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Schifino Wolmeister A, Hansen TG, Engelhardt T. Challenges of organizing pediatric anesthesia in low and middle-income countries. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024:844525. [PMID: 38906364 DOI: 10.1016/j.bjane.2024.844525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Anelise Schifino Wolmeister
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada; Hospital de Clínicas de Porto Alegre, Departamento de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil.
| | - Tom G Hansen
- Akershus University Hospital, Department of Anesthesia & Intensive Care, Lørenskog, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Thomas Engelhardt
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada
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Bandyopadhyay S, Philipo GS, Bokhary ZM, Lakhoo K. A review of twenty-first century developments in paediatric surgery in Africa. Pediatr Surg Int 2024; 40:137. [PMID: 38780635 DOI: 10.1007/s00383-024-05718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
This review explores the significant advancements in paediatric surgery in Africa during the twenty-first century, with a particular focus on capacity-building, education, infrastructural development, and research. Historically, paediatric surgery has been an overlooked sector, especially in low-and-middle-income countries in Africa. However, recent years have seen considerable progress. Collaborative efforts such as the Global Initiative for Children's Surgery, and the formation of the Pan African Paediatric Surgery Association, the College of Surgeons of East, Central and Southern Africa and the West African College of Surgeons have facilitated knowledge sharing, collaboration, and advocacy for enhancing surgical standards. Local training programmes, including Master of Medicine programmes and fellowships, have been instrumental in building a skilled workforce. These initiatives have been complemented by infrastructural developments through non-governmental organisations like Kids Operating Room, which have expanded access to paediatric surgical care. Technological advancements, particularly in telemedicine, have further enhanced accessibility. Task-sharing strategies, where non-specialist physicians are trained in paediatric surgical skills, have also been utilised to address the shortage of specialised surgeons. Research in paediatric surgery has experienced an upswing, with local health professionals taking the lead. Research has been crucial for understanding the epidemiology of paediatric surgical conditions, and developing prevention strategies, and is increasingly leading to the inclusion of paediatric surgery in national health plans. Despite the progress, challenges remain, including the need for sustainable funding, continued investment in infrastructure, and training and retention of healthcare professionals. The review emphasises the importance of ongoing efforts in community engagement, innovative technologies, and health systems strengthening for the sustainable development of paediatric surgical services in Africa.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Godfrey Sama Philipo
- The College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
- The Branch for Global Surgical Care (BGSC), University of British Columbia (UBC), Columbia, Canada
| | - Zaitun Mohamed Bokhary
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Alberti P, Bytyci J, Jindal J, Stephanou M, Thompson L, Tilahun Y, Ying Y, Killen A, Manirambona E, Niyukuri A, Lakhoo K, Ford K. Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study. Pediatr Surg Int 2024; 40:117. [PMID: 38695917 DOI: 10.1007/s00383-024-05704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. METHODS A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. RESULTS This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. CONCLUSIONS Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.
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Affiliation(s)
- Piero Alberti
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jola Bytyci
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jessy Jindal
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Michael Stephanou
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Thompson
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yedidiah Tilahun
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yuxin Ying
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Annabel Killen
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kathryn Ford
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Quintão VC, Concha M, Argüello LAS, Cavallieri S, Cortinez LI, de Sousa GS, Clemente MMM, Carlos RV, Rodríguez JM, Gutiérrez K, Jablonka DH, García-Marcinkiewicz AG. Pediatric anesthesiology in Brazil, Chile, and Mexico. Paediatr Anaesth 2024. [PMID: 38619275 DOI: 10.1111/pan.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. OBJECTIVE Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. DESCRIPTIONS AND CONCLUSIONS Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.
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Affiliation(s)
- Vinícius Caldeira Quintão
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Concha
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Silvana Cavallieri
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Anesthesiology, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Luis I Cortinez
- Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Soares de Sousa
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Serviços Médicos de Anestesia, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Ricardo Vieira Carlos
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Karla Gutiérrez
- Department of Pediatric Anesthesia, Instituto Mexicano del Seguro Social La Raza, Hospital Medica Sur, Mexico City, Mexico
| | - Denis H Jablonka
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Annery G García-Marcinkiewicz
- Children's Hospital of Philadelphia, USA Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Krakauer KN, Wong LY, Tobias J, Majekodunmi O, Balumuka D, Bravo K, Ameh E, Finlayson S, Nwomeh B, Sifri Z, Charles A, Krishnaswami S. Evaluating Global Surgery Partnerships From Low and Middle Income Country Perspectives. J Surg Res 2024; 296:681-688. [PMID: 38364695 DOI: 10.1016/j.jss.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Little is known about perceptions of low-income and middle-income country (LMIC) partners regarding global surgery collaborations with high-income countries (HICs). METHODS A survey was distributed to surgeons from LMICs to assess the nature and perception of collaborations, funding, benefits, communication, and the effects of COVID-19 on partnerships. RESULTS We received 19 responses from LMIC representatives in 12 countries on three continents. The majority (83%) had participated in collaborations within the past 5 y with 39% of collaborations were facilitated virtually. Clinical and educational partnerships (39% each) were ranked most important by respondents. Sustainability of the partnership was most successfully achieved in domains of education/training (78%) and research (61%). The majority (77%) of respondents reported expressing their needs before HIC team arrival. However, 54% of respondents were the ones to initiate the conversation and only 47% said HIC partners understood the overall environment well at arrival to LMIC. Almost all participants (95%) felt a formal process of collaboration and a structured partnership would benefit all parties in assessing needs. During the COVID-19 pandemic, 87% of participants reported continued collaborations; however, 44% of partners felt that relationships were weaker, 31% felt relationships were stronger, and 25% felt they were unchanged. CONCLUSIONS Our study provides a snapshot of LMIC surgeons' perspectives on collaboration in global surgery. Independent of location, LMIC partners cite inadequate structure for long-term collaborations. We propose a formal pathway and initiation process to assess resources and needs at the outset of a partnership.
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Affiliation(s)
- Kelsi N Krakauer
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Lye-Yeng Wong
- Department of Surgery, Oregon Health And Science University, Portland, Oregon.
| | - Joseph Tobias
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Olubunmi Majekodunmi
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | - Darius Balumuka
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Kali Bravo
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
| | - Emmanuel Ameh
- Department of Surgery, National Hospital Abuja, Abuja, Federal Capital Territory, Nigeria
| | | | - Benedict Nwomeh
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anthony Charles
- Department of Surgery, University Of North Carolina At Chapel Hill, Chapel Hill, North Carolina
| | - Sanjay Krishnaswami
- Department of Surgery, Oregon Health And Science University, Portland, Oregon
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Abbas A, Rice HE, Poenaru D, Samad L. Defining Feasibility as a Criterion for Essential Surgery: A Qualitative Study with Global Children's Surgery Experts. World J Surg 2023; 47:3083-3092. [PMID: 37838634 DOI: 10.1007/s00268-023-07203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The Disease Control Priorities (DCP-3) group defines surgery as essential if it addresses a significant burden, is cost-effective, and is feasible-yet the feasibility component remains largely unexplored. The aim of this study was to develop a precise definition of feasibility for essential surgical procedures for children. METHODS Four online focus group discussions (FGDs) were organized among 19 global children's surgery providers with experience of working in low- and lower-middle-income countries (LMICs), representing 10 countries. FGDs were transcribed verbatim, and qualitative data analysis was performed. Codes, categories, themes, and subthemes were identified. RESULTS Six determinants of feasibility were identified, including: adequate human resources; adequate material resources; procedure and disease complexity; team commitment and understanding of their setting; timely access to care; and the ability to monitor and achieve good outcomes. Factors unique to feasibility of children's surgery included children's right to health and their reliance on adults for accessing safe and timely care; the need for specialist workforce; and children's unique perioperative care needs. FGD participants reported a greater need for task-sharing and shifting, creativity, and adaptability in resource-limited settings. Resource availability was seen to have a direct impact on decision-making and prioritization, e.g., saving a life versus achieving the best outcome. CONCLUSIONS The identification of a precise definition of feasibility serves as a pivotal step in identifying a list of essential surgical procedures for children, which would serve as indicators of institutional surgical capacity for this age group.
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Affiliation(s)
- Alizeh Abbas
- Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Hospital and Health Network, Karachi, Pakistan.
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, 35233, USA.
| | - Henry E Rice
- Department of Surgery, Duke University, Durham, NC, USA
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
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Maraschin FG, Adella FJ, Nagraj S. A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002424. [PMID: 37992047 PMCID: PMC10664918 DOI: 10.1371/journal.pgph.0002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care.
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Affiliation(s)
- Francesca Giulia Maraschin
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Fidelis Jacklyn Adella
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
| | - Shobhana Nagraj
- Health Systems Collaborative, Centre for Global Health Research, The Nuffield Department of Medicine, The University of Oxford, Oxford, United Kingdom
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Yassegoungbe MG, Assan BR, Houegban ASCR, Metchihoungbe CS, Lecompte JF, Aguemon CT, Gbetey SB, Breaud J, Gbenou AS. Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000576. [PMID: 37899843 PMCID: PMC10603329 DOI: 10.1136/wjps-2023-000576] [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: 01/30/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023] Open
Abstract
Objective The multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute multidisciplinary consultation meetings for prenatal diagnosis (MCMPD) in Benin. Methods This is a descriptive cross-sectional study examining the knowledge, attitudes, and practices of Beninese practitioners in the field of MCMPD to develop the pilot phase of the project. Results We collected 108 participants from different specialties. Pediatricians and pediatric surgeons were in the majority at 23.9% and 16.5%, respectively. Sixty-seven percent of participants were from the public sector (n=75). One practitioner felt that it was not a good idea to implement these meetings. Almost all staff (96.2%) agreed that this meeting would have a positive impact on reducing neonatal mortality. Omphalocele (58.5%), spina bifida aperta (43.6%), and gastroschisis (34%) were the most commonly diagnosed antenatal conditions in Benin. No neonatal pathology required medical termination of the pregnancy according to 35.6% of the participants. Conclusions The objective of reducing infant mortality due to medical and surgical pathologies is a noble one and deserves to be supported. This innovative project, developed through this study, the first of its kind in the subregion, will contribute inexorably to the achievement of the third Goal Sustainable Development.
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Affiliation(s)
- Monsoia Gildas Yassegoungbe
- Pediatric Surgery Department, Mother and Child Teaching Hospital Lagune, University of Abomey-Calavi, Cotonou, Benin
| | - Beaudelaire Romulus Assan
- Pediatric Surgery Department, Mother and Child Teaching Hospital Lagune, University of Abomey-Calavi, Cotonou, Benin
| | | | - Codjo Serge Metchihoungbe
- Pediatric Surgery Department, National Teaching Hospital Hubert Koutoukou Maga, University of Abomey-Calavi, Cotonou, Benin
| | | | - Christine Tschabu Aguemon
- University Clinic of Gynecological Obstetrics, National Teaching Hospital Hubert Koutoukou Maga, University of Abomey-Calavi, Cotonou, Benin
| | - Sidoine Bitho Gbetey
- Intellectual Production Department, Center of Expertise in Applied Social Sciences, Cotonou, Benin
| | - Jean Breaud
- Pediatric Surgery Department, CHU-LENVAL Paediatric Hospitals of Nice, Nice, France
| | - Antoine Seraphin Gbenou
- Pediatric Surgery Department, Mother and Child Teaching Hospital Lagune, University of Abomey-Calavi, Cotonou, Benin
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Rapaport S, Enumah ZO, Ngude H, Rhee DS, Abbas M, Lekey A, Winch PJ, Sakran JV, Stevens KA. Patterns, procedures, and indications for pediatric surgery in a Tanzanian Refugee Camp: a 20-year experience. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000528. [PMID: 37396496 PMCID: PMC10314687 DOI: 10.1136/wjps-2022-000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/24/2023] [Indexed: 07/04/2023] Open
Abstract
Background There are 103 million displaced people worldwide, 41% of whom are children. Data on the provision of surgery in humanitarian settings are limited. Even scarcer is literature on pediatric surgery performed in humanitarian settings, particularly protracted humanitarian settings. Methods We reviewed patterns, procedures, and indications for pediatric surgery among children in Nyarugusu Refugee Camp using a 20-year retrospective dataset. Results A total of 1221 pediatric surgical procedures were performed over the study period. Teenagers between the ages of 12 and 17 years were the most common age group undergoing surgery (n=991; 81%). A quarter of the procedures were performed on local Tanzanian children seeking care in the camp (n=301; 25%). The most common procedures performed were cesarean sections (n=858; 70%), herniorrhaphies (n=197; 16%), and exploratory laparotomies (n=55; 5%). Refugees were more likely to undergo exploratory laparotomy (n=47; 5%) than Tanzanian children (n=7; 2%; p=0.032). The most common indications for exploratory laparotomy were acute abdomen (n=24; 44%), intestinal obstruction (n=10; 18%), and peritonitis (n=9; 16%). Conclusions There is a significant volume of basic pediatric general surgery performed in the Nyarugusu Camp. Services are used by both refugees and local Tanzanians. We hope this research will inspire further advocacy and research on pediatric surgical services in humanitarian settings worldwide and illuminate the need for including pediatric refugee surgery within the growing global surgery movement.
