Patterns, procedures, and indications for pediatric surgery in a Tanzanian Refugee Camp: a 20-year experience
Sarah Rapaport1, Zachary Obinna Enumah1,2, Hilary Ngude3
1Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Insights
Pediatric general surgery is provided in Nyarugusu Refugee Camp, serving both refugees and locals. This study highlights the need for more research and advocacy for pediatric surgery in humanitarian settings globally.
Area of Science:
- Global Health
- Pediatric Surgery
- Humanitarian Medicine
Background:
- Limited data exists on surgical care provision in humanitarian settings, especially for pediatric populations in protracted crises.
- Displaced populations worldwide exceed 103 million, with children comprising 41%.
Purpose of the Study:
- To analyze patterns, procedures, and indications for pediatric surgery in Nyarugusu Refugee Camp over two decades.
- To inform global surgical initiatives and advocacy for pediatric refugee care.
Main Methods:
- Retrospective analysis of 1221 pediatric surgical procedures performed over 20 years.
- Data collected from Nyarugusu Refugee Camp, including refugee and local Tanzanian patients.
Main Results:
- The most frequent procedures included cesarean sections (70%), herniorrhaphies (16%), and exploratory laparotomies (5%).
- Teenagers (12-17 years) were the primary recipients of surgery (81%).
- Refugees had higher rates of exploratory laparotomy for acute abdomen, intestinal obstruction, and peritonitis compared to local children.
Conclusions:
- Nyarugusu Camp provides a substantial volume of essential pediatric general surgery to both refugee and host communities.
- This research underscores the necessity of integrating pediatric refugee surgery into the global surgery agenda.
- Further advocacy and research are crucial for improving pediatric surgical services in humanitarian contexts worldwide.
Background:
There are 103 million displaced people worldwide, 41% of whom are children. Data on the provision of surgery in humanitarian settings are limited. Even scarcer is literature on pediatric surgery performed in humanitarian settings, particularly protracted humanitarian settings.
Methods:
We reviewed patterns, procedures, and indications for pediatric surgery among children in Nyarugusu Refugee Camp using a 20-year retrospective dataset.
Results:
A total of 1221 pediatric surgical procedures were performed over the study period. Teenagers between the ages of 12 and 17 years were the most common age group undergoing surgery (n=991; 81%). A quarter of the procedures were performed on local Tanzanian children seeking care in the camp (n=301; 25%). The most common procedures performed were cesarean sections (n=858; 70%), herniorrhaphies (n=197; 16%), and exploratory laparotomies (n=55; 5%). Refugees were more likely to undergo exploratory laparotomy (n=47; 5%) than Tanzanian children (n=7; 2%; p=0.032). The most common indications for exploratory laparotomy were acute abdomen (n=24; 44%), intestinal obstruction (n=10; 18%), and peritonitis (n=9; 16%).
Conclusions:
There is a significant volume of basic pediatric general surgery performed in the Nyarugusu Camp. Services are used by both refugees and local Tanzanians. We hope this research will inspire further advocacy and research on pediatric surgical services in humanitarian settings worldwide and illuminate the need for including pediatric refugee surgery within the growing global surgery movement.
