Prevalence of Pediatric Surgical Conditions Across Somaliland

Tessa Concepcion,Edna Adan Ismail,Emily R Smith,Dan Poenaru,Henry E Rice,Shugri Dahir,Mubarak Mohamed

doi:10.1001/jamanetworkopen.2018.6857

Abstract

Although surgical conditions are increasingly recognized as causing a significant health care burden among adults in low- and middle-income countries (LMICs), the burden of surgical conditions among children in LMICs remains poorly defined. To estimate the prevalence of pediatric surgical conditions across Somaliland using a nationwide community-based household survey. This cross-sectional study was conducted through a national community-based sampling survey from August through December 2017 in Somaliland. Participants were 1503 children surveyed using the Surgeons OverSeas Assessment of Surgical Need (SOSAS). The SOSAS survey contains 2 components, including a section on household demographics, deaths, and financial information and sections querying children's history of surgical conditions. In this cross-sectional study that included 1503 children (55.6% male; mean [SE] age, 6.4 [0.1] years), 221 surgical conditions were identified among 196 children, yielding a mean (SE) prevalence of pediatric surgical conditions of 12.2% (1.5%). Only 53 of these 221 surgical conditions (23.7%) had been surgically corrected at the time of the survey. The most common conditions encountered were congenital anomalies (33.8%) and wound-related injuries (24.6%). Nationally, an estimated 256 745 children have surgical conditions, with an estimated 88 345 to 199 639 children having unmet surgical needs. Using national sampling, this study found that children have a high burden of surgical conditions in Somaliland. These data highlight the need for a scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in LMICs.

Highlights

Recent estimates indicate that 5 billion people, predominantly in low- and middle-income countries (LMICs), lack access to safe and affordable surgery,[1] and surgical conditions contribute to up to 32% of the global disease burden.[2]
MAIN OUTCOMES AND MEASURES The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey contains 2 components, including a section on household demographics, deaths, and financial information and sections querying children’s history of surgical conditions. In this cross-sectional study that included 1503 children (55.6% male; mean [SE] age, 6.4 [0.1] years), 221 surgical conditions were identified among 196 children, yielding a mean (SE) prevalence of pediatric surgical conditions of 12.2% (1.5%)
These data highlight the need for a scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in LMICs

Summary

Introduction

Recent estimates indicate that 5 billion people, predominantly in low- and middle-income countries (LMICs), lack access to safe and affordable surgery,[1] and surgical conditions contribute to up to 32% of the global disease burden.[2] The World Health Organization, the World Bank, and the United Nations have all noted that access to adequate surgical care is essential to achieve the Sustainable Development Goals, which include health system strengthening and universal health coverage.[3,4,5] addressing surgical needs has been shown to form an essential part of functioning health care systems, little priority has been given to addressing gaps in the surgical care for children.[6,7].

Methods

Results

Discussion

Conclusion