Assessment of pediatric surgery capacity at government hospitals in sierra leone.
ABSTRACT Traditionally, efforts to reduce child mortality in low- and middle-income countries (LMICs) have focused on infectious diseases. However, surgical care is increasingly seen as an important component of primary health care. To understand the baseline surgical capacity in LMICs, a number of studies have recently been published, but none has focused on pediatric surgery.
The Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey was used to collect surgical capacity data from government hospitals in Sierra Leone. The data were analyzed specifically to identify baseline needs for pediatric surgery.
Nine hospitals were assessed, and all had a functioning laboratory to test blood and urine and were capable of undertaking resuscitation, suturing, wound débridement, incision and drainage of an abscess, appendectomy, and male circumcision. However, in only 67 % could a pediatric hernia repair be performed, and in none were more complex procedures such as cleft lip and clubfoot repairs performed. Fewer than 50 % of facilities had sufficient gloves, nasogastric tubes, intravenous cannulas, syringes, needles, sutures, urinary catheters, infusion sets, anesthesia machines, or compressed oxygen.
Using the standard PIPES tool, we found severe deficiencies in the pediatric surgical capacity at government hospitals in Sierra Leone. However, a pediatric-specific tool is required to understand more accurately the pediatric surgical situation.
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ABSTRACT: Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward.African Journal of Paediatric Surgery 10/2014; 11(4):312-6. DOI:10.4103/0189-6725.143139
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ABSTRACT: The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data. We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician-gynecologists, and anesthesiologists practicing in LMICs. Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce 'crisis.' Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (r (2) = 0.097, p = 0.0002). The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world.World Journal of Surgery 11/2013; 38(2). DOI:10.1007/s00268-013-2324-y · 2.35 Impact Factor
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ABSTRACT: IntroductionAttention to surgical conditions in low- and middle-income countries (LMICs) has increased in recent years. Because half of the population in the world’s poorest countries are children , paediatric surgical conditions compose a significant proportion of the global burden of disease (BoD), and there are critical shortages in workforce and skills to treat these diseases in LMICs. Several population-based studies have highlighted the magnitude of the need for paediatric surgery and the limited capacity, both in human resources and in infrastructure, to tackle the problem [2, 3]. Africa, in particular, has a grave shortage of paediatric surgeons. The number of fully trained paediatric surgeons ranges from 1 in Malawi (population 13 million) to 120 in Egypt (population of 80 million). In more than half of African countries, no full-time paediatric surgeon is available [4, 5]. LMICs in other world regions have a similar challenge. The problem is not only limited to a poor rati ...World Journal of Surgery 10/2014; 39(2). DOI:10.1007/s00268-014-2843-1 · 2.35 Impact Factor