Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
VIEWPOINT
Open Access

Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care

Isaac Wasserman, Alexander W. Peters, Lina Roa, Farhana Amanullah and Lubna Samad
Global Health: Science and Practice June 2020, 8(2):183-189; https://doi.org/10.9745/GHSP-D-20-00009
Isaac Wasserman
aIcahn School of Medicine at Mount Sinai, New York, NY, USA.
bProgram in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
cDepartment of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: wasserman.isaac@gmail.com
Alexander W. Peters
bProgram in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
cDepartment of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA.
dDepartment of Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lina Roa
bProgram in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
cDepartment of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA.
eDepartment of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Farhana Amanullah
fThe Indus Hospital, Karachi, Pakistan.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lubna Samad
gCenter for Essential Surgical and Acute Care, Indus Health Network, Karachi, Pakistan.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF
Loading

Key Messages

  • Despite the large role that children’s surgery plays in reducing morbidity and mortality, global child health initiatives have historically focused on nonsurgical diseases.

  • Children’s health care providers and children’s surgery providers can collaborate to improve children’s health through shared values.

  • Long-term investments in surgical workforce development must accompany more immediate measures addressing the current surgical burden.

  • The Lancet Commission on Global Surgery provides a framework to which children’s surgery can harmoniously be integrated.

  • Innovative funding mechanisms may invest to scale cost-effective operations along with ongoing data collection and research.

INTRODUCTION

The United Nations’ third Sustainable Development Goal (SDG-3) is to “ensure healthy lives and promote well-being for all at all ages.”1 In particular, this goal aspires to reduce neonatal mortality to less than 12 per 1,000 live births and under-5 mortality to less than 25 per 1,000.2 SDG-3 also addresses trauma, aspiring to halve “the number of global deaths and injuries from road traffic accidents” by 2020. Access to safe surgery and anesthesia will help achieve SDG-3 and will require focusing on low- and middle-income countries (LMICs),3 where more than 90% of child deaths occur.4 An estimated 43% of the population of sub-Saharan Africa is aged 15 and younger, and approximately 30% of the population in LMICs fall in this age group.5

Addressing the needs of this underserved community requires a coordinated “all hands on deck” approach between all stakeholders, particularly children’s health care providers, surgeons, and nonphysician clinicians. Global efforts addressing children’s health have historically, and to this day, focused their efforts on nonsurgical diseases (Figure).6,7

FIGURE.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE.

United Nations Children’s Fund Budget for Program Funding, 2018–2021a

a US$billion

BURDEN OF CHILDHOOD SURGICAL DISEASE

Children and adolescents comprise 1.7 billion of the nearly 5 billion people who lack access to surgical care.8–10 To make matters worse, in some LMICs like The Gambia, estimates predict 85% of children will require surgical care before they are aged 15 years.11 Children’s surgery plays a large role in reducing the morbidity associated with noncommunicable conditions, such as inguinal hernias,12,13 injuries, and congenital anomalies,14 as well as various infectious disease complications, such as hydrocephalus and blindness from trachoma.15

Specific, surgical interventions for children have been found to be even more cost-effective than accepted adult surgeries, even in low-resource settings.16–18 In particular, the cost-effectiveness of circumcision has been reported to be similar to bed nets for malaria prevention.17 Additionally, the cost-effectiveness of cleft lip or palate repair, general surgery, hydrocephalus surgery, and ophthalmic surgery were all similar to that of the BCG vaccine for tuberculosis. Finally, the cost-effectiveness of cesarean deliveries and orthopedic surgery were more favorable than the cost- effectiveness of medical treatment for ischemic heart disease and HIV treatment.

Road traffic injuries alone, for example, account for more deaths in children aged 5 to 14 years than HIV, tuberculosis, and malaria combined.19 However, this burden is not borne uniformly across the world; 95% of all children killed by road traffic accidents are in LMICs.20 Similarly, 80% of all children killed by fall-related injuries are also in LMICs. Integrating children’s surgical providers into all levels of coordination—from supply chains to public health policies—is integral to addressing pediatric traumatic morbidity and mortality.

The gap between trained children’s surgical providers and the need is vast.

