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Nizeyimana F, Skelton T, Bould MD, Beach M, Twagirumugabe T. Perioperative Anesthesia-Related Complications and Risk Factors in Children: A Cross-Sectional Observation Study in Rwanda. Anesth Analg 2024; 138:1063-1069. [PMID: 37678238 DOI: 10.1213/ane.0000000000006641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Despite an increasing awareness of the unmet burden of surgical conditions, information on perioperative complications in children remains limited especially in low-income countries such as Rwanda. The objective of this study was to estimate the prevalence of perioperative anesthesia-related adverse events and to explore potential risk factors associated with them among pediatric surgical patients in public referral hospitals in Rwanda. METHODS Data were collected for all patients under 5 years of age undergoing surgery in 3 public referral hospitals in Rwanda from June to December 2015. Patient and family history, type of surgery, comorbidities, anesthesia technique, intraoperative adverse events and postoperative events in the postanesthesia care unit (PACU) were recorded. The incidence of perioperative adverse events was assessed and associated risk factors analyzed with univariate logistic regression. RESULTS Of 354 patients enrolled in this study 11 children had a cardiac arrest. Six (1.7%) suffered an intraoperative cardiac arrest, 2 of whom (0.6%) died intraoperatively. In the PACU, 6 (1.8%) suffered a postoperative cardiac arrest, 5 of whom (1.5%) died in the PACU. One child had both an intraoperative cardiac arrest and then a cardiac arrest in PACU but survived. Eighty-nine children (25.1%) had an intraoperative adverse event, whereas 67 (20.6%) had an adverse event in PACU. A review of the cases where cardiac arrest or death occurred indicated that there were significant lapses in the expected standard of care. Age <1 week was associated with cardiac arrest or death. CONCLUSIONS The rate of perioperative complications, including death, for children undergoing surgery in tertiary care hospitals in Rwanda was high. Quality improvement measures are needed to decrease this rate among surgical pediatric patients in this low resource setting.
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Affiliation(s)
- Francoise Nizeyimana
- From the Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Dylan Bould
- Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Beach
- Department of Anesthesiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Theogene Twagirumugabe
- Department of Anaesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Anesthesiology and Pain Medicine, Critical Care and Emergency Medicine, University of Rwanda, Butare, Rwanda
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The intersection of pediatric surgery, climate change, and equity. J Pediatr Surg 2023; 58:943-948. [PMID: 36792419 DOI: 10.1016/j.jpedsurg.2023.01.017] [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: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
Climate change is occurring at an unprecedented rate. Recent years have seen heatwaves, wildfires, floods, droughts, and re-emerging infectious diseases fueled by global warming. Global warming has also increased the frequency and severity of surgical disease, particularly for children, who bear an estimated 88% of the global burden of disease attributable to climate change. Health care delivery itself weighs heavily on the environment, accounting for nearly 5% of global greenhouse gas emissions. Within the health care sector, surgery and anesthesia are particularly carbon intensive. The surgical community must prioritize the intersection of climate change and pediatric surgery in order to address pediatric surgical disease on a global scale, while reducing the climate impact of surgical care delivery. This review defines the current state of climate change and its effects on pediatric surgical disease, discusses climate justice, and outlines actions to reduce the climate impact of surgical services. LEVEL OF EVIDENCE: Level V.
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Broalet E, Konan L, Diaby R, Nitcheu I, Meuga W, Haidara A. An in-country humanitarian neurosurgical services as model for low-and-middle-income countries: The case of Cote d' Ivoire. BRAIN & SPINE 2023; 3:101742. [PMID: 37143527 PMCID: PMC10151258 DOI: 10.1016/j.bas.2023.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
•Initiated in 2019, Humanitarian neurosurgery in Cote d'Ivoire is entirely supported by national non-governmental entities.•Free neurosurgical care is made possible through fundraising campaigns operated via social networking platforms.•Humanitarian neurosurgical activities in Cote d'Ivoire target children with hydrocephalus and neural tube defects.