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Affiliation(s)
- Sarah Rapaport
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Zachary Obinna Enumah
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hilary Ngude
- Tanzania Red Cross Society, Dar es Salaam, Tanzania
| | - Daniel S Rhee
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of Pediatric Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | - Amber Lekey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph V Sakran
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Kent A Stevens
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Kakembo N, Grabski DF, Situma M, Ajiko M, Kayima P, Nyeko D, Shikanda A, Okello I, Tumukunde J, Nabukenya M, Ogwang M, Kisa P, Muzira A, Ruzgar N, Fitzgerald TN, Sekabira J, Ozgediz D. Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis. J Surg Res 2023; 286:23-34. [PMID: 36738566 DOI: 10.1016/j.jss.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 12/05/2022] [Accepted: 12/24/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Children's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation. MATERIALS AND METHODS Surgical volume, outcomes, and distribution of pediatric general surgical procedures were analyzed using prospective pediatric surgical databases from four separate regional hospitals in Uganda. The current averted burden of surgical disease through pediatric surgical delivery in Uganda and the unmet surgical need based on estimates from high-income country data was calculated. RESULTS A total of 8514 patients were treated at the four hospitals over a 6-year period corresponding to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000 children per year. The majority of complex congenital anomalies and surgical oncology cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability adjusted life years per year, which resulted in an economic benefit of approximately 23 million USD per year. However, the average case volume performed at the four regional hospitals currently represents 1% of the total projected pediatric surgical need. CONCLUSIONS This investigation is one of the first to demonstrate the distribution of pediatric surgical procedures at a country level through the use of a prospective locally created database. Significant disease burden was averted by local pediatric and adult surgical teams, demonstrating the economic benefit of pediatric surgical care delivery. These findings support several ongoing strategies to increase pediatric surgical access in Uganda.
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Affiliation(s)
- Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Mbarara Hospital, Mbarara, Uganda
| | - Margaret Ajiko
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Peter Kayima
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - David Nyeko
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Anne Shikanda
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Innocent Okello
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesiology, Makerere University School of Medicine, Kampala, Uganda
| | - Martin Ogwang
- Department of Surgery, St. Mary's Lacor Regional Referral Hospital, Lacor, Uganda
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Nensi Ruzgar
- Yale University School of Medicine, New Haven, Connecticut
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - John Sekabira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, California
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11
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Wimmer S, Truche P, Guadagno E, Ameh E, Samad L, Makasa EMM, Greenberg S, Meara JG, van Dijk TH, Poenaru D. Assessing the inclusion of children's surgical care in National Surgical, Obstetric and Anaesthesia Plans: a policy content analysis. BMJ Open 2023; 13:e051248. [PMID: 37080614 PMCID: PMC10124220 DOI: 10.1136/bmjopen-2021-051248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE While National Surgical, Obstetric and Anaesthesia Plans (NSOAPs) have emerged as a strategy to strengthen and scale up surgical healthcare systems in low/middle-income countries (LMICs), the degree to which children's surgery is addressed is not well-known. This study aims to assess the inclusion of children's surgical care among existing NSOAPs, identify practice examples and provide recommendations to guide inclusion of children's surgical care in future policies. DESIGN We performed two qualitative content analyses to assess the inclusion of children's surgical care among NSOAPs. We applied a conventional (inductive) content analysis approach to identify themes and patterns, and developed a framework based on the Global Initiative for Children's Surgery's Optimal Resources for Children's Surgery document. We then used this framework to conduct a directed (deductive) content analysis of the NSOAPs of Ethiopia, Nigeria, Rwanda, Senegal, Tanzania and Zambia. RESULTS Our framework for the inclusion of children's surgical care in NSOAPs included seven domains. We evaluated six NSOAPs with all addressing at least two of the domains. All six NSOAPs addressed 'human resources and training' and 'infrastructure', four addressed 'service delivery', three addressed 'governance and financing', two included 'research, evaluation and quality improvement', and one NSOAP addressed 'equipment and supplies' and 'advocacy and awareness'. CONCLUSIONS Additional focus must be placed on the development of surgical healthcare systems for children in LMICs. This requires a focus on children's surgical care separate from adult surgical care in the scaling up of surgical healthcare systems, including children-focused needs assessments and the inclusion of children's surgery providers in the process. This study proposes a framework for evaluating NSOAPs, highlights practice examples and suggests recommendations for the development of future policies.
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Affiliation(s)
- Sabrina Wimmer
- Harvey E Beardmore Division of Pediatric Surgery, McGill University Health Centre, Montreal, Ontario, Canada
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, McGill University Health Centre, Montreal, Ontario, Canada
| | - Emmanuel Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, Interactive Research & Development, Karachi, Pakistan
| | - Emmanuel Mwenda Malabo Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare, Department of Surgery, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Sarah Greenberg
- Division of Pediatric General & Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Tonnis H van Dijk
- Department of Pediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, McGill University Health Centre, Montreal, Ontario, Canada
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12
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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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13
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Raval MV, Brockel MA, Kolaček S, Simpson KE, Spoede E, Starr KNP, Wulf KL. Key Strategies for Optimizing Pediatric Perioperative Nutrition-Insight from a Multidisciplinary Expert Panel. Nutrients 2023; 15:nu15051270. [PMID: 36904269 PMCID: PMC10005187 DOI: 10.3390/nu15051270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Adequate nutrition is an essential factor in healing and immune support in pediatric patients undergoing surgery, but its importance in this setting is not consistently recognized. Standardized institutional nutrition protocols are rarely available, and some clinicians may be unaware of the importance of assessing and optimizing nutritional status. Moreover, some clinicians may be unaware of updated recommendations that call for limited perioperative fasting. Enhanced recovery protocols have been used in adult patients undergoing surgery to ensure consistent attention to nutrition and other support strategies in adult patients before and after surgery, and these are now under evaluation for use in pediatric patients as well. To support better adoption of ideal nutrition delivery, a multidisciplinary panel of experts in the fields of pediatric anesthesiology, surgery, gastroenterology, cardiology, nutrition, and research have gathered and reviewed current evidence and best practices to support nutrition goals in this setting.
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Affiliation(s)
- Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 63, Chicago, IL 60611, USA
- Correspondence:
| | - Megan A. Brockel
- Department of Anesthesiology, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Sanja Kolaček
- Referral Centre for Pediatric Gastroenterology and Nutrition, University Children’s Hospital Zagreb, 10000 Zagreb, Croatia
| | | | - Elizabeth Spoede
- Pediatric Clinical Dietitian, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Kathryn N. Porter Starr
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC 27708, USA
- Durham VA Health Care System, Durham, NC 27705, USA
| | - Karyn L. Wulf
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA
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14
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Laverde R, Majekodunmi O, Park P, Udeigwe-Okeke CR, Yap A, Klazura G, Ukwu N, Bryce E, Ozgediz D, Ameh EA. Impact of new dedicated pediatric operating rooms on surgical volume in Africa: Evidence from Nigeria. J Pediatr Surg 2023; 58:161-166. [PMID: 36289035 DOI: 10.1016/j.jpedsurg.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a large unmet children's surgical need in low- and middle-income countries (LMICs). This study examines the impact of installing dedicated pediatric operating rooms (ORs) on surgical volume at National Hospital Abuja, a hospital in Abuja, Nigeria. METHODS A Non-Governmental Organization installed two pediatric ORs in August 2019. We assessed changes in volume from July 2018 to September 2021 using interrupted time series analysis. RESULTS Total surgical volume increased by 13 cases (p = 0.01) in 1-month post-installation, with elective operations making up 85% (p = 0.02) of cases. There was an increase in elective volume by about 1 case per month (p = 0.01) post-installation and the difference between pre-and post-trends was 1.23 cases per month (p = 0.009). The baseline volume of neonatal surgeries increased by 9 cases per month (p < 0.001) post-installation and this difference between pre- and post-trends was statistically significant (p = 0.001). Similarly, one-month post-installation, the cases classified as ASA class >2 increased by 14 (p < 0.001). There was no significant difference between pre-and post-installation mortality rate at about 2% per month. CONCLUSIONS There were significant changes in surgical volume after OR installation, primarily composed of elective operations, reflecting an increased capacity to address surgical backlogs and/or perform more specialized surgeries. Despite a significant increase in volume and higher ASA class, there was no significant difference in mortality. This study supports the installation of surgical infrastructure in LMICs to strengthen capacity without increasing postoperative mortality.
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Affiliation(s)
- Ruth Laverde
- School of Medicine, University of California, 513 Parnassus Ave, Suite S-224, San Francisco, CA 94143, USA; Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA.
| | - Olubumni Majekodunmi
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Paul Park
- School of Medicine, University of California, 513 Parnassus Ave, Suite S-224, San Francisco, CA 94143, USA; Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA
| | - Chisom R Udeigwe-Okeke
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Ava Yap
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Department of Surgery, University of California, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA
| | - Greg Klazura
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nancy Ukwu
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Emma Bryce
- Kids Operating Room, Edinburgh, Scotland, United Kingdom
| | - Doruk Ozgediz
- Center for Health Equity in Surgery and Anesthesia, University of California, 550 16th St, 3rd Floor, Box 1224, San Francisco, CA 94158, USA; Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, PO Box 187, FCT, Abuja, Garki, Nigeria
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15
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Jiang T, Kost S, Doshi P, Ho PC, Phillips SD, Mutindi E, Mueller JL, Fitzgerald TN. Crucial Business Model Elements for Medical Device Startup Companies in Emerging Markets. Value Health Reg Issues 2023; 33:83-90. [PMID: 36327768 DOI: 10.1016/j.vhri.2022.09.004] [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: 01/17/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Medical devices that suit the needs and challenges of low- and middle-income countries are desperately needed. To provide sustainable access to such devices, business approaches must be developed to meet the demands of individual economic, healthcare, and innovation ecosystems. Currently, there is a gap in the literature regarding business models for medical devices in low- and middle-income countries. METHODS A multimodal approach using literature review and key informant interviews was performed to determine critical components of business models for medical device organizations operating in LMICs, specifically focusing on models in emerging markets. RESULTS The search resulted in 4,674 articles, of which 31 were determined to be relevant and were reviewed. Additional sources included 1 government website, 5 nongovernmental organization websites, 2 private enterprises, and 6 publicly available, non-peer reviewed websites and 1 video. From these sources, four major criteria were found to be necessary for successful development of medical device business models in emerging markets: value proposition, partnerships, strategic pricing, and funding models. CONCLUSIONS Innovators must custom tailor their business model when implementing these elements to the regulatory, cultural, and economic landscapes of each setting. This will improve access to safer, affordable medical care and successfully bring innovative technologies to emerging markets.
