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Overcoming Political Upheaval to Deliver Pediatric Surgical Care in Afghanistan: Prospective Analysis of the First
Dunya Moghul1,2,3, Phillip J Hsu4, Emma Bryce5,6
1From the Department of Surgery, Ataturk Hospital, Kabul, Afghanistan (Moghul, Obaidy, Sherzad).
Insights
A new pediatric operating room in Afghanistan successfully provided surgical care to over 1,000 children, demonstrating improved pediatric surgical capacity in a low-resource setting. The study highlights the need for further efforts to address untreated surgical conditions in children.
Area of Science:
- Global Surgery
- Pediatric Surgery
- Health Systems Strengthening
Background:
- Pediatric surgical care is critically limited in Afghanistan, with minimal data available on its provision.
- A children's charity established a new pediatric operating room to address this gap.
- This study investigates the impact of this new infrastructure on pediatric surgical services.
Purpose of the Study:
- To evaluate the initial impact of a newly established pediatric operating room on surgical care delivery in Afghanistan.
- To describe the types of surgical procedures performed and patient demographics.
- To assess the feasibility of providing pediatric surgical services in a low-resource, complex political environment.
Main Methods:
- Prospective collection of perioperative clinical data from March to December 2023 at Ataturk Hospital, Kabul.
- Inclusion of all pediatric patients (under 14 years) undergoing surgery.
- Descriptive analysis of data including demographics, diagnoses, procedures, and outcomes.
Main Results:
- A total of 1,014 operations were performed, with 34% being emergencies.
- Common emergent diagnoses included appendicitis and intussusception; common elective procedures involved hernias and undescended testes.
- Low rates of mortality (0.3%) and infectious complications (0.3%) were observed.
Conclusions:
- The new pediatric operating room successfully enhanced surgical capacity in a low-resource setting.
- This initiative demonstrates the potential for infrastructure development to improve pediatric surgical care in Afghanistan.
- Further research is needed to quantify the burden of untreated pediatric surgical disease to support advocacy and resource allocation.
Background:
Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children's charity on the provision of pediatric surgery in Afghanistan.
Study Design:
After the opening of the new Kids Operating Room at Ataturk Hospital in Kabul, Afghanistan, in March 2023, perioperative clinical data were prospectively collected until December 2023. All children (younger than 14 years of age) undergoing surgical procedures were included in a Research Electronic Data Capture database, and descriptive analyses were performed.
Results:
A total of 1,014 operations were performed during the study period. Seventy-three percent of the patients were from Kabul Province, and 80% were male. Thirty-four percent of the operations were emergencies. Mean age was 6.5 years. Patients who received elective surgery were, on average, younger (age 5.2 years) compared with those who received emergency surgery (age 7.6 years [p < 0.0001]). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). The rates of mortality and infectious complication were both 0.3%.
Conclusions:
This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts toward resource allocation and public health initiatives.
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