Prevalence and Risk Factors for Incarceration in Children Managed for Umbilical Hernias at Kenyatta National Hospital

Abstract

Background of the study: Umbilical hernia is common among children. The natural history is spontaneous involution of the defect by 5 years of age but can progress into adulthood. Most published literature recommends that asymptomatic umbilical hernias can be safely observed until 5 years of age while awaiting spontaneous closure. These recommendations are based on epidemiological studies mainly carried out in developed countries and on Caucasian population that report low incarceration rates hence no significant morbidity and mortality In Africa and black population in general higher incidence of incarcerations are reported with potentially serious complications. Therefore, the expectant management approach based on close observation and follow up until involution recommended by most western authors may not be feasible in Africa and some authors are advocating for operative intervention of umbilical hernia at the time of diagnosis due to high complication rates Despite the high incarceration rates in African population, umbilical hernias are poorly studied with paucity of local data. Therefore, more studies are needed to clearly understand the prevalence and risk factors for incarceration in black population. Objective: To determine the prevalence and risk factors for incarceration in children managed for umbilical hernias at Kenyatta National Hospital Materials and methods: This was a retrospective cross-sectional analytical study carried out at Kenyatta National Hospital health information department. A census of all children 13 years and below managed for umbilical hernias between January 2014 to December 2020 were carried out and their records retrieved. Data collection was by data extraction tool and was analyzed using SPSS 24.0. Data included the age at presentation, sex, weight, height, defect size, nutritional status, presence of comorbidities, and was presented as frequencies, proportions and percentages in tables and graphs. Pearson chi-square tests and logistic regression analysis was used to determine the factors responsible for incarceration in paediatric umbilical hernias at KNH. Odds ratio as well as 95% confidence interval were reported where applicable. Statistical significance for all tests was considered where the p < 0.05. Results: A total of 268 children managed for umbilical hernias were enrolled in the study. 147 (54.9%) were male and 121 (45.1%) were female. The mean age was 2.87 ranging from 1 month to 13 years. 131 (48.9%) were incarcerated while 137 (51.1%) were non-incarcerated. Among the..........................................................................