Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges

Pulvirenti, Rebecca; Gortan, Marianna; Cumba, Dioniso; Gamba, Piergiorgio; Tognon, Costanza

doi:10.3389/fped.2022.908699

Cited by 7 publications

(3 citation statements)

References 34 publications

(45 reference statements)

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“…Comparatively, ED was the section most successful at discriminating between levels of surgical care. Unlike outcomes, there is an aspect of positive validation that accompanies the presence of training programs and external collaborations that may lead to a reporting bias [23,24]. Historically, individual partnerships between low and high resource institutions have been the most common method of furthering the quality of care and access to surgical services [25].…”

Section: Discussionmentioning

confidence: 99%

GAPS II: Development and Pilot Results of the Global Assessment in Pediatric Surgery, an Evidence-Based Pediatric Surgical Capacity Assessment Tool for Low-Resource Settings

Yousef,

Cairo,

St-Louis

et al. 2024

Preprint

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PURPOSE: Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organisation. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings. METHODS: The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation. The resultant GAPS Version 2 underwent international pilot testing. Construct validation categorized institutions into providing Basic or Advanced Surgical Care. GAPS was further refined to Version 3 to include only questions with a > 75% response rate and those that significantly discriminated between Basic or Advanced Surgical settings. RESULTS: GAPS Version 1 included 139 items, which, after expert panel feedback, was expanded to 168 items in Version 2. Pilot testing, in 65 institutions yielded a high response rate. Of the 168 questions in GAPS Version 2, 64 significantly discriminated between Basic and Advanced Surgical Care. The refined GAPS Version 3 tool comprises 64 questions: Human Resources (9), Material Resources (39), Outcomes (3), Accessibility (3), and Education (10). CONCLUSION: The GAPS Version 3 tool presents a validated instrument for evaluating pediatric surgical capabilities in low-resource settings.

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Section: Discussionmentioning

confidence: 99%

GAPS II: Development and Pilot Results of the Global Assessment in Pediatric Surgery, an Evidence-Based Pediatric Surgical Capacity Assessment Tool for Low-Resource Settings

Yousef,

Cairo,

St-Louis

et al. 2024

Preprint

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“…The development of pediatric anesthesia in Barbados is challenged by the same problems faced by many low‐middle income countries: inadequate infrastructure, shortage of supplies and workforce 9,12 . Furthermore, there is a lack of recognition from the medical community and supporting administration that pediatric anesthesia is a true sub‐specialty and that children are not just small adults.…”

Section: Pediatric Anesthesia In Barbadosmentioning

confidence: 99%

Pediatric anesthesia in North America

Srinivasan,

Whyte,

Bailey

et al. 2024

Pediatric Anesthesia

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Background and ObjectivesThis educational review outlines the current landscape of pediatric anesthesia training, care delivery, and challenges across Canada, Barbados, and the United States.Descriptions and ConclusionsApproximately 5% of Canadian children undergo general anesthesia annually, administered by fellowship‐trained pediatric anesthesiologists in children's hospitals, general anesthesiologists in community hospitals, or family practice anesthesiologists in underserved regions. In Canada, the focus is on national‐level evaluation and accreditation of pediatric anesthesia fellowship training, addressing challenges arising from workforce shortages, particularly in remote areas. Barbados, a Caribbean nation, lacks dedicated pediatric hospitals but has provided pediatric anesthesia since 1972 through anesthetists with additional training. Challenges in its development, common to low‐middle‐income countries, include inadequate infrastructure and workforce shortages. Increased awareness of pediatric anesthesia as a sub‐specialty could enhance perioperative care for Barbadian children. Pediatric anesthesia encompasses various specialties in the United States, with pediatric anesthesiologists playing a foundational role. Challenges faced include recruitment and retention difficulties, supply‐chain shortages, and the proliferation of anesthesia sites, all impacting the delivery of modern, high‐quality, and cost‐effective patient care. Collaborative efforts at national and organizational levels strive to improve the quality and safety of pediatric anesthesia care in the United States.

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“…In order to inform the scale-up of paediatric surgical services, available data on existing services and resources at district hospitals in SSA need to be collected and analysed to enable local authorities to make informed decisions on how best to maximise the utilisation of scarce resources to meet population needs ( 11 ). However, little systematic evidence has been collected at the facility level ( 12 ), and no study has been done comparing the capacity of district facilities across countries. This study aimed to examine and compare the capacity of district hospitals in three SSA countries (MTZ) to provide paediatric surgical care, using tools specifically designed to measure the capacity components ( 13 ) so as to establish a baseline and inform policy and planning at country level.…”

Section: Introductionmentioning

confidence: 99%

Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania

et al. 2023

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IntroductionPaediatric surgical care is a significant challenge in Sub-Saharan Africa (SSA), where 42% of the population are children. Building paediatric surgical capacity to meet SSA country needs is a priority. This study aimed to assess district hospital paediatric surgical capacity in three countries: Malawi, Tanzania and Zambia (MTZ).MethodsData from 67 district-level hospitals in MTZ were collected using a PediPIPES survey tool. Its five components are procedures, personnel, infrastructure, equipment, and supplies. A PediPIPES Index was calculated for each country, and a two-tailed analysis of variance test was used to explore cross-country comparisons.ResultsSimilar paediatric surgical capacity index scores and shortages were observed across countries, greater in Malawi and less in Tanzania. Almost all hospitals reported the capacity to perform common minor surgical procedures and less complex resuscitation interventions. Capacity to undertake common abdominal, orthopaedic and urogenital procedures varied—more often reported in Malawi and less often in Tanzania. There were no paediatric or general surgeons or anaesthesiologists at district hospitals. General medical officers with some training to do surgery on children were present (more often in Zambia). Paediatric surgical equipment and supplies were poor in all three countries. Malawi district hospitals had the poorest supply of electricity and water.ConclusionsWith no specialists in district hospitals in MTZ, access to safe paediatric surgery is compromised, aggravated by shortages of infrastructure, equipment and supplies. Significant investments are required to address these shortfalls. SSA countries need to define what procedures are appropriate to national, referral and district hospital levels and ensure that an appropriate paediatric surgical workforce is in place at district hospitals, trained and supervised to undertake these essential surgical procedures so as to meet population needs.

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Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges

Cited by 7 publications

References 34 publications

GAPS II: Development and Pilot Results of the Global Assessment in Pediatric Surgery, an Evidence-Based Pediatric Surgical Capacity Assessment Tool for Low-Resource Settings

GAPS II: Development and Pilot Results of the Global Assessment in Pediatric Surgery, an Evidence-Based Pediatric Surgical Capacity Assessment Tool for Low-Resource Settings

Pediatric anesthesia in North America

Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania

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