academy of Christian Surgeons (PAACS) training programs. Since the late 1990s, COSECSA and PAACS partner in training African surgeons. When researching authorship of resulting publications, a search of peer-reviewed literature was undertaken to find the number of articles with COSECSA/PAACS-related first- and senior-author status (2^nd author sometimes considered senior).

Methods: Because all articles are open access, PubMed Central was chosen as the convenient database to collect articles for reviewing author affiliation using the terms: “COSECSA and Technology;” “COSECSA and Artificial Intelligence;” “COSECSA,” PAACS and Technology;" PAACS and Artificial Intelligence;" and “PAACS.”

Results: Six search terms produced 197 articles. After removing literature searches, crowd-sourcing articles, duplicates, or articles unrelated to the topics, 152 articles were analyzed: only 67(44%) had first authors and 65(43%) senior authors from the Global South. In 36(24%) papers Global South collaborators only appeared as a middle author—neither first, second nor last/senior – and 25 (16%) had no Global South authors at all. Below is a table showing Global South author positions.

Conclusion: The ethics of equitable authorship requires future research collaborations establishing the primacy of Global South authorship for presentations as well as publications for the participants who make possible the research from conception to manuscript. Too few first and senior authors are Global South collaborators.

Keywords: authorship; authorship and Africa; COSECSA; surgery and Africa

The Place of a Self-Directed, Low-Cost Laparoscopic Simulation-Based Training Model in Surgery Residency

Ngam Blessing Ngoin¹, Grace Kim², Rooney M. Deborah³, Mark Jonathan Snell¹, Keir Thelander⁴

1. PAACS -Mbingo Baptist Hospital

2. University of Michigan, Department of Surgery, Ann Arbor, MI

3. Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA

4. Pan-African Academy of Christian Surgeons

Correspondence: ngamngoin@yahoo.com

Abstract ID: 196

Background: Learning laparoscopic surgery in low- and middle-income countries (LMICs) is hindered by the dearth of technically skilled surgeons and affordable simulation centers. Alternative self-directed, low-cost simulation-based training programs could bridge this learning gap. To evaluate the effectiveness of this program, we assessed the differences in knowledge and laparoscopic skills between simulation-trained and simulation-naive residents.

Methods: This prospective cohort study involved Cameroonian surgery residents from a program with 3 years of mandatory laparoscopic simulation training exposure on the ALL-SAFE platform (group A; intervention) and residents from another training program in the country without simulation exposure (group B; control). All participants completed cognitive and psychomotor portions of a case-based laparoscopic cholecystectomy module on the ALL-SAFE platform from June 1^st to October 31^st, 2024. Using Kruskal-Wallis tests, we compared the pre- and post-training knowledge test scores, self-reported confidence and competence with laparoscopic skill acquisition, and psychomotor skill assessments via procedural checklist and global assessments of submitted videos.

Results: Twenty-six participants, including 14 in group A and 12 in group B, completed the module. There was no difference across groups in the pre-course confidence (P≥0.63) or competence ratings (P≥0.21). Both groups had identical pre-test scores, but group A’s post-test scores were markedly improved (P=0.005) over group B’s (P=0.28). The mean task completion time was 28.46(12.00) minutes for group A and 51.83(16.36) for B, P<0.001, d=14.16. Group B participants scored similarly or lower than group A on the checklist items (P=0.22), but significantly lower on all global items (P<0.001). Group B participants rated their own performances higher than peer raters from other institutions, while group A rated theirs the same, or lower, P=0.02, r=.35

Conclusion: Participants who had long-term exposure to simulation-based training had higher cognitive and psychomotor skill scores than those without exposure. Self-directed, low-cost simulation-based training may help surgical learners develop proficiency in laparoscopy.

Keywords: laparoscopy skill assessment, surgical training, low-cost simulation

Informed Consent in Surgical Practice - Bridging Ethical Principles and Implementation Challenges in the Democratic Republic of Congo: A Qualitative Exploration

Lele Mutombo Fabrice

NSK Hospital Ltd

Correspondence: fabricelele@gmail.com

Abstract ID: 192

Background: Informed consent is fundamental to ethical surgical practice but faces systemic challenges in resource-limited settings like the Democratic Republic of Congo (DRC). This study assessed the implementation and respect of surgical consent processes in the DRC, focusing on patient experiences.

Methods: A national qualitative study was conducted via an online questionnaire (Google Forms) distributed through social media and healthcare networks. Participants included 263 Congolese adults who underwent surgery or provided consent for a child’s procedure. Data collection captured experiences with consent disclosure, comprehension, decision-making autonomy, and perceived pressures. Thematic analysis identified barriers and improvement suggestions.

Results: Critical deficiencies were identified: Only 50.2% received risk/complication disclosures; 45.3% were offered surgical alternatives. 34.6% reported pressure to consent; 32.7% felt unable to refuse surgery. 38.0% never signed consent forms; 19.8% of signatories could not comprehend the form’s language. Decision-making was clinician-led (28.9%) or family-led (29.3%) in 58.2% of cases. Thematic analysis revealed demands for Plain-language explanations (77.4% of suggestions), enhanced risk/alternative disclosure (32.2%), reduced pressure and adequate deliberation time (17.4%)

Conclusions: Surgical consent in the DRC frequently fails to meet ethical standards, characterized by inadequate disclosure, linguistic barriers, and power imbalances. Context-sensitive reforms are urgently needed, including Adopting “sufficient consent” standards prioritizing material risks. Developing pictographic/multilingual consent tools. Implementing clinician communication training and patient feedback systems. These measures must balance communitarian decision-making norms with individual autonomy to transform consent from perfunctory documentation to meaningful dialogue.

Keywords: Informed Consent, Surgical Ethics, Resource-Limited Settings, Patient Autonomy