Paediatric lver transplantation for children treated at public health facilities in South Africa: Time for change

Lala, Sanjay G.; Britz, R; Botha, Jean F.; Loveland, Jerome

doi:10.7196/samj.8624

Cited by 5 publications

(9 citation statements)

References 6 publications

(6 reference statements)

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“…Of these 35 studies, 22 (62.9%) were published in the last 5 years of the study period (January 2012–November 2016), and 13 (37.1%) were published in the first 5 years (January 2007–December 2011). Of the 35 studies reviewed (Table 1), 14 (40%) were retrospective19–23,34–38,41,43,44, 7 (20%) were prospective14,25,27,29,30,33,39, 9 (25.7%)1,5,9,16,18,31,32,40,42, 2 (5.7%) were survey15,28, 2 (5.7%) were letters to an editor17,24 and one (2.9%) was a case report26. The SSA countries emphasized in the studies were Nigeria (14), South Africa (9), Kenya (8), Ghana (6), Malawi (5), Uganda (4), Zambia (4), Cameroon (3), Liberia (3), Sierra Leone (3), Mozambique (3) and Zimbabwe (3).…”

Section: Resultsmentioning

confidence: 99%

Funding paediatric surgery procedures in sub-Saharan Africa

Ekenze

2019

Mal. Med. J

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BackgroundIn sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. MethodsWe undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. ResultsThirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient’s family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding.ConclusionWhile considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.

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Section: Resultsmentioning

confidence: 99%

Funding paediatric surgery procedures in sub-Saharan Africa

Ekenze

2019

Mal. Med. J

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“…The situation in South Africa is no different, given the experiences shared by the participants and the findings of various local studies. These indicated the lack of availability of appropriate resources and equipment to deliver general healthcare for simple healthcare needs, let alone care for a 'minority demographic' (Ballot et al 2016;Benatar 2013;Butler & Adefuye 2019;Lala et al 2014;Skinner et al 2015).…”

Section: Category 4: Paediatric Calls Are More Demandingmentioning

confidence: 99%

“…In various countries, the lack of paediatric-specific facilities is so severe, it has been regarded as a barrier to good-quality care and a contributor to increased morbidity and mortality rates (Falgiani et al 2014;Hanewinckel et al 2010;Lala et al 2014). A particular South African study looked at an area with a population of 3 million people and found that of the 23 healthcare facilities, none were dedicated to paediatric care, and only two had dedicated paediatric units (Manchev et al 2015).…”

Section: Category 2: Lack Of Paediatric-specific Facilitiesmentioning

confidence: 99%

South African pre-hospital emergency care personnel’s lived experiences of managing paediatric emergencies: A qualitative research design utilising one-on-one interviews

Mosca

Stein

Lawrence

2021

Health SA Gesondheid

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Background: The phenomenon of managing paediatric emergencies in the pre-hospital environment within the South African setting is poorly understood with specific regard to what emergency care personnel are experiencing when managing paediatric emergencies.Aim: The aim of this study was to explore and describe the lived experiences of emergency care personnel in managing paediatric patients in the pre-hospital environment and to understand the meaning and the significance of these experiences.Setting: All participants were purposively sampled from emergency medical services agencies operating within the Johannesburg metropolitan city area.Methods: This study followed a qualitative, exploratory, descriptive, phenomenological design, whereby participants purposively sampled within the Johannesburg metropolitan city voluntarily consented to one-on-one interviews (n = 10).Results: Three main themes, with 11 contributing categories, were identified and contextualised with available literature. Emerging from the main themes was an overall sense that managing paediatric emergencies is a negative experience, coloured with feelings of inadequacy, stress, anxiety and even fear.Conclusions: The findings of this study provided new insights into what South African EMS are experiencing when managing paediatric emergencies, which enables future research efforts to identify research and practice gaps that are relevant to paediatric pre-hospital emergency care, and that are specific to the South African environment.Contribution: This research provides preliminary insight into the lived experiences of prehospital personnel managing paediatric emergencies as well as emerging recommendations for the improvement of the prehospital care of paediatric patients.

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“…Increased rates of spontaneous recovery close to 53% are ascribed to improved medical and intensive care of children with ALF 2 . Although we do not have comparable survival data for PALF in South Africa, some factors thought to compromise outcomes for affected children include lack of education and training amongst health care workers thereby resulting in late diagnosis, delayed referral, or no referral at all, lack of access to pediatric hepatology and transplant services, and limited availability of deceased donor organs, particularly when an organ is urgently required 11,12 …”

Section: Introductionmentioning

confidence: 99%

“…2 Although we do not have comparable survival data for PALF in South Africa, some factors thought to compromise outcomes for affected children include lack of education and training amongst health care workers thereby resulting in late diagnosis, delayed referral, or no referral at all, lack of access to pediatric hepatology and transplant services, and limited availability of deceased donor organs, particularly when an organ is urgently required. 11,12 Available services for PALF in South Africa are critically limited-only two of nine provinces in the country provide a pediatric liver transplant service. In the Western Cape, the Red Cross War Memorial Children's Hospital in Cape Town has been operational since 1991, and only offers deceased donor liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Bruckmann

Beretta

Demopolous

et al. 2020

Pediatric Transplantation

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Pediatric ALF is rare but life-threatening and may require urgent transplantation. In low and middle-income countries, access to transplantation is limited, deceased organ donation rates are low, and data on outcomes scarce. The Wits Donald Gordon Medical Centre, in Johannesburg, is one of only two centers in South Africa that perform pediatric liver transplant. We describe the etiology, clinical presentation, and outcomes of children undergoing liver transplant for ALF at our center over the past 14 years. We performed a retrospective chart review of all children undergoing liver transplantation for ALF from November 2005 to September 2019. Recipient data included demographics, clinical and biochemical characteristics pretransplant, post-operative complications, and survival. We conducted descriptive data analysis and used the Kaplan-Meier method for survival analysis. We performed 182 primary pediatric liver transplants. Of these, 27 (15%) were for ALF, mostly from acute hepatitis A infection (11/27;41%). Just over half of the grafts were from living donors (15/27;56%), and five grafts (5/27;19%) were ABO-incompatible. The most frequent post-transplant complications were biliary leaks (9/27;33%). There were two cases of hepatic artery thrombosis (2/27;7%), one of whom required re-transplantation. Unadjusted patient and graft survival at one and 3 years were the same, at 81% (95% CI 61%-92%) and 78% (95% CI 57%-89%), respectively. At WDGMC, our outcomes for children who undergo liver transplantation for ALF are excellent. We found workable solutions that effectively addressed our pervasive organ shortages without compromising patient outcomes.

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Paediatric lver transplantation for children treated at public health facilities in South Africa: Time for change

Cited by 5 publications

References 6 publications

Funding paediatric surgery procedures in sub-Saharan Africa

Funding paediatric surgery procedures in sub-Saharan Africa

South African pre-hospital emergency care personnel’s lived experiences of managing paediatric emergencies: A qualitative research design utilising one-on-one interviews

Minding the gap—Providing quality transplant care for South African children with acute liver failure

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