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Rhodes IJ, Alston CC, Zhang A, Arbuiso S, Medina SJ, Liao M, Ng JJ, Romeo D, Dahir S, Rhodes WR, Otterburn DM. The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps. J Craniofac Surg 2024; 35:1407-1410. [PMID: 38838366 DOI: 10.1097/scs.0000000000010340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world's fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation. METHODS The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed. RESULTS A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P <0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P =0.004). CONCLUSIONS In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dominic Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shugri Dahir
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - William R Rhodes
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
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Smith ER, Espinoza P, Metcalf M, Ogbuoji O, Cotache-Condor C, Rice HE, Shrime MG. Modeling the global impact of reducing out-of-pocket costs for children's surgical care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002872. [PMID: 38277421 PMCID: PMC10817198 DOI: 10.1371/journal.pgph.0002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.
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Affiliation(s)
- Emily R. Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Madeline Metcalf
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Population Health, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Cesia Cotache-Condor
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Henry E. Rice
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark G. Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Mercy Ships, Tyler, Texas, United States of America
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Bustorff-Silva J, Miranda ML, Rosendo A, Gerk A, Oliveira-Filho AG. Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000522. [PMID: 37215247 PMCID: PMC10193071 DOI: 10.1136/wjps-2022-000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in Brazil. Methods We collected data on the pediatric surgical workforce, surgical volume, Gross Domestic Product per capita, and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019. Results Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil, corresponding to 1414 pediatric surgeons (some pediatric surgeons are registered in more than one state), or 2.4 pediatric surgeons per 100 000 children 14 years of age and younger. There were 828 men and 586 women. The mean age was 51.5±12.8 years, and the mean time from graduation was 3.4±5.7 years. There is a higher concentration of pediatric surgeons in the wealthier Central-West, South, and Southeast regions. Individual surgical volume ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Of these, only nine (6.1%) were high-complexity (including neonatal) operations. MGITM tended to be higher in the poorer North and Northeast regions than in other regions of Brazil. Conclusions Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic status. Regions with an increased surgical workforce were associated with lower MGITM. The average number of complex operations performed annually by each pediatric surgeon was considerably low. Strategic investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil. Level of evidence Retrospective review; level IV.
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Affiliation(s)
| | - Marcio Lopes Miranda
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Amanda Rosendo
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
| | - Ayla Gerk
- Pediatric Surgery, State University of Campinas Medical School, Campinas, Brazil
- Medicine, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
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Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open 2023; 13:e069572. [PMID: 37130683 PMCID: PMC10163539 DOI: 10.1136/bmjopen-2022-069572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES An estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment. DESIGN AND SETTING This cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland. PARTICIPANTS AND OUTCOME MEASURES A surgical record review of all procedures on children up to 15 years old was conducted at 15 surgically capable hospitals. We modelled two rates of OOP cost reduction (reduction of OOP proportion from 70% to 50% and from 70% to 30% reduction in OOP costs) across five wealth quintiles (poorest, poor, neutral, rich, richest) and two geographical areas (urban and rural). The outcome measures of the study are catastrophic expenditures and risk of impoverishment due to surgery. We followed the Consolidated Health Economic Evaluation Reporting Standards. RESULTS We found that the risk of catastrophic and impoverishing expenditures related to OOP expenditures for paediatric surgery is high across Somaliland, but most notable in the rural areas and among the poorest quintiles. Reducing OOP expenses for surgical care to 30% would protect families in the richest wealth quintiles while minimally affecting the risk of catastrophic expenditure and impoverishment for those in the lowest wealth quintiles, particularly those in rural areas. CONCLUSION Our models suggest that the poorest communities in Somaliland lack protection against the risk of catastrophic health expenditure and impoverishment, even if OOP payments are reduced to 30% of surgical costs. A comprehensive financial protection in addition to reduction of OOP costs is required to prevent risk of impoverishment in these communities.
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Affiliation(s)
- Emily R Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Pranav Kapoor
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Treasure Ramirez
- Department of Economics, Hanmaker School of Business, Baylor University, Waco, Texas, USA
| | - Mubarak Mohamed
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Shukri Dahir
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edna Adan Ismail
- Founder and Director, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark G Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Mercy Ships, Tyler, Texas, USA
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Ademuyiwa AO, Nwomeh BC, Poenaru D, Seyi-Olajide JO, Ademuyiwa IY, Odugbemi TO, Abazie O, Ladipo-Ajayi OA, Bankole O, Elebute OA, Okusanya B, Alakaloko FM, Alabi EO, Makanjuola A, Gupta S, Tran T, Onwuka A A, Smith ER, Pius R, Harrison E, Bode CO. Picture Cards Versus Physical Examination: A Proof-of-Concept Study to Improve the SOSAS Survey Tool. J Surg Res 2023; 284:186-192. [PMID: 36580879 DOI: 10.1016/j.jss.2022.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed. METHODS We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool. RESULTS Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%. CONCLUSIONS The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.