Cardiac, neural tube, and craniofacial anomalies, such as cleft lip and palate, account for at least 32 million lost disability adjusted life-years (DALYs), 57% of which could be averted through childhood surgical interventions.15 Currently, more than 300,000 newborns die within 4 weeks due to congenital anomalies.21 Studies examining the unmet burden of children’s surgical disease are lacking, but recent attempts to quantify and clarify these numbers have relied on using surgical delay and the resulting backlog of cases.22 In a study examining burden of congenital anomalies in 13 African countries, the average surgical delay was more than 2 years—contributing to nearly 75,000 lost DALYs.23–25 Surgical burden for congenital anomalies is likely related to not only surgical workforce, but also population size and birth rate—highlighting the need for collaboration between surgical and obstetric providers with public health practitioners.

Furthermore, this burden is spread among all LMICs, with sub-Saharan Africa and South Asia sharing a similarly large burden of DALYs avertable through children’s surgery.26 Clearly, more attention must be given to preventing, identifying, and treating congenital and noncommunicable diseases, injuries, and burns if the health of children is to be improved in accordance with global commitments.

INADEQUATE SURGICAL WORKFORCE

The gap between trained children’s surgical providers and the need is vast. Currently, the number of children’s surgeons is inversely proportional to a country’s birth rate,27 meaning the countries that are most in need of surgical care for children have the least capacity for delivering this care. This need is most acute in many African nations, where the density of children’s surgeons ranges from 0.17 children’s surgeons per million children in Malawi, to 1.5 children’s surgeons per million in Egypt.28 Compared to a benchmark of 10 children’s surgeons per million children used by Krishnaswami et al., low-income African nations have a shortfall of more than 3,000 children’s surgeons.27 Equally essential, pediatric anesthesia faces severe workforce shortages, with specialized provider density estimated to be 100 times lower in LMICs than in high-income countries.29 To address this shortfall, LMICs need not only more anesthesia providers, but also providers who have specialty training and skills needed to manage pediatric anatomy and physiology.

OVERLAPPING GOALS: PEDIATRIC AND GLOBAL SURGERY COMMUNITIES

The solidarity between children’s health care providers and children’s surgery providers is deeper than merely sharing patient populations and an overarching goal of improving children’s health. Children’s surgery would be ineffective without the children’s health care provider correctly diagnosing and referring a child with, for example, a congenital anomaly. Moreover, the presurgical preparation and postsurgical care for these patients, especially neonates, ideally would involve joint coordination between children’s health care providers and their surgical colleagues. Finally, synergies between humanitarian and health development exist—preparation for surgical care is an integral part to disaster and emergency preparedness around the world.30

Some progress toward addressing bringing children’s health care providers and surgery providers closer together has been made. In 2002, the Surgical Advisory Panel of the American Academy of Pediatrics worked with children’s health care providers to develop referral guidelines, representing an U.S.-focused example of potential collaboration.31 The Global Initiative for Children’s Surgery (GICS), founded in 2016, provides a platform and an organized voice for children’s surgery. GICS members—representing surgeons, anesthetists, and nonphysician clinicians—work with stakeholders in LMICs to identify barriers to care and develop country-specific plans to improve children’s surgical care.32,33 In addition, in 2013, the American Board of Pediatrics convened a Global Health Task Force to coordinate the expansion of their “core mission—training assessment, certification, and quality improvement and continuing professional development”—into the international sphere, helping to train international children’s health care providers through their International In-Training Examination.4,34 Although not specific to children’s surgery, the Global Health Workforce Alliance (now Network) focused on bringing attention to human resources for health to augment health care capacity.35

There is much to be gained from further integrating children’s surgery into advocacy efforts and the broader global child health agenda. Building off the history of collaboration between children’s surgeons and the American Academy of Pediatrics as early as 1948, the time has come to extend that relationship to the global sphere.36 In short, promoting good global child health requires both children’s health care providers and surgery providers to work together and outside of their specialty-specific silos.

Promoting good global child health requires both children’s health care providers and surgery providers to work together and outside their specialty-specific silos.

Much can be gained from integrating children’s surgery into advocacy efforts and the broader global child health agenda.

RECOMMENDATIONS FOR IMPROVING GLOBAL CHILD HEALTH

Develop the Children’s Surgical Workforce

An adequate surgical workforce is indispensable in meeting the demand for children’s surgical care. As both GICS and the Global Health Task Force have articulated, training a robust global pediatric workforce, with a focus on sustainable, ground-up improvements, is critical. One such model builds on the example set by the U.S. National Institutes of Health-funded Medical Education Partnership Initiative.37 Between 2010 and 2015, 13 medical schools in 12 sub-Saharan African countries were awarded $130 million to work with a U.S.-based university to increase the schools’ abilities to (1) produce more and better-trained doctors, (2) strengthen relevant research, and (3) retain graduates. Building on this model, children’s health care providers and children’s surgeon groups can collaborate with local medical schools and governments to support the development of a workforce specific for children’s health care in each country that integrates the provision of both medical and surgical care.

