Improving Access to Pediatric Surgery in LMICs Through Capacity-Building: A Systematic Review
Mahnoor Malik1, Soham Bandyopadhyay2,3, Namayah Syeda Fatima Hussain4
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Capacity-strengthening projects improve pediatric surgical care in low- and middle-income countries (LMICs). This review identifies effective methods and barriers to implementing these vital interventions for children needing surgery.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Systems Strengthening
Background:
- Pediatric surgical conditions cause significant morbidity and mortality in low- and middle-income countries (LMICs).
- Access to pediatric surgical care is limited in LMICs due to surgeon shortages, inadequate training, and financial constraints.
- There is a shift towards capacity-strengthening initiatives to enhance local healthcare resources and skills.
Purpose of the Study:
- To systematically review and synthesize the literature on capacity-strengthening projects in pediatric surgery within LMICs.
- To identify the methods, outcomes, limitations, and barriers associated with these interventions.
Main Methods:
- Searched MEDLINE, EMBASE, Cochrane, and Web of Science databases until May 2023.
- Included studies focused on pediatric surgery patients, capacity-strengthening interventions, improved access (Lancet Commission on Global Surgery Indicators), and were conducted in World Bank-defined LMICs.
- Two independent reviewers performed study screening and data extraction.
Main Results:
- Eighty studies met the inclusion criteria, detailing interventions in 69 LMICs using 19 distinct capacity-strengthening methods.
- Common methods included international surgical visits, training programs, partnerships, mobile clinics, infrastructure enhancements, and telemedicine.
- These interventions facilitated 1,357,077 pediatric surgeries, with notable successes in training local providers and improving rural access.
Conclusions:
- The review highlights successful methods for implementing pediatric surgical capacity-strengthening interventions in LMICs, alongside identified challenges.
- Future research should prioritize reporting ethical considerations and quantitative outcomes to rigorously assess intervention effectiveness.
Objective:
Pediatric surgical conditions are a significant source of morbidity and mortality in low- and middle-income countries (LMICs), where children with surgically treatable conditions lack access to care owing to an insufficient number of pediatric surgeons, poor and limited training, and financial barriers. There is a growing shift from charitable missions to capacity-strengthening projects, which strengthen the skills and resources of communities. The objective of this study was to synthesize the literature to identify capacity-strengthening projects, their methods and outcomes, and their limitations and barriers.
Methods:
MEDLINE, EMBASE, Cochrane, and Web of Science were searched until May 5, 2023. Eligibility criteria were as follows: (1) inclusion of pediatric surgery patients; (2) designation as capacity-strengthening interventions; (3) outcomes of improved access defined through Lancet Commission on Global Surgery Indicators; and (4) designation as an LMIC defined by the World Bank. Two independent reviewers conducted screening and extraction.
Results:
A total of 80 studies met inclusion criteria. Interventions were implemented in 69 LMICs and used 19 different methods of capacity strengthening. Common capacity-strengthening methods included the following: international surgical visits, training programs, partnerships, mobile clinics and camps, infrastructure enhancements, and telemedicine. Common methods used included the following: training of local providers, continuous contact between both countries after the visit was completed, improved access for rural families, and economic support for low-income families. A total of 1 357 077 pediatric surgeries were performed through these interventions. Limitations included the fact that only peer-reviewed studies were included. Included studies were mainly case series or small observational studies with qualitative data.
Conclusions:
This review identifies methods to implement capacity-strengthening interventions in LMICs, including their successes and barriers. Future research should report ethical concerns and quantitative outcomes to determine effectiveness.
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