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The global challenges of surgical congenital anomalies: Evidence, models, and lessons
Salimah R Walani1, Norgrove Penny2, Doreen Nakku3
1MiracleFeet Chapel Hill, NC, United States.
Insights
Addressing congenital anomalies in low-income countries requires overcoming barriers like limited access to surgical care and expertise. Global collaboration and innovative care models are crucial for improving outcomes for children with birth defects.
Area of Science:
- Pediatric Surgery
- Global Health
- Congenital Anomalies
Background:
- Congenital anomalies (structural birth defects) require surgical sub-specialty care for children.
- Over 90% of infants with congenital anomalies are born in low- and middle-income countries (LMICs) with limited surgical access.
- Barriers include lack of early identification, registries, trained expertise, infrastructure, poverty, and social stigma.
Purpose of the Study:
- To highlight the global challenges in treating congenital anomalies in LMICs.
- To discuss successful models and strategies for expanding surgical care services.
- To emphasize the need for integrated national health policies for pediatric surgical care.
Main Methods:
- Review of global challenges in pediatric surgical care for congenital anomalies.
- Analysis of successful interventions and care models, including registry programs and specialized treatments.
- Examination of the role of non-governmental organizations and international health bodies.
Main Results:
- Growing recognition of the priority to expand services for congenital anomalies.
- Successful models include registry programs (e.g., Latin America), the Ponseti method for clubfoot, and NGO-supported initiatives (e.g., oro-facial clefts).
- Specialized hospitals contribute essential sub-specialist expertise.
Conclusions:
- Effective partnerships and innovative care distribution are essential for improving access.
- Developing national plans integrated into health policy is vital for sustainable care.
- Addressing congenital anomalies requires a multi-faceted approach focusing on infrastructure, expertise, and accessibility in LMICs.
Abstract:
The treatment of congenital anomalies (structural birth defects) is common to all the surgical sub-specialties dealing with children. Globally more than 90 % of all babies born with a congenital anomaly are born in middle-and-low-income countries where there is often limited access to needed surgical care. Challenges include lacks of early identification, registry and surveillance systems, missing referral pathways, shortage of trained surgical expertise and insufficient surgical infrastructure. Poverty, transportation logistics, financial constraints and social stigma are also serious barriers for families. There is, however, growing recognition of the priority to expand services, encouraged by the World Health Organization and other global players, and examples of successful models of care. Registry programs are growing, especially in Latin America. The Ponseti method of clubfoot care has been revolutionary on a global scale. The role of not-for-profit non-governmental-organizations has been instrumental in fundraising, training and logistical support as exemplified in the care of oro-facial clefts. Specialized "niche" hospitals are providing needed sub-specialist expertise. The way forward includes the need for effective partnerships, innovative methods to distribute care out from referral hospitals into the districts and the development of national plans embedded in national health policy.
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