The start-up phase of a non-specialist paediatric surgical service by outreach focused on capacity building at the Consolata Hospital Ikonda, Makete District, Tanzania.

Alessandro Calisti,Mariagrazia Andriani,Gian P Zara,Agnes Mlawa

doi:10.4102/phcfm.v12i1.2428

Alessandro Calisti, Mariagrazia Andriani + Show 2 more

Open Access

https://doi.org/10.4102/phcfm.v12i1.2428

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Abstract

BackgroundThe need for paediatric surgeons in Tanzania is largely unmet. Twelve in two main urban centres (0.06 for 100 000 population under 15 years of age) are far lower than the recommended workforce size. Complex conditions require a significant increase in the number of paediatric surgeons. In contrast, children with minor diseases, living in rural areas, could be managed even at the district level by trained general surgeons.AimThe aim of this study was to develop capacity for general paediatric surgical services in a district hospital by outreach with a focus on mentorship.MethodsCapacity building priorities for non-specialist paediatric surgery were identified and addressed using evidence-based guidelines. Local general surgeons were involved in supervised clinical decision-making and in all surgical procedures. The visiting team provided daily meetings, weekly lectures, and on-job training. Electronic copies of recent surgical textbooks were provided together with video-conferencing distant specialist consultations.ResultsA total of 715 children were handled by the visiting team during the 27-week period. Four hundred and fifty diseases were diagnosed amongst 406 children. Awareness of paediatric surgical needs, improved management of most common conditions like congenital hernias, undescended testis, hypospadias and anorectal malformations needing temporary colostomy occurred. Local general surgeons were assisted in treating 358 cases of general paediatric surgical conditions. Updated early management protocols were introduced for more complex diseases needing referral to specialist centres like solid tumours and neonatal abnormalities. The visiting team operated major paediatric surgical cases at the Consolata Hospital Ikonda.Lessons learntSurgical outreach and capacity building at the district hospital level could be a possible answer to the unmet paediatric surgical needs of children living in rural areas. Apprenticeship training for general surgeons may help to fill the gap provided that they are strongly motivated and supported on acquiring and implementing their paediatric surgical skills.Keywordsglobal health; paediatric surgery; humanitarian outreach.

Highlights

More than 50% of the African population is in the paediatric age group, and 85% may need an operative procedure, generally minor, by the age of 15 years.[1]
There is an intense debate on solutions to face the shortage of paediatric surgeons in low-income countries (LICs).[7,8,9,10]
General surgeons going to practise on paediatric cases in a small centre need only a basic paediatric training (Level-One – General Paediatric Surgery)

Summary

Introduction

More than 50% of the African population is in the paediatric age group, and 85% may need an operative procedure, generally minor, by the age of 15 years.[1] If paediatric surgery is a wellrecognised speciality in high-income countries (HICs) and specific standards and professional skills have been defined,[2] the number of specialists in low-income countries (LICs) is still far to meet the needs.[3]. Most paediatric cases risk so far falling under the coverage of general surgeons not exposed to paediatric surgery as a specialist field during their undergraduate training and internship.[4] They may be not always prepared to recognise that most of the paediatric diseases that they observe http://www.phcfm.org. Children with minor diseases, living in rural areas, could be managed even at the district level by trained general surgeons

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