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Affiliation(s)
- Tiffany Jiang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Samantha Kost
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Pratik Doshi
- School of Medicine, Duke University, Durham, NC, USA; Clark School of Engineering, University of Maryland, College Park, MD, USA
| | - Pei Ching Ho
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | | | | | - Jenna L Mueller
- Clark School of Engineering, University of Maryland, College Park, MD, USA
| | - Tamara N Fitzgerald
- School of Medicine, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA.
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16
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Abstract
More than two thirds of the global population lack access to safe, affordable surgical and anesthesia care. This inequity disproportionately affects children in low- and middle-income countries (LMIC). In 2016, a group of pediatric surgical care providers founded the Global Initiative for Children's Surgery (GICS). Their goal was to assemble a multidisciplinary team of specialists and advocates to improve surgical care for children, with a particular emphasis on those in low-resource settings. This review details the history of GICS, the process of its inception, the values guiding its work, its past achievements, and its current initiatives. The experience of GICS may serve as an effective model for global collaboration on other areas of public and global health.
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17
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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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18
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A CT scan-based formula for predicting central venous catheter length in pediatric patients. Pediatr Surg Int 2022; 38:1335-1340. [PMID: 35849175 DOI: 10.1007/s00383-022-05165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Placement of a central venous catheter (CVC) is the most commonly performed pediatric procedure. This study aims to develop simple formulas to calculate intravascular length of CVCs prior to insertion to minimize reliance on fluoroscopic and radiographic imaging, which may not be uniformly available. METHODS We performed a single-institution, retrospective review of 115 pediatric patients who received both CVC placement and computed tomography (CT) imaging of the chest within 3 months of the procedure. Using measurements from the CT imaging, formulas calculating the length of the intravascular component of the CVC based on height and insertion laterality were developed and compared to previously published formulas. These formulas were then trialed prospectively to validate reliability and application. RESULTS Formulas were developed for right-sided and left subclavian insertion. The right-side formula accurately predicted CVC length in 52.6% of patients, compared to 47.4% by the Andropoulos formula. The left subclavian formula accurately estimated 62.5%, compared to 34.5% by the Stroud formula. CONCLUSIONS The optimal intravascular length of central venous catheters may be determined by simple formulas based on patient height and insertion site. LEVEL OF EVIDENCE III.
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19
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Kang HS, Robertson E, Vohra H, Richter W, Lanning D, DeAntonio J. Providing care to children from low and middle-income countries with complex surgical problems: An 18 year review. J Pediatr Surg 2022; 57:824-828. [PMID: 35105455 DOI: 10.1016/j.jpedsurg.2021.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The burden of surgical disease in children from low and middle-income countries (LMICs) is becoming more recognized as significant and undertreated. We recently reviewed our health system's experience with providing quaternary-level surgical care to children from LMICs through a partnership with World Pediatric Project (WPP), a not-for-profit organization. METHODS A retrospective review was performed of all WPP-sponsored patients who received surgical care at our children's hospital from LMICs in the Caribbean and Central America from July 2000 to August 2018. RESULTS Two hundred and fifty-five patients (average age: 5.9 ± 5.3 years; range: <1-18 years) from 14 countries received a total of 371 moderately to significantly complex operations from 10 pediatric surgical subspecialties, with cardiac, neurosurgery, craniofacial and general/thoracic surgical subspecialties being the most common. The average length of hospital stay was 10.7 ± 18.9 days. All patients had the opportunity to follow-up with local providers and/or visiting WPP-sponsored surgical teams. 227 patients (93.8%) were seen by WPP providers or released to an in-country physician partnering with WPP. There were 21 (8.2%) total, minor and major, postoperative complications. Five deaths (2.0%) occurred at our institution and 7 from disease progression, after returning to their home country. CONCLUSIONS Providing complex surgical care to LMIC children in the US may help address a significant global burden. This care can be provided by multiple subspecialists with excellent outcomes, good follow-up, and low complication and mortality rates. Having a supportive health care system, volunteer surgeons, and an organization that manages logistics and provides financial support is essential. TYPE OF STUDY Clinical research, retrospective review LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Hae Sung Kang
- Division of Pediatric Surgery, Virginia Commonwealth University Health, Richmond, VA
| | | | | | | | - David Lanning
- Division of Pediatric Surgery, Virginia Commonwealth University Health, Richmond, VA; World Pediatric Project, Richmond, VA.
| | - Jonathan DeAntonio
- Division of Pediatric Surgery, Virginia Commonwealth University Health, Richmond, VA
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20
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Nguyen BU, Holterman A, Holterman M, Dinh LT. Academic Pediatric Surgery Capacity Building in Vietnam Through PASS, a Pediatric Acute Surgical Support Course. Front Surg 2022; 9:868483. [PMID: 35529908 PMCID: PMC9069233 DOI: 10.3389/fsurg.2022.868483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 01/06/2023] Open
Abstract
Neonatal and pediatric surgical emergencies in Low and Low Middle Income countries remain a significant challenge in combatting the burden and inequities of global health. IPSAC-Vietnam is a small Non-Governmental Organization that has been engaged in a 12-year multi-pronged partnership with several children’s hospitals in Vietnam VN to enhance pediatric surgery capacity. We describe the health care, medical training and emergency system in VN as the background for IPSAC activities and development of Pediatric Acute Surgical Support (PASS) course. The course goal is to prepare health care personnel in the immediate management of neonatal/pediatric life-threatening surgical conditions and road injuries at their first point of entry into Vietnam hospitals. PASS is a horizontal outreach initiative that adopts an interprofessional, multidisciplinary, team-training, train-the-trainers, and outcome-based training approach. PASS can be used as a tool for sustainable horizontal capacity-building by champion leaders at the teaching children’s hospitals and medical universities in developing countries, to strengthen training for pediatric surgical emergencies, to integrate pediatric and pediatric surgical care and to advocate for a comprehensive approach to emergency care of the critically ill child.
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Affiliation(s)
- Bich-Uyen Nguyen
- Department of Pediatric Surgery, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Aixuan Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Mark Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Le-Thanh Dinh
- Department of Pediatric Surgery, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Correspondence: L-T Dinh
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21
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Evans FM, Wake PB, Gathuya ZN, McDougall RJ. Access to Safe Pediatric Anesthesia in LMICs-The Problem Is Clear; It Is Time to Solve It! Anesth Analg 2022; 134:724-727. [PMID: 35299212 DOI: 10.1213/ane.0000000000005924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Faye M Evans
- From the Department of Anesthesiology, Critical Care, and Pain Medicine and Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Pauline B Wake
- Discipline of Anaesthesiology and Intensive Care, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | | | - Robert J McDougall
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, the Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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22
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Ravi K, Killen A, Alexander A, Bell-Davies F, Biganiro Sebintu J, Brazeal A, Butoyi JMV, Diaz FE, Drabile R, Fanny M, Fernie L, Gunawardana S, Hartley E, Hawu YN, Hendron H, Joseph SA, Lamahewage A, Mahagedera R, Manirambona E, Morisho BK, Muchunu P, Niyukuri A, Ntaganda E, Orliacq F, Orliacq J, Wobenjo A, Young P, Lakhoo K, Ford K. An OxPLORE Initiative Evaluating Children's Surgery Resources Worldwide: A Cross-sectional Implementation of the OReCS Document. World J Surg 2022; 46:476-485. [PMID: 34846547 PMCID: PMC8803801 DOI: 10.1007/s00268-021-06377-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children's Surgery (OReCS) document in 2019, listing standards of children's surgical care by level of healthcare facilities within low resource settings. We have previously created and piloted an audit tool based on the OReCS criteria in a high-income setting. In this study, we aimed to validate its use in identifying gaps in children's surgery provision worldwide. METHODS Our OReCS audit tool was implemented in 10 hospitals providing children's surgery across eight countries. Collaborators were recruited via the Oxford Paediatrics Linking Our Research with Electives (OxPLORE) international network of medical students and trainees. The audit tool measured a hospital's current capacity for children's surgery. Data were analysed firstly to express the percentage of 'essential' criteria met for each specialty. Secondly, the 'OxPLORE method' was used to allocate each hospital specialty a level based on procedures performed and resources available. A User Evaluation Tool (UET) was developed to obtain feedback on the ease of use of the tool. RESULTS The percentage of essential criteria met within each category varied widely between hospitals. The level given to hospitals for subspecialties based on OReCS criteria often did not reflect their self-defined level. The UET indicated the audit tool was practicable across multiple settings. CONCLUSIONS We recommend the use of the OReCS criteria to identify areas for local hospital improvement and inform national children's surgical plans. We have made informed suggestions to increase usability of the OReCS audit tool.
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Affiliation(s)
- Krupa Ravi
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Annabel Killen
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Angus Alexander
- Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, Australia
| | | | | | | | | | | | - Romeo Drabile
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Tshwane, Gauteng Province South Africa
| | | | - Lucila Fernie
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | | | - Emma Hartley
- University of Sydney, The Children’s Hospital at Westmead, Westmead, Australia
- Central Coast Local Health District, New South Wales, Australia
| | - Yolisa N. Hawu
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Pretoria North, Gauteng Province South Africa
| | - Holly Hendron
- Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Patrick Muchunu
- Department of General Surgery, Kiambu County Hospital, Kiambu, Kenya
| | - Alliance Niyukuri
- Mercy Surgeons-Burundi, Research Department, Bujumbura, Burundi
- Hope Africa University Frank-Ogden Medical School, Bujumbura, Burundi
| | - Edmond Ntaganda
- Pediatric Surgery Service, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
| | | | - Josefina Orliacq
- Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Adili Wobenjo
- Kenyatta University, Nairobi County, Kenya
- Department of General Surgery, Kiambu County Hospital, Kiambu, Kenya
| | - Pablo Young
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Kathryn Ford
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, UK
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Room 6607, Level 6, Headington, Oxford, Ox3 9du UK
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Financing Pediatric Surgery: A Provider's Perspective from the Global Initiative for Children's Surgery. World J Surg 2022; 46:1220-1234. [PMID: 35175384 DOI: 10.1007/s00268-022-06463-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Half the world's population is at risk of catastrophic health expenditure (CHE, out-of-pocket spending of more than 10% of annual expenditure) should they require surgery. Protection against CHE is a key indicator of successful health care delivery and has been identified as a priority area by the Global Initiative for Children's Surgery (GICS). Data specific to pediatric surgical patients is limited. This study examines the financial risks for pediatric surgical patients and their families from a provider's perspective. METHODS We surveyed GICS members about the existing financial protection mechanisms and estimated expenditures for their patients. Questions were structured based on the National Surgical, Obstetric and Anesthesia Planning Surgical Indicators and finalized based on multi-institutional consensus between high-income country and low-and middle-income country (LMIC) providers. Chi-squared test, Fisher's exact test and student's t-test were used as appropriate. RESULTS Among 107 respondents, 72.4% were from low income or lower-middle income (LIC/LMIC) countries, and 55.1% were attending or consultant physicians. Families were most likely to decline surgery in LIC/LMIC due to inability to afford treatment (mean Likert = 3.77 ± 1.06). The odds of incurring CHE after children's surgery are up to 17 times greater in LIC/LMIC (P = 0.001, unadjusted OR 17.28, 95%CI 2.13-140.02). Over 50% of families of children undergoing major surgery in these settings face CHE. An estimated 5.1% of providers in LIC/LMIC and 56.2% (P < 0.001) of providers in UMIC/HIC reported that families are able to pay for their direct medical costs with the assistance available to them and were more likely to sell assets (74.4% vs. 33.3%, P = 0.005). CONCLUSION Patients in LMICs are at greater risk for CHE and have less financial risk protection than their HIC counterparts. Given this disparity, intervention is needed to make safe surgery affordable for children worldwide.