A survey of children’s surgeons in Africa demonstrated a clear preference for “collaborative professional development” over mission-based direct clinical care.38 The coordination of both pediatric- and surgery-specific organizations to improve in-country training opportunities and promote effective recognition and referral pathways for care is needed. These organizations should work with respective ministries of health, academic partners, and other stakeholders to develop local, pediatric-specific postgraduate residency training programs.

There exists a potential trade-off between the timeline necessary to sustainably develop and train a specialized workforce and the immediate clinical need today. Working closely with ministries of health, professional organizations, and existing referral networks, children’s health care providers and surgery providers should task shift and task share carefully selected components of care to nonspecialty trained providers as a potential, short-term bridge to the development of a robust and sustainable surgical workforce.39 Leveraging the critical importance of nonphysician clinicians is essential in achieving this “all hands-on deck” approach.40 Although large variations exist between countries, the volume of surgery performed by nonphysician providers can be significant: nearly 90% of obstetric surgeries and 39% of general surgery procedures—including 43% of nonobstetric laparotomies.39,41 Recent studies seek to assess the safety and efficacy of these surgeries.42–44 Future work must continue to focus on evaluating the outcomes of task sharing, as well as articulating best practices for supporting trained nonspecialty providers. Additionally, attention to retention of workforce is critical. Previous studies have suggested that surgical graduates in LMICs primarily migrate for “professional reasons.”45 Attempts through National Surgical Obstetric and Anesthesia Plans (NSOAPs, discussed later) to improve training alongside infrastructure may mitigate this problem.

Although secondary benefits of integrating efforts to increase a system’s surgical capacity for children exist to strengthen the health system as a whole, this approach requires sustained investment over time. In the more immediate term, there may be an ongoing role for selective, vertical programs to avert DALYs today, while broader health systems strengthening and capacity building are ongoing.46 In addition to the clinical impact of these surgical “camps,” potentials to engage with local infrastructure and workforce exist.47 Each country must decide whether to use this intervention, and every effort must be taken that these interventions are well regulated and do not detract from the longer-term goal of an increase in children’s surgical providers.

Focus on “Best Buy” Surgeries

Children’s surgical care is cost-effective. In particular, inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, male circumcision, congenital heart surgery, and orthopedic procedures are considered the 6 essential children’s surgical procedures because of the economic value for the health burdens they avert.48 These procedures, with the exception of congenital heart surgery, align with the 44 procedures deemed “essential” by the Disease Control Priorities Network, a joint enterprise devoted to determine disease control priorities around the world, particularly in LMICs.49

Although not traditionally considered as “children’s surgery,” reemphasizing the importance of cesarean deliveries must be included to address neonatal mortality and complications of pregnancy, the leading cause of death for girls aged 15 to 19 years.50,51 There is an inverse association between prevalence of cesarean deliveries and maternal and neonatal mortality for cesarean delivery rates up to 19%.52,53 The Disease Control Priorities Network noted that, as late as 2010, of the worldwide 16 million DALYs lost due to maternal disorders, 6.4 million DALYs were attributable to surgically preventable obstetric complications, including unsafe abortion.54,55

Children’s health care providers and surgery providers, alike, must work with obstetric providers to improve access to obstetric care and coordinate the appropriate referrals to optimize maternal and neonatal care. Through a focus on these cost-effective, “best buy” surgeries, the integration of surgical care can be sustainable, allowing for meaningful and lasting progress toward achieving the SDGs.

By focusing on “best buy” surgeries, the integration of surgical care can be sustainable and allow for meaningful progress toward achieving the SDGs.