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Affiliation(s)
- Esperance Broalet
- Department of Neurosurgery CHU Bouaké, UFR Sciences Medicales Bouaké, University Alassane Ouattara, Cote d’Ivoire
| | - Landry Konan
- Department of Neurosurgery CHU Yopougon, UFR Sciences Medicales Abidjan, University Felix Houphouet Boigny, Cote d’Ivoire
- Corresponding author.
| | - Raissa Diaby
- Department of Neurosurgery CHU Yopougon, UFR Sciences Medicales Abidjan, University Felix Houphouet Boigny, Cote d’Ivoire
| | - Igor Nitcheu
- Department of Neurosurgery CHU Yopougon, UFR Sciences Medicales Abidjan, University Felix Houphouet Boigny, Cote d’Ivoire
| | - Wilfried Meuga
- Department of Neurosurgery CHU Yopougon, UFR Sciences Medicales Abidjan, University Felix Houphouet Boigny, Cote d’Ivoire
| | - Aderehime Haidara
- Department of Neurosurgery CHU Bouaké, UFR Sciences Medicales Bouaké, University Alassane Ouattara, Cote d’Ivoire
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Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq. Ann Surg 2022; 276:732-742. [PMID: 35837945 DOI: 10.1097/sla.0000000000005592] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations. BACKGROUND International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949 these standards expanded to include injured civilians. In 2001, the Global War on Terror began in Afghanistan and expanded to Iraq in 2003. US MTFs provided care to all military forces, civilians, and enemy prisoners. A thorough understanding of the scope, epidemiology, resource requirements and outcomes of civilian trauma in combat zones has not been previously characterized. METHODS Retrospective cohort analysis of the Department of Defense Trauma Registry from 2005-2019. Inclusion criteria were civilians and non-NATO coalition personnel (NNCP) with traumatic injuries treated at MTFs in Afghanistan and Iraq. Patient demographics, mechanism of injury, resource requirements, procedures, and outcomes were categorized. RESULTS A total of 29,963 casualties were eligible from the Registry. There were 16,749 (55.9%) civilians and 13,214 (44.1%) NNCP. The majority of patients were age >13 years [26,853 (89.6%)] and male [28,000 (93.4%)]. Most injuries were battle-related: 12,740 (76.1%) civilians and 11,099 (84.0%) NNCP. Penetrating trauma was the most common cause of both battle and nonbattle injuries: 12,293 (73.4%) civilian and 10,029 (75.9%) NNCP. Median injury severity score (ISS) was 9 in each cohort with ISS scores ≥ 25 in 2,236 (13.4%) civilians and 1,398 (10.6%) NNCP. Blood products were transfused to 35% of each cohort: 5,850 civilians received a transfusion with 2,118 (12.6%) of them receiving ≥10 units; 4,590 NNCPs received a transfusion with 1,669 (12.6%) receiving ≥ 10 units. MTF mortality rates were civilians 1,263 (7.5%) and NNCP 776 (5.9%). Interventions, both operative and non-operative, were similar between both groups. CONCLUSIONS In accordance with International Humanitarian Law, as well as the US military's medical rules of eligibility, civilians injured in combat zones were provided the same level of care as non-NATO Coalition Personnel. Injured civilians and NNCP had similar mechanisms of injury, injury patterns, transfusion needs, and ISS. This analysis demonstrates resource equipoise in trauma care delivered to civilians and NNCP. Hospitals in combat zones must be prepared to manage large numbers of civilian casualties with significant human and material resources allocated to optimize survival. The provision of humanitarian trauma care is resource-intensive, and these data can be used to inform planning factors for current or future humanitarian care in combat zones.
