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Mangla M, Nerakh G, Anne RP, Kaliappan A, Kaur H, Singla D. A Practical, Systematic Approach to Genetic Diagnosis in a Fetus or Neonate with Congenital Anomalies. Neoreviews 2024; 25:e537-e550. [PMID: 39217133 DOI: 10.1542/neo.25-9-e537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 09/04/2024]
Abstract
Congenital anomalies contribute significantly to perinatal, neonatal, and infant morbidity and mortality. The causes of these anomalies vary, ranging from teratogen exposure to genetic disorders. A high suspicion for a genetic condition is especially important because a genetic diagnosis carries a risk of recurrence in future pregnancies. Various methods are available for genetic testing, and each plays a role in establishing a genetic diagnosis. This review summarizes a practical, systematic approach to a fetus or neonate with congenital anomalies.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | | | - Rajendra Prasad Anne
- Department of Neonatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ariyanachi Kaliappan
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Harpreet Kaur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Deepak Singla
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Goel A, Goel A. Optimal timing for plastic surgical procedures for common congenital anomalies: A review. World J Clin Pediatr 2024; 13:90583. [PMID: 38947997 PMCID: PMC11212758 DOI: 10.5409/wjcp.v13.i2.90583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 06/07/2024] Open
Abstract
Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents. The global incidence of children born with congenital anomalies has been reported to be 3%-6% with more than 90% of these occurring in low- and middle-income group countries. The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons. These children are operated under several surgical disciplines, viz, paediatric-, plastic reconstructive, neuro-, cardiothoracic-, orthopaedic surgery etc. These conditions may be life-threatening, e.g., trachea-oesophageal fistula, critical pulmonary stenosis, etc. and require immediate surgical intervention. Some, e.g., hydrocephalus, may need intervention as soon as the patient is fit for surgery. Some, e.g., patent ductus arteriosus need 'wait and watch' policy up to a certain age in the hope of spontaneous recovery. Another extremely important category is that of patients where the operative intervention is done based on their age. Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery (many as multiple stages of correction) at appropriate ages. There are advantages and disadvantages of intervention at different ages. In this article, we present a review of optimal timings, along with reasoning, for surgery of many of the common congenital anomalies which are treated by plastic surgeons. Obstetricians, paediatricians and general practitioners/family physicians, who most often are the first ones to come across such children, must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.
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Affiliation(s)
| | - Arun Goel
- Department of Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi 110002, India
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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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Banu T, Sharma S, Chowdhury TK, Aziz TT, Martin B, Seyi-Olajide JO, Ameh E, Ozgediz D, Lakhoo K, Bickler SW, Meara JG, Bundy D, Jamison DT, Klazura G, Sykes A, Yap A, Philipo GS. Surgically Correctable Congenital Anomalies: Reducing Morbidity and Mortality in the First 8000 Days of Life. World J Surg 2023; 47:3408-3418. [PMID: 37311874 DOI: 10.1007/s00268-023-07087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Congenital anomalies are a leading cause of morbidity and mortality worldwide. We aimed to review the common surgically correctable congenital anomalies with recent updates on the global disease burden and identify the factors affecting morbidity and mortality. METHOD A literature review was done to assess the burden of surgical congenital anomalies with emphasis on those that present within the first 8000 days of life. The various patterns of diseases were analyzed in both low- and middle-income countries (LMIC) and high-income countries (HIC). RESULTS Surgical problems such as digestive congenital anomalies, congenital heart disease and neural tube defects are now seen more frequently. The burden of disease weighs more heavily on LMIC. Cleft lip and palate has gained attention and appropriate treatment within many countries, and its care has been strengthened by global surgical partnerships. Antenatal scans and timely diagnosis are important factors affecting morbidity and mortality. The frequency of pregnancy termination following prenatal diagnosis of a congenital anomaly is lower in many LMIC than in HIC. CONCLUSION Congenital heart disease and neural tube defects are the most common congenital surgical diseases; however, easily treatable gastrointestinal anomalies are underdiagnosed due to the invisible nature of the condition. Current healthcare systems in most LMICs are still unprepared to tackle the burden of disease caused by congenital anomalies. Increased investment in surgical services is needed.
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Affiliation(s)
- Tahmina Banu
- Chittagong Research Institute for Children Surgery (CRICS), Panchlaish, Chittagong, 4203, Bangladesh.
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kabir Chowdhury
- Department of Pediatric Surgery, Chittagong Medical College and Hospital (CMCH), Chittagong, Bangladesh
| | - Tasmiah Tahera Aziz
- Chittagong Research Institute for Children Surgery (CRICS), Panchlaish, Chittagong, 4203, Bangladesh
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Emmanuel Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Alicia Sykes
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Woestenberg PJ, de Feijter M, Bergman JEH, Lutke LR, Passier AJLM, Kant AC. Maternal first trimester COVID-19 vaccination and risk of major non-genetic congenital anomalies. Birth Defects Res 2023; 115:1746-1757. [PMID: 37737482 DOI: 10.1002/bdr2.2251] [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: 07/12/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Information regarding the risk of early pregnancy COVID-19 vaccination on the development of major congenital anomalies in the offspring is still limited. Here, we study the association between any COVID-19 vaccination during the 1st trimester and at least one major non-genetic congenital anomaly in the offspring. METHODS We used data from the Dutch Pregnancy Drug Register, an ongoing cohort study. We selected participants with a pregnancy that ended after at least 20 weeks gestation. Pregnant participants self-reported their COVID-19 vaccination status and the presence of congenital anomalies in the offspring. We used logistic regression analyses to study the association between 1st trimester COVID-19 vaccination (gestational week 2 + 0 to 12 + 6) and the risk of at least one major non-genetic congenital anomaly in the offspring. Clustering of anomalies on the ICD10 level by 1st trimester COVID-19 vaccination status was explored using Fisher exact tests. RESULTS We included 3721 participants of whom 795 (21.4%) were COVID-19 vaccinated during the 1st trimester. The percentage of participants who gave birth to a child with at least one major non-genetic congenital anomaly was comparable between participants who were 1st trimester vaccinated (1.1%) and participants who were not (1.2%) (adjusted odd ratio 0.78 [95% confidence interval 0.35-1.71]). We found no clustering of major non-genetic congenital anomalies by 1st trimester COVID-19 vaccination status (p > .05). CONCLUSIONS There were no indications of an increased risk of major non-genetic congenital anomalies in the offspring after maternal 1st trimester COVID-19 vaccination. Our findings suggest COVID-19 vaccines are safe during early pregnancy.
