Surgery in the First 8000 Days of Life: Avertable Deaths from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries

Abstract

Background: Surgical care is an important, yet often neglected component of child health in LMICs. This study examines the potential impact of scaling up surgical care at first-level hospital in LMICs on the first 8000 days of life. Methods: Epidemiological data from the Global Burden of Disease (GBD) 2019 Study and a counterfactual method developed for the Disease Control Priorities; 3rd Edition (DCP3) were used to estimate the number of avertable deaths in the under 20-year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. Findings: An estimated 314 609 (95% UI, 239 619-402 005) deaths per year in the under 20-year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the avertable deaths are in the under-five year age group (80·9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of avertable deaths after age 5 years. Sixty-one percent of the avertable deaths occur in lower-middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. Interpretation: Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 8000 days of life. Funding: None to declare. Declaration of Interest: None to declare.