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

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

doi:10.1016/j.surg.2021.05.007

Cited by 11 publications

(7 citation statements)

References 53 publications

(33 reference statements)

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“…The implications of our ndings, however, are more than just intuitive. General surgeons perform most of the pediatric surgery in Uganda (5). Developing surgical infrastructure to support their work is no small feat because despite the heroic efforts from general and pediatric surgeons less than 4% of the total burden of pediatric surgical disease is treated in Uganda (18).…”

Section: Discussionmentioning

confidence: 99%

“…To meet the burden of pediatric surgical disease in Uganda continued collaboration with partners who are committed to long term investment is vital. These collaborations have the ability to upscale the amount of surgery provided and make a tremendous impact on the health and wealth of Uganda (5).…”

Section: Discussionmentioning

confidence: 99%

“…As of 2022, there were only seven pediatric surgeons practicing in two cities, yet approximately 170 are needed (4). Due to this shortage and concentration of specialists in the capital (5), Ugandan general surgeons treat most pediatric surgical pathology at regional referral centers (5).…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals

Klazura,

Kayima,

Situma

et al. 2024

Preprint

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Background: In 2022 there were only seven pediatric surgeons in Uganda, but approximately 170 are needed. Consequently, Ugandan general surgeons treat most pediatric surgical problems at regional hospitals. Accordingly, stakeholders created the Pediatric Emergency Surgery Course, which teaches rural providers identification, resuscitation, treatment and referral of pediatric surgical conditions. In order to improve course offerings and better understand pediatric surgery needs we collected admission and operative logbook data from four participating sites. One participating site, Lacor Hospital, rarely referred patients and had a much higher operative volume. Therefore, we sought to understand the causes of this difference and the resulting economic impact. Methods: Over a four-year period, data was collected from logbooks at four different regional referral hospitals in Uganda. Patients < 18 years old with a surgical diagnosis were included. Patient LOS, referral volume, age, and case type were compared between sites and DALYs were calculated and converted into monetary benefit. Results: Over four sites, 8,615 admissions, and 5,457 cases were included. Lacor patients were younger, had a longer length of stay, and were referred less. Additionally, Lacor’s long-term partnerships with a high-income country institution, a missionary organization, and visiting Ugandan and international pediatric surgeons were unique. In 2018, the pediatric surgery case volume was: Lacor (967); Fort Portal (477); Kiwoko (393); and Kabale (153), resulting in a substantial difference in long-term monetary health benefit. Conclusion: Long-term international partnerships may advance investments in surgical infrastructure, workforce, and education in low- and middle-income countries. This collaborative model allows stakeholders to make a greater impact than any single institution could make alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals

Klazura,

Kayima,

Situma

et al. 2024

Preprint

Self Cite

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“…Approximately 300 million surgical procedures are performed annually worldwide 1) , and even with medication, approximately 40% of patients experience moderate or severe postoperative pain. 2,3) In the management of postoperative pain, traditional analgesics and interventions are often ineffective or only partially effective.…”

Section: Introductionmentioning

confidence: 99%

CCL17 Blockade by CCL17mAb/GSK-J4 Ameliorates Hyperalgesia in a Rat Model of Postoperative Pain

Zhang

et al. 2023

Biological & Pharmaceutical Bulletin

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CCL17 (C-C motif chemokine ligand 17), an important chemokine, plays a vital role in regulating immune balance in the central nervous system. In this study, we explored the potential roles of CCL17 in a rat postoperative pain model and that of blocking CCL17 in the prevention of postoperative pain in rats. A right plantar incision in rat was used as a model of postoperative pain. A behavioral change was measured preoperatively and postoperatively using mechanical withdrawal thresholds and thermal withdrawal latency. CCL17 and its upstream Jmjd-3 mRNA levels in the spinal cord were detected using real-time PCR, CCL17 levels in the serum were measured using ELISA, and the expression of IRF4, which interacts with Jmjd-3, was detected by immunohistochemistry staining. After that, rats were intraperitoneally injected with either anti-CCL17mAb or GSK-J4 (the Jmjd3 inhibitor) to evaluate the protective effects of blocking CCL17 on postoperative pain. We found that CCL17 and Jmjd-3 were significantly increased in the spinal cords of the postoperative pain rat, consistent with changes in hyperalgesia. In addition, our results showed that the mechanical and thermal allodynia was significantly ameliorated using anti-CCL17mAb or GSK-J4. Moreover, we found that anti-CCL17mAb or GSK-J4 treatment decreased c-fos expression in response to peripheral stimulation. Finally, our preliminary exploration found that anti-CCL17mAb or GSK-J4 had a protective effect on tissue damage. These findings indicated that high expression of CCL17 played a critical role in postoperative pain induced by plantar incision and that CCL17 blockade may serve as an effective approach to managing postoperative pain.

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“…This is especially true in rural settings and in low- and middle-income countries (LMIC) like Uganda where general surgeons perform the majority of general pediatric surgeries. 5 , 6 In the USA as many as 40% of all pediatric inpatient surgical procedures are performed in adult hospitals. 7 Furthermore, children are far more complex than just smaller adults yet the WHO SSC does not consider and fully address the intricacies of pediatric surgery.…”

Section: Introductionmentioning

confidence: 99%

The Creation of a Pediatric Surgical Checklist for Adult Providers

Rapolti,

Kisa,

Situma

et al. 2023

Preprint

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Purpose: To address the need for a pediatric surgical checklist for adult providers. Background: Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications, Methods: Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2022 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias. Results: 42 papers with 8529061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies. Conclusion: The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes. Funding: Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540

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

Cited by 11 publications

References 53 publications

Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals

Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals

CCL17 Blockade by CCL17mAb/GSK-J4 Ameliorates Hyperalgesia in a Rat Model of Postoperative Pain

The Creation of a Pediatric Surgical Checklist for Adult Providers

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