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Affiliation(s)
- Adesoji O Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tinuola O Odugbemi
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ogechi Abazie
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwaseun A Ladipo-Ajayi
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olumide A Elebute
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Babasola Okusanya
- Dept of Obstetrics and Gynaecology, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Lagos, Nigeria
| | - Felix M Alakaloko
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Eyitayo O Alabi
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayomide Makanjuola
- Department of Orthopaedics and Trauma, Lagos University Teaching Hospital, Lagos, Nigeria; General Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Shailvi Gupta
- Adams Cowley Shock Trauma Centre and University of Maryland Medical System, Baltimore, Maryland
| | - Tu Tran
- University of Minnesota, Minnesota
| | | | - Emily R Smith
- Department of Surgery, Duke University, Duke Global Health Institute, Durham, North Carolina
| | - Riinu Pius
- Department of Surgery, University of Edinburgh, UK
| | | | - Christopher O Bode
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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Dahir S, Cotache-Condor C, Grimm A, Mohamed M, Rice H, Smith E, Ismail EA. Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000472. [PMID: 38328393 PMCID: PMC10848631 DOI: 10.1136/wjps-2022-000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023] Open
Abstract
Background Childhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide, particularly in low and middle-income countries. However, there are limited data on the disease prevalence and delays in care for pediatric neurosurgical conditions in very low-resource settings. This study aims to characterize the delays in access to care for pediatric neurosurgical conditions in Somaliland. Methods We performed a retrospective review of all children with congenital hydrocephalus and spina bifida admitted to the Edna University Hospital (EAUH) in Somaliland between 2011 and 2018. Patient demographics were analyzed with descriptive statistics and χ2 test statistics. We defined delays in care for each condition based on standard care in high-income settings. Univariate and multivariate logistic regression were performed to evaluate predictors of delay in care. Statistical significance was set at p<0.05. Results A total of 344 children were admitted to EAUH with neurosurgical conditions from 2011 to 2018. The most common condition was congenital hydrocephalus (62%). Delays in care were found for 90% of patients and were associated with the type of diagnosis and region. The longest delay among children with spina bifida was 60 months, while the longest delay for children with congenital hydrocephalus was 36 months. Children with congenital hydrocephalus or spina bifida traveling from foreign countries had the highest waiting time to receive care, with a median delay of 8 months (IQR: 5-11 months) and 4 months (IQR: 3-7 months), respectively. Conclusion We found significant delays in care for children with neurosurgical conditions in Somaliland. This country has an urgent need to scale up its surgical infrastructure, workforce, and referral pathways to address the needs of children with hydrocephalus and spina bifida.
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Affiliation(s)
- Shukri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Andie Grimm
- Department of Public Health, Baylor University, Waco, TX, USA
| | | | - Henry Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, USA
| | - Emily Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Surgery, Duke School of Medicine, Durham, North Carolina, USA
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Enumah ZO, Rafiq MY, Rhee D, Manyama F, Ngude H, Stevens K, Juma O, Sakran JV. Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling. BMC Pediatr 2022; 22:518. [PMID: 36050745 PMCID: PMC9434863 DOI: 10.1186/s12887-022-03576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions among a pediatric population, however these studies often fail to include forced migrant or refugees. The goal of this study was to estimate the prevalence of pediatric surgical conditions among refugees in east Africa. METHODS We used the previously validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) that utilizes cross-sectional design with random cluster sampling to assess prevalence of surgical disease among participants aged 0 to 18 years in Nyarugusu refugee camp, Tanzania. We used descriptive and multivariable analyses including an average marginal effects model. RESULTS A total of 1,658 participants were included in the study. The mean age of our sample was 8.3 ± 5.8 years. A total of 841 participants (50.7%) were male and 817 participants (49.3%) were female. A total of 513 (n = 30.9%) reported a history or presence of a problem that may be surgical in nature, and 280 (54.6%) of them reported the problem was ongoing or untreated. Overall, 16.9% had an ongoing problem that may be amenable to surgery. We found that increasing age and recent illness were associated with having a surgical problem on both our multivariable analyses. CONCLUSION To our knowledge, this is the first and largest study of prevalence of surgical conditions among refugee children in sub-Saharan Africa. We found that over 16% (one-in-six) of refugee children have a problem that may be amenable to surgery. Our results provide a benchmark upon which other studies in conflict or post-conflict zones with refugee or forced migrant populations may be compared.