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Gray RM, Cronjé L, Kalipa MN, Lee CA, Evans FM. Paediatric anaesthesia care in Africa: challenges and opportunities. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.1.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- RM Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
- Division of Global Surgery, Department of Surgery, University of Cape Town,
South Africa
| | - L Cronjé
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal,
South Africa
| | - MN Kalipa
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria,
South Africa
| | - CA Lee
- Department of Paediatric Anaesthesia, Nelson Mandela Children’s Hospital and Department of Anaesthesiology, University of the Witwatersrand,
South Africa
| | - FM Evans
- Boston Children’s Hospital, Department of Anesthesiology, Critical Care, and Pain Medicine and Harvard Medical School,
United States of America
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Pulvirenti R, Gortan M, Cumba D, Gamba P, Tognon C. Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges. Front Pediatr 2022; 10:908699. [PMID: 35967563 PMCID: PMC9369455 DOI: 10.3389/fped.2022.908699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022] Open
Abstract
Low-middle income countries (LMICs) are currently experiencing an important population growth, leading to a substantial raise in the number of children living in those areas. As a consequence, the existing gap between the need for surgical and anesthetic care and the available therapeutic options will increase. To overcome this, an improvement in the available expertise, infrastructures, and supplies will be mandatory. The implementation of educational and training programs for local healthcare providers should be a top priority. Alongside, the population's awareness on the necessity to seek for medical care should be deployed, together with an eased access to health facilities. Based on the existing literature and our 20-years' experience in humanitarian missions, our article aims to investigate the status of pediatric surgery in LMICs, and the role of western aids in the implementation of this ever-increasing field of expertise.
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Affiliation(s)
- Rebecca Pulvirenti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Marianna Gortan
- Pediatric Surgery Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Dioniso Cumba
- Department of Surgery, Pediatric Hospital of Sao José Em Bor, Bissau, Guinea-Bissau
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Costanza Tognon
- Anesthesiology Pediatric Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
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Analysis of challenges faced and the scientific content of a hybrid pediatric surgical conference arranged during the COVID-19 pandemic. ANNALS OF PEDIATRIC SURGERY 2021; 17:67. [PMID: 34899883 PMCID: PMC8493362 DOI: 10.1186/s43159-021-00135-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Scientific conferences which are considered as an important event for dissemination of research and related academic activities were badly affected during the COVID-19 pandemic. Virtual format for interaction was used as an alternative method to continue such academic discourse. However, this did not provide the same level of communication and interest as that of in-person meetings. With evolving knowledge about the COVID-19 pandemic especially its transmission, role of vaccine, and observing standard operating procedures (SOPs), fear among healthcare providers is mitigated to some extent. Keeping in mind the importance of scientific conferences in the context of sharing knowledge and its impact on the training of faculty members and postgraduate residents, a hybrid conference was planned by the national association of pediatric surgeons.The purpose of this study was to retrospectively review the challenges faced during the organization of this conference as well as to analyze the pattern of registration, number of abstracts received, the gender of the participants and their status, region of the country they represented, type of presentation made, and scientific subject covered. SPSS version 22 was used for data entry. Descriptive and inferential statistics were used to present data. Chi square test was applied to find out the association between categorical variables and a p value < 0.05 was considered as significant. Results A total of 170 pediatric surgeons and postgraduate residents participated from all over the country and abroad. Nearly half (47.1%) of the registrants were postgraduate residents. Most of the participants (90%) opted for in-person attendance. The venue was selected with a capacity to house more than double the number of registrants with provision of safe distance. Availability of face masks, gloves, and sanitizers was ensured by the organizers. Packed meal boxes were arranged and served at the venue site in an open place on the terrace. A total of 97 abstracts were accepted for presentation that included 57 (58.8%) long oral podium and 40 (41.2%) poster presentations. Most of the studies (n=48-49.4%) were related to the subject of gastroenterology including pancreatico-hepatobiliary system and spleen. Majority of the presenters were male (p = 0.046) and postgraduate residents (p = 0.001). Conclusion It was possible to organize a hybrid annual medical conference where most of the participants preferred physical presence. A rich scientific program was made to cater the needs for pediatric surgical fraternity. Residents made attractive presentations. It was noted that physical presence during clinical conference produced effective communication and learning.
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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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28
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Aronson DC. Commentary on bilateral Wilms' tumour: An international comparison of treatments and outcomes. J Pediatr Surg 2021; 56:1494. [PMID: 33573806 DOI: 10.1016/j.jpedsurg.2021.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
This is a commentary on the manuscript titled "Bilateral wilms' tumour: An international comparison of treatments and outcomes" by Drysdale H, Fawkner-Corbett D, Solomon Z, et al.
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Affiliation(s)
- Daniel C Aronson
- Department of Paediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich 8032, Switzerland.
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29
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Biswas SK. The Digital Era and the Future of Pediatric Surgery. J Indian Assoc Pediatr Surg 2021; 26:279-286. [PMID: 34728911 PMCID: PMC8515525 DOI: 10.4103/jiaps.jiaps_136_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
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Wright NJ, Leather AJ, Ade-Ajayi N, Sevdalis N, Davies J, Poenaru D, Ameh E, Ademuyiwa A, Lakhoo K, Smith ER, Douiri A, Elstad M, Sim M, Riboni C, Martinez-Leo B, Akhbari M, Tabiri S, Mitul A, Aziz DAA, Fachin C, Niyukuri A, Arshad M, Ibrahim F, Moitt N, Doheim MF, Thompson H, Ubhi H, Williams I, Hashim S, Philipo GS, Herrera L, Yunus A, Vervoort D, Parker S, Benaskeur YI, Alser OH, Adofo-Ansong N, Alhamid A, Salem HK, Saleh M, Elrais SA, Abukhalaf S, Shinondo P, Nour I, Aydin E, Vaitkiene A, Naranjo K, Dube AM, Ngwenya S, Yacoub MA, Kwasau H, Hyman G, Elghazaly SM, Al-Slaibi I, Hisham I, Franco H, Arbab H, Samad L, Soomro A, Chaudhry MA, Karim S, Khattak MAK, Nah SA, Dimatatac DM, Choo CSC, Maistry N, Mitul AR, Hasan S, Karim S, Yousuf H, Qureshi T, Nour IR, Al-Taher RN, Sarhan OAK, Garcia-Aparicio L, Prat J, Blazquez-Gomez E, Tarrado X, Iriondo M, Bragagnini P, Rite S, Hagander L, Svensson E, Owusu S, Abdul-Mumin A, Bagbio D, Ismavel VA, Miriam A, T S, Anaya Dominguez M, Ivanov M, Serban AM, Derbew M, Elfiky M, Olivos Perez M, Abrunhosa Matias M, Arnaud AP, Negida A, King S, Fazli MR, Hamidi N, Touabti S, Chipalavela RF, Lobos P, Jones B, Ljuhar D, Singer G, Hasan S, Cordonnier A, Jáuregui L, Zvizdic Z, Wong J, St-Louis E, Shu Q, Lui Y, Correa C, Pos L, Alcántara E, Féliz E, Zea-Salazar LE, Ali L, Peycelon M, Anatole NK, Jallow CS, Lindert J, Ghosh D, Adhiwidjaja CF, Tabari AK, Lotfollahzadeh S, Mussein HM, Vatta F, Pasqua N, Kihiko D, Gohil H, Nour IR, Elhadi M, Almada SA, Verkauskas G, Risteski T, Peñarrieta Daher A, Outani O, Hamill J, Lawal T, Mulu J, Yapo B, Saldaña L, Espineda B, Toczewski K, Tuyishime E, Ndayishimiye I, Raboe E, Hammond P, Walker G, Djordjevic I, Chitnis M, Son J, Lee S, Hussien M, Malik S, Ismail EM, Boonthai A, Dahman NBH, Hall N, Castedo Camacho FR, Sobrero H, Butler M, Makhmud A, Novotny N, Hammouri AG, Al-Rayyes M, Bvulani B, Muraveji Q, Murzaie MY, Sherzad A, Haidari SA, Monawar AB, Samadi DAZ, Thiessen J, Venant N, Hospital SI, Jérémie N, Mbonicura JC, Vianney BJM, Tadesse A, Negash S, Roberts CA, Jabang JN, Bah A, Camamra K, Correa A, Sowe B, Gai A, Jaiteh M, Raymond KJ, Mvukiyehe JP, Itangishaka I, Kayibanda E, Manirambona E, Lule J, Costas-Chavarri A, Shyaka Gashugi I, Ndata A, Gasana G, Nezerwa YC, Simeon T, Muragijimana JDD, Rashid S, Msuya D, Elisante J, Solanki M, Manjira E, Lodhia J, Jusabani M, Tarmohamed M, Koipapi S, Souhem T, Sara N, Sihem B, Dania B, Toufik IA, Mounira BNEI, Habiba A, Aragão L, Gonçalves V, Lino Urquizo MM, Varela MF, Mercado P, Horacio B, Damiani A, Mac C, Putruele D, Liljesthrom K, Bernaus M, Jauri C, Cripovich A, Bianchin E, Puig MG, Andreussi L, Iracelay S, Marcos D, Herrera C, Palacios N, Avile R, Serezo B, Montoya D, Cepeda R, Vaquila J, Veronica S, Pardo L, Valeria P, Julio L, Martin AD, Lucio P, Gabriel C, Marianella D, Calderón Arancibia JA, Huespe E, Losa GN, Arancibia Gutiérrez