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Affiliation(s)
- Petra J Woestenberg
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Maud de Feijter
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L Renée Lutke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Agnes C Kant
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
- Department of Clinical Pharmacology and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
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Zouari M, Ameur HB, Krichen E, Saad NB, Dhaou MB, Mhiri R. Risk factors for adverse outcomes following surgical repair of esophageal atresia. A retrospective cohort study. Dis Esophagus 2023; 36:doac070. [PMID: 36214334 DOI: 10.1093/dote/doac070] [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] [Received: 06/28/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Esophageal atresia (EA) is a life-threatening congenital malformation of the esophagus. Despite considerable recent advances in perinatal resuscitation and neonatal care, EA remains an important cause of mortality and morbidity, especially in low-income countries. The aim of this study was to assess risk factors for adverse outcomes following surgical repair of EA at a single center in Tunisia. We performed a retrospective analysis using medical records of neonates with surgical management of EA at our institution from 1 January 2007 to 31 December 2021. In total, 88 neonates were included with a mortality rate of 25%. There were 29 girls and 59 boys. The diagnosis of EA was suspected prenatally in 19 patients. The most common associated anomalies were congenital heart diseases. Prematurity, low birth weight, outborn birth, age at admission >12 hours, congenital heart disease, postoperative sepsis, and anastomotic leak were risk factors for mortality following surgical repair of EA. Anastomotic tension was the only factor associated with short-term complications and the occurrence of short-term complications was predictive of mid-term complications. This study provides physicians and families with contemporary information regarding risk factors for adverse outcomes following surgical repair of EA. Thus, any effort to reduce these risk factors would be critical to improving patient outcomes and reducing cost. Future multi-institutional studies are needed to identify, investigate, and establish best practices and clinical care guidelines for neonates with EA.
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Affiliation(s)
- Mohamed Zouari
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Hana Ben Ameur
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nesrine Ben Saad
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Nimanya S, Kisa P, Abdullah F, Langer M. Surgical neonates in a low-resource setting: Baseline nutrition and outcome assessment. J Pediatr Surg 2023; 58:981-985. [PMID: 36841705 DOI: 10.1016/j.jpedsurg.2023.01.025] [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: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Congenital anomalies necessitating prolonged fasting have a high mortality in low-income settings, partially due to malnutrition and electrolyte disturbances in the absence of parenteral nutrition (PN). Interventions to address these problems require an accurate baseline quantification of the morbidity and mortality of this population. This prospective study aimed to determine peri-operative morbidity, fluid and electrolyte disturbance, growth, and mortality in neonates with gastroschisis (GS), intestinal atresia (IA), and esophageal atresia (EA) in Uganda. METHODS Standardized patient care of 45 neonates treated in Uganda from Oct 2021 to March 2022 with protocolized fluid and nutrition, vital signs, and routine laboratory measurements. Patient demographics, admission and hospital characteristics are described with mean ± SD. Characteristics of survivors and non-survivors were compared with Fischer's exact tests, logrank tests, and CoX Ph model. RESULTS Twenty-eight (62.2%) patients had GS, 4 (8.9%) EA, and 13 (28.9%) IA. Thirty-six percent (16/44) of patients survived to discharge (26% GS, 50% EA, 54% IA) with an average length of stay of 17.3 days ( ± 2.2) (survivors) and 9 days ( ± 1.7) (non-survivors). Average weight was 2.21 kg ( ± 0.62) at presentation, with no significant weight change during the study. Abnormal serum sodium in 64%, phosphate 36.5%, and magnesium 20.8% of measurements. Mortality did not correlate with diagnosis (p = 0.47), electrolyte derangement, or weight change. CONCLUSION Mortality of neonates born with GS, EA, and IA is high in Uganda. Malnutrition and fluid/electrolyte derangements are common and may affect mortality. This study provides a comparison group for studying interventions to improve outcomes for these populations. TYPE OF STUDY Prospective cohort. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Stella Nimanya
- Mulago National Referral Hospital, Mulago Road, Kampala, Uganda and Makerere University, 7062 University Rd, Kampala, Uganda
| | - Phyllis Kisa
- Mulago National Referral Hospital, Mulago Road, Kampala, Uganda and Makerere University, 7062 University Rd, Kampala, Uganda
| | - Fizan Abdullah
- Lurie Children's Hospital Dept of Surgery, and Northwestern University, 225 East Chicago Avenue, Box 63, Chicago, IL 60611-2991, USA
| | - Monica Langer
- Lurie Children's Hospital Dept of Surgery, and Northwestern University, 225 East Chicago Avenue, Box 63, Chicago, IL 60611-2991, USA.
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How to deal with rare pediatric surgical diseases in the small developing country with limited resources: Insights from Bosnia and Herzegovina. J Pediatr Surg 2022; 57:1033. [PMID: 35850735 DOI: 10.1016/j.jpedsurg.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
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Maia VO, Pavarino E, Guidio LT, de Souza JPD, Ruano R, Schmidt AF, Fabbro ALD, Sbragia L. Crossing birth and mortality data as a clue for prevalence of congenital diaphragmatic hernia in Sao Paulo State: A cross sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100328. [PMID: 36777389 PMCID: PMC9903978 DOI: 10.1016/j.lana.2022.100328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Congenital diaphragmatic hernia (CDH) is a severe embryological defect that causes pulmonary hypoplasia and hypertension. The prevalence and mortality rate of CDH varies around the world and little information is available about CDH in Latin America. Our aim was to estimate the general prevalence, mortality rate, prevalence of associated anomalies and features related to the outcomes of CDH in newborns from São Paulo state, Brazil. Methods Population-based cross-sectional study based on data gathered from the Live Births Information System (SINASC) and the Mortality Information System (SIM) of children born in São Paulo state between January 1st, 2006, and December 31st, 2017. Findings From 7,311,074 total survival discharges between 2006 and 2017, 1,155 were CDH-related, resulting in a prevalence rate of 1:6329 (95%CI = 1/6715 - 1/5984) and a mortality rate of 63·72% (95%CI = 60.95 - 66.50), 510 presented complex associated anomalies (44·15%). Maternal data showed higher prevalence among older mothers (older than 35 years old: 2·13 per 10,000) and, also, women with more years of schooling (higher than 12 years: 1·99 per 10,000). Presence of associated anomalies (95%CI = 5.69-11.10), 1-min Apgar (95%CI = 1.44-2.95), maternal schooling (95%CI = 1.06-2.43) and birth weight (95%CI = 1.04-2.26) were the most significant features associated with mortality. Interpretation There was 1 CDH case for every 6329 newborns in São Paulo and the mortality rate among those cases was 63·72% - a high rate compared to other countries. Funding This study didn't receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Affiliation(s)
- Victoria Oliveira Maia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Pavarino
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Leandro Tonderys Guidio
- Medical School of Bauru, School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - João Paulo Dias de Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Ruano
- Department of Pediatrics and Department of Obstetrics, Gynecology and Reproductive Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Augusto Frederico Schmidt
- Department of Pediatrics and Department of Obstetrics, Gynecology and Reproductive Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amaury Lelis Dal Fabbro
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Lourenço Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil,Corresponding author at: Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo. Av. Bandeirantes 3900 - Monte Alegre, Ribeirão Preto, SP Zipcode: 14049-900, Brazil.