Integrate Children’s Surgery Into NSOAPs

In 2015, the Lancet Commission on Global Surgery proposed a framework for the creation of NSOAPs, providing an opportunity for governments to strengthen surgical care. Children’s surgery fits into this framework, and health officials should be encouraged to integrate children’s surgical care into both NSOAPs and national child health strategies. Nigeria has successfully included children’s surgery and nursing as a key component of their NSOAP.56 Additionally, children’s health care providers and children’s surgeons must collaborate to ensure that academic, governmental, and nongovernmental organizations working on various child health priorities communicate and collaborate, not only with one another, but also with ministries of health. Moreover, enabling the environment for children’s surgery requires attention to diverse domains, including infrastructure, blood supply, infection control, and quality improvement. The NSOAP provides a mechanism for achieving this whole-of-systems approach.57 Using the Lancet Commission’s framework, all pediatric-focused groups must advocate for the inclusion of pediatric-specific interventions at the government level into national and regional health planning using the GICS Optimal Resources guide.32

Standardize Data Collection and Research

Planning and effectively incorporating children’s surgery into national health systems is not possible without adequate and reliable information. Recent strides have been made to improve data collection around children’s surgery,58–61 but these efforts must be scaled, standardized, and aligned with existing surgical indicators as described by the Lancet Commission on Global Surgery (i.e., children’s surgical volume, access to care within 2 hours, workforce density, financial risk protection, and perioperative mortality).62 Building off existing initiatives such as the Quality of Care Network to encompass more children’s health areas is a potential way to scale and standardize these efforts.63 Additionally, baseline assessments of the surgical services available at hospitals, such as through the District Health Information Software or Service Provision/Service Availability and Readiness Assessments,64,65 need to be updated and emphasized to specifically include children’s surgery.66 A combined effort within the global child health community can help standardize data collections, distribute analyses, and collaborate with in-country providers to set country-driven research agendas. Developing a nation’s capacity to gather and analyze their own children’s health data will improve all areas of children’s health care.67

Leverage Financing

Harnessing the ethical, health, and economic arguments for investing in children’s health, which necessarily includes surgery, requires public, private, and academic partnerships. Given their impact on development, untreated pediatric and surgical conditions carry an additional burden of lifelong disability and ensuing economic disadvantage. Surgery is a cost-effective global health intervention; thus it is essential that both public and private funders incorporate surgical care within the package of services aimed at promoting global child health.17 One particular avenue is through the World Bank’s Global Financing Facility for Women, Children, and Adolescents, whose ultimate aim, through investment cases in maternal and child health, is to “gradually shift countries away from relying on developmental aid and onto a sustainable financing path.”68 Helping to champion pediatric surgical priorities among existing funders of children’s health is an area where children’s health care providers, with more experience in navigating funders and funding mechanisms, can drive global access to children’s surgery forward.

CONCLUSION

Addressing preventable neonatal and child deaths and achieving SDG-3 requires a coordinated approach between children’s health care providers and the surgical and anesthesia providers. Global child health demands surgery, and timely surgery, in turn, arrives only with the support and collaboration between children’s health care providers and their colleagues. By aligning advocacy and fundraising efforts to include specific, cost-effective, and necessary surgeries, the global child health care and surgery communities can more effectively partner with countries to achieve this goal and offer comprehensive children’s health care to those who need it most.

Notes

Peer Reviewed

Competing Interests: None declared.

Cite this article as: Wasserman I, Peters AW, Roa L, Amanullah F, Samad L. Breaking silos: improving global child health through essential surgical care. Glob Health Sci Pract. 2020;8(2):183-189. https://doi.org/10.9745/GHSP-D-20-00009

  • Received: December 19, 2019.
  • Accepted: May 19, 2020.
  • Published: June 30, 2020.
  • © Wasserman et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00009

