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Disparities in surgical care for children across Brazil: Use of geospatial analysis
João R N Vissoci1,2,3,4, Cecilia T Ong1,5, Luciano de Andrade4
1Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States of America.
Insights
Surgical care for children in Brazil shows significant regional disparities in resources and access. Improving access to pediatric surgery is linked to lower child mortality, regardless of socioeconomic status.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Systems Research
Background:
- Surgical care for children in low- and middle-income countries is not well understood.
- Characterizing pediatric surgical care delivery in Brazil is crucial.
- Identifying links between surgical resources and childhood mortality is a key objective.
Purpose of the Study:
- To characterize the delivery of surgical care for children in Brazil's public health system.
- To identify associations between surgical resources and childhood mortality rates.
Main Methods:
- Cross-sectional, ecological study of pediatric surgical care in Brazil (2010-2015).
- Analysis of national databases and geospatial methods (two-step floating catchment, Getis-Ord-Gi, geographically weighted regression).
- Exploration of relationships between infrastructure, workforce, access, procedure rates, under-5 mortality rate (U5MR), and perioperative mortality rate (POMR).
Main Results:
- Uneven distribution of surgical workforce (pediatric surgeons per 100,000 children) and resources across Brazil's regions.
- Significant disparities in hospital infrastructure, procedure rates, and access to care, favoring South and Southeast regions.
- Increased access to surgical care correlated with lower under-5 mortality rate (U5MR), independent of socioeconomic status.
Conclusions:
- Wide disparities exist in pediatric surgical care across Brazil.
- Access to surgical care is independently associated with improved child survival.
- Policy interventions should focus on equitable resource allocation for pediatric surgical services based on population needs.
Background:
Health systems for surgical care for children in low- and middle-income countries remain poorly understood. Our goal was to characterize the delivery of surgical care for children across Brazil and to identify associations between surgical resources and childhood mortality.
Methods:
We performed a cross-sectional, ecological study to analyze surgical care for children in the public health system (Sistema Único de Saúde) across Brazil from 2010 to 2015. We collected data from several national databases, and used geospatial analysis (two-step floating catchment, Getis-Ord-Gi analysis, and geographically weighted regression) to explore relationships between infrastructure, workforce, access, procedure rate, under-5 mortality rate (U5MR), and perioperative mortality rate (POMR).
Results:
A total of 246,769 surgical procedures were performed in 6,007 first level/ district hospitals and 491 referral hospitals across Brazil over the study period. The surgical workforce is distributed unevenly across the country, with 0.13-0.26 pediatric surgeons per 100,000 children in the poorer North, Northeast and Midwest regions, and 0.6-0.68 pediatric surgeons per 100,000 children in the wealthier South and Southeast regions. Hospital infrastructure, procedure rate, and access to care is also unequally distributed across the country, with increased resources in the South and Southeast compared to the Northeast, North, and Midwest. The U5MR varies widely across the country, although procedure-specific POMR is consistent across regions. Increased access to care is associated with lower U5MR across Brazil, and access to surgical care differs by geographic region independent of socioeconomic status.
Conclusions:
There are wide disparities in surgical care for children across Brazil, with infrastructure, manpower, and resources distributed unevenly across the country. Access to surgical care is associated with improved U5MR independent of socioeconomic status. To address these disparities, policy should direct the allocation of surgical resources commensurate with local population needs.
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