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Published in: Pediatric Surgery International 3/2018

01-03-2018 | Original Article

Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study

Authors: Sarah B. Cairo, Luc Malemo Kalisya, Richard Bigabwa, David H. Rothstein

Published in: Pediatric Surgery International | Issue 3/2018

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Abstract

Purpose

Characterize pediatric surgical capacity in the eastern Democratic Republic of Congo (DRC) to identify areas of potential improvement.

Methods

The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey was used in two representative eastern DRC provinces to assess existing surgical infrastructure and capacity. We compared our results to previously published reports from other sub-Saharan African countries.

Results

Fourteen hospitals in the eastern DRC and 37 in 19 sub-Saharan African (SSA) countries were compared. The average PediPIPES index for the DRC was 7.7 compared to 13.5 for SSAs. The greatest disparities existed in the areas of personnel and infrastructure. Running water was reportedly available to 57.1% of the hospitals in the DRC, and the majority of hospitals (78.6%) were dependent on generators and solar panels for electricity. Only two hospitals in the DRC (14.3%) reported a pediatric surgeon equivalent on staff, compared to 86.5% of facilities sampled in SSA reporting ≥ 1 pediatric surgeon.

Conclusions

Significant barriers in personnel, infrastructure, procedures, equipment, and supplies impede the provision of adequate surgical care to children. Further work is needed to assess allocation and utilization of existing resources, and to enhance training of personnel with specific attention to pediatric surgery.
Literature
1.
go back to reference Gosselin R, Ozgediz D, Poenaru D (2013) A square peg in a round hole? Challenges with DALY-based burden of disease calculations in surgery and a call for alternative metrics. World J Surg 37(11):2507–2511CrossRefPubMed Gosselin R, Ozgediz D, Poenaru D (2013) A square peg in a round hole? Challenges with DALY-based burden of disease calculations in surgery and a call for alternative metrics. World J Surg 37(11):2507–2511CrossRefPubMed
2.
go back to reference McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81(1):83–92CrossRefPubMed McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81(1):83–92CrossRefPubMed
3.
4.
go back to reference Forrester JD, Forrester JA, Kamara TB et al (2016) Self-reported determinants of access to surgical care in 3 developing countries. JAMA Surg 151(3):257–263CrossRefPubMed Forrester JD, Forrester JA, Kamara TB et al (2016) Self-reported determinants of access to surgical care in 3 developing countries. JAMA Surg 151(3):257–263CrossRefPubMed
5.
go back to reference Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH (2015) Patterns of congenital malformations and barriers to care in Eastern Democratic Republic of Congo. PLoS One 10:e0132362CrossRefPubMedPubMedCentral Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH (2015) Patterns of congenital malformations and barriers to care in Eastern Democratic Republic of Congo. PLoS One 10:e0132362CrossRefPubMedPubMedCentral
8.
go back to reference Ahuka OL, Toko RM, Omanga FU, Tshimpanga BJ (2006) Congenital malformations in the North-Eastern Democratic Republic of Congo during civil war. East Afr Med J 83(2):95–99CrossRefPubMed Ahuka OL, Toko RM, Omanga FU, Tshimpanga BJ (2006) Congenital malformations in the North-Eastern Democratic Republic of Congo during civil war. East Afr Med J 83(2):95–99CrossRefPubMed
9.
go back to reference Meara JG, Greenberg SL (2015) Global surgery as an equal partner in health: no longer the neglected stepchild. Lancet Glob Health 3(Suppl 2):S1–S2CrossRefPubMed Meara JG, Greenberg SL (2015) Global surgery as an equal partner in health: no longer the neglected stepchild. Lancet Glob Health 3(Suppl 2):S1–S2CrossRefPubMed
10.
go back to reference Fuller AT, Butler EK, Tran TM et al (2015) Surgeons overseas assessment of surgical need (SOSAS) Uganda: update for household survey. World J Surg 39(12):2900–2907CrossRefPubMed Fuller AT, Butler EK, Tran TM et al (2015) Surgeons overseas assessment of surgical need (SOSAS) Uganda: update for household survey. World J Surg 39(12):2900–2907CrossRefPubMed
11.
go back to reference Groen R, Kamara T, Dixon-Cole R, Kwon S, Kingham T, Kushner A (2012) A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. SpringerLink. World J Surg 36:1970CrossRef Groen R, Kamara T, Dixon-Cole R, Kwon S, Kingham T, Kushner A (2012) A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. SpringerLink. World J Surg 36:1970CrossRef
12.
go back to reference Okoye M, Ameh E, Kushner A, Nwomeh B (2015) A pilot survey of pediatric surgical capacity in West Africa. SpringerLink. World J Surg 39:669–676 Okoye M, Ameh E, Kushner A, Nwomeh B (2015) A pilot survey of pediatric surgical capacity in West Africa. SpringerLink. World J Surg 39:669–676
