Abstract
Purpose
Pediatric surgical care in developing countries is not well studied. We sought to
identify the range of pediatric surgery available, the barriers to provision, and
level of safety of surgery performed for the entire pediatric population in Zambia.
Methods
In cooperation with the Ministry of Health, we validated and adapted a World Health
Organization instrument. During onsite visits, the availability of 32 emergency and
essential surgical procedures relevant to children was surveyed. The availability
of basic World Health Organization surgical safety criteria was determined.
Results
A single interviewer visited 103 (95%) of 108 surgical hospitals in Zambia and carried
out 495 interviews. An average of 68% of the 32 emergency and essential surgical procedures
was available (range 32%–100%). Lack of surgical skill was the primary reason for
referral in 72% of procedure types, compared with 24%, 2% and 3% due to lack of equipment,
supplies and anesthesia skills, respectively (p < 0.001). Minimum pediatric surgical safety criteria were met by 14% of hospitals.
Conclusion
The primary limitation to providing pediatric surgical care in Zambia is lack of surgical
skills. Minimum safety standards were met by 14% of hospitals. Efforts to improve
pediatric surgery should prioritize teaching surgical skills to expand access and
providing safety training, equipment and supplies to increase safety.
Key words
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References
- Putting the “global” back in global health.Arch Surg. 2012; 147: 404-407
- Surgery as a public health intervention: common misconceptions versus the truth.Bull World Health Organ. 2011; 89: 394
- Global surgical initiatives to reduce the surgical burden of disease.JAMA. 2012; 307: 667-668
- Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.Lancet. 2006; 367: 1747-1757
- Surgery.in: Jamison D.T. Breman J.G. Measham A.R. Disease control priorities in developing countries. 2006 ([Washington, DC])
CIA World Fact Book 2012. https://www.cia.gov/library/publications/the-world-factbook. Accessed December 1, 2012.
- World report on child injury prevention.Inj Prev. 2008; 14: 69
- Injury prevention and the attainment of child and adolescent health.Bull World Health Organ. 2009; 87: 390-394
- Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study.Bull World Health Organ. 2009; 87: 345-352
- Grand challenges in chronic non-communicable diseases.Nature. 2007; 450: 494-496
- An estimation of the global volume of surgery: a modelling strategy based on available data.Lancet. 2008; 372: 139-144
- A surgical safety checklist to reduce morbidity and mortality in a global population.N Engl J Med. 2009; 360: 491-499
- WHO guidelines for safe surgery. 9789241598552 World Health Organization, Geneva2009
United Nations and Republic of Zambia: Republic of Zambia Census, 2010. Lusaka, Zambia, 2010.
World Health Organization: WHO Integrated Management for Emergency & Essential Surgical Care (IMEESC) toolkit. http://www.who.int/surgery/publications/imeesc/en/index.html. Accessed December 1, 2012.
World Health Organization: Global Initiative for Emergency and Essential Surgical Care. http://www.who.int/surgery/globalinitiative/en/. Accessed December 1, 2012.
- Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi.Hum Resour Health. 2007; 5: 17
- Plastic and reconstructive surgery in Zambia: epidemiology of 16 years of practice.World J Surg. 2012; 36: 241-246
- Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.Ann Surg. 2010; 251: 976-980
- Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.Lancet. 2010; 376: 1055-1061
Article info
Publication history
Accepted:
March 8,
2013
Received:
February 24,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