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Affiliation(s)
- Zachary Obinna Enumah
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. .,Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Mohamed Yunus Rafiq
- Department of Anthropology, New York University Shanghai, Shanghai, China.,Ifakara Health Institute, Bagamoyo, Tanzania
| | - Daniel Rhee
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | | | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Kent Stevens
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.,Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Omar Juma
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins Global Surgery Initiative (JHGSI), Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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Management Outcome and Factors Associated with Pediatric Surgical Patient Admitted to Arbaminch General Hospital, Southern Ethiopia, 2021: Retrospective Cross-Sectional Study. Surg Res Pract 2022; 2022:6865874. [PMID: 36060296 PMCID: PMC9436610 DOI: 10.1155/2022/6865874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Pediatric surgical situations are often disregarded around the world, particularly in developing countries. The number of children hospitalized for surgical reasons has climbed dramatically. There is extensive research on the management outcome of pediatric surgical admissions in industrialized countries, but developing countries have paid little attention to it. Furthermore, to the best of the authors' knowledge, there has been no research in the study area on the management outcome of pediatric surgical patient admission. Objective To assess management outcome and factors associated with pediatric surgical patients admitted to Arbaminch General Hospital, Southern Ethiopia, 2021. Method An institution-based retrospective cross-sectional study design was employed among 265 children with surgical problems. Data were collected from patients' medical records using pretested data collection checklist. Epi Data 4.2 was used to enter data, and data were exported to SPSS version 25 for analysis. Those variables with P-value ≤0.25 in bivariable analysis were entered into multivariable logistic regression analysis, and statistical significance was declared at P < 0.05. Result A total of 265 surgically admitted children were included in this study. About 26% of study subjects were discharged with unfavorable management outcome. Children admitted due to trauma cause (AOR: 5.753, 95% CI: 2.366–13.987), children with a preexisting medical condition (AOR: 3.240, 95% CI: 1.436–7.310), children with an early complication (AOR: 2.515, 95% CI: 1.130–5.599), presenting to hospital ≥24 hr after the onset (AOR:8.351, 95% CI: 2.089–33.381), hospital stay >7 days (AOR: 10.671, 95% CI: 1.363–83.546), and children treated with surgery (AOR: 2.742, 95% CI: 1.137–6.611) were associated with unfavorable management outcome. Conclusion and recommendations: Twenty-six percent of patients were discharged with unfavorable outcome. Reasons for admission, preexisting medical condition, early complications, duration of hospital presentation, length of hospitalization, and type of management were all linked to the outcome of pediatric surgical admission. To have a good outcome, early identification and treatment of the cause are required, as well as well-equipped surgical care centers.
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Vigliotti VS, Concepcion T, Mohamed M, Dahir S, Ismail EA, Poenaru D, Rice HE, Smith ER. Modeling the Scale-up of Surgical Services for Children with Surgically Treatable Congenital Conditions in Somaliland. World J Surg 2022; 46:2489-2497. [PMID: 35838776 DOI: 10.1007/s00268-022-06651-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Congenital conditions comprise a significant portion of the global burden of surgical conditions in children. In Somaliland, over 250,000 children do not receive required surgical care annually, although the estimated costs and benefits of scale-up of children's surgical services to address this disease burden is not known. METHODS We developed a Markov model using a decision tree template to project the costs and benefits of scale-up of surgical care for children across Somaliland. We used a proxy set of congenital anomalies across Somaliland to estimate scale-up costs using three different scale-up rates. The cost-effectiveness ratio and net societal monetary benefit were estimated using these models, supported by disability weights in existing literature. RESULTS Overall, we found that scale-up of surgical services at an aggressive rate (22.5%) over a 10-year time horizon is cost effective. Although the scale-up of surgical care for most conditions in the proxy set was cost effective, scale-up of hydrocephalus and spina bifida are not as cost effective as other conditions. CONCLUSIONS Our analysis concludes that it is cost effective to scale-up surgical services for congenital anomalies for children in Somaliland.
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Affiliation(s)
| | | | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | | | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Duke Department of Surgery, Duke University School of Medicine, Durham, USA.
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Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study. World J Surg 2022; 46:2262-2269. [PMID: 35752679 DOI: 10.1007/s00268-022-06626-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. METHODS We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common non-surgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. RESULTS We found that increased SAO density is associated with decreased U5MR and NMR (P < 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of < 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of < 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. CONCLUSIONS Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.
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Varela C, Viste A, Young S, Groen RS, Banza L, Nandi B, Mkandawire N, Moen BE. Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey. Malawi Med J 2021; 33:73-81. [PMID: 34777702 PMCID: PMC8560351 DOI: 10.4314/mmj.v33i2.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need. Aim To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries. Methods A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. Results There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. Conclusion An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.
