Implementation of a contextually appropriate pediatric emergency surgical care course in Uganda

Ullrich, Sarah; Kisa, Phyllis; Ruzgar, Nensi; Okello, Innocent; Oyania, Felix; Kayima, Peter; Kakembo, Nasser; Sekabira, John; Situma, Martin; Ozgediz, Doruk

doi:10.1016/j.jpedsurg.2020.10.004

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…This is consistent with retrospective reports in the literature from surgical skills courses set up in low and middle income countries, especially when this has been done in collaboration with high income countries [ 20 – 23 ]. The advantage to using a preliminary consensus meeting, or even a needs based assessment widely used in other work, is being able to anticipate and avoid such obstacles beforehand [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…from watching to doing [ 26 ]. Though some courses heavily feature didactic teaching [ 20 , 25 ], most other courses have aimed to keep a mix of teaching modalities [ 22 – 24 ]. When the possibility of diversifying the course was discussed with the group, they emphasised that if second or third ranked delivery options were selected for the final programme now or in later versions of the programme, such as practicals, they should be preceded by a lecture on the background and the material used should be sourced locally, i.e.…”

Section: Discussionmentioning

confidence: 99%

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Using a consensus meeting to enhance fracture care education in low income countries

et al. 2023

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Background A key strategy to building surgical capacity in low income countries involves training care providers, particularly in the interventions highlighted by the Lancet Commission for Global Surgery, including the management of open fractures. This is a common injury, especially in areas with a high incidence of road traffic incidents. The aim of this study was to use a nominal group consensus method to design a course on open fracture management for clinical officers in Malawi. Methods The nominal group meeting was held over two days, including clinical officers and surgeons from Malawi and the UK with various levels of expertise in the fields of global surgery, orthopaedics and education. The group was posed with questions on course content, delivery and evaluation. Each participant was encouraged to suggest an answer and the advantages and disadvantages of each suggestion were discussed before voting through an anonymous online platform. Voting included use of a Likert scale or ranking available options. Ethical approval for this process was obtained from the College of Medicine Research and Ethics Committee Malawi and the Liverpool School of Tropical Medicine. Results All suggested course topics received an average score of greater than 8 out of 10 on a Likert scale and were included in the final programme. Videos was the highest ranking option as a method for delivering pre-course material. The highest ranking methods for each course topic included lectures, videos and practicals. When asked what practical skill should be tested at the end of the course, the highest ranking option was “initial assessment”. Conclusion This work outlines how a consensus meeting can be used to design an educational intervention to improve patient care and outcomes. Through combining the perspectives of both the trainer and trainee, the course aligns both agendas so that it is relevant and sustainable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using a consensus meeting to enhance fracture care education in low income countries

et al. 2023

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“…29 As with the consideration of not creating more work it is vital to adapt these ndings to the local resources as the goal of the SSC is to standardize surgical care and provide guidance Towards the goal of providing standardized guidance for pediatric patients, Ugandan pediatric surgeons also developed the Pediatric Emergency Surgery Course (PESC). It is a three day course targeted at rural general surgeons and healthcare providers 71 . Similar to this checklist the course aims to improve resuscitation and referral patterns for complex surgical conditions such as high anorectal malformations.…”

Section: Discussionmentioning

confidence: 99%

The Creation of a Pediatric Surgical Checklist for Adult Providers

Rapolti,

Kisa,

Situma

et al. 2023

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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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“…Surveys from course participants revealed that additional hands-on training was the highest priority intervention for them to deliver pediatric surgical care. [26] Targeted, longitudinal surgical camps could be given in conjunction with the Pediatric Emergency Surgery Course. This model would provide both didactics and an opportunity to provide hands-on, mentored practice for anesthesia and surgical providers in these communities.…”

Section: Discussionmentioning

confidence: 99%

Pediatric surgery backlog at a Ugandan tertiary care facility: COVID-19 makes a chronic problem acutely worse

et al. 2022

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Background 1.7 billion of the world's 2.2 billion children do not have access to surgical care. COVID-19 acutely exacerbated this problem; delaying or preventing presentation and access to surgical care globally. We sought to quantify the effect of COVID-19 on children requiring surgery in Uganda. Methods Average monthly incident, elective pediatric surgical patient volume was calculated by sampling clinic logs before and during the pandemic, and case volume was quantified by reviewing operative logbooks for all surgeries in 2020 at Mulago Hospital, Kampala. Disability-Adjusted Life Years (DALYs) resulting from untreated disease were calculated and used to estimate economic impact using three different models. Results Expected elective pediatric surgery cases were 956. In 2020, pediatric surgery at Mulago was limited to 46 elective cases, approximately 5% of the expected incident cases, leading to a backlog of 910 patients and a loss of 10,620.12 DALYs. The economic impact of more than 10,000 disability years in Uganda is conservatively estimated at $23 million USD with other measures estimating ~ $120 million USD. ConclusionThe COVID-19 pandemic limited access to pediatric surgery in Uganda, making a chronic problem acutely worse, with costly consequences for the children and health system.

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Implementation of a contextually appropriate pediatric emergency surgical care course in Uganda

Cited by 14 publications

References 21 publications

Using a consensus meeting to enhance fracture care education in low income countries

Using a consensus meeting to enhance fracture care education in low income countries

The Creation of a Pediatric Surgical Checklist for Adult Providers

Pediatric surgery backlog at a Ugandan tertiary care facility: COVID-19 makes a chronic problem acutely worse

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