Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

David F Grabski,Margaret Ajiko,Peter Kayima,Nensi Ruzgar,David Nyeko,Tamara N Fitzgerald,Monica Langer,Maija Cheung,Bruno Cigliano,Sergio D’Agostino,Robert Baird,Damian Duffy,Janat Tumukunde,Mary Nabukenya,Martin Ogwang,Phyllis Kisa,John Sekabira,Nasser Kakembo,Doruk Ozgediz

doi:10.1016/j.surg.2021.05.007

Abstract

BackgroundSignificant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children’s surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity. MethodsTwo years of a prospective clinical database of children’s surgery admissions at 2 regional referral hospitals in Uganda were reviewed. Primary outcomes included case volume and clinical outcomes of children at each hospital. Additionally, the disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Using a value of statistical life calculation, we also estimated the economic benefit of the pediatric surgical care currently being delivered. ResultsFrom 2016 to 2019, more than 300 surgical procedures were performed at each hospital per year. The majority of cases were standard general surgery cases including hernia repairs and intussusception as well as procedures for surgical infections and trauma. In-hospital mortality was 2.4% in Soroti and 1% in Lacor. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted life-years averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society. ConclusionThis investigation demonstrates that lifesaving pediatric procedures are safely performed by general surgeons in Uganda. General surgeons who perform pediatric surgery significantly increase surgical access to rural regions of the country and add a large economic benefit to Ugandan society. Overall, the results of the study support increasing pediatric surgical capacity in rural areas of low- and middle-income countries through support and training of general surgeons and anesthesia providers.

Highlights

Recent estimates suggest that 1.7 billion children lack access to safe surgical care around the world, largely in low- and middle-income countries (LMICs).[5]
Recommendations by the American Pediatric Surgery Association include an appropriate ratio of 1 pediatric surgeon for every 100,000 children.[17]
The number of fellowship-trained pediatric surgeons and pediatric anesthesiologists is slowly increasing, attention must still be directed at supporting general surgeons and their perioperative teams to deliver pediatric surgical care, through ongoing education, support, and outreach.[20,24]

Summary

Introduction

The significant economic benefit of increasing surgical capacity in low- and middle-income countries (LMICs) has been highlighted,[1,2] investment in children’s surgical capacity in LMICs continues to be neglected.[3,4] Recent estimates suggest that 1.7 billion children lack access to safe surgical care around the world, largely in LMICs.[5]. The board-certified pediatric surgeons in Uganda currently work in the capital city of Kampala and the major referral hospital in western Uganda, Mbarara. Recent global children’s surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity. Methods: Two years of a prospective clinical database of children’s surgery admissions at 2 regional referral hospitals in Uganda were reviewed. The disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted lifeyears averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society

Methods

Results

Conclusion