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A critical threshold for global pediatric surgical workforce density

Megan E Bouchard1, Yao Tian2, Jeanine Justiniano3

  • 1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA. mbouchard@luriechildrens.org.

Pediatric Surgery International
|June 9, 2021
PubMed

Insights

Pediatric surgical workforce density (PSWD) significantly impacts child survival rates globally. Improving PSWD above 0.37 per 100,000 children is crucial for reducing pediatric mortality, especially in low- and middle-income countries.

Area of Science:

  • Global Health
  • Pediatric Surgery
  • Health Workforce Analysis

Background:

  • 1.7 billion children worldwide lack access to essential surgical care.
  • Pediatric surgical workforce density (PSWD) is a key indicator of surgical access.
  • Existing data suggests PSWD correlates with survival for complex pediatric surgical cases.

Purpose of the Study:

  • To investigate the correlation between PSWD and population-level pediatric mortality rates.
  • To identify the PSWD threshold associated with improved child survival outcomes.
  • To assess the adequacy of current PSWD in low- and middle-income countries (LMICs) relative to child mortality goals.

Main Methods:

  • Identified pediatric surgeons in 26 countries (2015-2019) using medical licensing registries.
  • Calculated country-specific PSWD as pediatric surgeons per 100,000 children.
  • Assessed correlations between PSWD and neonatal, infant, and under-5 mortality rates using statistical models.

Main Results:

  • Analyzed data from 420 million children across LIC, L-MIC, UMIC, and HIC countries.
  • Median PSWD varied significantly by income: 0.03 (LIC), 0.12 (L-MIC), 1.34 (UMIC), and 2.13 (HIC).
  • Strong correlations found between PSWD and reduced mortality rates (neonatal: 0.78, infant: 0.82, under-5: 0.83).
  • Child survival rates improved with increasing PSWD, showing a significant threshold at 0.37.

Conclusions:

  • PSWD is a significant determinant of pediatric population mortality.
  • A PSWD exceeding 0.37 per 100,000 children is associated with substantially improved survival.
  • Current PSWD in LMICs is insufficient to meet the UN Sustainable Development Goal 3.2 for child mortality.
Abstract

Keywords:
Childhood mortalityNational surgical planningPediatric surgeryWorkforce density

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