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Affiliation(s)
- Carlos Varela
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Sven Young
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou S Groen
- Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bip Nandi
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, Blantyre, Malawi/Kamuzu University of Health Sciences
| | - Bente Elisabeth Moen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Budde-Schwartzman B, Shwarzman O, Lakhoo K, Owusu F. Bringing specialist paediatric surgical care to the doorstep in rural Ghana: A mobile paediatric surgery clinic. Afr J Paediatr Surg 2021; 18:195-200. [PMID: 34341302 PMCID: PMC8423172 DOI: 10.4103/ajps.ajps_121_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The contribution of paediatric surgical conditions to the total burden of disease in low- and middle-income countries (LMICs) has recently been highlighted and it is widely agreed that solutions are needed to provide access to safe and affordable surgery for these children. MATERIALS AND METHODS We present a simple, cost-effective model that brings paediatric surgery to the doorstep of remote areas and uses the existing health system structure in its entity to fulfil patients' needs. Mobile clinic teams whose members are integrated staff in affiliated mission hospitals reach out daily on a rotational basis to 10 health posts. The team receives continuous paediatric surgery education from a paediatric surgeon to diagnose and treat simple cases. RESULTS The catchment area of the Gye Nyame Mobile Clinic includes 832,984 inhabitants. From 2008 to 2019, 4362 children visited the mobile clinic with a median age of 4.41 years. Totally 4142 (95.0%) children could be treated in the health post, 150 (3.4%) children were taken to the affiliated missionary hospitals, 55 (1.3%) needed a third-level facility and 15 (0.3%) were taken to the traditional healers by the family. The common paediatric surgical diagnosis on outreach was deep soft-tissue infection/skin lesion for surgical treatment (672/23.8% children), followed by abdominal wall hernia/abdominal wall malformation (586/20.8% children) and gastrointestinal conditions (521/18.5%). CONCLUSION This model of paediatric surgery mobile clinic includes capacity-building, task-sharing, outreach and proven 12-year sustainability. We recommend this model for paediatric surgery care in remote areas of LMIC's.
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Affiliation(s)
- Britta Budde-Schwartzman
- Department of Surgery, Gye Nyame Mobile Clinic Affiliated to St. Patrick's Missionary Hospital, Maase- Offinso, Ghana; Department of Pediatric Surgery, Kaplan Medical Center, Hebrew University, Rehovot, Jerusalem, Israel
| | - Ori Shwarzman
- Department of Surgery, Gye Nyame Mobile Clinic Affiliated to St. Patrick's Missionary Hospital, Maase- Offinso, Ghana; Department of African Studies, Ben Gurion University, Beer Sheva, Israel
| | - Kokila Lakhoo
- Department of Surgical Sciences, University of Oxford, Oxford, England, UK
| | - Frank Owusu
- Department of Surgery, Gye Nyame Mobile Clinic Affiliated to St. Patrick's Missionary Hospital; Department of Surgery, St. Patrick's Missionary Hospital, Maase- Offinso, Ghana
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Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study. BMJ Glob Health 2021; 6:bmjgh-2020-004406. [PMID: 34475022 PMCID: PMC8413881 DOI: 10.1136/bmjgh-2020-004406] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs). METHODS A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant. RESULTS 1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis. CONCLUSION Mortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.
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Cotache-Condor CF, Moody K, Concepcion T, Mohamed M, Dahir S, Adan Ismail E, Cook J, Will J, Rice HE, Smith ER. Geospatial analysis of pediatric surgical need and geographical access to care in Somaliland: a cross-sectional study. BMJ Open 2021; 11:e042969. [PMID: 34290060 PMCID: PMC8296779 DOI: 10.1136/bmjopen-2020-042969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The global burden of disease in children is large and disproportionally affects low-income and middle-income countries (LMICs). Geospatial analysis offers powerful tools to quantify and visualise disparities in surgical care in LMICs. Our study aims to analyse the geographical distribution of paediatric surgical conditions and to evaluate the geographical access to surgical care in Somaliland. METHODS Using the Surgeons OverSeas Assessment of Surgical Need survey and a combined survey from the WHO's (WHO) Surgical Assessment Tool-Hospital Walkthrough and the Global Initiative for Children's Surgery Global Assessment in Paediatric Surgery, we collected data on surgical burden and access from 1503 children and 15 hospitals across Somaliland. We used several geospatial tools, including hotspot analysis, service area analysis, Voronoi diagrams, and Inverse Distance Weighted interpolation to estimate the geographical distribution of paediatric surgical conditions and access to care across Somaliland. RESULTS Our analysis suggests less than 10% of children have timely access to care across Somaliland. Patients could travel up to 12 hours by public transportation and more than 2 days by foot to reach surgical care. There are wide geographical disparities in the prevalence of paediatric surgical conditions and access to surgical care across regions. Disparities are greater among children travelling by foot and living in rural areas, where the delay to receive surgery often exceeds 3 years. Overall, Sahil and Sool were the regions that combined the highest need and the poorest surgical care coverage. CONCLUSION Our study demonstrated wide disparities in the distribution of surgical disease and access to surgical care for children across Somaliland. Geospatial analysis offers powerful tools to identify critical areas and strategically allocate resources and interventions to efficiently scale-up surgical care for children in Somaliland.