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Coelho A, Marinho AS, Barbosa-Sequeira J, Nikutme A, Noya L, Rêgo C, Carvalho F, Moreira-Pinto J. Early results of a distance learning paediatric surgery programme in Mozambique. Afr J Paediatr Surg 2022; 19:164-166. [PMID: 35775518 PMCID: PMC9290362 DOI: 10.4103/ajps.ajps_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A pre-graduate training programme in paediatric surgery was applied to students in four medical schools of Mozambique. In this paper, we evaluate the early results of the programme. MATERIALS AND METHODS A pre-graduate training programme was developed and applied in two stages, theoretical education available at an online platform and a face-to-face session. To evaluate the programme, a diagnostic test was applied to all participants before the face-to-face session and, the same test, was applied again at the end of the session. RESULTS A total of 236 students participated in the programme. Forty-four per cent had a negative score on the diagnostic test. When the test was repeated, 91.9% had a positive score, and the difference between the scores in both tests reached statistical significance (P < 0.05). The participants who completed the first phase of the programme presented a higher median score in both tests (P < 0.05). CONCLUSIONS : The diagnostic tests allowed us to verify there was an increase in knowledge before and after the face-to-face session. There was also a significant difference between those participants who completed the online phase of the programme and those who did only the face-to-face session, which allows us to conclude that the online teaching programme was effective.
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Affiliation(s)
- Ana Coelho
- Department of Pediatric Surgery, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, Porto, Portugal
| | - Ana Sofia Marinho
- Department of Pediatric Surgery, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, Porto, Portugal
| | - Joana Barbosa-Sequeira
- Department of Pediatric Surgery, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, Porto, Portugal
| | - André Nikutme
- Instituto Superior de Ciência e Tecnologia Alberto Chipande, Avenida Correia de Brito, n° 1298, Beira, Mozambique
| | - Leyani Noya
- Universidade Lúrio, Bairro de Marrere, n° 4250, Nampula, Mozambique
| | - Carla Rêgo
- Hospital CUF Porto, Estrada da Circunvalação, n° 14341; CINTESIS - Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa; ESB - Universidade Católica Portuguesa, Rua de Diogo Botelho n° 1327, Porto; Health4Moz ONGD, Rua Francisco Sá Carneiro n°142 - 5°Esq, Leça da Palmeira, Portugal
| | - Fátima Carvalho
- Department of Pediatric Surgery, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, Porto; Health4Moz ONGD, Rua Francisco Sá Carneiro n°142 - 5°Esq, Leça da Palmeira, Portugal
| | - João Moreira-Pinto
- Department of Pediatric Surgery, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Largo do Professor Abel Salazar, Porto; Health4Moz ONGD, Rua Francisco Sá Carneiro n°142 - 5°Esq, Leça da Palmeira; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR); Instituto de Investigação, Inovação e Desenvolvimento, Fundação Fernando Pessoa (FP-I3ID), Porto; Pediatric Surgery, Hospital-Escola Fernando Pessoa, Universidade Fernando Pessoa, Porto, Portugal
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Abstract
UNLABELLED Over the course of approximately 60 years, the field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guidelines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is decreasing. In low-and middle-income countries (LMICs), health systems for large populations are currently in a state of stress. Here we briefly review the history of pediatric urology as a surgical subspecialty, identify unmet needs especially in LMICs and place the field in the context of a global surgical ecosystem. METHODS The English language literature on workforce trends in pediatric urology, pediatric surgery and urology was reviewed as well as development of the emerging field of global surgery. Global surgery looks at the social, economic and political context of health systems as well as unmet clinical need. World trends in fertility rates were reviewed to identify regions of workforce surplus and gaps, supply chain needs, infrastructure and systems strengths and weaknesses. RESULTS The proliferation of training programs in pediatric surgery and specialties in high-income countries (HICs) coupled with declining birth rates has led to a saturation of specialists and declining surgical case load. In LMICs, while the birth rate has also been declining, surgical specialization has not progressed. In the lowest income countries, especially in sub-Saharan Africa, training in pediatric surgical specialties and urology is rare. The broad workforce that supports surgical care, such as anesthesia, intensivist pediatrics, radiology, laboratory, and nursing face similar challenges. Supply chains for specialized pediatric urological surgery are weak. CONCLUSION There is an evolving maldistribution of pediatric surgical and pediatric urological workforce globally, with too few practitioners in LMICs and too many in HICs. The high cost of specialized equipment limits access to quality care, and the supply chain for consumables and medication is patchy. In LIC's, basic community-based infrastructure for health including reliable electricity is lacking. Recent experience with Covid and environmental disasters has highlighted that even in HICs surgical resilience can be challenged. This is an opportunity to consider the state of children's urological care globally and to build resilience by identifying and addressing strengths and gaps.
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Affiliation(s)
- Catherine R deVries
- University of Utah School of Medicine, Center for Global Surgery, 30 N. 1900 E RM 3B110 SOM, Salt Lake City, UT 84132, USA.
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12
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Fuerboeter M, Boettcher J, Barkmann C, Zapf H, Nazarian R, Wiegand-Grefe S, Reinshagen K, Boettcher M. Quality of life and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic. Orphanet J Rare Dis 2021; 16:498. [PMID: 34838064 PMCID: PMC8626760 DOI: 10.1186/s13023-021-02129-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 has affected our society at large, particularly vulnerable groups, such as children suffering from rare diseases and their parents. However, the psychosocial influences of COVID-19 on these have yet to be investigated. As such, the study’s goal was to evaluate the health-related quality of life (HRQoL), quality of life (QoL), and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic and lockdown measures. Methods A survey of n = 210 parents of children with rare congenital surgical diseases and a control group of n = 88 parents of children without rare diseases was conducted cross-sectionally between April 2020 to April 2021. Data on HRQoL, QoL, and mental health was collected using standardized psychometric questionnaires for children and parents presenting to the pediatric surgery department at a university hospital. Results Mothers of children with rare pediatric surgical diseases showed significantly lower QoL and significantly higher impairment in mental health than a control group and norm data. For fathers, this was solely the case for their QoL. Children’s parent-reported HRQoL and mental health were partially impaired. Social and disease-specific risk factors of the respective outcomes in affected families were identified through regression analysis models. Conclusion Parents of children with rare diseases report severe psychosocial impairment regarding themselves and their children during the COVID-19 pandemic. Therefore, affected families should receive attention and supportive care in the form of a family-center approach to alleviate the additional burden of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02129-0.