REFERENCES

  1. 1.↵
    United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development. United Nations; 2015. Accessed May 29, 2020. https://sustainabledevelopment.un.org/post2015/transformingourworld/publication
  2. 2.↵
    1. Stenberg K,
    2. Hanssen O,
    3. Edejer TT-T, et al
    . Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Heal. 2017;5(9):e875–e887. doi:10.1016/s2214-109x(17)30263-2. pmid:28728918
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Roa L,
    2. Jumbam DT,
    3. Makasa E,
    4. Meara JG
    . Global surgery and the sustainable development goals. Br J Surg. 2019;106(2):e44–e52. doi:10.1002/bjs.11044. pmid:30620060
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Pitt MB,
    2. Moore MA,
    3. John CC, et al
    . Supporting global health at the pediatric department level: why and how. Pediatrics. 2017;139(6):e20163939. doi:10.1542/peds.2016-3939. pmid:28562273
    OpenUrlFREE Full Text
  5. 5.↵
    World Development Indicators DataBank. World Bank; 2020. Accessed May 29, 2020. http://databank.worldbank.org/data/source/world-development-indicators
  6. 6.↵
    United Nations Children’s Fund (UNICEF). UNICEF Integrated Budget 2018–2021. UNICEF; 2017. Accessed May 29, 2020. https://www.unicef.org/about/execboard/files/2018-2021_Integrated_Budget_EB_Informal_23_June_FINAL.pdf
  7. 7.↵
    1. Chaiban T
    . UNICEF Programming Priorities: Orientation for New UNICEF Focal Points Based in Government Missions in NY. United Nation’s Children’s Fund. Accessed May 29, 2020. https://www.unicef.org/publicpartnerships/files/UNICEF_Programme_Priorities.pdf
  8. 8.↵
    1. Bickler SW,
    2. Sanno-Duanda B
    . Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78(11):1330–1336. pmid:11143193
    OpenUrlPubMed
  9. 9.
    1. Butler EK,
    2. Tran TM,
    3. Nagarajan N, et al
    . Epidemiology of pediatric surgical needs in low-income countries. PLoS One. 2017;12(3):e0170968. doi:10.1371/journal.pone.0170968. pmid:28257418
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Ozgediz D,
    2. Poenaru D
    . The burden of pediatric surgical conditions in low and middle income countries: a call to action. J Pediatr Surg. 2012;47(12):2305–2311. doi:10.1016/j.jpedsurg.2012.09.030. pmid:23217895
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Bickler SW,
    2. Telfer ML,
    3. Sanno-Duanda B
    . Need for paediatric surgery care in an urban area of The Gambia. Trop Doct. 2003;33(2):91–94. doi:10.1177/004947550303300212. pmid:12680542
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Ekenze SO,
    2. Anyanwu PA,
    3. Ezomike UO,
    4. Oguonu T
    . Profile of pediatric abdominal surgical emergencies in a developing country. Int Surg. 2010;95(4):319–324. pmid:21309414
    OpenUrlPubMed
  13. 13.↵
    1. Debas HT,
    2. Donkor P,
    3. Gawande A, et al
    Beard JH, Ohene-Yeboah M, Devries C, Schecter WP. Hernia and hydrocele. In: Debas HT, Donkor P, Gawande A, et al., eds. Essential Surgery: Disease Control Priorities. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2015. Accessed May 29, 2020. https://www.ncbi.nlm.nih.gov/books/NBK333501/
  14. 14.↵
    1. Owen RM,
    2. Capper B,
    3. Lavy C
    . Clubfoot treatment in 2015: a global perspective. BMJ Glob Heal. 2018;3(4):e000852. doi:10.1136/bmjgh-2018-000852. pmid:30233830
    OpenUrlCrossRefPubMed
  15. 15.↵
    1. Debas HT,
    2. Donkor P,
    3. Gawande A, et al
    Farmer D, Sitkin N, Lofberg K, Donkor P, Ozgediz D. Surgical interventions for congenital anomalies. In: Debas HT, Donkor P, Gawande A, et al., eds. Essential Surgery: Disease Control Priorities. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2015. Accessed May 29, 2020. https://www.ncbi.nlm.nih.gov/books/NBK333522/
  16. 16.↵
    1. Smith ER,
    2. Concepcion TL,
    3. Niemeier KJ,
    4. Ademuyiwa AO
    . Is global pediatric surgery a good investment? World J Surg. 2019;43(6):1450–1455. doi:10.1007/s00268-018-4867-4. pmid:30506288
