Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

Abstract

Background: An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti-Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation. Methods: The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are reported. Methods utilized to assess local needs and to develop Partnership activities are described. Results: Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex management and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to assist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists and nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of infrastructure together with training opportunities in Italy were included by the Program. Despite ongoing efforts, actions have not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase health workers motivation and prevent brain drain. Conclusions: The key role that an Academic Partnership can play, acting through expatriated Teams working in the same constrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health Initiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care and level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention policy, reflecting in poor motivation and low performance.

Defining the Current Deployment of Neonatal Infusion Pumps in Low- and Lower-Middle-Income Countries: A Rapid Review

“…Only the results by Lelli Chiesa et al 28 and Tuyisenge et al 29 discussed the actual usability of syringe pumps. These 2 results discussed how although some syringe pumps were available, most of the facilities lacked the disposable infusion sets that are required to utilize the pumps.…”

“…Only the results by Lelli Chiesa et al 28 and Tuyisenge et al. 29 discussed the actual usability of syringe pumps.…”

Developing an Assessment Tool for Post-Surgical Paediatric Rehabilitative Care in Tanzania: an Interprofessional Approach

“…Currently, there are few examples in the literature on outcome measurement tools for post-surgical paediatric care in low-resource settings. The literature focuses primarily on client safety outcomes or quality of care centred around the time in the hospital (Butler, 2016;Lelli Chiesa et al, 2020;Philipo et al, 2020) or preparing for surgery (de Oliveira Pires et al, 2013), thus overlooking postoperative rehabilitation (Berry et al, 2019). It is noteworthy that there are diligent efforts to address client safety by the WHO in creating Global Patient Safety Action Plan 2021-2030, with a vision of prioritising safe and respectful care (World Health Organisation, 2021).…”

“…In countries like Tanzania in East Africa, the shortage of surgeons and the handful of specialty hospitals and centres in a geographically large country severely limit the access to paediatric surgery (Butler, 2016;Lelli Chiesa et al, 2020). The number of surgeons, obstetricians and anaesthesiologists (SOA) falls short of the recommendations set by Tanzania's Ministry of Health, for 20 SOA per 100,000 population, with a ratio of 0.46 per 100,000 population (Ministry of Health Community Development, Gender, Elderly and Children, 2018;Philipo et al, 2020).…”

“…While there are numerous global initiatives to increase access to paediatric surgical care and rehabilitation in low-resource areas, many of these are unpublished, creating an absence of literature on the subject (Lelli Chiesa et al, 2020). While standards of care have been set by the WHO for the intraoperative period, there is a paucity of provisions for perioperative care and rehabilitation.…”