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Affiliation(s)
| | - Katelyn Moody
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Tessa Concepcion
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Shukri Dahir
- Edna Adan University Hospital, Hargeisa, Somalia
| | | | - Jonathan Cook
- Center for Spatial Research, Baylor University, Waco, Texas, USA
| | - John Will
- Center for Spatial Research, Baylor University, Waco, Texas, USA
| | - Henry E Rice
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily R Smith
- Department of Public Health, Baylor University, Waco, Texas, USA
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
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15
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Landrum K, Cotache-Condor CF, Liu Y, Truche P, Robinson J, Thompson N, Granzin R, Ameh E, Bickler S, Samad L, Meara J, Rice HE, Smith ER. Global and regional overview of the inclusion of paediatric surgery in the national health plans of 124 countries: an ecological study. BMJ Open 2021; 11:e045981. [PMID: 34135040 PMCID: PMC8211076 DOI: 10.1136/bmjopen-2020-045981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study evaluates the priority given to surgical care for children within national health policies, strategies and plans (NHPSPs). PARTICIPANTS AND SETTING We reviewed the NHPSPs available in the WHO's Country Planning Cycle Database. Countries with NHPSPs in languages different from English, Spanish, French or Chinese were excluded. A total of 124 countries met the inclusion criteria. PRIMARY AND SECONDARY OUTCOME MEASURES We searched for child-specific and surgery-specific terms in the NHPSPs' missions, goals and strategies using three analytic approaches: (1) count of the total number of mentions, (2) count of the number of policies with no mentions and (3) count of the number of policies with five or more mentions. Outcomes were compared across WHO regional and World Bank income-level classifications. RESULTS We found that the most frequently mentioned terms were 'child*', 'infant*' and 'immuniz*'. The most frequently mentioned surgery term was 'surg*'. Overall, 45% of NHPSPs discussed surgery and 7% discussed children's surgery. The majority (93%) of countries did not mention selected essential and cost-effective children's procedures. When stratified by WHO region and World Bank income level, the West Pacific region led the inclusion of 'pediatric surgery' in national health plans, with 17% of its countries mentioning this term. Likewise, low-income countries led the inclusion of surg* and 'pediatric surgery', with 63% and 11% of countries mentioning these terms, respectively. In both stratifications, paediatric surgery only equated to less than 1% of the total terms. CONCLUSION The low prevalence of children's surgical search terms in NHPSPs indicates that the influence of surgical care for this population remains low in the majority of countries. Increased awareness of children's surgical needs in national health plans might constitute a critical step to scale up surgical system in these countries.
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Affiliation(s)
- Kelsey Landrum
- Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Yingling Liu
- Department of Sociology, Baylor University, Waco, Texas, USA
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Robinson
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Nealey Thompson
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Ryann Granzin
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Emmanuel Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Steve Bickler
- Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, California, USA
- Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Lubna Samad
- Department of Pediatric Surgery, Indus Hospital, Karachi, Pakistan
| | - John Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Henry E Rice
- Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily R Smith
- Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
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16
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Concepcion TL, Dahir S, Mohamed M, Hiltbrunn K, Ismail EA, Poenaru D, Rice HE, Smith ER. Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework. World J Surg 2021; 44:1712-1718. [PMID: 32030443 DOI: 10.1007/s00268-020-05414-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are complex barriers that increase delays to surgical care in low- and middle-income countries, particularly among the vulnerable population of children. Understanding these barriers to surgical care can result in targeted and strategic intervention efforts to improve care for children. The three-delay model is a widely used framework in global health for evaluating barriers associated with seeking (D1), reaching (D2), and receiving health care (D3). The goal of our study is to evaluate reasons for delays in the surgical care for children in Somaliland using the three-delay framework. METHODS Data were collected in a cross-sectional study in Somaliland from 1503 children through a household survey. Among children with a surgical need, we quantified the number of children seeking, reaching, and receiving care along the surgical care continuum, according to the three-delay framework. We evaluated predictors of the three delays through a multivariate logistic regression model, including the child's age, gender, village type, household income level, region, and household size. RESULTS Of the 196 children identified with a surgical condition, 50 (27.3%) children had a delay in seeking care (D1), 28 (20.6%) children had a delay in reaching care (D2), and 84 (71.2%) children had a delay in receiving care (D3), including 10 children who also experienced D1 and D2. The main reasons cited for D1 included seeking a traditional healthcare provider, while lack of money and availability of care were main reasons cited for D2. Significant predictors for delays included household size for D1 and D3 and condition type and region for D2. CONCLUSION Children in Somaliland experience several barriers to surgical care along the entire continuum of care, allowing for policy guidance tailored to specific local challenges and resources. Since delays in surgical care for children can substantially impact the effectiveness of surgical interventions, viewing delays in surgical care under the lens of the three-delay framework can inform strategic interventions along the pediatric surgical care continuum, thereby reducing delays and improving the quality of surgical care for children.
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Affiliation(s)
| | - Shukri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Kyle Hiltbrunn
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1621 S. 5th Street, Waco, TX, 76706, USA
| | | | | | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, 1621 S. 5th Street, Waco, TX, 76706, USA.
