Top 10 Resources in Global Surgery

Niyikuri, Alliance; Smith, Emily R.; Vervoort, Dominique; Shrime, Mark G.; Brown, Stav; Peters, Alexander W.; Yamey, Gavin; Makasa, Emmanuel

doi:10.9745/ghsp-d-20-00050

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…Despite calls for investment in surgical systems to improve the health and wellbeing for neglected populations across the world, it remains difficult to monitor for optimal surgical delivery growth [31, 32]. Although the LCoGS introduced broad metrics designed to track surgical system strength, there remain few meaningful metrics to guide expansion of surgical services for children's care at the national level.…”

Section: Discussionmentioning

confidence: 99%

Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross‐Sectional Study

et al. 2022

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Objectives To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. Methods We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common nonsurgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. ResultsWe found that increased SAO density is associated with decreased U5MR and NMR (P \ 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of \ 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of \ 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. Conclusions Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.

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Section: Discussionmentioning

confidence: 99%

Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross‐Sectional Study

et al. 2022

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The Impact of Gender on Pediatric Surgical Access and Outcomes in Africa

Williams,

Serhan,

Wang

et al. 2024

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IntroductionGirls, whose care is often affected by barriers steeped in gender inequity, may be at higher risk of poor surgical outcomes. This study explored the impact of gender on pediatric surgical care in Africa.MethodsDifferences in access to care and clinical outcomes for boys and girls were examined for pediatric surgical conditions that do not differ by physiological sex. A systematic review of African pediatric surgical studies ensued, followed by a random effects meta-analysis, and risk of bias assessment.ResultsOf the 12281 records retrieved, 54 were selected for review. Most studies were retrospective (57.4%), single-site (94.4%), from Egypt, Nigeria, Ghana, or Ethiopia (55.6%), focussed on gastrointestinal conditions (63.0%), published in 2010 or sooner (85.1%), had study durations of 5 years or less (68.5%), and cohorts of less than 200 children (57.4%). Sixty percent reported the outcome of mortality. Meta-analysis odds ratios revealed surgery was performed 3.6 times more often on boys (95% CI: 2.6, 4.9); and mortality was 1.6 times greater for girls (95% CI: 1.3, 2.0).ConclusionAfrican girls appear to face gender inequities in pediatric surgical care. Findings will be further explored in a mixed-methods study.Level of evidenceIHighlightsGender disparities in global surgical care have been documented in the African adult population. However gender specific differentials in surgical access and outcomes have yet to be documented for African pediatric populations.This study provides first-time evidence of gender inequity in pediatric surgical care in Africa.

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Epidemiology of surgery in a protracted humanitarian setting: a 20-year retrospective study of Nyarugusu Refugee Camp, Kigoma, Western Tanzania

et al. 2021

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Background There are 80 million forcibly displaced persons worldwide, 26.3 million of whom are refugees. Many refugees live in camps and have complex health needs, including a high burden of non-communicable disease. It is estimated that 3 million procedures are needed for refugees worldwide, yet very few studies exist on surgery in refugee camps, particularly protracted refugee settings. This study utilizes a 20-year dataset, the longest dataset of surgery in a refugee setting to be published to date, to assess surgical output in a setting of protracted displacement. Methods A retrospective review of surgeries performed in Nyarugusu Camp was conducted using paper logbooks containing entries between November 2000 and September 2020 inclusive. Abstracted data were digitized into standard electronic form and included date, patient nationality, sex, age, indication, procedure performed, and anesthesia used. A second reviewer checked 10% of entries for accuracy. Entries illegible to both reviewers were excluded. Demographics, indication for surgery, procedures performed, and type of anesthesia were standardized for descriptive analysis, which was performed in STATA. Results There were 10,799 operations performed over the 20-year period. Tanzanians underwent a quarter of the operations while refugees underwent the remaining 75%. Ninety percent of patients were female and 88% were 18 years of age or older. Caesarean sections were the most common performed procedure followed by herniorrhaphies, tubal ligations, exploratory laparotomies, hysterectomies, appendectomies, and repairs. The most common indications for laparotomy procedures were ectopic pregnancy, uterine rupture, and acute abdomen. Spinal anesthesia was the most common anesthesia type used. Although there was a consistent increase in procedural volume over the study period, this is largely explained by an increase in overall camp population and an increase in caesarean sections rather than increases in other, specific surgical procedures. Conclusion There is significant surgical volume in Nyarugusu Camp, performed by staff physicians and visiting surgeons. Both refugees and the host population utilize these surgical services. This work provides context to the surgical training these settings require, but further study is needed to assess the burden of surgical disease and the extent to which it is met in this setting and others.

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Top 10 Resources in Global Surgery

Cited by 3 publications

References 25 publications

Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross‐Sectional Study

Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross‐Sectional Study

The Impact of Gender on Pediatric Surgical Access and Outcomes in Africa

Epidemiology of surgery in a protracted humanitarian setting: a 20-year retrospective study of Nyarugusu Refugee Camp, Kigoma, Western Tanzania

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