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Cairo SB, Pu Q, Malemo Kalisya L, Fadhili Bake J, Zaidi R, Poenaru D, Rothstein DH. Geospatial Mapping of Pediatric Surgical Capacity in North Kivu, Democratic Republic of Congo. World J Surg 2021; 44:3620-3628. [PMID: 32651605 DOI: 10.1007/s00268-020-05680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite recent attention to the provision of healthcare in low- and middle-income countries, improvements in access to surgical services have been disproportionately lagging. METHODS This study analyzes the geographic variability in access to pediatric surgical services in the province of North Kivu, Democratic Republic of Congo (DRC). On-site data collection was conducted using the Global Assessment of Pediatric Surgery tool. Spatial distribution of providers was mapped using the Geographical Information System and open-sourced spatial data to determine distances traveled to access surgical care. RESULTS Forty facilities were evaluated across 32 health zones; 68.9% of the provincial population was within 15 km of these facilities. Eleven facilities met a minimum World Health Organization safety score of 8; 48.1% of the population was within 15 km of corresponding facilities. The majority of children were treated by someone with specific pediatric surgery training in only 4 facilities; one facility had a trained pediatric anesthesia provider. Fifty-seven percent of the population was within 15 km of a facility with critical care and emergency medicine (EM) capabilities. There was one pediatric critical care provider and no pediatric EM providers identified within the province. Location-allocation assessment is needed to combine geographic area with potential for greatest impact and facility assessment. CONCLUSIONS Limitations in access to surgical care in the DRC are multifactorial with poor resources, few formally trained surgical providers, and near-absent access to pediatric anesthesiologists. The study highlights the deficits in the capacity for surgical care while demonstrating a reproducible model for assessment and identification of ways to improve access to care.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA. .,Department of Surgery, Maine Medical Center, Portland, ME, USA.
| | - Qiang Pu
- Department of Geography, University At Buffalo, The State University of New York, Buffalo, NY, USA
| | - Luc Malemo Kalisya
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Jacques Fadhili Bake
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Rene Zaidi
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Dan Poenaru
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, University At Buffalo, The State University of New York, Buffalo, NY, USA
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Traynor MD, Trelles M, Hernandez MC, Dominguez LB, Kushner AL, Rivera M, Zielinski MD, Moir CR. North American pediatric surgery fellows' preparedness for humanitarian surgery. J Pediatr Surg 2020; 55:2088-2093. [PMID: 31839370 DOI: 10.1016/j.jpedsurg.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The overwhelming burden of pediatric surgical need in humanitarian settings has prompted mutual interest between humanitarian organizations and pediatric surgeons. To assess adequate fit, we correlated pediatric surgery fellowship case mix and load with acute pediatric surgical relief efforts in conflict and disaster zones. METHODS We reviewed pediatric (age < 18) cases logged by the Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) from a previously validated and published database spanning 2008-2014 and cases performed by American College of Graduate Medical Education (ACGME) pediatric surgery graduates from 2008 to 2018. Non-operative management for trauma, endoscopic procedures, and basic wound care were excluded as they were not tracked in either dataset. ACGME procedures were classified under 1 of 32 MSF pediatric surgery procedure categories and compared using chi-squared tests. RESULTS ACGME fellows performed procedures in 44% of tracked MSF-OCB categories. Major MSF-OCB pediatric cases were comprised of 62% general surgery, 23% orthopedic surgery, 9% obstetrical surgery, 3% plastic/reconstructive surgery, 2% urogynecologic surgery, and 1% specialty surgery. In comparison, fellows' cases were 95% general surgery, 0% orthopedic surgery, 0% obstetrical surgery, 5% urogynecologic surgery, and 1% specialty surgery. Fellows more frequently performed abdominal, thoracic, other general surgical, urology/gynecologic, and specialty procedures, but performed fewer wound and burn procedures (all p < 0.05). Fellows received no experience in Cesarean section or open fracture repair. Fellows performed a greater proportion of surgeries for congenital conditions (p < 0.05). CONCLUSION While ACGME pediatric surgical trainees receive significant training in general and urogynecologic surgical techniques, they lack sufficient case load for orthopedic and obstetrical care - a common need among children in humanitarian settings. Trainees and program directors should evaluate the fellow's role and scope in a global surgery rotation or provide advanced preparation to fill these gaps. Upon graduation, pediatric surgeons interested in humanitarian missions should seek out additional orthopedic and obstetrical training, or select missions that do not require such skillsets. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Miguel Trelles
- Surgical Care Unit, Médecins Sans Frontières, Brussels, Belgium
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Lelli Chiesa P, Osman OTM, Aloi A, Andriani M, Benigni A, Catucci C, Giambelli P, Lisi G, Nugud FM, Presutti P, Prussiani V, Racalbuto V, Rossi F, Santoponte G, Turchetta B, Salman DEYM, Chiarelli F, Calisti A. Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership. Ital J Pediatr 2020; 46:80. [PMID: 32517726 PMCID: PMC7285579 DOI: 10.1186/s13052-020-00827-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation. Methods The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described. Results Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain. Conclusions The key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.
