Abstract
ObjectiveAccording to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs.MethodsA cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering.ResultsA total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0–18 years of age) with median age of 8 (Interquartile range [IQR]: 4–13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns.ConclusionSurgery has been elevated as an “indivisible, indispensable part of health care” in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
Highlights
The burden of surgical conditions in low-income and middle-income countries (LMICs) is striking with an estimated 5 billion people lacking access to surgical care when needed[1,2] and the burden among children high[2,3,4]
The number of children living with a surgical need in these four LMICs is estimated at 3.7 million
Surgery has been elevated as an “indivisible, indispensable part of health care” in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care
Summary
The burden of surgical conditions in low-income and middle-income countries (LMICs) is striking with an estimated 5 billion people lacking access to surgical care when needed[1,2] and the burden among children high[2,3,4]. While recent attention to global surgery has been expanding, the burden of conditions requiring surgery among the highly vulnerable pediatric age group is relatively unknown, within LMICs. children make up approximately 50% of the total population in LMICs, there is little focus on childhood surgical conditions and attention has instead been on infectious diseases and obstetric care[6]. Children make up approximately 50% of the total population in LMICs, there is little focus on childhood surgical conditions and attention has instead been on infectious diseases and obstetric care[6] These efforts aimed on reducing infectious diseases and increasing obstetric care are certainly notable, approximately 85% of children in LMICs will have a surgically-treatable condition by the age of 15[2], highlighting the immense need for research and interventions aimed at reducing these burdens and providing quality surgical care when needed
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