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Affiliation(s)
- Mareike Fuerboeter
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Zapf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rojin Nazarian
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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13
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Varela C, Viste A, Young S, Groen RS, Banza L, Nandi B, Mkandawire N, Moen BE. Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey. Malawi Med J 2021; 33:73-81. [PMID: 34777702 PMCID: PMC8560351 DOI: 10.4314/mmj.v33i2.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Untreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need. Aim To estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries. Methods A cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. Results There were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. Conclusion An extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.
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Affiliation(s)
- Carlos Varela
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Asgaut Viste
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Sven Young
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Reinou S Groen
- Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, USA.,Department of Obstetrics and Gynecology, Alaska Native Medical Centre, Anchorage, USA
| | - Leonard Banza
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Surgery, University of Malawi, College of Medicine, Lilongwe, Malawi/Kamuzu University of Health Sciences.,Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bip Nandi
- Department of Surgery Kamuzu Central Hospital, Lilongwe, Malawi.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi, College of Medicine, Blantyre, Malawi/Kamuzu University of Health Sciences
| | - Bente Elisabeth Moen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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14
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Malherbe HL, Aldous C, Christianson AL, Darlison MW, Modell B. Modelled epidemiological data for selected congenital disorders in South Africa. J Community Genet 2021; 12:357-376. [PMID: 33674966 PMCID: PMC8241974 DOI: 10.1007/s12687-021-00513-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
Congenital disorders (CD) remain an unprioritized health care issue in South Africa with national surveillance underreporting by > 95%. This lack of empiric data contributes to an underestimation of the CD disease burden, resulting in a lack of services for those affected. Modelling offers estimated figures for policymakers to plan services until surveillance is improved. This study applied the Modell Global Database (MGDb) method to quantify the South African CD disease burden in 2012. The MGDb combines birth prevalence data from well-established registries with local demographic data to generate national baseline estimates (birth prevalence and outcomes) for specific early-onset, endogenous CDs. The MGBd was adapted with local South African demographic data to generate baseline (no care) and current care national and provincial estimates for a sub-set of early-onset endogenous CDs. Access to care/impact of interventions was quantified using the infant mortality rate as proxy. With available care in 2012, baseline birth prevalence (27.56 per 1000 live births, n = 32,190) decreased by 7% with 2130 less affected births, with 5400 (17%) less under-5 CD-related deaths and 3530 (11%) more survivors at 5 years, including 4720 (15%) effectively cured and 1190 (4%) less living with disability. Results indicate a higher proportion of CD-affected births than currently indicated by national surveillance. By offering evidence-based estimates, the MGDb may be considered a tool for policymakers until accurate empiric data becomes available. Further work is needed on key CD groups and costing of specific interventions.
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Affiliation(s)
- Helen L Malherbe
- KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Arnold L Christianson
- Wits Centre for Ethics (WiCE), University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Institute of Health Informatics, University College London, London, UK
| | - Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Institute of Health Informatics, University College London, London, UK
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15
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Age at Primary Cleft Lip Repair: A Potential Bellwether Indicator for Pediatric Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3657. [PMID: 34235039 PMCID: PMC8225376 DOI: 10.1097/gox.0000000000003657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
The bellwether procedures described by the Lancet Commission on Global Surgery represent the ability to deliver adult surgical services after there is a clear and easily made diagnosis. There is a need for pediatric surgery bellwether indicators. A pediatric bellwether indicator would ideally be a routinely performed procedure, for a relatively common condition that, in itself, is rarely lethal at birth, but that should ideally be treated with surgery by a standard age. Additionally, the condition should be easy to diagnose, to minimize the confounding effects of delays or failures in diagnosis. In this study, we propose the age at primary cleft lip (CL) repair as a bellwether indicator for pediatric surgery. Method We reviewed the surgical records of 71,346 primary cleft surgery patients and ultimately studied age at CL repair in 40,179 patients from 73 countries, treated by Smile Train partners for 2019. Data from Smile Train's database were correlated with World Bank and WHO indicators. Results Countries with a higher average age at CL repair (delayed access to surgery) had higher maternal, infant, and child mortality rates as well as a greater risk of catastrophic health expenditure for surgery. There was also a negative correlation between delayed CL repair and specialist surgical workforce numbers, life expectancy, percentage of deliveries by C-section, total health expenditure per capita, and Lancet Commission on Global Surgery procedure rates. Conclusion These findings suggest that age at CL repair has potential to serve as a bellwether indicator for pediatric surgical capacity in Lower- and Middle-income Countries.
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16
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Kisa P, Scotland K, Afshar K, MacNeily AE. Surveying unmet pediatric urological needs in low- and middle-income countries. J Pediatr Urol 2021; 17:171.e1-171.e9. [PMID: 33546977 DOI: 10.1016/j.jpurol.2020.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/09/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Access to pediatric urological surgery is low in low-and-middle income countries (LMICs). Pediatric Urological missions have often been undertaken without best practice guidelines. Many strides have been made in pediatric general surgery and other surgery but little in pediatric urology as a component of global surgery. STUDY AIMS The purpose of this study was to identify challenges to delivery of pediatric urological care in LMICs and make recommendations for its advancement. STUDY DESIGN An internet search for reports and websites was undertaken. Published surveys from Global Initiative for Children Surgery (GICS) and American Pediatric Surgical Association (APSA) were evaluated. We developed and administered an additional questionnaire. Respondents included LMIC pediatric surgeons, HIC pediatric surgeons and HIC pediatric urologists and LMIC urologists and general surgeons. RESULTS Most global surgical visits were short one-time visit, and respondents citing complex pediatric urologic patients as most neglected in LMICs with the main challenge reported as a lack of specialist surgeons, poor communication between groups and poor infrastructure. Local specialist training was universally recommended as the most effective way to address unmet needs, although the form of training was not clear. DISCUSSION Most published work has looked at global general surgery or pediatric general surgery [1][2][3][6][8][11][13] but little on pediatric urology. Most of the information provided was blog posts of social engagements but rarely did these websites provide information on the surgical experience, challenges and solutions gleaned overtime[41][43][44][45][56] It is recognised by pediatric urologists, general urologists and pediatric surgeons that complex urologic anomalies are the most neglected among children's surgical conditions with a higher disability weight attributed to urologic conditions compared to anorectal conditions. [6][8][14][27][31][36][46], yet there's little expertise on ground and many challenges to its advancement. This study was limited by the number of questions we could explore due to the need to make questions fewer and more concise. CONCLUSIONS Pediatric urological conditions remain among the most neglected in global surgery. Current missions face significant challenges that may result in suboptimal outcomes. A comprehensive effort to establish guidelines for these missions is imperative.
