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Pediatric surgery backlog at a Ugandan tertiary care facility: COVID-19 makes a chronic problem acutely worse
Greg Klazura1,2,3,4,5, Phyllis Kisa6, Anne Wesonga6
1Department of Surgery, University of Illinois at Chicago, Chicago, USA. greg.klazura@gmail.com.
Insights
The COVID-19 pandemic severely restricted pediatric surgery in Uganda, with only 5% of expected cases performed. This resulted in a significant backlog and an estimated economic impact of at least $23 million USD.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Economics
Background:
- 1.7 billion children worldwide lack surgical care access.
- COVID-19 worsened global access to essential surgical services.
- Uganda faces a critical deficit in pediatric surgical care.
Purpose of the Study:
- To quantify the impact of the COVID-19 pandemic on pediatric surgical care in Uganda.
- Assess the backlog and economic consequences of reduced surgical access.
Main Methods:
- Analyzed pediatric surgical patient volumes before and during the pandemic at Mulago Hospital.
- Reviewed operative logs for 2020 to determine case volume.
- Calculated Disability-Adjusted Life Years (DALYs) and estimated economic impact.
Main Results:
- Only 46 elective pediatric surgeries were performed in 2020, a 5% of the expected 956 cases.
- A backlog of 910 patients was created, resulting in 10,620 DALYs lost.
- Economic impact conservatively estimated at $23 million USD, potentially reaching $120 million USD.
Conclusions:
- The COVID-19 pandemic drastically reduced pediatric surgery access in Uganda.
- This exacerbated existing challenges, leading to significant health and economic costs.
- Urgent interventions are needed to address the pediatric surgical care crisis.
Background:
1.7 billion of the world's 2.2 billion children do not have access to surgical care. COVID-19 acutely exacerbated this problem; delaying or preventing presentation and access to surgical care globally. We sought to quantify the effect of COVID-19 on children requiring surgery in Uganda.
Methods:
Average monthly incident, elective pediatric surgical patient volume was calculated by sampling clinic logs before and during the pandemic, and case volume was quantified by reviewing operative logbooks for all surgeries in 2020 at Mulago Hospital, Kampala. Disability-Adjusted Life Years (DALYs) resulting from untreated disease were calculated and used to estimate economic impact using three different models.
Results:
Expected elective pediatric surgery cases were 956. In 2020, pediatric surgery at Mulago was limited to 46 elective cases, approximately 5% of the expected incident cases, leading to a backlog of 910 patients and a loss of 10,620.12 DALYs. The economic impact of more than 10,000 disability years in Uganda is conservatively estimated at $23 million USD with other measures estimating ~ $120 million USD.
Conclusion:
The COVID-19 pandemic limited access to pediatric surgery in Uganda, making a chronic problem acutely worse, with costly consequences for the children and health system.
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