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Affiliation(s)
- Pierluigi Lelli Chiesa
- Cattedra e UOC di Chirurgia Pediatrica - Università "Gabriele d'Annunzio" Chieti-Pescara, Via Fonte Romana, 8, 65124, Pescara, Italy.
| | | | - Antonio Aloi
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy
| | | | - Alberto Benigni
- Dipartimento di Emergenza, Urgenza e Area Critica - A.S.S.T. "Papa Giovanni XXIII", Bergamo, Italy
| | | | - Paolo Giambelli
- Agenzia Italiana Cooperazione Allo Sviluppo, Sede di Khartoum, Wad Medani, Sudan
| | - Gabriele Lisi
- Cattedra e UOC di Chirurgia Pediatrica - Università "Gabriele d'Annunzio" Chieti-Pescara, Via Fonte Romana, 8, 65124, Pescara, Italy
| | - Faisal M Nugud
- Gezira National Center Of Pediatric Surgery, Wad Medani, Sudan
| | - Paola Presutti
- Anestesia e Rianimazione, A.O. "San Camillo Forlanini", Roma, Italy
| | - Viviana Prussiani
- Dipartimento di Emergenza, Urgenza e Area Critica - A.S.S.T. "Papa Giovanni XXIII", Bergamo, Italy
| | - Vincenzo Racalbuto
- Agenzia Italiana Cooperazione Allo Sviluppo, Sede di Khartoum, Wad Medani, Sudan
| | - Fabio Rossi
- UOC di Chirurgia Pediatrica, A.O.U. "Maggiore della Carità", Novara, Italy
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Coventry CA, Dominguez L, Read DJ, Trelles M, Ivers RQ, Montazerolghaem M, Holland AJA. Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future? JOURNAL OF SURGICAL EDUCATION 2020; 77:131-137. [PMID: 31451427 DOI: 10.1016/j.jsurg.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.
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Affiliation(s)
- Charles A Coventry
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Lynette Dominguez
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, NT, Australia
| | - Miguel Trelles
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew J A Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Data Collection Tools for Maternal and Child Health in Humanitarian Emergencies: An Updated Systematic Review. Disaster Med Public Health Prep 2019; 14:601-619. [PMID: 31818343 DOI: 10.1017/dmp.2019.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The worst rates of preventable mortality and morbidity among women and children occur in humanitarian settings. Reliable, easy-to-use, standardized, and efficient tools for data collection are needed to enable different organizations to plan and act in the most effective way. In 2015, the World Health Organization (WHO) commissioned a review of tools for data collection on the health of women and children in humanitarian emergencies. An update of this review was conducted to investigate whether the recommendations made were taken forward and to identify newly developed tools. Fifty-three studies and 5 new tools were identified. Only 1 study used 1 of the tools identified in our search. Little has been done in terms of the previous recommendations. Authors may not be aware of the availability of such tools and of the importance of documenting their data using the same methods as other researchers. Currently used tools may not be suitable for use in humanitarian settings or may not include the domains of the authors' interests. The development of standardized instruments should be done with all key workers in the area and could be coordinated by the WHO.