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Abdul-Mumin A, Cotache-Condor C, Owusu SA, Mahama H, Smith ER. Timing and causes of neonatal mortality in Tamale Teaching Hospital, Ghana: A retrospective study. PLoS One 2021; 16:e0245065. [PMID: 33439915 PMCID: PMC7806127 DOI: 10.1371/journal.pone.0245065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Neonatal deaths now account for more than two-thirds of all deaths in the first year of life and for about half of all deaths in children under-five years. Sub-Saharan Africa accounts up to 41% of the total burden of neonatal deaths worldwide. Our study aims to describe causes of neonatal mortality and to evaluate predictors of timing of neonatal death at Tamale Teaching Hospital (TTH), Ghana. This retrospective study was conducted at TTH located in Northern Ghana. All neonates who died in the Neonatal Intensive Care Unit (NICU) from 2013 to 2017 were included and data was obtained from admission and discharge books and mortality records. Bivariate and multivariate logistic regression were used to assess predictors of timing of neonatal death. Out of the 8,377 neonates that were admitted at the NICU during the 5-year study period, 1,126 died, representing a mortality rate of 13.4%. Of those that died, 74.3% died within 6 days. There was an overall downward trend in neonatal mortality over the course of the 5-year study period (18.2% in 2013; 14.3% in 2017). Preterm birth complications (49.6%) and birth asphyxia (21.7%) were the top causes of mortality. Predictors of early death included being born within TTH, birth weight, and having a diagnosis of preterm birth complication or birth asphyxia. Our retrospective study found that almost 3/4 of neonatal deaths were within the first week and these deaths were more likely to be associated with preterm birth complications or birth asphyxia. Most of the deaths occurred in babies born within health facilities, presenting an opportunity to reduce our mortality by improving on quality of care provided during the perinatal period.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, University for Development Studies School of Medicine and Health Sciences, Tamale, Ghana
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Cesia Cotache-Condor
- Department of Public Health, Baylor University, Waco, TX, United States of America
| | | | - Haruna Mahama
- Sissala West District Hospital, Gwollu, Upper West Region, Ghana
| | - Emily R. Smith
- Department of Public Health, Baylor University, Waco, TX, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- * E-mail:
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Dahir S, Cotache-Condor CF, Concepcion T, Mohamed M, Poenaru D, Adan Ismail E, Leather AJM, Rice HE, Smith ER. Interpreting the Lancet surgical indicators in Somaliland: a cross-sectional study. BMJ Open 2020; 10:e042968. [PMID: 33376180 PMCID: PMC7778782 DOI: 10.1136/bmjopen-2020-042968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The unmet burden of surgical care is high in low-income and middle-income countries. The Lancet Commission on Global Surgery (LCoGS) proposed six indicators to guide the development of national plans for improving and monitoring access to essential surgical care. This study aimed to characterise the Somaliland surgical health system according to the LCoGS indicators and provide recommendations for next-step interventions. METHODS In this cross-sectional nationwide study, the WHO's Surgical Assessment Tool-Hospital Walkthrough and geographical mapping were used for data collection at 15 surgically capable hospitals. LCoGS indicators for preparedness was defined as access to timely surgery and specialist surgical workforce density (surgeons, anaesthesiologists and obstetricians/SAO), delivery was defined as surgical volume, and impact was defined as protection against impoverishment and catastrophic expenditure. Indicators were compared with the LCoGS goals and were stratified by region. RESULTS The healthcare system in Somaliland does not meet any of the six LCoGS targets for preparedness, delivery or impact. We estimate that only 19% of the population has timely access to essential surgery, less than the LCoGS goal of 80% coverage. The number of specialist SAO providers is 0.8 per 100 000, compared with an LCoGS goal of 20 SAO per 100 000. Surgical volume is 368 procedures per 100 000 people, while the LCoGS goal is 5000 procedures per 100 000. Protection against impoverishing expenditures was only 18% and against catastrophic expenditures 1%, both far below the LCoGS goal of 100% protection. CONCLUSION We found several gaps in the surgical system in Somaliland using the LCoGS indicators and target goals. These metrics provide a broad view of current status and gaps in surgical care, and can be used as benchmarks of progress towards universal health coverage for the provision of safe, affordable, and timely surgical, obstetric and anaesthesia care in Somaliland.