13.
go back to reference Meara JG, Leather AJ, Hagander L et al (2016) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78CrossRefPubMed Meara JG, Leather AJ, Hagander L et al (2016) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78CrossRefPubMed
14.
go back to reference Chao TE, Sharma K, Mandigo M et al (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2(6):e334–e345CrossRefPubMed Chao TE, Sharma K, Mandigo M et al (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2(6):e334–e345CrossRefPubMed
15.
go back to reference Bickler S, Weiser T, Kassebaum N et al (2015) The international bank for reconstruction and development, the world bank. In: Bank TIBfRaDTW (eds) Essential surgery: disease control priorities, vol 1, 3rd edn, chap 2. Washington, DC Bickler S, Weiser T, Kassebaum N et al (2015) The international bank for reconstruction and development, the world bank. In: Bank TIBfRaDTW (eds) Essential surgery: disease control priorities, vol 1, 3rd edn, chap 2. Washington, DC
16.
go back to reference Ozgediz D, Poenaru D (2012) The burden of pediatric surgical conditions in low and middle income countries: a call to action. J Pediatr Surg 47(12):2305–2311CrossRefPubMed Ozgediz D, Poenaru D (2012) The burden of pediatric surgical conditions in low and middle income countries: a call to action. J Pediatr Surg 47(12):2305–2311CrossRefPubMed
17.
go back to reference Badrinath R, Kakembo N, Kisa P, Langer M, Ozgediz D, Sekabira J (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda. J Pediatr Surg 49(12):1825–1830CrossRefPubMed Badrinath R, Kakembo N, Kisa P, Langer M, Ozgediz D, Sekabira J (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda. J Pediatr Surg 49(12):1825–1830CrossRefPubMed
18.
go back to reference Black RE, Cousens S, Johnson HL et al (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730):1969–1987CrossRefPubMed Black RE, Cousens S, Johnson HL et al (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730):1969–1987CrossRefPubMed
19.
go back to reference Rosano A, Botto LD, Botting B, Mastroiacovo P (2000) Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health 54(9):660–666CrossRefPubMedPubMedCentral Rosano A, Botto LD, Botting B, Mastroiacovo P (2000) Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health 54(9):660–666CrossRefPubMedPubMedCentral
20.
go back to reference Morse T, Haller J, B O (1976) Checklist for a children’s trauma room. J Trauma 16(10):763–765 Morse T, Haller J, B O (1976) Checklist for a children’s trauma room. J Trauma 16(10):763–765
21.
go back to reference Kushner AL, Cherian MN, Noel L, Spiegel DA, Groth S, Etienne C (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159CrossRefPubMed Kushner AL, Cherian MN, Noel L, Spiegel DA, Groth S, Etienne C (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159CrossRefPubMed
22.
go back to reference Oldham KT (2014) Task force for children’s surgical care: optimal resources for children’s surgical care in the United States. J Am Coll Surg 218(3):480–487e Oldham KT (2014) Task force for children’s surgical care: optimal resources for children’s surgical care in the United States. J Am Coll Surg 218(3):480–487e
24.
go back to reference Bickler SW, Kyambi J, Rode H (2001) Pediatric surgery in sub-Saharan Africa. Pediatr Surg Int 17(5–6):442–447CrossRefPubMed Bickler SW, Kyambi J, Rode H (2001) Pediatric surgery in sub-Saharan Africa. Pediatr Surg Int 17(5–6):442–447CrossRefPubMed
25.
go back to reference Millar AJ, Rode H, Davies MR, Cywes S (1993) Paediatric surgery in the RSA—practice and training. S Afr Med J 83(2):85–88PubMed Millar AJ, Rode H, Davies MR, Cywes S (1993) Paediatric surgery in the RSA—practice and training. S Afr Med J 83(2):85–88PubMed
26.
go back to reference O’Flynn D, O’Flynn E, Deneke A, Yohannan P, da Costa A, O’Boyle C, Byrne E (2017) Training surgeons as medical educators in Africa. J Surg Educ 74(3):539–542 O’Flynn D, O’Flynn E, Deneke A, Yohannan P, da Costa A, O’Boyle C, Byrne E (2017) Training surgeons as medical educators in Africa. J Surg Educ 74(3):539–542
27.
go back to reference Amado V, Martins DB, Karan A, Johnson B, Shekherdimian S, Miller LT, Taela A, DeUgarte DA (2017) Global general pediatric surgery partnership: the UCLA–Mozambique experience. J Pediatr Surg (e-pub ahead of print) Amado V, Martins DB, Karan A, Johnson B, Shekherdimian S, Miller LT, Taela A, DeUgarte DA (2017) Global general pediatric surgery partnership: the UCLA–Mozambique experience. J Pediatr Surg (e-pub ahead of print)
29.
go back to reference Zoumenou E, Gbenou S, Assouto P et al (2010) Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa. Paediatr Anaesth 20(8):741–747CrossRefPubMed Zoumenou E, Gbenou S, Assouto P et al (2010) Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa. Paediatr Anaesth 20(8):741–747CrossRefPubMed
30.