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Abstract
Children are affected by all types of disasters disproportionately compared with adults. Despite this, planning and readiness to care for children in disasters is suboptimal locally, nationally, and internationally. These planning gaps increase the likelihood that a disaster will have a greater negative impact on children when compared with adults. New voluntary regional coalitions have been developed to fill this gap. Some are pediatric focused or have pediatrics well integrated into the greater coalition. This article discusses key points of pediatric disaster planning, specific vulnerabilities, and the care of children in general and in specific disaster situations.
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Affiliation(s)
- Mitchell Hamele
- Department of Pediatrics-Critical Care, Tripler Army Medical Center, Honolulu, HI 96859, USA.
| | - Ramon E Gist
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY 11203, USA
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, BC Children's Hospital, Sunny Hill Health Centre for Children, UBC, Child and Family Research Institute, B245 - 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada
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11
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Khan M. General surgical training for Operation Trenton. BMJ Mil Health 2019; 167:327-329. [DOI: 10.1136/jramc-2018-001142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/03/2022]
Abstract
The UK military commitment to United Nations operations has led to a new challenge in identifying and developing skill sets required for humanitarian operations. The last two decades have concentrated on kinetic operations, with haemorrhage control being the main driver. The austere location and prolonged evacuation timelines have led to identifying management strategies of conditions that would previously have been evacuated to higher echelons of care. The Defence Medical Services have a multifaceted approach to training military personnel for operations, varying from regular exposure to high-acuity trauma and general surgery within their host NHS Trust, to validated training platforms that evolve continually to address the training needs demanded by differing fields of conflict.
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12
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Zha Y, Stewart B, Lee E, Remick KN, Rothstein DH, Groen RS, Burnham G, Imagawa DK, Kushner AL. Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons. World J Surg 2017; 40:2628-2634. [PMID: 27225996 DOI: 10.1007/s00268-016-3579-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sixty million people were displaced from their homes due to conflict, persecution, or human rights violations at the end of 2014. This vulnerable population bears a disproportionate burden of disease, much of which is surgically treatable. We sought to estimate the surgical needs for forcibly displaced persons globally to inform humanitarian assistance initiatives. METHODS Data regarding forcibly displaced persons, including refugees, internally displaced persons (IDPs), and asylum seekers were extracted from United Nations databases. Using the minimum proposed surgical rate of 4669 procedures per 100,000 persons annually, global, regional, and country-specific estimates were calculated. The prevalence of pregnancy and obstetric complications were used to estimate obstetric surgical needs. RESULTS At least 2.78 million surgical procedures (IQR 2.58-3.15 million) were needed for 59.5 million displaced persons. Of these, 1.06 million procedures were required in North Africa and the Middle East, representing an increase of 50 % from current unmet surgical need in the region. Host countries with the highest surgical burden for the displaced included Syria (388,000 procedures), Colombia (282,000 procedures), and Iraq (187,000). Between 4 and 10 % of required procedures were obstetric surgical procedures. Children aged <18 years made up 52 % of the displaced, portending a substantial demand for pediatric surgical care. CONCLUSION Approximately three million procedures annually are required to meet the surgical needs of refugees, IDPs, and asylum seekers. Most displaced persons are hosted in countries with inadequate surgical care capacity. These figures should be considered when planning humanitarian assistance and targeted surgical capacity improvements.
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Affiliation(s)
- Yuanting Zha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,University of California, Irvine School of Medicine, Irvine, CA, USA.
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA.,School of Medical Sciences, Kwame Nkrumah University, Kumasi, Ghana.,Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eugenia Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kyle N Remick
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Military Deputy, Combat Casualty Care Research Program, Fort Detrick, MD, USA
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Reinou S Groen
- Department of Gynecology & Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David K Imagawa
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Adam L Kushner
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Surgery, Columbia University, New York, NY, USA.,Surgeons OverSeas, New York, NY, USA
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13
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Sex disparities among persons receiving operative care during armed conflicts. Surgery 2017; 162:366-376. [PMID: 28400124 DOI: 10.1016/j.surg.2017.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. METHODS We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones. RESULTS Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1-105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score (P = .003), degree of urgency (P = .02), mechanism (P < .0001), and a country's predominant religion (P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country (P = .006). CONCLUSION Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.
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