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Affiliation(s)
- Phyllis Kisa
- Division of Pediatric Urology, Department of Urologic Sciences, University of British Columbia, Canada; Department of Surgery, Makerere University, Kampala, Uganda.
| | - Kymora Scotland
- Department of Urology, University of California Los Angeles, USA
| | - Kourosh Afshar
- Division of Pediatric Urology, Department of Urologic Sciences, University of British Columbia, Canada
| | - Andrew E MacNeily
- Division of Pediatric Urology, Department of Urologic Sciences, University of British Columbia, Canada
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17
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Mody KS, Henstenburg J, Herman MJ. The Health & Economic Disparities of Congenital Musculoskeletal Disease Worldwide: An Analysis of 25 Years (1992-2017). Glob Pediatr Health 2021; 8:2333794X21994998. [PMID: 33718527 PMCID: PMC7917875 DOI: 10.1177/2333794x21994998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Large disparities exist in congenital musculoskeletal disease burden worldwide. The purpose of this study is to examine and quantify the health and economic disparities of congenital musculoskeletal disease by country income level from 1992 to 2017. Methods: The Global Burden of Disease database was queried for information on disease burden attributed to "congenital musculoskeletal and limb anomalies" from 1992 to 2017. Gross national income per capita was extracted from the World Bank website. Nonparametric Kruskal-Wallis tests were used to compare morbidity and mortality across years and income levels. The number of avertable DALYs was converted to an economic disparity using the human-capital and value of a statistical life approach. Results: From 1992 to 2017, a significant decrease in deaths/100 000 was observed only in upper-middle and high income countries. Northern Africa, the Middle East, and Eastern Europe were disproportionately affected. If the burden of disease in low- and middle- income countries (LMICs) was equivalent to that in high income countries (HICs), 10% of all DALYs and 70% of all deaths attributable to congenital musculoskeletal disease in LMICs could be averted. This equates to an economic disparity of about $2 billion to $3 billion (in 2020 $USD). Conclusion: Considerable inequity exists in the burden of congenital musculoskeletal disease worldwide and there has been no change over the last 25 years in total disease burden and geographical distribution. By reducing the disease burden in LMICs to rates found in HICs, a large proportion of the health and economic consequences could be averted.
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Affiliation(s)
- Kush S. Mody
- Columbia Business School, New York, NY, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
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18
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Choi S, Shin H, Heo J, Gedlu E, Nega B, Moges T, Bezabih A, Park J, Kim WH. How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia? BMC Health Serv Res 2021; 21:110. [PMID: 33526022 PMCID: PMC7852139 DOI: 10.1186/s12913-021-06083-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgery can correct congenital heart defects, but disease management in low- and middle-income countries can be challenging and complex due to a lack of referral system, financial resources, human resources, and infrastructure for surgical and post-operative care. This study investigates the experiences of caregivers of children with CHD accessing the health care system and pediatric cardiac surgery. METHODS A qualitative study was conducted at a teaching hospital in Ethiopia. We conducted semi-structured interviews with 13 caregivers of 10 patients with CHD who underwent cardiac surgery. We additionally conducted chart reviews for triangulation and verification. Interviews were conducted in Amharic and then translated into English. Data were analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework. RESULTS The following four observations emerged from the interviews: (a) most patients were diagnosed with CHD at birth if they were born at a health care facility, but for those born at home, CHD was discovered much later (b) many patients experienced misdiagnoses before seeking care at a large hospital, (c) after diagnosis, patients were waiting for the surgery for more than a year, (d) caregivers felt anxious and optimistic once they were able to schedule the surgical date. During the care-seeking journey, caregivers encountered financial constraints, struggled in a fragmented delivery system, and experienced poor service quality. CONCLUSIONS Delayed access to care was largely due to the lack of early CHD recognition and financial hardships, related to the inefficient and disorganized health care system. Fee waivers were available to assist low-income children in gaining access to health services or medications, but application information was not readily available. Indirect costs like long-distance travel contributed to this challenge. Overall, improvements must be made for district-level screening and the health care workforce.
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Affiliation(s)
- Sugy Choi
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heesu Shin
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Jongho Heo
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- National Assembly Futures Institute, Seoul, Republic of Korea.
| | - Etsegenet Gedlu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Nega
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamirat Moges
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bezabih
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jayoung Park
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woong-Han Kim
- Program in Global Surgery and Implementation Science, JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Baticulon RE, Dewan MC, Wittayanakorn N, Aldana PR, Maixner WJ. Pediatric neurosurgery in Asia and Australasia: training and clinical practice. J Neurosurg Pediatr 2021; 27:93-101. [PMID: 33036002 DOI: 10.3171/2020.6.peds20399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are limited data on the pediatric neurosurgical workforce in Asia and Australasia. The training and clinical practice of pediatric neurosurgeons need to be characterized in order to identify gaps in knowledge and skills, thereby establishing a framework from which to elevate pediatric neurosurgical care in the region. METHODS An online survey for pediatric neurosurgeons was created in REDCap (Research Electronic Database Capture), collecting demographic information and data on pediatric neurosurgical training and clinical practice. The link to answer the survey was sent to the mailing lists of the Asian Australasian Society for Pediatric Neurosurgery and the Japanese Society for Pediatric Neurosurgery, disseminated during the 2019 Asian Australasian Pediatric Neurosurgery Congress, and spread through social media. The survey was open to neurosurgeons who operated on patients ≤ 18 years old in Asian Australasian countries, whether or not they had completed fellowship training in pediatric neurosurgery. Descriptive statistics were computed and tabulated. Data were stratified and compared based on surgeon training and World Bank income group. RESULTS A total of 155 valid survey responses were analyzed, representing neurosurgeons from 21 countries. A total of 107 (69%) considered themselves pediatric neurosurgeons, of whom 66 (43%) had completed pediatric neurosurgery training. Neurosurgeons in East Asia commonly undergo a fellowship in their home countries, whereas the rest train mostly in North America, Europe, and Australia. A majority (89%) had operating privileges, and subspecialty pediatric training usually lasted from 6 months to 2 years. On average, trained pediatric neurosurgeons perform a higher number of pediatric neurosurgical operations per year compared with nonpediatric-trained respondents (131 ± 129 vs 56 ± 64 [mean ± SD], p = 0.0001). The mean number of total neurosurgical operations per year is similar for both groups (184 ± 129 vs 178 ± 142 [mean ± SD], p = 0.80). Respondents expressed the desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors. CONCLUSIONS Both pediatric and general neurosurgeons provide neurosurgical care to children in Asia and Australasia. There is a need to increase pediatric neurosurgery fellowship programs in the region. Skill sets and training needs in pediatric neurosurgery vary depending on the country's economic status and between pediatric-trained and nonpediatric-trained surgeons.