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Affiliation(s)
- Shukri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Tessa Concepcion
- Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Dan Poenaru
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | | | - Andy J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Henry E Rice
- Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily R Smith
- Department of Public Health, Baylor University, Waco, Texas, USA
- Global Health Institute, Duke University, Durham, North Carolina, USA
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Smith ER, Concepcion TL, Shrime M, Niemeier K, Mohamed M, Dahir S, Ismail EA, Poenaru D, Rice HE. Waiting Too Long: The Contribution of Delayed Surgical Access to Pediatric Disease Burden in Somaliland. World J Surg 2020; 44:656-664. [PMID: 31654200 DOI: 10.1007/s00268-019-05239-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Delayed access to surgical care for congenital conditions in low- and middle-income countries is associated with increased risk of death and life-long disabilities, although the actual burden of delayed access to care is unknown. Our goal was to quantify the burden of disease related to delays to surgical care for children with congenital surgical conditions in Somaliland. METHODS We collected data from medical records on all children (n = 280) receiving surgery for a proxy set of congenital conditions over a 12-month time period across all 15 surgically equipped hospitals in Somaliland. We defined delay to surgical care for each condition as the difference between the ideal and the actual ages at the time of surgery. Disability-adjusted life years (DALYs) attributable to these delays were calculated and compared by the type of condition, travel distance to care, and demographic characteristics. RESULTS We found long delays in surgical care for these 280 children with congenital conditions, translating to a total of 2970 attributable delayed DALYs, or 8.4 avertable delayed DALYs per child, with the greatest burden among children with neurosurgical and anorectal conditions. Over half of the families seeking surgical care had to travel over 2 h to a surgically equipped hospital in the capital city of Hargeisa. CONCLUSIONS Children with congenital conditions in Somaliland experience substantial delays to surgical care and travel long distances to obtain care. Estimating the burden of delayed surgical care with avertable delayed DALYs offers a powerful tool for estimating the costs and benefits of interventions to improve the quality of surgical care.
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Affiliation(s)
- Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA.
| | | | - Mark Shrime
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Kelli Niemeier
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, MMGYM Room 218, One Bear Place #97313, Waco, TX, 76798-7313, USA
| | - Mubarak Mohamed
- Edna Adan University Hospital, Hargeisa, Somaliland, Somalia
| | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland, Somalia
| | | | | | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Abdul-Mumin A, Anyomih TTK, Owusu SA, Wright N, Decker J, Niemeier K, Benavidez G, Abantanga FA, Smith ER, Tabiri S. Burden of Neonatal Surgical Conditions in Northern Ghana. World J Surg 2020; 44:3-11. [PMID: 31583459 PMCID: PMC6925064 DOI: 10.1007/s00268-019-05210-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Congenital anomalies have risen to become the fifth leading cause of under-five mortality globally. The majority of deaths and disability occur in low- and middle-income countries including Ghana. This 3-year retrospective review aimed to define, for the first time, the characteristics and outcomes of neonatal surgical conditions in northern Ghana. Methods A retrospective study was conducted to include all admissions to the Tamale Teaching Hospital (TTH) neonatal intensive care unit (NICU) with surgical conditions between January 2014 and January 2017. Data were collected on demographics, diagnosis and outcomes. Descriptive analysis was performed on all data, and logistic regression was used to predict determinants of neonatal mortality. p < 0.05 was deemed significant. Results Three hundred and forty-seven neonates were included. Two hundred and sixty-one (75.2%) were aged 7 days or less at presentation, with males (n = 177, 52%) slightly higher than females (n = 165, 48%). The majority were delivered by spontaneous vaginal delivery (n = 247, 88%); 191 (58%) were born in hospital. Congenital anomalies accounted for 302 (87%) of the neonatal surgical cases and 45 (96%) deaths. The most common anomalies were omphalocele (n = 48, 13.8%), imperforate anus (n = 34, 9.8%), intestinal obstruction (n = 29, 8.4%), spina bifida (n = 26, 7.5%) and hydrocephalus (n = 19, 5.5%). The overall mortality rate was 13.5%. Two-thirds of the deaths (n = 30) from congenital anomalies were conditions involving the digestive system with gastroschisis having the highest mortality of 88%. Omphalocele (n = 11, 23.4%), gastroschisis (n = 7, 14.9%) and imperforate anus (n = 6, 12.8%) contributed to the most deaths. On multivariate analysis, low birthweight was significantly associated with mortality (OR 3.59, CI 1.4–9.5, p = 0.009). Conclusion Congenital anomalies are a major global health problem associated with high neonatal mortality in Ghana. The highest burden in terms of both caseload and mortality is attributed to congenital anomalies involving the digestive system, which should be targeted to improve outcomes. Electronic supplementary material The online version of this article (10.1007/s00268-019-05210-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alhassan Abdul-Mumin
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Salaga Road, Tamale, Ghana
| | | | | | - Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK.
