Global Paediatric Surgery: A comparison of paediatric surgery in the district hospitals of low, middle and high-income countries, and an exploration of paediatric surgery performed by non-specialists in Africa

Thesis

The lack of adequate surgical care accounts for around one-third of the global disease burden (Meara et al., 2018). Approximately 2.5 billion children in low-income and middle-income countries (LMICs) lack surgical care (Goodman et al., 2018; Meara et al., 2018).

The first part of this study is a systematic review of the volume and variety of children’s surgery in district general hospitals/rural hospitals in LMICs compared to high-income countries (HICs). The Odds Ratios (OR) calculations showed that a child is 21.415-fold more likely to experience mortality or morbidity following surgery in a low-income setting compared to a high-income setting. The chances were 19.537-fold higher when comparing LIC to a middle-income country (MIC). This is much smaller when comparing MIC and HIC, whereby the OR shows a child has a 1.096-fold increased risk of a negative procedural outcome. The results demonstrate considerable inequalities in children's surgery between LICs and HICs remain. The results can be used to champion further efforts to investigate why this is.

The next aspect of the study utilised logbook data collected from the College of Surgeons of East & Central and Southern Africa (COSECSA). The logbook data was analysed to give the number of procedures across the regions of Africa, with the total number being 33,606 between 01/01/2012 - 01/01/2022. The surgical trainees performing the children’s surgeries were analysed, and it showed that there used to be many more non-paediatric surgeons doing the surgeries. Still, in more recent years, this has dropped and remains steady at approximately 31% of procedures done by non-paediatric surgeons across sub-Saharan Africa. This work could help advocate for increased training of paediatric surgeons.

Authors: Leahy, P

• DOI: 10.5287/ora-o590kgxky
• Type of award: MSc by Research
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English