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Current Landscape of Children's Surgery in Africa: A Multicenter Analysis of 16,000 Cases
Phillip J Hsu1, Madeleine Carroll2, Alan Zambeli-Ljepovic3
1Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Insights
This study details pediatric surgical care in Africa, finding congenital conditions and emergent surgeries lead to higher mortality. Improvements are needed to reduce global disparities in children's surgical access.
Area of Science:
- Global Surgery
- Pediatric Surgery
- Public Health in LMICs
Background:
- Limited large-scale data on pediatric surgical disease burden in low- and middle-income countries (LMICs).
- Previous estimates relied on modeling or smaller surveys.
- Need for comprehensive descriptions of procedures and outcomes in African children.
Purpose of the Study:
- To describe the epidemiology of pediatric surgical care across multiple African centers.
- To analyze outcomes of surgical procedures in children under 18.
- To identify factors influencing mortality in pediatric surgical patients.
Main Methods:
- Prospective collection of perioperative clinical data from 2018-2023.
- Involved 17 hospitals across 11 African countries.
- Utilized a preexisting data collection tool and REDCap for analysis.
Main Results:
- 16,454 procedures performed, predominantly in younger children (mean age 4.5 years).
- Common diagnoses: congenital malformations, acquired genitourinary, and gastrointestinal conditions.
- Overall mortality rate of 3.7%, with higher rates in neonates, emergent surgeries, and specific conditions (e.g., intestinal perforation, burns).
Conclusions:
- First large-scale assessment of pediatric surgical care epidemiology and outcomes in LMICs.
- Findings align with disease burden studies, showing younger children access surgery more frequently.
- Mortality rates are comparable to other African studies but higher than in high-income countries (HICs), necessitating further research and advocacy.
Background:
Although prior studies have estimated the burden of pediatric surgical disease in low- and middle-income countries (LMICs) through statistical modeling and hospital- or household-based surveys, few large-scale descriptions of procedures and outcomes have been published. We aimed to describe the epidemiology and outcomes of children's surgical care at multiple centers across Africa.
Methods:
Perioperative clinical data were collected prospectively from 2018 to 2023 at 17 hospitals in 11 African countries using a preexisting tool. Data came from children (age < 18 years) who underwent a surgical procedure in facilities equipped by the NGO Kids Operating Room. Data were stored on REDCap and descriptively analyzed.
Results:
16,454 procedures were performed, with a higher frequency of procedures performed in younger children than in older children (mean age 4.5 years). Congenital malformations, acquired genitourinary conditions, and acquired gastrointestinal conditions made up the most common diagnoses. We found a mortality rate of 3.7%, with higher mortality in neonates compared to younger children; conditions associated with the greatest mortality included congenital conditions, intestinal perforation, burns, and intussusception. Emergent operations were associated with much higher rates of mortality than elective operations.
Conclusions:
For the first time at this scale, we have assessed the epidemiology and outcomes of pediatric surgical care in LMICs. Findings were consistent with studies on the burden of disease, with a larger proportion of younger children accessing surgery, comparable mortality to other African studies, and higher mortality than in HICs. Future research and multilevel advocacy are needed to identify gaps in care and to design more effective interventions to reduce global disparities in access to surgical care for children.