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Affiliation(s)
- Ronnie E Baticulon
- 1Department of Neurosciences, Philippine General Hospital and Department of Anatomy, College of Medicine, University of the Philippines, Manila, Philippines
| | - Michael C Dewan
- 2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nunthasiri Wittayanakorn
- 3Division of Neurosurgery, Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Philipp R Aldana
- 4Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Florida; and
| | - Wirginia J Maixner
- 5Department of Neurosurgery, The Royal Children's Hospital, Melbourne, Australia
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Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study. BMJ Glob Health 2020; 5:e003429. [PMID: 33272940 PMCID: PMC7716674 DOI: 10.1136/bmjgh-2020-003429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. METHODS A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). RESULTS Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. CONCLUSION The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.
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Kim KH, Kim HY, Kwon YJ, Mar TT, Aye A, Hwang HY, Kim KH, Im YJ, Lee KW, Cheon JE, Lee SH. The Effect of Global Surgery Fellowship for Tertiary Hospital Professionals from Myanmar: Current Issues and Future Challenges. JOURNAL OF SURGICAL EDUCATION 2020; 77:1169-1178. [PMID: 32389573 DOI: 10.1016/j.jsurg.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE As the surgical burden of diseases grows higher than ever, the development of skilled surgeons and surgery teams is of fundamental importance. However, there is scarce evidence of the effectiveness of surgical training programs. Our study aims to evaluate the effectiveness of a global surgery fellowship program. DESIGN In 2018, Myanmar subspecialty surgeons were trained for a 3-month in tertiary hospital of Korea. We evaluated the reactions, learning, and transfer of the 11 trainees using Kirkpatrick's Evaluation Model. SETTING Myanmar and Korean tertiary hospital. PARTICIPANTS Eleven participants of fellowship from Myanmar. RESULTS Participants' overall reaction scores were 4.45 ± 0.52 out of 5.00. Regarding overall competency, the trainees assessed themselves as at an "advanced beginner level" (3.63 ± 1.38 out of 10.00) at the beginning and at a "competent level" (5.40 ± 1.70 out of 10.00) after the training (p for difference = 0.014). The trainees stated that their transfer in clinical practice was between "quite applicable" and "I am very sure that I can do this" (3.39 ± 0.61 out of 4.00). Their transfer in education was second, ranked around "quite applicable" (3.21 ± 0.77 out of 4.00), and their transfer in research was last and ranked "applicable, but just a little" (2.81 ± 0.67 out of 4.00). However, in our online survey, native and foreign trainers had mixed opinions about the transfer of training and were not entirely confident in the trainees' competency. Trainees felt that there were multifactorial challenges for transfer and cited infrastructure, facilities, human resources, perioperative care, and financing. CONCLUSIONS Surgical trainees reported high-level satisfaction and increased knowledge after training. However, further onsite surgical experiences are necessary for a successful transfer to the real setting. Challenges for such transfers were multifactorial, and surgical care must be systemically strengthened.
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Affiliation(s)
- Kyae Hyung Kim
- Division of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea.
| | - Hyun-Young Kim
- Division of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea; Department of Pediatric Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jin Kwon
- Division of Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Tin Tin Mar
- Department of Hepatobiliary-Pancreas Surgery, Yangon Specialty Hospital, Yangon, Myanmar
| | - Aye Aye
- Department of Pediatric Surgery, Yangon Children Hospital, Yangon, Myanmar
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jae Im
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Hepatobiliary and Pancreatic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Pediatric Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
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Kim NE, Vervoot D, Hammouri A, Riboni C, Salem H, Grimes C, Wright NJ. Cost-effectiveness of neonatal surgery for congenital anomalies in low-income and middle-income countries: a systematic review protocol. BMJ Paediatr Open 2020; 4:e000755. [PMID: 32923695 PMCID: PMC7462241 DOI: 10.1136/bmjpo-2020-000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Congenital anomalies are the fifth leading cause of death in children under 5 years old globally (591 000 deaths reported in 2016). Over 95% of deaths occur in low-income and middle-income countries (LMICs). It is estimated that two-thirds of the congenital anomaly health burden could be averted through surgical intervention and that such interventions can be cost-effective. This systematic review aims to evaluate current evidence regarding the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs. METHODS AND ANALYSIS A systematic literature review will be conducted in PubMed, MEDLINE, Embase, Cochrane Library, Scielo, Google Scholar, African Journals OnLine and Regional WHO's African Index Medicus databases for articles on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs. The following search strings will be used: (1) congenital anomalies; (2) LMICs; and (3) cost-effectiveness of surgical interventions. Articles will be uploaded to Covidence software, duplicates removed and the remaining articles screened by two independent reviewers. Cost information for interventions or procedures will be extracted by country and condition. Outcome measurements by reported unit and cost-effectiveness ratios will be extracted. Methodological quality of each article will be assessed using the Drummond checklist for economic evaluations. The Agency for Healthcare Research and Quality's Effective Health Care Program guidance will be followed to assess the grade of the studies. ETHICS AND DISSEMINATION No ethical approval is required for conducting the systematic review. There will be no direct collection of data from individuals. The finalised article will be published in a scientific journal for dissemination. The protocol has been registered with PROSPERO (International Prospective Register of Systematic Reviews). CONCLUSION Congenital anomalies form a large component of the global health burden that is amenable to surgical intervention. This study will systematically review the current literature on the cost-effectiveness of neonatal surgery for congenital anomalies in LMICs. PROSPERO REGISTRATION NUMBER CRD42020172971.
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Affiliation(s)
- Na Eun Kim
- Department of General Surgery, Boston Medical Center, Boston, Massachusetts, USA
- King's College London, London, UK
| | - Dominique Vervoot
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ahmad Hammouri
- Department of Internal Medicine, Bethlehem Arab Society for Rehabilitation, Bethlehem, Palestine, State of
| | | | | | - Caris Grimes
- King's College London, London, UK
- Department of Surgery, Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - Naomi Jane Wright
- King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK
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Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance. World J Surg 2020; 43:2934-2944. [PMID: 31297580 DOI: 10.1007/s00268-019-05079-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.
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Global Initiative for Children's Surgery: A Model of Global Collaboration to Advance the Surgical Care of Children. World J Surg 2019; 43:1416-1425. [PMID: 30623232 PMCID: PMC7019676 DOI: 10.1007/s00268-018-04887-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles. METHODS Three global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships. RESULTS GICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second- and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care. CONCLUSION Worldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children.
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Bath M, Bashford T, Fitzgerald JE. What is 'global surgery'? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4:e001808. [PMID: 31749997 PMCID: PMC6830053 DOI: 10.1136/bmjgh-2019-001808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
'Global surgery' is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.