    OpenUrlCrossRefPubMed
  17. 17.↵
    1. Chao TE,
    2. Sharma K,
    3. Mandigo M, et al
    . Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Heal. 2014;2(6):e334–45. doi:10.1016/s2214-109x(14)70213-x. pmid:25103302
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Saxton AT,
    2. Poenaru D,
    3. Ozgediz D, et al
    . Economic analysis of children’s surgical care in low- and middle-income countries: a systematic review and analysis. PLoS One. 2016;11(10):e0165480. doi:10.1371/journal.pone.0165480. pmid:27792792
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Ritchie H,
    2. Roser M
    . Causes of Death. OurWorldInData.org. Published online February 2018. Accessed May 29, 2020. https://ourworldindata.org/causes-of-death
  20. 20.↵
    1. Kiragu AW,
    2. Dunlop SJ,
    3. Mwarumba N, et al
    . Pediatric trauma care in low resource settings: challenges, opportunities, and solutions. Front Pediatr. 2018;6:155. doi:10.3389/fped.2018.00155. pmid:29915778
    OpenUrlCrossRefPubMed
  21. 21.↵
    World Health Organization. Congenital anomalies. Published September 7, 2016. Accessed May 29, 2020. https://www.who.int/news-room/fact-sheets/detail/congenital-anomalies
  22. 22.↵
    1. Yousef Y,
    2. Lee A,
    3. Ayele F,
    4. Poenaru D
    . Delayed access to care and unmet burden of pediatric surgical disease in resource-constrained African countries. J Pediatr Surg. 2019;54(4):845–853. doi:10.1016/j.jpedsurg.2018.06.018. pmid:30017069
    OpenUrlCrossRefPubMed
  23. 23.↵
    1. Poenaru D,
    2. Pemberton J,
    3. Cameron BH
    . The burden of waiting: DALYs accrued from delayed access to pediatric surgery in Kenya and Canada. J Pediatr Surg. 2015;50(5):765–770. doi:10.1016/j.jpedsurg.2015.02.033. pmid:25783371
    OpenUrlCrossRefPubMed
  24. 24.
    1. Poenaru D,
    2. Pemberton J,
    3. Frankfurter C,
    4. Cameron BH
    . Quantifying the disability from congenital anomalies averted through pediatric surgery: a cross-sectional comparison of a pediatric surgical unit in Kenya and Canada. World J Surg. 2015;39(9):2198–2206. doi:10.1007/s00268-015-3103-8. pmid:26037026
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Poenaru D,
    2. Pemberton J,
    3. Frankfurter C,
    4. Cameron BH,
    5. Stolk E
    . Establishing disability weights for congenital pediatric surgical conditions: a multi-modal approach. Popul Health Metr. 2017;15(1):8. doi:10.1186/s12963-017-0125-5. pmid:28259148
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Debas HT,
    2. Donkor P,
    3. Gawande A, et al
    Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT. Essential surgery: key messages of this volume. In: In: Debas HT, Donkor P, Gawande A, et al., eds. Essential Surgery Disease Control Priorities. 3rd ed. The International Bank for Reconstruction and Development, The World Bank; 2015. Accessed May 29, 2020. https://www.ncbi.nlm.nih.gov/books/NBK333511/
  27. 27.↵
    1. Krishnaswami S,
    2. Nwomeh BC,
    3. Ameh EA
    . The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg. 2016;25(1):32–42. doi:10.1053/j.sempedsurg.2015.09.007. pmid:26831136
    OpenUrlCrossRefPubMed
  28. 28.↵
    1. Chirdan LB,
    2. Ameh EA,
    3. Abantanga FA,
    4. Sidler D,
    5. Elhalaby EA
    . Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg. 2010;45(3):610–618. doi:10.1016/j.jpedsurg.2009.11.007. pmid:20223329
    OpenUrlCrossRefPubMed
  29. 29.↵
    1. Dubowitz G,
    2. Detlefs S,
    3. McQueen KAK
    . Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg. 2010;34(3):438–444. doi:10.1007/s00268-009-0229-6. pmid:19795163
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Pyda J,
    2. Patterson RH,
    3. Caddell L, et al
    . Towards resilient health systems: opportunities to align surgical and disaster planning. BMJ Glob Heal. 2019;4(3):e001493. doi:10.1136/bmjgh-2019-001493. pmid:31275620
    OpenUrlAbstract/FREE Full Text
  31. 31.↵
