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A pilot survey of pediatric surgical capacity in West Africa
Mekam T Okoye1, Emmanuel A Ameh, Adam L Kushner
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, mokoye@jhmi.edu.
Insights
Pediatric surgical capacity in West Africa is limited, with shortages in surgeons, intensive care units, and essential equipment. The PediPIPES survey highlights critical gaps in resources needed for optimal pediatric surgical care in the region.
Area of Science:
- Global Health
- Pediatric Surgery
- Surgical Capacity Assessment
Background:
- Limited data exist on pediatric surgical capacity in low- and middle-income countries (LMICs).
- Assessing pediatric surgical capacity is crucial for resource allocation and planning in LMICs.
- A specific tool was needed to evaluate pediatric surgical capacity in these regions.
Purpose of the Study:
- To develop and utilize a pediatric survey tool (PediPIPES) to assess pediatric surgical capacity.
- To document the availability of personnel, infrastructure, procedures, equipment, and supplies for pediatric surgery in West Africa.
Main Methods:
- The pediatric PIPES (PediPIPES) survey was adapted from the original PIPES survey.
- The PediPIPES survey was reviewed and refined by nine pediatric surgeons.
- The survey was administered to surgeons across 37 hospitals in 10 West African countries.
Main Results:
- Over half of surveyed hospitals had fewer than three pediatric surgeons.
- More than 50% of hospitals lacked neonatal or general intensive care units.
- Essential pediatric equipment, like apnea monitors, was unavailable in 65% of hospitals, and less-invasive procedures were infrequently performed.
Conclusions:
- The PediPIPES survey effectively documented pediatric surgical capacity in West Africa.
- Many West African hospitals are inadequately prepared to provide optimal pediatric surgical care.
- Significant shortages exist in personnel, infrastructure, procedures, equipment, and supplies for pediatric surgery.
Background:
While some data exist for the burden of pediatric surgical disease in low- and middle-income countries (LMICs), little is known about pediatric surgical capacity. In an effort to better plan and allocate resources for pediatric surgical care in LMICs, a survey of pediatric surgical capacity using specific tool was needed.
Methods:
Based on the previously published Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey, a pediatric PIPES (PediPIPES) survey was created. To ensure relevance to local needs and inclusion of only essential items, a draft PediPIPES survey was reviewed by nine pediatric surgeons and modifications were incorporated into a final tool. The survey was then distributed to surgeons throughout sub-Saharan Africa. Data from West Africa (37 hospitals in 10 of the 16 countries in the subregion) were analyzed.
Results:
Fewer than 50% (18/37) of the hospitals had more than two pediatric surgeons. Neonatal or general intensive care units were not available in 51.4% (19/37) of hospitals. Open procedures such as appendectomy were performed in all the hospitals whereas less-invasive interventions such as non-operative intussusception reduction were done in only 41% (15/37). Life-saving pediatric equipment such as apnea monitors were not available in 65% (24/37) of the hospitals.
Conclusions:
The PediPIPES survey was useful in documenting the pediatric surgical capacity in West Africa. Many hospitals in West Africa are not optimally prepared to undertake pediatric surgery. Our study showed shortages in personnel, infrastructure, procedures, equipment, and supplies necessary to adequately and appropriately provide surgical care for pediatric patients.
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