go back to reference Bang’na Maman O, Kabore A, Zoumenou E et al. (2009) Anesthesia for children in Sub-Saharan Africa—a description of settings, common presenting conditions, techniques and outcomes. Pediatr Anaesth 19:7–11 Bang’na Maman O, Kabore A, Zoumenou E et al. (2009) Anesthesia for children in Sub-Saharan Africa—a description of settings, common presenting conditions, techniques and outcomes. Pediatr Anaesth 19:7–11
31.
go back to reference Amponsah G (2010) Challenges of anaesthesia in the management of the surgical neonates in Africa. Afr J Paediatr Surg 7(3):134–139CrossRefPubMed Amponsah G (2010) Challenges of anaesthesia in the management of the surgical neonates in Africa. Afr J Paediatr Surg 7(3):134–139CrossRefPubMed
32.
go back to reference Ameh EA, Chirdan LB (2001) Paediatric surgery in the rural setting: prospect and feasibility. West Afr J Med 20(1):52–55PubMed Ameh EA, Chirdan LB (2001) Paediatric surgery in the rural setting: prospect and feasibility. West Afr J Med 20(1):52–55PubMed
33.
go back to reference Ilori I, Ituen A, Eyo C (2013) Factors associated with mortality in neonatal surgical emergencies in a developing ter tiary hospital in Nigeria. Open J Pediatr 3:231–235CrossRef Ilori I, Ituen A, Eyo C (2013) Factors associated with mortality in neonatal surgical emergencies in a developing ter tiary hospital in Nigeria. Open J Pediatr 3:231–235CrossRef
34.
go back to reference Ford K, Poenaru D, Moulot O et al (2016) Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg 51(8):1262–1267CrossRefPubMed Ford K, Poenaru D, Moulot O et al (2016) Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg 51(8):1262–1267CrossRefPubMed
35.
go back to reference Chirdan LB, Uba AF, Pam SD (2004) Intestinal atresia: management problems in a developing country. Pediatr Surg Int 20(11–12):834–837CrossRefPubMed Chirdan LB, Uba AF, Pam SD (2004) Intestinal atresia: management problems in a developing country. Pediatr Surg Int 20(11–12):834–837CrossRefPubMed
36.
go back to reference Ezomike UO, Ekenze SO, Amah CC (2014) Outcomes of surgical management of intestinal atresias. Niger J Clin Pract 17(4):479–483CrossRefPubMed Ezomike UO, Ekenze SO, Amah CC (2014) Outcomes of surgical management of intestinal atresias. Niger J Clin Pract 17(4):479–483CrossRefPubMed
37.
go back to reference Forestier C, Cox AT, Horne S (2016) Coordination and relationships between organisations during the civil–military international response against Ebola in Sierra Leone: an observational discussion. J R Army Med Corps 162(3):156–162CrossRefPubMed Forestier C, Cox AT, Horne S (2016) Coordination and relationships between organisations during the civil–military international response against Ebola in Sierra Leone: an observational discussion. J R Army Med Corps 162(3):156–162CrossRefPubMed
38.
go back to reference Taro T, Yao C, Ly S et al (2016) The global surgery partnership: an innovative partnership for education, research, and service. Acad Med 91(1):75–78CrossRefPubMed Taro T, Yao C, Ly S et al (2016) The global surgery partnership: an innovative partnership for education, research, and service. Acad Med 91(1):75–78CrossRefPubMed
39.
go back to reference Yao CA, Taro TB, Wipfli HL et al (2016) The Tsao fellowship in global health: a model for international fellowships in a surgery residency. J Craniofac Surg 27(2):282–285CrossRefPubMed Yao CA, Taro TB, Wipfli HL et al (2016) The Tsao fellowship in global health: a model for international fellowships in a surgery residency. J Craniofac Surg 27(2):282–285CrossRefPubMed
40.
go back to reference Chirdan LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA (2010) Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 45(3):610–618CrossRefPubMed Chirdan LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA (2010) Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 45(3):610–618CrossRefPubMed
41.
go back to reference Elhalaby EA, Uba FA, Borgstein ES, Rode H (2012) Training and practice of pediatric surgery in Africa: past, present, and future. Semin Pediatr Surg 21(2):103–110CrossRefPubMed Elhalaby EA, Uba FA, Borgstein ES, Rode H (2012) Training and practice of pediatric surgery in Africa: past, present, and future. Semin Pediatr Surg 21(2):103–110CrossRefPubMed
42.
go back to reference Krishnaswami S, Nwomeh BC, Ameh EA (2016) The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 25(1):32–42CrossRefPubMed Krishnaswami S, Nwomeh BC, Ameh EA (2016) The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 25(1):32–42CrossRefPubMed
43.
go back to reference Central Intelligence Agency. The World Factbook (2017) Democratic Republic of Congo. Accessed 2017 Central Intelligence Agency. The World Factbook (2017) Democratic Republic of Congo. Accessed 2017
Metadata
Title
Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study
Authors
Sarah B. Cairo
Luc Malemo Kalisya
Richard Bigabwa
David H. Rothstein
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 3/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-017-4215-z

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