    Surgical Advisory Panel. American Academy of Pediatrics. Guidelines for referral to pediatric surgical specialists. Pediatrics. 2002;110(1 Pt 1):187–191. pmid:12093970
    OpenUrlFREE Full Text
  32. 32.↵
    1. Goodman L,
    2. St-Louis E,
    3. Yousef Y, et al
    . The global initiative for children’s surgery: optimal resources for improving care. Eur J Pediatr Surg. 2018;28(01):51–59. doi:10.1055/s-0037-1604399. pmid:28806850
    OpenUrlCrossRefPubMed
  33. 33.↵
    Global Initiative for Children’s Surgery. Global initiative for children’s surgery: a model of global collaboration to advance the surgical care of children. World J Surg. 2019;43(6):1416–1425. doi:10.1007/s00268-018-04887-8. pmid:30623232
    OpenUrlCrossRefPubMed
  34. 34.↵
    1. Butteris S,
    2. Haig V
    . Mind the Gap: Lessons from One Board’s Focus on Global Health. Presentation of The American Board of Pediatrics Global Health Task Force. September 26, 2017. Accessed May 29, 2020. https://static1.squarespace.com/static/5581c84de4b08614acb89b1f/t/59cd37c52278e76a7ff30a5e/1506621385211/09.26_0915_Butteris_Haig_MOC-LLSA-032.pdf
  35. 35.↵
    Global Health Workforce Alliance: About the Alliance. World Health Organization web site. Accessed May 29, 2020. https://www.who.int/workforcealliance/about/en/
  36. 36.↵
    1. Klein MD
    . The pediatric surgeon and the American Academy of Pediatrics (AAP): an important partnership for surgeons and children. J Pediatr Surg. 2013;48(6):1405–1409. doi:10.1016/j.jpedsurg.2013.03.034. pmid:23845638
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. Omaswa F,
    2. Kiguli-Malwadde E,
    3. Donkor P, et al
    . Medical Education Partnership Initiative gives birth to AFREhealth. Lancet Glob Heal. 2017;5(10):e965–e966. doi:10.1016/s2214-109x(17)30329-7. pmid:28911758
    OpenUrlCrossRefPubMed
  38. 38.↵
    1. Toobaie A,
    2. Emil S,
    3. Ozgediz D,
    4. Krishnaswami S,
    5. Poenaru D
    . Pediatric surgical capacity in Africa: current status and future needs. J Pediatr Surg. 2017;52(5):843–848. doi:10.1016/j.jpedsurg.2017.01.033. pmid:28168989
    OpenUrlCrossRefPubMed
  39. 39.↵
    1. Hoyler M,
    2. Hagander L,
    3. Gillies R, et al
    . Surgical care by non-surgeons in low-income and middle-income countries: a systematic review. Lancet. 2015;385 Suppl 2:S42. doi:10.1016/s0140-6736(15)60837-6. pmid:26313091
    OpenUrlCrossRefPubMed
  40. 40.↵
    1. Federspiel F,
    2. Mukhopadhyay S,
    3. Milsom PJ,
    4. Scott JW,
    5. Riesel JN,
    6. Meara JG
    . Global surgical, obstetric, and anesthetic task shifting: a systematic literature review. Surgery. 2018;164(3):553–558. doi:10.1016/j.surg.2018.04.024. pmid:30145999
    OpenUrlCrossRefPubMed
  41. 41.↵
    1. Wren SM,
    2. Kushner AL
    . Task shifting in surgery-what US health care can learn from Ghana. JAMA Surg. 2019;154(9):860. doi:10.1001/jamasurg.2019.1745. pmid:31241737
    OpenUrlCrossRefPubMed
  42. 42.↵
    1. Wilhelm TJ,
    2. Thawe IK,
    3. Mwatibu B,
    4. Mothes H,
    5. Post S
    . Efficacy of major general surgery performed by non-physician clinicians at a central hospital in Malawi. Trop Doct. 2011;41(2):71–75. doi:10.1258/td.2010.100272. pmid:21303987
    OpenUrlCrossRefPubMed
  43. 43.
    1. Tariku Y,
    2. Gerum T,
    3. Mekonen M,
    4. Takele H
    . Surgical task shifting helps reduce neonatal mortality in Ethiopia: a retrospective cohort study. Surg Res Pract. 2019;2019:5367068. doi:10.1155/2019/5367068. pmid:30854416
    OpenUrlCrossRefPubMed
  44. 44.↵
    1. Beard JH,
    2. Ohene-Yeboah M,
    3. Tabiri S, et al
    . Outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. JAMA Surg. 2019;154(9):853–859. doi:10.1001/jamasurg.2019.1744. pmid:31241736
    OpenUrlCrossRefPubMed
  45. 45.↵
    1. Hagander LE,
    2. Hughes CD,
    3. Nash K, et al
    . Surgeon migration between developing countries and the United States: train, retain, and gain from brain drain. World J Surg. 2013;37:14–23. doi:10.1007/s00268-012-1795-6. pmid:23052799
