Geospatial analysis of unmet pediatric surgical need in Uganda

Smith, Emily R.; Vissoci, João Ricardo Nickenig; Rocha, Thiago Augusto Hernandes; Tran, Tu M.; Fuller, Anthony T.; Butler, Eric; Andrade, Luciano de; Makumbi, Fredrick; Luboga, Samuel; Muhumuza, Christine; Namanya, Didacus B.; Chipman, Jeffrey G.; Galukande, Moses; Haglund, Michael M.

doi:10.1016/j.jpedsurg.2017.03.045

Cited by 30 publications

(25 citation statements)

References 18 publications

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“…Our findings align with studies of adult surgical workforce in Brazil which have shown inequities in the density of SAO professionals across the country, with rural regions disproportionately affected 26. Similar to many counties around the world, the rural areas in Brazil have high levels of poverty and a scarcity of health infrastructure 27 28. Brazil has successfully increased access to the primary care workforce in rural areas through the Mais Médicos programme,29 and our findings suggest that similar expansion of the surgical workforce may improve the health of children.…”

Section: Discussionsupporting

confidence: 86%

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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ObjectivesThe optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.DesignThis study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participantsWe collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measuresWe performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).FindingsThere were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.ConclusionsWe found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.

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Section: Discussionsupporting

confidence: 86%

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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“…As a result, the average patient in LICs and lMICs must travel a much greater distance to seek neurosurgical care. 22 Beyond simply the distance required to seek a neurosurgeon, neurosurgeons themselves in many LMICs describe basic equipment needs, including drills and microscopes, which are essential for safe neurosurgical operations. Endoscopic skills and advanced management of epilepsy and vascular disorders in particular were described by surgeons across many regions and lower income groups as essential areas of training need.…”

Section: Discussionmentioning

confidence: 99%

“…Staffed hospitals and clinics, equipped and sterile operating theaters, blood-banking facilities, capable anesthesiologists, and services accessible and affordable to the at-risk populations are all fundamental to the provision of effective pediatric neurosurgical care. Societal and civic entities external to the healthcare sector-public transportation, welfare programs, education and awareness, geopolitical and geospatial forces 6,22 are also vital to equitable and far-reaching delivery of care. 4 Task sharing is a viable, albeit controversial, reality in many healthcare networks in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Dewan

Baticulon

Rattani

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.

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“…Each identified surgical condition was rated by two or more surgeons and medical/surgical trainees as surgically-treatable and non- surgically treatable conditions. Among the surgically-treatable conditions, each case was coded by surgeons or surgical trainees as treated or untreated based on whether the patient received appropriate surgical care [ 9 , 25 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The range of percentages were based on the number of children in four low-income countries with injuries, acquired deformities, and congenital deformities as these children would likely need services and supports post-operatively [ 9 , 26 ]. Within each scenario, we examined capacity at the domain level using the number of children geographically located within each region based on a previous geospatial analysis, detailed elsewhere [ 25 ]. For each of the three scenarios of need we determined whether those children would have minimal, moderate, or extensive capacity to rehabilitation, assistive devices, social and family supports, and school re-integration services.…”

Section: Methodsmentioning

confidence: 99%

Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda

Smith

Water

Martin

et al. 2018

BMC Health Serv Res

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BackgroundCommunity services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need.MethodsThis study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services.ResultsOf 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions.ConclusionsOur study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.

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Geospatial analysis of unmet pediatric surgical need in Uganda

Cited by 30 publications

References 18 publications

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda

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