Pediatric surgical care for gastroschisis in Tanzania: Progress, persistent challenges and the need for sustainable systems strengthening

Gastroschisis remains one of the most challenging neonatal surgical conditions in sub-Saharan Africa, where mortality rates continue to remain high despite advances in health care. In high-income countries, survival rates are greater than 90% while mortality in many African regions reaches nearly 100%, largely due to delayed diagnosis, inadequate resuscitation, sepsis, limited neonatal intensive care capacity, shortages of trained personnel, and lack of access to parenteral nutrition and preformed silo bags. Tanzania has made progress through the implementation of a national gastroschisis care bundle, establishment of a national database, and distribution of standardized management protocols, resulting in improved survival in some centres. However, significant barriers remain, including delayed referral, resource constraints, and dependence on foreign aid. From literature review from the region and our local experiences, this perspective demonstrates some of the challenges of gastroschisis management in Tanzania and highlights practical strategies, local innovations, and regional collaborations in improving neonatal surgical outcomes across East Africa and other LMICs.