Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda

Fuller, Anthony T.; Haglund, Michael M.; Lim, Stephanie; Mukasa, John; Muhumuza, Michael; Kiryabwire, Joel; Ssenyonjo, Hussein; Smith, Emily R.

doi:10.1016/j.wneu.2016.07.090

Cited by 29 publications

(22 citation statements)

References 21 publications

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“…A second area that should be focused on, is increasing the number of surgeons and increasing the size of the surgical workforce that are able to perform surgical procedures. [ 26 – 28 ] Within LMICs the burden that is placed on families, children, and the healthcare system is far outweighing the current capacity for treatment. With a limited surgical workforce, the unmet need in Uganda is continuing to grow and the surgical need will continue to be high.…”

Section: Discussionmentioning

confidence: 99%

Rural and urban differences in treatment status among children with surgical conditions in Uganda

et al. 2018

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BackgroundIn low and middle-income countries, approximately 85% of children have a surgically treatable condition before the age of 15. Within these countries, the burden of pediatric surgical conditions falls heaviest on those in rural areas. The objective of the current study was to evaluate the relationship between rurality, surgical condition and treatment status among a cohort of Ugandan children.MethodsWe identified 2176 children from 2315 households throughout Uganda using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey. Children were randomly selected and were included in the study if they were 18 years of age or younger and had a surgical condition. Location of residence, surgical condition, and treatment status was compared among children.ResultsOf the 305 children identified with surgical conditions, 81.9% lived in rural areas. The most prevalent causes of surgical conditions reported among rural and urban children were masses (24.0% and 25.5%, respectively), followed by wounds due to injury (19.6% and 16.4%, respectively). Among children with untreated surgical conditions, 79.1% reside in rural areas while 20.9% reside in urban areas. Among children with untreated surgical conditions, the leading reason for not seeking surgical care among children living in both rural and urban areas was a lack of money (40.6% and 31.4%, respectively), and the leading reason for not receiving care in both rural and urban settings was a lack of money (48.0% and 42.8%, respectively).ConclusionsOur data suggest that over half of the children with a surgical condition surveyed are not receiving surgical care and a large majority of children with surgical needs were living in rural areas. Future interventions aimed at increasing surgical access in rural areas in low-income countries are needed.

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Section: Discussionmentioning

confidence: 99%

Rural and urban differences in treatment status among children with surgical conditions in Uganda

et al. 2018

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“…[1] However, these studies do not measure how the presence of a surgical condition itself impacts the risks of poverty, regardless of health care expenditures. Furthermore, given that up to 50% of the population in the majority of LMICs are children and many of these children will have surgical conditions,[10–20] the financial impact of surgical care for children constitutes a much-needed research area. [21] Why some families are devastated by surgical costs while similar families are able to rebound economically is not well understood.…”

Section: Introductionmentioning

confidence: 99%

The contribution of pediatric surgery to poverty trajectories in Somaliland

et al. 2019

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Background The provision of health care in low-income and middle-income countries (LMICs) is recognized as a significant contributor to economic growth and also impacts individual families at a microeconomic level. The primary goal of our study was to examine the relationship between surgical conditions in children and the poverty trajectories of either falling into or coming out of poverty of families across Somaliland. Methods This work used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a validated household, cross-sectional survey designed to determine the burden of surgical conditions within a community. We collected information on household demographic characteristics, including financial information, and surgical condition history on children younger than 16 years of age. To assess poverty trajectories over time, we measured household assets using the Stages of Progress framework. Results We found there were substantial fluxes in poverty across Somaliland over the study period. We confirmed our study hypothesis and found that the presence of a surgical condition in a child itself, regardless of whether surgical care was provided, either reduced the chances of moving out of poverty or increased the chances of moving towards poverty. Conclusion Our study shows that the presence of a surgical condition in a child is a strong singular predictor of poverty descent rather than upward mobility, suggesting that this stressor can limit the capacity of a family to improve its economic status. Our findings further support many existing macroeconomic and microeconomic analyses that surgical care in LMICs offers financial risk protection against impoverishment.

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“…In 2014, the Surgeons OverSeas Assessment of Surgical need (SOSAS) questionnaire was administered to individuals within households surveyed across 105 enumeration areas (EAs) in Uganda using a two-stage, cluster-randomized sampling design, described elsewhere [ 23 ]. In short, the households were randomly selected based on geographic sub-regions to collect data based on proportional-to-size methodology to obtain a national representative sample.…”

Section: Methodsmentioning

confidence: 99%

“…In short, the households were randomly selected based on geographic sub-regions to collect data based on proportional-to-size methodology to obtain a national representative sample. The SOSAS study surveyed 4248 individuals in 2315 households of which 1082 (24.4%) were considered to be school-aged children between 5 and 14 years of age [ 23 ]. In Uganda, primary school begins at age 6 and is 7 years in length [ 24 ].…”

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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Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda

Cited by 29 publications

References 21 publications

Rural and urban differences in treatment status among children with surgical conditions in Uganda

Rural and urban differences in treatment status among children with surgical conditions in Uganda

The contribution of pediatric surgery to poverty trajectories in Somaliland

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

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