E, Scherl H, Gonzalez DE, Baistrocchi V, Silva Y, Galdeano M, Medard P, Sueiras I, Romero Manteola E, Defago VH, Mieres C, Alberto C, Cornelli F, Molina M, Ravetta P, Patiño Gonzalez CC, Dallegre MB, Szklarz MT, Leyba MF, Rivarola NI, Charras MD, Morales A, Caseb P, Toselli L, Millán C, Junes MDC, Di Siervi O, Gilardi J, Simon S, Contreras CS, Rojas N, Arnoletto LB, Blain OE, Bravo MN, Sanchez N, Herrera Pesara LM, Moreno ME, Sferco CA, Huq U, Ferdousi T, Al-Mamun A, Sultana S, Mahmud R, Mahmud K, Sayeed F, Svirsky A, Sempertegui D, Negrete A, Teran A, Sadagurschi M, Popovic N, Karavdic K, Milisic E, Jonuzi A, Mesic A, Terzic S, Dendusic N, Biber E, Sehic A, Zvizdic N, Letic E, Saracevic A, Hamidovic A, Selak N, Horozic D, Hukic L, Muhic A, Vanis N, Sokolovic E, Sabic A, Becker K, Novochadlo Klüppel E, dos Santos Dias AIB, Agulham MA, Bischoff C, Sabbatini S, Fernandes de Souza R, Souza Machado AB, Werneck Raposo J, da Silva Augusto ML, Martins BM, de Souza Santos Ferreira M, Fernandes de Oliveira D, Silva dos Santos C, Ribeiro de Fernández y Alcázar F, Alves Dutra da Silva É, Furtado M, Tamada H, Silva Ferreira dos Santos M, Lopes de Almeida T, Oliveira de Andrade S, Gurgel do Amaral AC, Sartori Giovanoni L, de Deus Passos Leles K, Corrêa Costa E, Feldens L, Ferraz Schopf L, Soares de Fraga JC, Colombo de Holanda F, Brolin Santis Isolan PM, Loyola Ferreira J, Bruxel CL, Lopes Teixeira Ferdinando D, Zottis Barcelos F, Baseggio N, Knorr Brenner N, Trindade Deyl R, Dure C, Nunes Kist I, Bueno Mazzuca R, Bueno Motter S, Ramos Y, Suzana Trein C, Rezende Rosa B, de Assis Silva M, Menin FA, Semensato Carloni IC, Norberto da Silva JA, Gomes AL, Girão Tauffer M, Bassan Gonçalves PC, Nogueira Marques GM, Moriya E, Labonia C, Carrasco AL, Furtado Meyer K, Farion-Aguiar L, Amado F, Antunes A, Silva E, Telles L, Almeida G, Belmino Gadelha AA, de Azevedo Belesa F, Gonçalves da Cunha, Jr A, Souza Barros B, Zanellato JB, Guimarães P, Silva KID, Ribas B, Reuter C, Casado FT, Correa Leite MT, Testoni D, Guinsburg R, de Campos Vieira Abib S, Khodor Cury E, Dornellas do Nascimento S, Almeida Aguiar A, Melo Gallindo R, Gonçalves Borges C, Liu Y, Duote C, Wang J, Gao Z, Liang L, Luo W, Zhao X, Chen R, Wang P, Han Y, Huang T, Donglai H, Xiaodong G, Junjie C, Zhu L, Wu G, Bao X, Li H, Lv J, Li Z, Yong F, Gao ZC, Bai Q, Tang W, Xie H, Motee J, Zhu J, Wen G, Ruan W, Li S, Chen L, Huang S, Lv Z, Lu J, Huang L, Yu M, Dajia W, Bai YZ, Rincon LC, Mancera J, Alzate Gallego E, Torres-Canchala L, Silva Beltrán N, Osorio Fory G, Castaño Avila D, Forero Ladino AM, Gomez J, Jaramillo M, Morales O, Sanchez B, Tinoco Guzmán NJ, Castañeda Espinosa S, Prieto Vargas O, Pardo LM, Toral E, Cáceres Aucatoma F, Hinostroza D, Valencia S, Salinas V, Landivar Cino E, Ponce Fajardo GY, Astudillo M, Garcia V, Muñoz G, Verduga L, Verduga I, Murillo E, Bucaram E, Guayelema M, Marmol M, Sanchez J, Vergara C, Mena A, Velaña J, Salazar K, Lara S, Chiriboga E, Silva J, Gad D, Samy D, Elsadek MA, Mohammed HM, Abouheba M, Ali KO, Rashwan H, Fawzy OM, Kamel TM, Nemer R, Hassan MA, Falah EH, Abdelhady DS, Zain M, Ibrahim EAA, Elsiraffy OO, Aboelela A, Farag EM, Oshiba AM, Emam OS, Attia AM, Laymouna MA, Ghorab IA, Mohammed MM, Soliman NA, Ghaly KAE, Sadek K, Elsherbiny M, Saleh A, Sheir H, Wafa T, Elmenam MA, Abdelmaksoud S, Reda A, Mansour I, Elzohiri M, Waseem B, Elewaily M, El-Ghazaly M, Elhattab A, Shalaby A, Elsaied A, Adawy A, Sadek M, Ahmed MA, Herdan MO, Elassall GMH, Mohammed AA, Takrouney MH, Essa TM, Mahmoud AM, Saad AM, Fouly MAN, Ibrahim MA, Nageh M, Saad MM, Badr H, Fouda MF, Nofal AH, Almohamady H, Arafa MA, Amad M, Mansour MA, O'Connor J, O'Connor Z, Anatole N, Nkunzimana E, Machemedze S, Dieudonné L, Appeadu-Mensah W, Anyomih TTK, Alhassan P, Abantanga FA, Michael V, Mary Koshy R, Raj A, Kumar V, PT S, Prabhu PS, Vosoughi A, Al-Mayoof AF, Fadhle MJ, Joda AE, Algabri HNO, Al-Taher RN, Abdelhamid SS, Al-Momani HM, Amarin M, Zaghlol LY, Alsaadi NN, Qwaider YZ, Qutishat H, Aliwisat AH, Arabiat E, Bsisu I, Murshidi RM, Jabaiti MS, Bataineh ZA, Abuhayyeh HA, Quran TMA, Za'nouneh FJA, Alebbini MM, Qudah HA, Hussein OG, Murad AM, Amarin JZ, Suradi HH, Alzraikat SH, Omari RY, Matour BM, Al-Halbouni L, Zurikat RO, Yanis AH, Hussein SA, Shoubaki A, Ghanem WH, David K, Chitiavi SW, Mose M, Mugo R, Ndungu J, Mwai T, Shahbal S, Malik J, Chauhan N, Syovata F, Ochieng K, Omendo Liyenzero P, Hussain SR, Mugambi S, Ochieng R, Elkhazmi EOA, Khaled A, Albozidi A, Enbaya MB, Elgammudi M, Soula E, Khalel WIA, Elhajjaji YA, Alwaggaa NA, Ghayth S, Zreeg DA.S, Tantush SA, Bibas F, Layas T, Sharif RAM, Aljadidi WOFS, Tarek A, Ahmed H, Essamilghi KAM, Alfoghi M, Abuhlega MA, Arrmali S, Abduljawad FM, Alosta HM, Abuajaila A, Abdelmutalib F, Bashir F, Almengar I, Annajjar MH, Deyab A, Elzowawi F, Krayem Y, Drah W, Meftah A, Mohammed A, Arrmalli LA, Aljaboo H, Elayeb A, Altomi M, Altaweel A, Tumi M, Bazozi HM, Shaklawoon A, Alglaib MM, Elkaloush AA, Trainba S, Swessi H, Alnaeri A, Shnishah AE, Mustufa H, Gargum SA, Tarniba SA, Shalluf HA, Shokri HA, Sarkaz TL, Tababa O, Elhadi A, Naunova VC, Jovcheski L, Kamilovski M, Gavrilovska-Brzanov A, Latiff ZA, Pauzi SFM, Osman M, Lim F, Bakar AHA, Zaman ASK, Ishak S, Teo R, Qi DTTH, Othman MYB, Zahari DDZB, Hassan ZBM, Shan CH, Lechmiannandan A, Tamaddun HFB, Adanan MFSBM, Abdullah MYB, Junyi W, Nor MTM, Noor WR, Hassan MRB, Dalek NFRA, Hashim HHB, Zarwawi AZB, Vellusamy VMM, Yuen QS, Kannessan HA, Ramli NB, Bujarimin ASB, Anntinea J, Dass A, Khalid HM, Hanifah NABM, Jyun KWY, Razak RBA, Naim NABM, Hamzah SNABH, Vidal CRZ, Bracho Blanchet E, Dávila Perez R, Fernandez Portilla E, Villegas Silva R, Ibarra D, Calderon Moore A, Carrasco-Ortega C, Noguez Castillo M, Herappe Mellado D, Yanowsky Reyes G, Gonzalez Cortez LF, Santana Ortiz R, Orozco Perez J, Corona C.Rivera JR, Cardenas Ruiz Velasco JJ, Quiles Corona M, Peña Padilla C, Bobadilla Morales L, Corona Rivera A, Rios Flores IM, Aranda Sánchez CI, Ambriz-González G, Martínez Hernández Magro N, León Frutos FJ, Cárdenas Barón JDJ, González Ojeda A, Yarza Fernández J, Porras JD, Aguirre-Lopez P, Sánchez Paredes V, Montalvo Marin A, Diaz Gomez JM, Caamal LJ, Bulnes Mendizabal D, Sanchez Valladares P, Garcia Martinez H, Adesanya O, Olanrewaju M, Adegboyega R, Abdulraheem N, Aremo A, Dedeke F, Chukwuemeka ALJ, Mohammad MA, Lawalbarau A, Collins N, Ibukunolu O, Shonubi A, Ladipo-Ajayi O, Elebute OA, Seyi-Olajide J, Alakaloko F, Ihediwa G, Olayade K, Bode C, Ogundoyin O, Olulana DI, Egbuchulem IK, Kumolalo FO, Ulasi I, Ezomike UO, Ekenze SO, Nwankwo EP, Nwangwu EI, Chukwu I, Amah CC, Obianyo NE, Williams O, Osuoji RI, Faboya OM, Ajai OT, Abdulsalam MA, Agboola TH, Temilade BB, Osazuwa M, Salawu MM, Ejinkeonye EC, Yola MM, Mairami AB, Otuneye AT, Igoche M, Tanimola AG, Ajao EA, Agelebe E, Olori S, Mshelbwala PM, Osagie O, Oyinloye A, Abubakar AM, Oyebanji L, Shehu I, Cletus C, Bamanga A, Suleiman F, Adamu S, C.Nwosu D, S.Alkali Y, Jalo I, Rasaki A, T.Sambo Y, A.Mohammed K, M.Ballah A, Modekwe V, Ekwunife OH, Ezidiegwu US, Osuigwe AN, Ugwu JO, Ugwunne CA, Akhter N, Gondal MF, Raza R, Chaudary AR, Ali H, Nisar MU, Jamal MU, Pandit GS, Mumtaz U, Amjad MB, Talat N, Rehman WU, Saleem M, Mirza MB, Hashim I, Haider N, Hameed S, Saleem A, Dogar S, Sharif M, Bashir MK, Naumeri F, Rani Z, Baniowda MA, Ba'baa' B, Hassan MYM, Darwish A, Sehwiel AS, Shehada M, Balousha AG, Ajrami Y, Alzamari AAM, Yaghi B, Al-saleem HSHA, Farha MSA, Abdelhafez MOM, Anaya F, Qadomi AB, Odi AANB, Assi MAF, Sharabati F, Abueideh A, Beshtawi DMS, Arafat H, Khatatba LZA, Abatli SJ, Al-Tammam H, Jaber D, Kayed YIO, Abumunshar AA, Misk RA, Alzeer AMS, Sharabati M, Ghazzawi I, Darras OM, M.Qabaja M, Hajajreh MS, Samarah YA, Yaghi DH, Qunaibi MAF, Mayaleh AA, Joubeh S, Ebeido A, Adawi S, Adawi I, Alqor MOI, Arar AS, Awad H, Abu-Nejmah F, Shabana OS, Alqarajeh F, Alzughayyar TZ, Madieh J, Sbaih MF, Alkareem RMA, Lahlooh RA, Halabi YA, Baker W, Almusleh TFH, Tahyneh AAA, Atatri YYM, Jamie NA, Massry NAA, Lubbad W, A.Nemer A, Alser M, Salha AAS, Alnahhal K, Elmzyyen AM, Ghabayen ATS, Alamrain AAA, Al-Shwaikh SH, Elshaer OA, Shaheen N, Fares J, Dalloul H, Qawwash A, Jayyab MA, Ashour DA, Shaheen AA, Naim SRR, Shiha EA, Dammagh NMA, Almadhoun W, Al-Salhi AA, Hammato AY, Salim JM, Hasanain DK, Alwadia SMS, Nassar I, Al-Attar HM, Alshaikhkhalil HAA, Jamie YMKA, Ashour YS, Alijla SS, Tallaa MAE, Abuattaya AA, Wishah BD, ALDIRAWI MOHAMMEDA, Darwish AS, Alzerei ST, Wishah N, Alijla S, Garcia I, Diaz Echegaray M, Cañapataña Sahuanay VR, Trigoso Mori F, Alvarado Zelada J, Salinas Barreto JJ, Rivera Altamirano P, Torres Miranda C, Anicama Elias R, Rivera Alvarez J, Vasquez Matos JP, Ayque Rosas F, Ledesma Peraza J, Gutarra Palomino A, Vega Centen S, Casquero V, Ortiz Argomedo MR, Lapouble F, Llap Unchón G, Delgado Malaga FP, Ortega Sotelo L, Gamboa Kcomt S, Villalba Villalba A, Mendoza Leon NR, Cardenas Alva LR, Loo Neyra MS, Alanguia Chipana CL, Torres Picón CMDJ, Huaytalla Quiroz N, Dominguez D, Segura Calle C, Arauco J, Ormeño Calderón L, Ghilardi Silva X, Fernandez Wilson MD, Gutierrez Maldonado JE, Diaz Leon C, Berrocal Anaya W, Chavez Galvez P, Aguilar Gargurevich PP, Diaz Castañeda FDM, Guisse C, Ramos Paredes E, Apaza Leon JL, Aguilar Aguilar F, Ramirez De La Cruz R, Flores Carbajal L, Mendoza Chiroque C, Sulca Cruzado GJ, Tovar Gutierrez N, Sotelo Sanchez J, Paz Soldan C, Hernández Córdova K, Delgado Quinteros EF, Brito Quevedo LM, Mendoza Oviedo JJ, Samanez Obeso A, Paredes Espinoza P, de Guzman J, Yu R, Cosoreanu V, Ionescu S, Mironescu A, Vida L, Papa A, Verdeata R, Gavrila B, Muntean L, Lukac M, Stojanovic M, Toplicic D, Slavkovic M, Slavkovi A, Zivanovic D, Kostic A, Raicevic M, Nkuliza D, Sidler D, Vos CD, Merwe EV, Tasker D, Khamag O, Rengura C, Siyotula T, Jooma U, Delft DV, Arnold M, Mangray