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Affiliation(s)
- Michael Bath
- Centre for Neuroscience, Surgery, and Trauma, Queen Mary University of London, London, UK
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, Division of Anaesthesia, University of Cambridge, Cambridge, UK
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The disproportionate cost of operation and congenital anomalies in infancy. Surgery 2019; 165:1234-1242. [PMID: 31056199 DOI: 10.1016/j.surg.2018.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 12/04/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Congenital anomalies are the leading cause of infant death and pediatric hospitalization, but existing estimates of the associated costs of health care are either cross-sectional surveys or economic projections. We sought to determine the percent of total hospital health care expenditures attributable to major anomalies requiring surgery within the first year of life. METHODS Utilizing comprehensive California statewide data from 2008 to 2012, cohorts of infants undergoing major surgery, with birth defects and with surgical anomalies, were constructed alongside a referent group of newborns with no anomalies or operations. Cost-to-charge and physician fee ratios were used to estimate hospital and professional costs, respectively. For each cohort, costs were broken down according to admission, birth episode, and first year of life, with additional stratifications by birth weight, gestational age, and organ system. RESULTS In total, 68,126 of 2,205,070 infants (3.1%) underwent major surgery (n = 32,614) or had a diagnosis of a severe congenital anomaly (n = 57,793). These accounted for $7.7 billion of the $18.9 billion (40.7%) of the total health care costs/expenditures of the first-year-of-life hospitalizations, $7.0 billion (48.6%) of the costs for infants with comparatively long birth episodes, and $5.2 billion (54.7%) of the total neonatal intensive care unit admission costs. Infants with surgical anomalies (n = 21,264) totaled $4.1 billion (21.7%) at $80,872 per infant. Cardiovascular and gastrointestinal diseases accounted for most admission costs secondary to major surgery or congenital anomalies. CONCLUSION In a population-based cohort of infant births compared with other critically ill neonates, surgical congenital anomalies are disproportionately costly within the United States health care system. The care of these infants, half of whom are covered by Medi-Cal or Medicaid, stands as a particular focus in an age of reform of health care payments.
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Concepcion T, Mohamed M, Dahir S, Adan Ismail E, Poenaru D, Rice HE, Smith ER. Prevalence of Pediatric Surgical Conditions Across Somaliland. JAMA Netw Open 2019; 2:e186857. [PMID: 30646203 PMCID: PMC6484554 DOI: 10.1001/jamanetworkopen.2018.6857] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Although surgical conditions are increasingly recognized as causing a significant health care burden among adults in low- and middle-income countries (LMICs), the burden of surgical conditions among children in LMICs remains poorly defined. OBJECTIVE To estimate the prevalence of pediatric surgical conditions across Somaliland using a nationwide community-based household survey. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted through a national community-based sampling survey from August through December 2017 in Somaliland. Participants were 1503 children surveyed using the Surgeons OverSeas Assessment of Surgical Need (SOSAS). MAIN OUTCOMES AND MEASURES The SOSAS survey contains 2 components, including a section on household demographics, deaths, and financial information and sections querying children's history of surgical conditions. RESULTS In this cross-sectional study that included 1503 children (55.6% male; mean [SE] age, 6.4 [0.1] years), 221 surgical conditions were identified among 196 children, yielding a mean (SE) prevalence of pediatric surgical conditions of 12.2% (1.5%). Only 53 of these 221 surgical conditions (23.7%) had been surgically corrected at the time of the survey. The most common conditions encountered were congenital anomalies (33.8%) and wound-related injuries (24.6%). Nationally, an estimated 256 745 children have surgical conditions, with an estimated 88 345 to 199 639 children having unmet surgical needs. CONCLUSIONS AND RELEVANCE Using national sampling, this study found that children have a high burden of surgical conditions in Somaliland. These data highlight the need for a scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in LMICs.
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Affiliation(s)
- Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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Dewan MC, Baticulon RE, Ravindran K, Bonfield CM, Poenaru D, Harkness W. Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide. Childs Nerv Syst 2018; 34:1837-1846. [PMID: 30030605 DOI: 10.1007/s00381-018-3902-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Quantifying the global burden of pediatric neurosurgical disease-and current efforts addressing it-is challenging, particularly in the absence of uniform terminology. We sought to establish bellwether procedures for pediatric neurosurgery, in order to standardize terminology, establish priorities, and facilitate goal-oriented capacity building. METHODS Members of international pediatric neurosurgical and pediatric surgical societies were surveyed via the Research Electronic Data Capture (REDCap) platform. Among 15 proposed neurosurgical procedures, respondents assigned numerical grades of surgical necessity and selected hospital-level designation within a three-tiered system. A procedure was considered a bellwether if (a) the majority of respondents deemed it necessary for either a primary- or secondary-level hospital and (b) the procedure was graded at or above the 90th percentile on a continuous scale of essentiality. Data were compiled and analyzed using Stata software. RESULTS Complete responses were obtained from 459 surgeons from 76 countries, the majority of whom practiced in a tertiary referral hospital (88%), with a primarily public patient population (64%). Six bellwether procedures were identified for pediatric neurosurgery: shunt for hydrocephalus, myelomeningocele closure, burr holes, trauma craniotomy, external ventricular drain (EVD) insertion, and cerebral abscess evacuation. Few differences in bellwether criteria designations were observed among respondents from different World Health Organization regions and World Bank income groups. CONCLUSIONS The six bellwether procedures identified can be used as markers of infrastructure capacity at various hospital levels, hence allowing targeted neurosurgical capacity-building in low-resource settings in order to avert disability and death from childhood neurosurgical disease.
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Affiliation(s)
- Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN, 37232-2380, USA.
| | - Ronnie E Baticulon
- Department of Anatomy, University of the Philippines College of Medicine, Manila, Philippines
| | | | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN, 37232-2380, USA
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre and Montréal Children's Hospital, Montréal, Canada
| | - William Harkness
- Great Ormond Street Hospital, Institute of Child Health, University College London, London, UK
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Dewan MC, Baticulon RE, Rattani A, Johnston JM, Warf BC, Harkness W. Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide. Neurosurg Focus 2018; 45:E13. [DOI: 10.3171/2018.7.focus18272] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.
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Affiliation(s)
- Michael C. Dewan
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ronnie E. Baticulon
- 2Department of Neurosurgery, University of the Philippines College of Medicine, Mabani, Ermita, Manila, Philippines
| | - Abbas Rattani
- 3Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - James M. Johnston
- 4Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Benjamin C. Warf
- 5Department of Neurological Surgery, Boston Children’s Hospital, Boston, Massachusetts; and
| | - William Harkness
- 6Department of Neurosciences, Institute for Child Health, London, United Kingdom
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Petroze RT, Castle SL, Radulescu A, Grant C, Van Arendonk K, Neff LP. An appeal from fellows. J Pediatr Surg 2018; 53:1259-1260. [PMID: 29618411 DOI: 10.1016/j.jpedsurg.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Robin T Petroze
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | | | - Andrei Radulescu
- Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL.
| | - Christa Grant
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
| | | | - Lucas P Neff
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA.
