Health-related quality of life of children with gastroesophageal reflux disease after nissen fundoplication and gastrostomy tube insertion
Date of Award
Master of Medicine (MMed)
Dr Stanely Machoki Mugambi
Prof. Pauline Samia
Dr Waceke Ng’ang’a Kombe
Paediatrics and Child Health (East Africa)
Background: Gastroesophageal reflux disease (GERD) negatively impacts the health-related quality of life (HRQoL). Nissen fundoplication is done when medical treatment fails. Goal of therapy is to eliminate symptoms and improve quality of life.
Justification: HRQoL is a key indicator that we can use to evaluate the impact of our interventions so that we can make evidence-based decisions and advice our patients appropriately based on the outcomes of these interventions.
Objectives: The primary objective was to assess the HRQoL of children with GERD after Nissen fundoplication alone or Nissen fundoplication and gastrostomy tube insertion.
Methods: Design- Observational retrospective cohort study. Setting- Aga Khan University Hospital, Nairobi (AKUHN) and Gertrude’s Children’s Hospital (GCH). Study population- Children under 18 years with GERD who had Nissen fundoplication or Nissen fundoplication plus gastrostomy tube insertion at AKHUN and GCH between 1st January 2010 and 31st December 2020. Sample size and sampling method- The study used the census method to recruit all children with GERD who had undergone Nissen fundoplication or Nissen fundoplication and gastrostomy from 1st January 2010 to 31st December 2020. Study procedures- Data was collected from the medical records and also through an interviewer-administered Paediatrics Quality of Life Inventory questionnaire through a phone call interview. Data analysis: Global quality of life score was generated as the mean of all the different domains of the HRQoL. Independent samples t-test was done to compare means of HRQoL for gender, complications, and comorbidities while Spearman’s correlation was done for HRQoL and age.
Results: Eighty-two children had undergone Nissen fundoplication between 1st January 2010 and 31st December 2020. Eighty-four percent had comorbidities with 74.4% having neurological impairment. The rate of complications was at 33%. 91.5% had open Nissen fundoplication while 8.5% had laparoscopic Nissen fundoplication. Fifty-six children had a concurrent gastrostomy tube insertion. The global mean HRQoL score was 75.8 (SD: 23.5, 95% CI: 70.4 - 81.2). Nissen fundoplication failure rate was 9.8% while the mortality rate was 8.5%.
Conclusion: The global score of the health-related quality of life was acceptable as a majority of the children had an excellent quality of life.
Musibi, F. W. (2021). Health-related quality of life of children with gastroesophageal reflux disease after nissen fundoplication and gastrostomy tube insertion (Unpublished master's dissertation). Aga Khan University, East Africa.