Inclusion of Children’s Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children’s Surgery

Seyi‐Olajide, Justina O.; Anderson, Jamie E.; Kaseje, Neema; Ozgediz, Doruk; Gathuya, Zipporah; Poenaru, Dan; Johnson, Walt; Bickler, Stephen W.; Farmer, Diana L.; Lakhoo, Kokila; Oldham, Keith T.; Ameh, Emmanuel A.

doi:10.1007/s00383-020-04813-x

Cited by 19 publications

(17 citation statements)

References 34 publications

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“…Assuming the COVID-19 pandemic has not increased the risk of death in children in LMICs, children in HICs and LMICs are anticipated to have a 12-month mortality of 20% and 40%, respectively (these assumptions maximise the sample size needed, reducing the risk of the study being underpowered). 34 Less than 20% of all paediatric cancers are found in HICs. Therefore, an enrolment ratio of 4:1 between LMICs and HICs is expected.…”

Section: Methods and Analysismentioning

confidence: 99%

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

2021

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IntroductionChildhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes.Methods and analysisThis is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2 analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and disseminationAt the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal.

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Section: Methods and Analysismentioning

confidence: 99%

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

2021

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“…2 Despite being ostensibly highly curable diseases, delays in diagnosis and paucity of care for many patients with paediatric cancer has resulted in paediatric cancer being the second leading cause of noncommunicable disease deaths for children worldwide. [1][2][3][4] More than 90% of these deaths occur in low-income and middle-income countries (LMICs). 4 The inordinately high number of person-years of life lost make paediatric cancer care a global health priority.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…4 The inordinately high number of person-years of life lost make paediatric cancer care a global health priority. 2 The COVID-19 pandemic may have exacerbated the imbalance of paediatric cancer outcomes between LMICs and HICs. There were reports globally on the cancellation of elective health services-including paediatric surgery and radiotherapy, essential outpatient services, shortage of essential medications, delays in diagnosis, hospital inpatient services being overwhelmed and healthcare staffing issues.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Approximately 200 000-400 000 children are newly diagnosed with cancer annually. [1][2][3][4] Cancers in the paediatric population differ greatly from those in adults, particularly in the diagnoses seen and the availability of suitable healthcare. 5 Fewer than 20% of all paediatric cancers are found in highincome countries (HICs), where multimodal…”

Section: Introductionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

2022

BMJ Open

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ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001).ConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

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“…These challenges are magnified when providing surgical care for children, and pediatric-specific Bellwether procedures have yet to be defined. 2,3 Practically, most of these decisions are determined locally, guided by the training and skill of the perioperative team.…”

Section: Glossarymentioning

confidence: 99%

Access to Safe Pediatric Anesthesia in LMICs—The Problem Is Clear; It Is Time to Solve It!

Evans

Wake

Gathuya

et al. 2022

Anesthesia &Amp; Analgesia

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Inclusion of Children’s Surgery in National Surgical Plans and Child Health Programmes: the need and roadmap from Global Initiative for Children’s Surgery

Cited by 19 publications

References 34 publications

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Access to Safe Pediatric Anesthesia in LMICs—The Problem Is Clear; It Is Time to Solve It!

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