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Cairo SB, Agyei J, Nyavandu K, Rothstein DH, Kalisya LM. Neurosurgical management of hydrocephalus by a general surgeon in an extremely low resource setting: initial experience in North Kivu province of Eastern Democratic Republic of Congo. Pediatr Surg Int 2018; 34:467-473. [PMID: 29453580 DOI: 10.1007/s00383-018-4238-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Evaluate the management of hydrocephalus in pediatric patients in the Eastern Democratic Republic of Congo by a general surgeon. METHODS Retrospective review of a single institution in the province of North Kivu. Patient charts and surgical notes were reviewed from 2003 to 2016. RESULTS 116 procedures were performed for an average of 8.9 per year. 51.7% of surgeries were on female patients with an average age of 13.6 ± 22.7. The average distance traveled from home to hospital was 153.7 km but ranged from 5 to 1420 km. The majority of hydrocephalus was due to neonatal sepsis (57%); 33.6% were classified as congenital; 9.5% of cases followed myelomeningocele closure. 97.4% had a ventriculoperitoneal (VP) shunt placed. Endoscopic third ventriculostomy combined choroid plexus cauterization (ETV/CPC) was performed in 2.5% of patients. Shunt infection occurred in 9.5% of patients, shunt dysfunction or obstruction in 5.2% and shunt exteriorization in 1.7%; no complications occurred in patients who underwent ETV/CPC. CONCLUSION VP shunt is the predominant management for hydrocephalus in this environment with increasing use of ETV/CPC. Further research is needed to evaluate variability by etiology, short and long-term outcomes of procedures performed by neurosurgeons and general surgeons, and regional epidemiologic variability.
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Affiliation(s)
- Sarah B Cairo
- John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Justice Agyei
- Department of Neurosurgery, State University of New York at Buffalo, 955 Main Street, Buffalo, NY, 14203, USA
| | - Kavira Nyavandu
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
| | - David H Rothstein
- John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, State University of New York at Buffalo, 955 Main Street, Buffalo, NY, 14203, USA
| | - Luc Malemo Kalisya
- COSECSA Training Program, HEAL Africa Hospital, Goma, North Kivu, Democratic Republic of Congo
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Burgos CM, Bolkan HA, Bash-Taqi D, Hagander L, von Schreeb J. The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap. World J Surg 2018; 42:652-665. [PMID: 28932917 PMCID: PMC5801385 DOI: 10.1007/s00268-017-4244-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In low- and middle-income countries, there is a gap between the need for surgery and its equitable provision, and a lack of proxy indicators to estimate this gap. Sierra Leone is a West African country with close to three million children. It is unknown to what extent the surgical needs of these children are met. AIM To describe a nationwide provision of pediatric surgical procedures and to assess pediatric hernia repair as a proxy indicator for the shortage of surgical care in the pediatric population in Sierra Leone. METHODS We analyzed results from a nationwide facility survey in Sierra Leone that collected data on surgical procedures from operation and anesthesia logbooks in all facilities performing surgery. We included data on all patients under the age of 16 years undergoing surgery. Primary outcomes were rate and volume of surgical procedures. We calculated the expected number of inguinal hernia in children and estimated the unmet need for hernia repair. RESULTS In 2012, a total of 2381 pediatric surgical procedures were performed in Sierra Leone. The rate of pediatric surgical procedures was 84 per 100,000 children 0-15 years of age. The most common pediatric surgical procedure was hernia repair (18%), corresponding to a rate of 16 per 100,000 children 0-15 years of age. The estimated unmet need for inguinal hernia repair was 88%. CONCLUSIONS The rate of pediatric surgery in Sierra Leone was very low, and inguinal hernia was the single most common procedure noted among children in Sierra Leone.
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Affiliation(s)
| | - Håkon Angell Bolkan
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Lars Hagander
- Surgery and Public Health, Pediatric Surgery, Department of Clinical Sciences in Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Johan von Schreeb
- Global Health-Health System and Policy Department of Public Health Sciences, Centre for Research on Health Care in Disasters, Stockholm, Sweden
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Abstract
This review will outline the role of visiting cardiac surgical teams in low- and middle-income countries drawing on the collective experience of the authors in a wide range of locations. Requests for assistance can emerge from local programmes at a beginner or advanced stage. However, in all circumstances, careful pre-trip planning is necessary in conjunction with clinical and non-clinical local partners. The clinical evaluation, surgical procedures, and postoperative care all serve as a template for collaboration and education between the visiting and local teams in every aspect of care. Education focusses on both common and patient-specific issues. Case selection must appropriately balance the clinical priorities, safety, and educational objectives within the time constraints of trip duration. Considerable communication and practical challenges will present, and clinicians may need to make significant adjustments to their usual practice in order to function effectively in a resource-limited, unfamiliar, and multilingual environment. The effectiveness of visiting trips should be measured and constantly evaluated. Local and visiting teams should use data-driven evaluations of measurable outcomes and critical qualitative evaluation to repeatedly re-assess their interim goals. Progress invariably takes several years to achieve the final goal: an autonomous self-governing, self-financed, cardiac programme capable of providing care for children with complex CHD. This outcome is consistent with redundancy for the visiting trips model at the site, although fraternal, professional, and academic links will invariably remain for many years.
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Global surgery: current evidence for improving surgical care. Curr Opin Otolaryngol Head Neck Surg 2017; 25:300-306. [DOI: 10.1097/moo.0000000000000374] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Manickchund Y, Hadley GP. Paediatric surgery outreach: analysis of referrals to a tertiary paediatric surgery service to plan an outreach programme Kwa-Zulu Natal, South Africa. Trop Doct 2017; 47:305-311. [PMID: 28682220 DOI: 10.1177/0049475517718103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paediatric surgical disease is a neglected health problem. Patients travel great distances to tertiary level care for management. This study aimed at analysing referral patterns to design an outreach programme for paediatric surgery in KwaZulu Natal. Data forms of patients referred to the service between January and July 2016 were correlated with the clinical record. Delays in management were compared to morbidity and mortality. Out of 781, 158 referrals were accepted as emergencies. The majority (62%) were children aged < 1 year. Gastro-intestinal problems (38.4%) and congenital anomalies (26.9%) formed the majority. Patients who died had a significantly longer delay in transfer. Longer total delay was associated with statistically significant greater morbidity. In a setting where a large rural population is served by single-centre tertiary care, delays exist and contribute to morbidity. The authors advocate the establishment of an outreach programme to address these issues.
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Affiliation(s)
- Yashoda Manickchund
- 1 Paediatric Surgery Registrar, Department of Paediatric Surgery Nelson R Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa
| | - G P Hadley
- 2 Professor Emeritus, Department of Paediatric Surgery, Nelson R Mandela School of Medicine, University of Kwazulu Natal, Durban, South Africa
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