H, Harilal S, Madziba S, Wijekoon N, Gamage T, Bright BP, Abdulrahman A, Mohammed OAA, Salah M, Ajwa AEA, Morjan M, Batal MM, Faks V, Mouti MB, Assi A, Al-Mouakeh A, Tarabishi AS, Aljarad Z, Alhamid A, Khorana J, Poocharoen W, Liukitithara S, Sriniworn A, Nuntasunti W, Ngerncham M, Phannua R, Thaiwatcharamas K, Tanming P, Sahnoun L, Kchiche N, Abdelmoumen R, Eroğlu E, Ozen MA, Cömert HSY, İmamoğlu M, Sarıhan H, Kader Ş, Mutlu M, Aslan Y, Beşir A, Geze Ş, Çekiç B, Yalcinkaya A, Sönmez K, Karabulut R, Türkyılmaz Z, Şeref K, Altın M, Aykut M, Akan M, Erdem M, Ergenekon E, Türkyılmaz C, Keleş E, Canözer A, Yeniay AÖ, Eren E, Cesur İB, Özçelik Z, Kurt G, Mert MK, Kaya H, Çelik M, Karakus SC, Erturk N, Suzen A, Hakan N, Akova F, Pasaoglu M, Eshkabilov S, Yuldashev RZ, Abdunomonovich DA, Muslimovich AM, Patel A, Kapihya C, Ensar N, Nataraja RM, Sivasubramaniam M, Jones M, Teague W, Tanny ST, Thomas G, Roberts K, Venkatraman SS, Till H, Pigeolet M, Dassonville M, Shikha A, Win WSP, Ahmad ZAH, Meloche-Dumas L, Caouette-Laberge L, St-Vil D, Aspirot A, Piché N, Joharifard S, Safa N, Laberge JM, Emil S, Puligandla P, Shaw K, Wissanji H, Duggan E, Guadagno E, Puentes MC, Leal PO, Mendez Benavente C, Rygl M, Trojanová B, Berková K, Racková T, Planka L, Škvařil J, Štichhauer R, Sabti S, Macdonald A, Bouhadiba N, Kufeji D, Pardy C, Mccluney S, Keshtgar A, Roberts R, Rhodes H, Burns K, Garrett-Cox R, Ford K, Cornwall H, Ravi K, Arthur F, Losty P, Lander T, Jester I, Arul S, Gee O, Soccorso G, Singh M, Pachl M, Martin B, Alzubair A, Kelay A, Sutcliffe J, Middleton T, Thomas AH, Kurian M, Cameron F, Sivaraj J, Thomas MC, Rex D, Jones C, Bradshaw K, Bonnard A, Delforge X, Duchesne C, Gall CL, Defert C, Laraqui Hossini S, Guerin F, Hery G, Fouquet-Languillat V, Kohaut J, Broch A, Blanc T, Harper L, Delefortrie T, Ballouhey Q, Fourcade L, Grosos C, Parmentier B, Levard G, Grella MG, Renaux Petel M, Grynberg L, Abbo O, Mouttalib S, Juricic M, Scalabre A, Haraux E, Rissmann A, Krause H, Goebel P, Patzer L, Rolle U, Schmedding A, Antunez-Mora A, Tillig B, Bismarck SV, Barbosa PR, Knorr C, Stark D, Brunero M, Avolio L, Manni F, Molinelli M, Guazzotti M, Raffaele A, Romano PG, Cavaiuolo S, Parigi GB, Juhasz L, Rieth A, Strumila A, Dagilytė R, Liubsys A, Gurskas P, Malcius D, Mikneviciute A, Vinskaite A, Barauskas V, Vierboom L, Hall T, Beasley S, Goddard L, Stringer M, Weeratunga N, Adams S, Cama J, Wong M, Jayaratnam S, Kukkady A, Samarakkody U, Gerus S, Patkowski D, Wolny A, Koszutski T, Tobor S, Osowicka M, Czauderna P, Wyrzykowski D, Garnier H, Anzelewicz S, Marta O, Knurowska A, Weiszewsk A, Grabowski A, Korlacki W, Pasierbek M, Wolak P, Piotrowska A, Roszkiewicz A, Kalicińsk P, Trypens A, Kowalewsk G, Sigalet D, Alsaied A, Ali M, Alsaggaf A, Ghallab A, Owiwi Y, Zeinelabdeen A, Fayez M, Atta A, Zidan M, Radwan AS, Shalaby H, Abdelbaqi R, Alattas K, Kano Y, Sindi O, Alshehri A, Altokhais T, Alturki F, Almosaibli M, Krisanova D, Abbas W, Yang HB, Kim HY, Youn JK, Chung JH, Cho SH, Hwang IJ, Lee JY, Song ES, Arboleda J, Ruiz de Temiño Bravo M, Siles Hinojosa A, García M, Casal Beloy I, Oliu San Miguel D, Molina Vazquez ME, Alonso V, Sanchez A, Gomez O, Carrillo I, Wester T, Mesas Burgos C, Hagander L, Salö M, Omling E, Rudolfson N, Granéli C, Arnadóttir H, Grottling E, Abrahamsson K, Gatzinsky V, Dellenmark Blom M, Borbonet D, Puglia P, Jimenez Morejon V, Acuna G, Moraes M, Chan J, Brahmamdam P, Tom A, Sherer K, Gonzales B, Cunningham A, Krishnaswami S, Baertschiger R, Leech M, Williams R, Camp L, Gosain A, Mora M, Lyttle BD, Chang J, McColl Makepeace L, Fowler KL, Mansfield S, Hodgman E, Amaechi C, Beres A, Pernik MN, Dosselman LJ, Almasri M, Jain S, Modi V, Fernandez Ferrer M, Coon J, Gonzalez J, Honhar M, Ruzgar N, Coghill G, Ullrich S, Cheung M, Løfberg K, Greenberg J, Davenport K, Gadepalli S, Fox S, Johnson S, Pilkington M, Hamilton A, Lin N, Sola J, Yao Y, Davis JK, Langer M, Vacek J, Abdullah F, Khlevner J, Middlesworth W, Levitt M, Ahmad H, Siddiqui SM, Bowder A, Derks T, Amoabin AA, Pinar B, Owusu-Sekyere F, Saousen B, Naidoo R, Karamustafic A, Oliveira DPD, Motter SB, Andrade J, Šafus A, Langley J, Wilke A, Deya C, Murtadi HM, Berzanskis M, Calistus N, Ajiboye OS, Felix M, Olabisi OO, Erçin S, Muradi T, Burks SS, Lerma S, Jacobson J, Calancea C, Valerio-Vazquez R, Sikwete G, Sekyere O, Mbonisweni A, Syed S, Hyeon CS, Pajouhandeh F, Kunfah SMP. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet 2021; 398:325-339. [PMID: 34270932 PMCID: PMC8314066 DOI: 10.1016/s0140-6736(21)00767-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. METHODS We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FINDINGS We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2·8 kg (2·3-3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88-4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59-2·79], p<0·0001), sepsis at presentation (1·20 [1·04-1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1·82 [1·40-2·35], p<0·0001; ASA 3 vs ASA 1-2, 1·58, [1·30-1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02-1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41-2·71], p=0·0001; parenteral nutrition 1·35, [1·05-1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47-0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50-0·86], p=0·0024) or percutaneous central line (0·69 [0·48-1·00], p=0·049) were associated with lower mortality. INTERPRETATION Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. FUNDING Wellcome Trust.
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Stokes SC, Farmer DL. Paediatric surgery for congenital anomalies: the next frontier for global health. Lancet 2021; 398:280-281. [PMID: 34270931 DOI: 10.1016/s0140-6736(21)01547-6] [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] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Sarah C Stokes
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - Diana L Farmer
- Division of Pediatric General, Thoracic and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA; Shriners Hospital for Children-Northern California, Sacramento, CA, USA.
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Tsang VWL, Luo LH, Kisa P, Blair GK. Ten Global Surgical Care Statements for Children: examining our commitment to the future. Pediatr Surg Int 2021; 37:957-964. [PMID: 33689002 DOI: 10.1007/s00383-021-04875-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lack of access to essential surgery for many of our world's children is a global health crisis. A third of all deaths in the pediatric population are due to surgical conditions. In low- and middle-income countries, an average of nine in ten children lack access to basic surgical care. METHODS This review examines ten commitment statements ratified by numerous global pediatric surgical organizations aimed at addressing existing gaps in global surgical care for children. They are substantiated by a review of literature and represent over-arching principles. RESULTS They prompt the recognition of childhood surgical disease as a global health priority and advocate for availability to safe surgical and anesthetic care. Calls to action highlight the importance of capacity building in the areas of education, data gathering, workforce, research, and international collaborations. DISCUSSION Eventually, there is the hope for widespread approval of the guiding principles they represent and that the statements themselves, as encapsulations of these beliefs, may act as a continued call for advocacy and action for the necessary work, resources, and funding to mitigate global pediatric surgical disparities.
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Affiliation(s)
- Vivian W L Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Lerly H Luo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Phyllis Kisa
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Geoffrey K Blair
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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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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Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals. Surgery 2021; 170:1397-1404. [PMID: 34130809 DOI: 10.1016/j.surg.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Significant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children's surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity. METHODS Two years of a prospective clinical database of children's surgery admissions at 2 regional referral hospitals in Uganda were reviewed. Primary outcomes included case volume and clinical outcomes of children at each hospital. Additionally, the disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Using a value of statistical life calculation, we also estimated the economic benefit of the pediatric surgical care currently being delivered. RESULTS From 2016 to 2019, more than 300 surgical procedures were performed at each hospital per year. The majority of cases were standard general surgery cases including hernia repairs and intussusception as well as procedures for surgical infections and trauma. In-hospital mortality was 2.4% in Soroti and 1% in Lacor. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted life-years averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society. CONCLUSION This investigation demonstrates that lifesaving pediatric procedures are safely performed by general surgeons in Uganda. General surgeons who perform pediatric surgery significantly increase surgical access to rural regions of the country and add a large economic benefit to Ugandan society. Overall, the results of the study support increasing pediatric surgical capacity in rural areas of low- and middle-income countries through support and training of general surgeons and anesthesia providers.
