Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling

Abstract

Importance Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions among a pediatric population, however these studies often fail to include forced migrant or refugees. The goal of this study was to estimate the prevalence of pediatric surgical conditions among refugees in east Africa. Methods We used the previously validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) that utilizes cross-sectional design with random cluster sampling to assess prevalence of surgical disease among participants aged 0 to 18 years in Nyarugusu refugee camp, Tanzania. We used descriptive and multivariable analyses including an average marginal effects model. Results A total of 1,658 participants were included in the study. The mean age of our sample was 8.3 ± 5.8 years. A total of 841 participants (50.7%) were male and 817 participants (49.3%) were female. A total of 513 (n = 30.9%) reported a history or presence of a problem that may be surgical in nature, and 280 (54.6%) of them reported the problem was ongoing or untreated. Overall, 16.9% had an ongoing problem that may be amenable to surgery. We found that increasing age and recent illness were associated with having a surgical problem on both our multivariable analyses. Conclusion To our knowledge, this is the first and largest study of prevalence of surgical conditions among refugee children in sub-Saharan Africa. We found that over 16% (one-in-six) of refugee children have a problem that may be amenable to surgery. Our results provide a benchmark upon which other studies in conflict or post-conflict zones with refugee or forced migrant populations may be compared.

Increasing access to pediatric surgical care: Assessing district hospital readiness in rural Rwanda

“…In East Africa, estimates for the prevalence of untreated surgical conditions range from 7.4% to 39%, and individuals aged <21 years reported as being twice as likely to have an untreated surgical condition 6–10 . Thirty percent of surgical patients with nonobstetric conditions are children 11 .…”

“…4,5 In East Africa, estimates for the prevalence of untreated surgical conditions range from 7.4% to 39%, and individuals aged <21 years reported as being twice as likely to have an untreated surgical condition. [6][7][8][9][10] Thirty percent of surgical patients with nonobstetric conditions are children. 11 Injuries from burns, falls, and motor vehicle accidents are leading causes of mortality among children and commonly require surgery and transfer to a higher level of care.…”