| | - Janae Decker
- Department of Public Health, Baylor University, 1301 S University Parks Dr, Waco, TX, 76706, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Kelli Niemeier
- Department of Public Health, Baylor University, 1301 S University Parks Dr, Waco, TX, 76706, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Gabriel Benavidez
- Department of Public Health, Baylor University, 1301 S University Parks Dr, Waco, TX, 76706, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Francis A Abantanga
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Salaga Road, Tamale, Ghana
| | - Emily R Smith
- Department of Public Health, Baylor University, 1301 S University Parks Dr, Waco, TX, 76706, USA
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Stephen Tabiri
- School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Salaga Road, Tamale, Ghana
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21
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Commander SJ, Ellis D, Williamson H, Oyania F, Ruhigwa C, Situma M, Fitzgerald TN. Social and financial barriers may contribute to a "hidden mortality" in Uganda for children with congenital anomalies. Surgery 2020; 169:311-317. [PMID: 33097243 DOI: 10.1016/j.surg.2020.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The true incidence of congenital anomalies in sub-Saharan Africa is unknown. Owing to complex challenges associated with congenital anomalies, many affected babies may never present to a health facility, resulting in an underestimation of disease burden. METHODS Interviews were conducted with Ugandans between September 2018 and May 2019. Responses from community members versus families of children with congenital anomalies were compared. RESULTS A total of 198 Ugandans were interviewed (91 family members, 80 community members). All participants (N = 198) believed that seeking surgical care would lead to poverty, 43% (n = 84) assumed fathers would abandon the child, and 26% (n = 45) thought a child with a congenital anomaly in their community had been left to die. Causes of anomalies were believed to be contraceptive methods (48%, n = 95), witchcraft (17%, n = 34), or drugs (10%, n = 19). Of family members, 25 (28%) were advised to allow the child to die. Families with affected children were more likely to have a lower income (P < .001), believe anomalies could be treated (P = .007), but thought that allowing the child to die was best for the family (32% vs 9%; P < .0001). Monthly household income <50,000 Uganda shillings ($13 United States dollars) was a significant predictor of the father leaving the family (P = .024), being advised to not pursue medical care (P = .046), and believing that God should decide the child's fate (P = .047). CONCLUSION Families face significant financial and social pressures when deciding to seek surgical care for a child with a congenital anomaly. Many children with anomalies may die and never reach a health facility to be counted, thus contributing to a hidden mortality.
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Affiliation(s)
| | - Danielle Ellis
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Felix Oyania
- Department of Pediatric Surgery, Mbarara National Referral Hospital, Uganda
| | - Comfart Ruhigwa
- Department of Pediatric Surgery, Mbarara National Referral Hospital, Uganda
| | - Martin Situma
- Department of Pediatric Surgery, Mbarara National Referral Hospital, Uganda
| | - Tamara N Fitzgerald
- Department Surgery, Duke University, Durham, NC; Duke Global Health Institute, Durham, NC.
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22
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Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance. World J Surg 2020; 43:2934-2944. [PMID: 31297580 DOI: 10.1007/s00268-019-05079-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.
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23
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Barton SJ, Sandhu S, Doan I, Blanchard L, Dai A, Paulenich A, Smith ER, van de Water BJ, Martin AH, Seider J, Namaganda F, Opolot S, Ekeji N, Bility MM, Bettger JP. Perceived barriers and supports to accessing community-based services for Uganda's pediatric post-surgical population. Disabil Rehabil 2019; 43:2172-2183. [PMID: 31841047 DOI: 10.1080/09638288.2019.1694999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders. MATERIALS AND METHODS This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach. RESULTS Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration. CONCLUSIONS Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda.Implications for rehabilitationMultiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda.The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations.Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery.Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration.Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal.
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Affiliation(s)
- Sarah Jean Barton
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, USA
| | - Sahil Sandhu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Isabelle Doan
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Lillian Blanchard
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Alex Dai
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | | | - Emily R Smith
- Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Brittney J van de Water
- Department of Global Health and Social Medicine, Harvard University School of Medicine, Boston, MA, USA
| | - Anna H Martin
- Global Campaign for Education, Light for the World, Washington, DC, USA
| | | | - Florence Namaganda
- The Mukisa Foundation, Kampala, Uganda.,The Special Children's Trust, Kampala, Uganda
| | - Shem Opolot
- The Neurosurgical Society of Uganda, Kampala, Uganda.,Duke Global Neurosurgery and Neuroscience, Durham, NC, USA
| | - Nelia Ekeji
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
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24
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Smith ER, Concepcion TL, Mohamed M, Dahir S, Ismail EA, Rice HE, Krishna A. The contribution of pediatric surgery to poverty trajectories in Somaliland. PLoS One 2019; 14:e0219974. [PMID: 31348780 PMCID: PMC6660125 DOI: 10.1371/journal.pone.0219974] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. METHODS This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. RESULTS We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. CONCLUSION Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment.
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Affiliation(s)
- Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States of America
| | - Tessa L. Concepcion
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Anirudh Krishna
- Sanford School of Public Policy, Duke University, Durham, NC, United States of America
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Beard JH, Ajiko MM, Löfgren J. From Measuring Disease Burden to Designing and Evaluating Solutions-Global Surgery Research in Evolution. JAMA Netw Open 2019; 2:e186840. [PMID: 30646200 DOI: 10.1001/jamanetworkopen.2018.6840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jessica H Beard
- Division of Trauma and Surgical Critical Care, Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Margaret M Ajiko
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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