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Potentially Avertable Child Mortality Associated with Surgical Workforce Scale-up in Low- and Middle-Income Countries: A Global Study. World J Surg 2021; 45:2643-2652. [PMID: 34110458 DOI: 10.1007/s00268-021-06181-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Expansion of access to surgical care can improve health outcomes, although the impact that scale-up of the surgical workforce will have on child mortality is poorly defined. In this study, we estimate the number of child deaths potentially avertable by increasing the surgical workforce globally to meet targets proposed by the Lancet Commission on Global Surgery. METHODS To estimate the number of deaths potentially avertable through increases in the surgical workforce, we used log-linear regression to model the association between surgeon, anesthetist and obstetrician workforce (SAO) density and surgically amenable under-5 mortality rate (U5MR), infant mortality rate (IMR), and neonatal mortality rate (NMR) for 192 countries adjusting for potential confounders of childhood mortality, including the non-surgical workforce (physicians, nurses/midwives, community health workers), gross national income per capita, poverty rate, female literacy rate, health expenditure per capita, percentage of urban population, number of surgical operations, and hospital bed density. Surgically amenable mortality was determined using mortality estimates from the UN Inter-agency Group for Child Mortality Estimation adjusted by the proportion of deaths in each country due to communicable causes unlikely to be amenable to surgical care. Estimates of mortality reduction due to upscaling surgical care to support the Lancet Commission on Global Surgery (LCoGS) minimum target of 20-40 SAO/100,000 were calculated accounting for potential increases in surgical volume associated with surgical workforce expansion. RESULTS Increasing SAO workforce density was independently associated with lower surgically amenable U5MR as well as NMR (p < 0.01 for each model). When accounting for concomitant increases in surgical volume, scale-up of the surgical workforce to 20-40 SAO/100,000 could potentially prevent between 262,709 (95% CI 229,643-295,434) and 519,629 (465,046-573,919) under 5 deaths annually. The majority (61%) of deaths averted would be neonatal deaths. CONCLUSION Scale up of surgical workforce may substantially decrease childhood mortality rates around the world. Our analysis suggests that scale-up of surgical delivery through increase in the SAO workforce could prevent over 500,000 children from dying before the age of 5 annually. This would represent significant progress toward meeting global child mortality reduction targets.
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Tchervenkov CI, Herbst C, Jacobs JP, Al-Halees Z, Edwin F, Dearani JA, Finucane K, Sandoval N, Sarris GE, Fragata J, Abdulgani HB, Arboleda M, Bacha EA, Barron DJ, Becker P, Boumzebra D, Cervantes J, Elgamal A, Helvind MH, Iyer KS, Jatene MB, Jun TG, Kirklin JK, Kreutzer C, Lee C, Lotto AA, Manuel V, Maruszewski B, Najm H, Overman D, Rahmat B, Reddy D, Sakamoto K, Samankatiwat P, Sivalingam S, St Louis JD, Stellin G, Stephens EH, Tretter JT, Truong NLT, Tweddell JS, Vida V, Vosloo S, Zhang H, Zheleva B, Jonas RA. Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2021; 12:394-405. [PMID: 33942697 DOI: 10.1177/21501351211003520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.
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Affiliation(s)
- Christo I Tchervenkov
- Division of Cardiovascular Surgery, 10040The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Claudia Herbst
- Department of Cardiac Surgery, Pediatric Cardiac Surgery, 27271Medical University of Vienna, Austria
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, USA
| | - Zohair Al-Halees
- Heart Center, 37852King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Frank Edwin
- National Cardiothoracic Centre, Accra, Ghana.,University of Health and Allied Sciences, Ho, Ghana
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nestor Sandoval
- Department of Cardiac Surgery, Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota, Colombia
| | | | - Jose Fragata
- Cardiothoracic Surgery, Santa Marta Hospital, NOVA Medical School, Lisbon, Portugal
| | | | - Miguel Arboleda
- Pediatric Cardiovascular Surgery, Instituto Nacional Cardiovascular (INCOR), Lima, Peru
| | - Emile A Bacha
- Department of Surgery, Section of Pediatric and Congenital Heart Surgery, Columbia University New York-Presbyterian/Morgan Stanley Children's Hospital, New York, NY, USA
| | - David J Barron
- Pediatric Cardiac Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pedro Becker
- Cardiovascular Surgery, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Drissi Boumzebra
- Cardiovascular Surgery Unit, Mohamed VI University Hospital, Marrakech, Morocco
| | - Jorge Cervantes
- Department of Pediatric Cardiac and Congenital Heart Surgery, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Adel Elgamal
- Congenital and Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Morten H Helvind
- Department of Congenital Heart Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | - Krishna S Iyer
- Pediatric & Congenital Heart Surgery, Fortis-Escorts Heart Institute, New Delhi, India
| | | | | | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, AL, USA
| | - Christian Kreutzer
- Division of Pediatric Cardiovascular Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Attilio A Lotto
- Pediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Valdano Manuel
- Cardiovascular Surgery, Clinica Girassol, Luanda, Angola
| | - Bohdan Maruszewski
- Pediatric Cardiothoracic Surgery Department, Children's Memorial Health Institute, Warsaw, Poland
| | - Hani Najm
- Division of Cardiovascular Surgery, Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - David Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA
| | - Budi Rahmat
- Pediatric and Congenital Heart Surgery Division, National Cardiovascular Center, Harapan Kita, Jakarta, Indonesia
| | - Darshan Reddy
- Lenmed Ethekwini Hospital and Heart Centre, Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mount Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Piya Samankatiwat
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sivakumar Sivalingam
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - James D St Louis
- Departments of Surgery and Pediatrics, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | | | - Justin T Tretter
- Department of Pediatrics, University of Cincinnati College of Medicine, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nguyen Ly Thinh Truong
- Department of Cardiovascular Surgery, Children's Heart Center, National Children's Hospital, Hanoi, Vietnam
| | - James S Tweddell
- Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical, Cincinnati, OH, USA
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Susan Vosloo
- Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - Hao Zhang
- Shanghai Children's Medical Center and National Medical Center, Shanghai, China
| | | | - Richard A Jonas
- Cardiac Surgery, Center for Neuroscience Research, Children's National Hospital, Washington, DC, USA
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Olatunji RB, Akinmoladun JA, Atalabi OM. Capacity for paediatric radiology in Nigeria: a survey of radiologists. Pediatr Radiol 2021; 51:587-591. [PMID: 31996937 DOI: 10.1007/s00247-019-04610-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/16/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Children account for nearly half the population of Nigeria yet the capacity for effective imaging of children is unknown. In order to determine clinical resources for and challenges of paediatric radiology in Nigeria, certified radiologists at an exit examination in radiology for resident doctors, and resident doctors in radiology attending an update course, completed a semi-structured questionnaire detailing personal information, radiology training, practice and perceived priorities of paediatric radiology in Nigeria. Of 100 questionnaires, 80 were returned, completed (80%) by 46 (58%) certified radiologists, 14 (18%) senior and 20 (25%) junior radiology residents. Only 1 (2.2%) certified radiologist received dedicated albeit short training in paediatric radiology. Nine (20.0%) certified radiologists and 1 (2.9%) resident doctor target their practice to paediatric imaging. Only 2 (4.4%) certified radiologists devote at least half of their time to paediatric radiology. Forty-two (91%) of the certified radiologists are not aware of any radiologist primarily affiliated with a dedicated children's hospital or who practices in a dedicated paediatric unit of a mixed hospital. Eight (19%) radiologists work in a facility with a consultant who has some training in paediatric radiology. Surgeons (64%), neonatologists (53%) and neurologists (45%) were the other paediatric specialties usually available where the respondent works. Fourteen (4.9%), 4 (2.1%), and 1 (1.3%) ultrasound, X-ray and magnetic resonance imaging (MRI) units, respectively, were reserved for paediatric imaging while no fluoroscopy or computed tomography (CT) unit was dedicated to children. Lack of dedicated equipment (44%) and trained paediatric radiologists (24%) were the main challenges to paediatric imaging as perceived by the respondents. Substantial deficits in human and material resources require informed investment in dedicated equipment and training to boost capacity for paediatric radiology in Nigeria.
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Affiliation(s)
- Richard B Olatunji
- Department of Radiology, College of Medicine, University College Hospital, University of Ibadan, PMB 5116, Ibadan, 200212, Nigeria.
| | - Janet A Akinmoladun
- Department of Radiology, College of Medicine, University College Hospital, University of Ibadan, PMB 5116, Ibadan, 200212, Nigeria
| | - Omolola M Atalabi
- Department of Radiology, College of Medicine, University College Hospital, University of Ibadan, PMB 5116, Ibadan, 200212, Nigeria
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Abstract
Introduction: Global surgical care is increasingly recognized in the global health agenda and requires multidisciplinary engagement. Despite high interest among medical students, residents and other learners, many surgical faculty and health experts remain uniformed about global surgical care. Methods: We have operated an interdisciplinary graduate-level course in Global Surgical Care based on didactics and interactive group learning. Students completed a pre- and post-course survey regarding their learning experiences and results were analyzed using the Wilcoxon signed-rank test. Results: Fourteen students completed the pre-course survey, and 11 completed the post-course survey. Eleven students (79%) were enrolled in a Master’s degree program in global health, with eight students (57%) planning to attend medical school. The median ranking of surgery on the global health agenda was fifth at the beginning of the course and third at the conclusion (p = 0.11). Non-infectious disease priorities tended to stay the same or increase in rank from pre- to post-course. Infectious disease priorities tended to decrease in rank (HIV/AIDS, p = 0.07; malaria, p = 0.02; neglected infectious disease, p = 0.3). Students reported that their understanding of global health (p = 0.03), global surgery (p = 0.001) and challenges faced by the underserved (p = 0.03) improved during the course. When asked if surgery was an indispensable part of healthcare, before the course 64% of students strongly agreed, while after the course 91% of students strongly agreed (p = 0.3). Students reported that the interactive nature of the course strengthened their skills in collaborative problem-solving. Conclusions: We describe an interdisciplinary global surgery course that integrates didactics with team-based projects. Students appeared to learn core topics and held a different view of global surgery after the course. Similar courses in global surgery can educate clinicians and other stakeholders about strategies for building healthy surgical systems worldwide.
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Bergkvist E, Zimunhu T, Mbanje C, Hagander L, Muguti GI. Nutritional status and outcome of surgery: A prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe. J Pediatr Surg 2021; 56:368-373. [PMID: 33131772 DOI: 10.1016/j.jpedsurg.2020.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Undernutrition contributes to nearly 50% of all child deaths in the world, yet there is conflicting evidence regarding the association between nutritional status and postoperative complications. The aim was to describe the preoperative nutritional status among pediatric surgery patients in Zimbabwe, and to assess if nutritional status was a risk factor for adverse postoperative outcome of mortality, surgical site infection, reoperation, readmission, and longer length of stay. METHODS This prospective observational cohort study included 136 children undergoing surgery at a tertiary pediatric hospital in Zimbabwe. Nutritional status was standardized using Z-scores for BMI, length, weight, and middle upper arm circumference. Primary outcomes after 30 days included mortality, surgical site infection, reoperation, and readmission. Secondary outcome was length of stay. Univariate and multivariable analyses with logistic regression were performed. RESULTS Of the 136 patients, 31% were undernourished. Postoperative adverse outcome occurred in 20%; the mortality rate was 6%, the surgical site infection rate was 17%, the reoperation rate was 3.5%, and readmission rate was 2.5%. Nutritional status, higher ASA classification, major surgical procedures, and lower preoperative hemoglobin levels were associated with adverse outcome. Univariate logistic regression identified a seven-fold increased risk of postoperative complications among undernourished children (OR 7.3 [2.3-22.8], p = 0.001), and there was a four- to six-fold increased adjusted risk after adjustment for ASA, major surgery, and preoperative hemoglobin. CONCLUSION A third of all pediatric surgery patients were undernourished, and undernourished children had a considerably higher risk of adverse outcome. With a positive correlation identified between undernourishment and increased postoperative complications, future aims would include assessing if preoperative nutritional treatment could be especially beneficial for undernourished children. LEVELS OF EVIDENCE Level II treatment study.
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Affiliation(s)
- Emil Bergkvist
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Taurai Zimunhu
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Chenesa Mbanje
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa
| | - Lars Hagander
- Pediatric surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - G I Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe, Africa.
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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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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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Niyikuri A, Smith ER, Vervoort D, Shrime MG, Brown S, Peters AW, Yamey G, Makasa E. Top 10 Resources in Global Surgery. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:606-611. [PMID: 33008867 PMCID: PMC7541111 DOI: 10.9745/ghsp-d-20-00050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022]
Abstract
This resource list could serve to orient those interested in global surgery and could be supplemented with resources advocating for global surgery from clinical, population health, or policy perspectives.
