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Met and Unmet Need for Pediatric Surgical Access in Uganda: A Country-Wide Prospective Analysis
Nasser Kakembo1, David F Grabski2, Martin Situma3
1Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
Insights
Pediatric surgical care in Uganda is limited, with only 1% of the need met. Despite this, local surgical teams avert significant disease burden and provide economic benefits, supporting strategies to improve access.
Area of Science:
- Global Surgery
- Pediatric Surgery
- Health Systems Research
Background:
- Access to pediatric surgical care is critically limited in low- and low-middle income countries.
- Understanding surgical access is vital for effective resource allocation and improving child health outcomes.
Purpose of the Study:
- To analyze surgical volume, outcomes, and distribution of pediatric general surgical procedures in Uganda.
- To quantify the averted burden of surgical disease and unmet surgical need in the pediatric population.
Main Methods:
- Prospective data from pediatric surgical databases across four regional hospitals in Uganda over six years.
- Calculation of averted disease burden and unmet surgical need using high-income country data as a benchmark.
Main Results:
- 1350 pediatric surgical cases annually (6 per 100,000 children), representing only 1% of the total need.
- Significant disease burden averted: 27,000 disability-adjusted life years annually, with an economic benefit of $23 million USD.
- Complex cases concentrated in hospitals with dedicated pediatric surgical teams.
Conclusions:
- Local surgical teams significantly reduce disease burden and offer economic benefits, highlighting the value of pediatric surgical care.
- Findings support ongoing strategies to enhance pediatric surgical access in Uganda.
- This study provides crucial country-level data on pediatric surgical procedures using a local database.
Introduction:
Children's surgical access in low and low-middle income countries is severely limited. Investigations detailing met and unmet surgical access are necessary to inform appropriate resource allocation.
Materials And Methods:
Surgical volume, outcomes, and distribution of pediatric general surgical procedures were analyzed using prospective pediatric surgical databases from four separate regional hospitals in Uganda. The current averted burden of surgical disease through pediatric surgical delivery in Uganda and the unmet surgical need based on estimates from high-income country data was calculated.
Results:
A total of 8514 patients were treated at the four hospitals over a 6-year period corresponding to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000 children per year. The majority of complex congenital anomalies and surgical oncology cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability adjusted life years per year, which resulted in an economic benefit of approximately 23 million USD per year. However, the average case volume performed at the four regional hospitals currently represents 1% of the total projected pediatric surgical need.
Conclusions:
This investigation is one of the first to demonstrate the distribution of pediatric surgical procedures at a country level through the use of a prospective locally created database. Significant disease burden was averted by local pediatric and adult surgical teams, demonstrating the economic benefit of pediatric surgical care delivery. These findings support several ongoing strategies to increase pediatric surgical access in Uganda.
