Abstract
Introduction
Children's surgical access in low and low-middle income countries is severely limited.
Investigations detailing met and unmet surgical access are necessary to inform appropriate
resource allocation.
Materials and methods
Surgical volume, outcomes, and distribution of pediatric general surgical procedures
were analyzed using prospective pediatric surgical databases from four separate regional
hospitals in Uganda. The current averted burden of surgical disease through pediatric
surgical delivery in Uganda and the unmet surgical need based on estimates from high-income
country data was calculated.
Results
A total of 8514 patients were treated at the four hospitals over a 6-year period corresponding
to 1350 pediatric surgical cases per year in Uganda or six surgical cases per 100,000
children per year. The majority of complex congenital anomalies and surgical oncology
cases were performed at Mulago and Mbarara Hospitals, which have dedicated pediatric
surgical teams (P < 0.0001). The averted burden of pediatric surgical disease was 27,000 disability
adjusted life years per year, which resulted in an economic benefit of approximately
23 million USD per year. However, the average case volume performed at the four regional
hospitals currently represents 1% of the total projected pediatric surgical need.
Conclusions
This investigation is one of the first to demonstrate the distribution of pediatric
surgical procedures at a country level through the use of a prospective locally created
database. Significant disease burden was averted by local pediatric and adult surgical
teams, demonstrating the economic benefit of pediatric surgical care delivery. These
findings support several ongoing strategies to increase pediatric surgical access
in Uganda.
Keywords
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Article info
Publication history
Published online: February 02, 2023
Accepted:
December 24,
2022
Received in revised form:
December 5,
2022
Received:
May 21,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