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Affiliation(s)
- Alliance Niyikuri
- Frank Ogden Medical School, Hope Africa University, Bujumbura, Burundi
| | - 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, Waco, TX, USA
| | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Stav Brown
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Emmanuel Makasa
- Cabinet Office, Government of the Republic of Zambia, Lusaka, Zambia.,Department of Surgery, School of Medicine, University of Witwatersrand, Johannesburg, South Africa
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Pelizzo G, Bagolan P, Morini F, Aceti M, Alberti D, Andermarcher M, Avolio L, Bartoli F, Briganti V, Cacciaguerra S, Camoglio FS, Ceccarelli P, Cheli M, Chiarenza F, Ciardini E, Cimador M, Clemente E, Cozzi DA, Dall' Oglio L, De Luca U, Del Rossi C, Esposito C, Falchetti D, Federici S, Gamba P, Gentilino V, Mattioli G, Martino A, Messina M, Noccioli B, Inserra A, Lelli Chiesa P, Leva E, Licciardi F, Midrio P, Nobili M, Papparella A, Paradies G, Piazza G, Pini Prato A, Rossi F, Riccipetitoni G, Romeo C, Salerno D, Settimi A, Schleef J, Milazzo M, Calcaterra V, Lima M. Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery. Ital J Pediatr 2020; 46:134. [PMID: 32938472 PMCID: PMC7493058 DOI: 10.1186/s13052-020-00889-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy. Methods A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units. Results The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern <Northern<Central, p < 0.03). The most frequent clinical characteristics of neonates was preterm neonates with birthweight < 1200 g, with cardiorespiratory instability and/or ventilatory dependence. The most frequently selected indications to surgery were pneumothorax, pleural effusion, pericardial effusion, central venous catheter (CVC) positioning, intestinal perforation, patent ductus arteriosus ligation and congenital diaphragmatic hernia. More than 60% of respondents report no institutional recommendations and dedicated informed consent on bedside surgical procedures. The lack of dedicated areas and infrastructures is considered a relative contraindication to the performance of bedside surgery. Conclusion Bedside surgery is performed in the majority of the Italian pediatric surgery centers included in this census. The introduction of a national set of surgery guidelines would be widely welcomed.
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Affiliation(s)
- Gloria Pelizzo
- Department of Paediatric Surgery, Ospedale dei Bambini "V. Buzzi" Children's Hospital, University of Milano, Milano, Italy.
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Morini
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Daniele Alberti
- Department of Pediatric Surgery, Spedali Civili and University of Brescia, Brescia, Italy
| | | | - Luigi Avolio
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Fabio Bartoli
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Maurizio Cheli
- Department of Pediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Enrico Ciardini
- Pediatric Surgery Unit, Ospedale Santa Chiara, Trento, Italy
| | - Marcello Cimador
- Pediatric Urology Unit, Department PRO.MI.SE, University of Palermo, Palermo, Italy
| | - Ennio Clemente
- Pediatric Surgery Unit, University of Salerno, Salerno, Italy
| | - Denis A Cozzi
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - Luigi Dall' Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy
| | - Ugo De Luca
- Day Surgery Unit, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmine Del Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II Hospital, University of Naples, Naples, Italy
| | - Diego Falchetti
- Pediatric Surgery Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo Del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, G. Gaslini Children's Hospital, University of Genoa, Genoa, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnico delle Marche University, Ancona, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Alessandro Inserra
- Surgical Oncology Unit, Department of Surgery, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Paola Midrio
- Pediatric Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | - Alfonso Papparella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Piazza
- Pediatric Surgery Unit, Sant'Antonio Abate Hospital, Trapani, Italy
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Rossi
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità , Novara, Italy
| | - Giovanna Riccipetitoni
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Carmelo Romeo
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Messina, Italy
| | - Domenico Salerno
- Pediatric Surgery Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Alessandro Settimi
- Pediatric Surgery Unit, Federico II Hospital, University of Naples , Naples, Italy
| | - Jurgen Schleef
- Department of Pediatric Surgery, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Mario Milazzo
- Pediatric Surgery Unit, Ospedale del Bambini "G. Di Cristina", ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia and Pediatric Unit V. Buzzi Children's Hospital, Milan, Italy
| | - Mario Lima
- Department of Pediatric Surgery, University of Bologna, Bologna, Italy
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Onyia CU, Ojo OA. Collaborative International Neurosurgery Education for Africa–The Journey So Far and the Way Forward. World Neurosurg 2020; 141:e566-e575. [DOI: 10.1016/j.wneu.2020.05.242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
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Goley SM, Sakula-Barry S, Adofo-Ansong N, Isaaya Ntawunga L, Tekyiwa Botchway M, Kelly AH, Wright N. Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2020; 4:e000684. [PMID: 32864479 PMCID: PMC7443309 DOI: 10.1136/bmjpo-2020-000684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of under-5 mortality globally. The greatest burden is faced by those in low/middle-income countries (LMICs), where over 95% of deaths occur. Many of these deaths may be preventable through antenatal diagnosis and early intervention. This systematic literature review investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in LMICs. METHODS A systematic literature review was conducted using three search strings: (1) structural congenital anomalies; (2) LMICs; and (3) antenatal diagnosis. The search was conducted on the following databases: Medline, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening was undertaken in duplicate by two reviewers independently. Consensus among the wider authorship was sought for discrepancies. The primary analysis focused on the availability and effectiveness of antenatal ultrasound for diagnosing structural congenital anomalies. Secondary outcomes included neonatal morbidity and mortality, termination rates, referral rates for further antenatal care and training level of the ultrasonographer. Relevant policy data were sought. RESULTS The search produced 4062 articles; 97 were included in the review. The median percentage of women receiving an antenatal ultrasound examination was 50.0% in African studies and 90.7% in Asian studies (range 6.8%-98.8%). Median detection rates were: 16.7% Africa, 34.3% South America, 34.7% Asia and 47.3% Europe (range 0%-100%). The training level of the ultrasound provider may affect detection rates. Four articles compared morbidity and mortality outcomes, with inconclusive results. Significant variations in termination rates were found (0%-98.3%). No articles addressed referral rates. CONCLUSION Antenatal detection of congenital anomalies remains highly variable across LMICs and is particularly low in sub-Saharan Africa. Further research is required to investigate the role of antenatal diagnosis for improving survival from congenital anomalies in LMICs. PROSPERO REGISTRATION NUMBER CRD42019105620.
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Affiliation(s)
| | | | - Nana Adofo-Ansong
- Department of Paediatrics, Mafikeng Provincial Hospital, Mafikeng, South Africa
| | | | - Maame Tekyiwa Botchway
- Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Ann Horton Kelly
- Department of Global Health & Social Medicine, King’s College London, London, UK
| | - Naomi Wright
- King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
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Othman MY, Blair S, Nah SA, Ariffin H, Assanasen C, Soh SY, Jacobsen AS, Lam C, Loh AHP. Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia. JCO Glob Oncol 2020; 6:1328-1345. [PMID: 32886560 PMCID: PMC7529532 DOI: 10.1200/go.20.00284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs. METHODS Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. RESULTS In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs (P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported > 50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers. CONCLUSION This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- Department of Pediatric Surgery, Hospital Tunku Azizah (Women’s and Children’s Hospital), Kuala Lumpur, Malaysia
| | - Sally Blair
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, National University of Singapore, Singapore
| | - Shireen A. Nah
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Ariffin
- Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chatchawin Assanasen
- Vietnam Pediatric Hematology Oncology Programme, Ho Chi Minh City, Vietnam
- Southeast Asia Pediatric Hematology Oncology, Division of Hematology/Oncology Department of Pediatrics, UT Health San Antonio, San Antonio, TX
| | - Shui Yen Soh
- Haematology/Oncology Service, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
| | - Anette S. Jacobsen
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
| | - Catherine Lam
- St Jude Global, St Jude Children’s Research Hospital, Memphis, TN
| | - Amos H. P. Loh
- Department of Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore
- SingHealth-Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
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Arivoli M, Biswas A, Burroughs N, Wilson P, Salzman C, Kakembo N, Mugaga J, Ssekitoleko RT, Saterbak A, Fitzgerald TN. Multidisciplinary Development of a Low-Cost Gastroschisis Silo for Use in Sub-Saharan Africa. J Surg Res 2020; 255:565-574. [PMID: 32645490 DOI: 10.1016/j.jss.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/01/2020] [Accepted: 05/03/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Gastroschisis silos are often unavailable in sub-Saharan Africa (SSA), contributing to high mortality. We describe a collaboration between engineers and surgeons in the United States and Uganda to develop a silo from locally available materials. METHODS Design criteria included the following: < $5 cost, 5 ± 0.25 cm opening diameter, deformability of the opening construct, ≥ 500 mL volume, ≥ 30 N tensile strength, no statistical difference in the leakage rate between the low-cost silo and preformed silo, ease of manufacturing, and reusability. Pugh scoring matrices were used to assess designs. Materials considered included the following: urine collection bags, intravenous bags, or zipper storage bags for the silo and female condom rings or O-rings for the silo opening construct. Silos were assembled with clothing irons and sewn with thread. Colleagues in Uganda, Malawi, Tanzania, and Kenya investigated material cost and availability. RESULTS Urine collection bags and female condom rings were chosen as the most accessible materials. Silos were estimated to cost < $1 in SSA. Silos yielded a diameter of 5.01 ± 0.11 cm and a volume of 675 ± 7 mL. The iron + sewn seal, sewn seal, and ironed seal on the silos yielded tensile strengths of 31.1 ± 5.3 N, 30.1 ± 2.9 N, and 14.7 ± 2.4 N, respectively, compared with the seal of the current standard-of-care silo of 41.8 ± 6.1 N. The low-cost silos had comparable leakage rates along the opening and along the seal with the spring-loaded preformed silo. The silos were easily constructed by biomedical engineering students within 15 min. All silos were able to be sterilized by submersion. CONCLUSIONS A low-cost gastroschisis silo was constructed from materials locally available in SSA. Further in vivo and clinical studies are needed to determine if mortality can be improved with this design.
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Affiliation(s)
| | - Arushi Biswas
- Pratt School of Engineering, Duke University, Durham, North Carolina
| | - Nolan Burroughs
- Pratt School of Engineering, Duke University, Durham, North Carolina
| | - Patrick Wilson
- Pratt School of Engineering, Duke University, Durham, North Carolina
| | - Caroline Salzman
- Pratt School of Engineering, Duke University, Durham, North Carolina
| | - Nasser Kakembo
- Department of Surgery, Makerere University, Kampala, Uganda
| | - Julius Mugaga
- Makerere University College of Health Sciences, Kampala, Uganda; Duke-Makerere University Biomedical Engineering Partnership, Durham, North Carolina and Kampala, Uganda
| | - Robert T Ssekitoleko
- Makerere University College of Health Sciences, Kampala, Uganda; Duke-Makerere University Biomedical Engineering Partnership, Durham, North Carolina and Kampala, Uganda
| | - Ann Saterbak
- Pratt School of Engineering, Duke University, Durham, North Carolina; Duke-Makerere University Biomedical Engineering Partnership, Durham, North Carolina and Kampala, Uganda
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina.
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50
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Wasserman I, Peters AW, Roa L, Amanullah F, Samad L. Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:183-189. [PMID: 32606090 PMCID: PMC7326524 DOI: 10.9745/ghsp-d-20-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/19/2020] [Indexed: 01/17/2023]
Abstract
Children’s health care providers and children’s surgery providers can partner to improve children’s health by developing the surgical workforce, focusing on “best buy” surgeries, integrating children’s surgery into national plans, streamlining data collection and research, and leveraging financing.
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Affiliation(s)
- Isaac Wasserman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
| | | | - Lubna Samad
- Center for Essential Surgical and Acute Care, Indus Health Network, Karachi, Pakistan
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