Access to paediatric surgery: the geography of inequality in Nigeria
Mohamed Abd Salam El Vilaly1, Maureen A Jones1, Makela Cordero Stankey2
1Technical Division, Population and Development Branch, United Nations Population Fund, New York, New York, USA.
Insights
Most Nigerian children lack access to timely paediatric surgical care, with significant state-level disparities. Improving surgical services and training is crucial for child health and reducing surgical disease burden.
Area of Science:
- Paediatric Surgery
- Health Services Research
- Geospatial Analysis
Background:
- Nigeria has 96.3 million children and adolescents (0-19 years), representing 54% of the population.
- Inadequate surgical access leads to disability and mortality for treatable conditions in Nigerian youth.
- Unique perioperative needs necessitate evaluating paediatric surgical and anaesthesia workforce distribution.
Purpose of the Study:
- To determine the percentage of Nigerian youth (0-19 years) residing within a 2-hour travel time of paediatric surgical care.
- To identify geographical disparities in paediatric surgical access at national and state levels.
Main Methods:
- Utilized workforce data from the Association of Paediatric Surgeons of Nigeria and Nigeria Society of Anaesthetists.
- Integrated health facility locations with geospatial data and population estimates (2016-2017).
- Defined timely access as residing within a 2-hour travel catchment area around a facility.
Main Results:
- Paediatric surgical access varies widely, with 2.1%-30.5% of youth within 2 hours of care across states.
- 3 states have only 2.1%-4.8% access, 12 states have 4.9%-13.8%, and 8 states have 13.9%-22.6% access.
- 69.5%-98% of Nigerian youth lack access to paediatric surgical care within a 2-hour radius.
Conclusions:
- Significant state-level variations in surgical care access exist for Nigerian children.
- Developing services and training workforce in underserved states is vital for child health.
- Addressing surgical disease burden aligns with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan.
Background:
About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population's unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study's aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level.
Methods:
The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access.
Results:
Across Nigeria's 36 states and Federal Capital Territory, the percentage of Nigeria's 0-19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%-30.5%. In 3 states, only 2.1%-4.8% of the population can access a facility within 2 hours, 12 have 4.9%-13.8%, and 8 have 13.9%-22.6%.
Conclusion:
There is significant variation across Nigerian states regarding access to surgical care, with 69.5%-98% of Nigeria's 0-19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria's 0-19 population and reducing Nigeria's burden of surgical disease, in line with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan.
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