Epidemiology of pediatric surgical needs in low-income countries
Elissa K Butler1, Tu M Tran2, Neeraja Nagarajan3
1Department of Surgery, University of Washington, Seattle, WA, United States of America.
Insights
Millions of children in low- and middle-income countries (LMICs) have unmet surgical needs. Addressing pediatric surgical conditions is crucial for improving child health and achieving global development goals.
Area of Science:
- Global Health
- Pediatric Surgery
- Public Health Policy
Background:
- Surgically-treatable diseases represent a significant global burden of disease.
- In low- and middle-income countries (LMICs), up to 85% of children face a surgically-treatable condition by age 15.
Purpose of the Study:
- To estimate the prevalence and nature of pediatric surgical needs in LMICs.
- To quantify the unmet burden of surgical conditions among children in these regions.
Main Methods:
- A cross-sectional, countrywide household survey was conducted in four LMICs (Rwanda, Sierra Leone, Nepal, Uganda).
- Data collection included demographics, verbal examinations, and access to care assessments.
- Global estimates were derived using combined data, accounting for country-level clustering.
Main Results:
- 19% of surveyed children (0-18 years) had a surgical need, with 62% of these unmet.
- An estimated 3.7 million children in the studied LMICs live with a surgical need.
- Unmet needs were most common for head, face, neck, and extremity conditions; untreated conditions included masses, while treated ones were often wounds/burns.
Conclusions:
- Pediatric surgical care is essential for improving child health in LMICs.
- Scaling up pediatric surgical services is vital for achieving global health and development goals, including the Sustainable Development Goals.
Objective:
According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs.
Methods:
A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering.
Results:
A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0-18 years of age) with median age of 8 (Interquartile range [IQR]: 4-13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns.
Conclusion:
Surgery has been elevated as an "indivisible, indispensable part of health care" in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:26Kidney Transplant II: Surgical Procedure
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...