    OpenUrlCrossRefPubMed
  46. 46.↵
    1. Moon W,
    2. Perry H,
    3. Baek RM
    . Is international volunteer surgery for cleft lip and cleft palate a cost-effective and justifiable intervention? a case study from East Asia. World J Surg. 2012;36(12):2819–2830. doi:10.1007/s00268-012-1761-3. pmid:22986629
    OpenUrlCrossRefPubMed
  47. 47.↵
    1. Blair GK,
    2. Duffy D,
    3. Birabwa-Male D, et al
    . Pediatric surgical camps as one model of global surgical partnership: a way forward. J Pediatr Surg. 2014;49(5):786–790. doi:10.1016/j.jpedsurg.2014.02.069. pmid:24851771
    OpenUrlCrossRefPubMed
  48. 48.↵
    1. Saxton AT,
    2. Poenaru D,
    3. Ozgediz D, et al
    . Economic analysis of children’s surgical care in low- and middle-income countries: a systematic review and analysis. PLoS One. 2016;11(10):e0165480. doi:10.1371/journal.pone.0165480. pmid:27792792
    OpenUrlCrossRefPubMed
  49. 49.↵
    1. Debas HT,
    2. Donkor P,
    3. Gawande A,
    4. Jamison DT,
    5. Kruk ME,
    6. Mock CN
    . Essential Surgery. The International Bank for Reconstruction and Development, The World Bank; 2015.
  50. 50.↵
    1. Alkema L,
    2. Chou D,
    3. Hogan D, et al
    . Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. 2016;387(10017):462–474. doi:10.1016/s0140-6736(15)00838-7. pmid:26584737
    OpenUrlCrossRefPubMed
  51. 51.↵
    1. Black RE,
    2. Laxminarayan R,
    3. Temmerman M, et al
    Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al., eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2016.
  52. 52.↵
    1. Maswime S
    . Improving access to caesarean sections and perioperative care in LMICs. Lancet. 2019;393(10184):1919–1920. doi:10.1016/s0140-6736(18)32589-3. pmid:30929892
    OpenUrlCrossRefPubMed
  53. 53.↵
    1. Molina G,
    2. Weiser TG,
    3. Lipsitz SR, et al
    . Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015;314(21):2263–2270. doi:10.1001/jama.2015.15553. pmid:26624825
    OpenUrlCrossRefPubMed
  54. 54.↵
    1. Adanu RMK
    1. Debas HT,
    2. Donkor, P,
    3. Gawande A, et al
    Johnson CT, Johnson TRB, Adanu RMK. Global burden of surgically treatable obstetric conditions. In: Debas HT, Donkor, P, Gawande A, et al., eds. Essential Surgery: Disease Control Priorities. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; 2015.
  55. 55.↵
    1. Higashi H,
    2. Barendregt JJ,
    3. Kassebaum NJ,
    4. Weiser TG,
    5. Bickler SW,
    6. Vos T
    . Surgically avertable burden of obstetric conditions in low- and middle-income regions: A modelled analysis. BJOG. 2015;122(2):228–236. doi:10.1111/1471-0528.13198. pmid:25546047
    OpenUrlCrossRefPubMed
  56. 56.↵
    1. Peters AW,
    2. Roa L,
    3. Rwamasirabo E, et al
    . National Surgical, Obstetric, and Anesthesia Plans Supporting the Vision of Universal Health Coverage. Glob Heal Sci Pract. 2020;8(1):1–9. doi:10.9745/ghsp-d-19-00314. pmid:32234839
    OpenUrlCrossRefPubMed
  57. 57.↵
    1. deVries CR,
    2. Rosenberg JS
    . Global Surgical Ecosystems: A Need for Systems Strengthening. Ann Glob Heal. 2016;82(4):605–613. doi:10.1016/j.aogh.2016.09.011. pmid:27986227
    OpenUrlCrossRefPubMed
  58. 58.↵
    1. Butler MW,
    2. Ozgediz D,
    3. Poenaru D, et al
    . The Global Paediatric Surgery Network: a model of subspecialty collaboration within global surgery. World J Surg. 2015;39(2):335–342. doi:10.1007/s00268-014-2843-1. pmid:25344143
    OpenUrlCrossRefPubMed
  59. 59.
    1. Elhalaby EA,
    2. Millar AJW
    . Challenges of pediatric surgical practice in Africa. Preface. Semin Pediatr Surg. 2012;21(2):101–102. doi:10.1053/j.sempedsurg.2012.01.001. pmid:22475114
    OpenUrlCrossRefPubMed
  60. 60.
    1. Greenberg SLM,
    2. Ng-Kamstra JS,
    3. Ameh EA,
    4. Ozgediz DE,
    5. Poenaru D
    . An investment in knowledge: research in global pediatric surgery for the 21st century. Semin Pediatr Surg. 2016;25(1):51–60. doi:10.1053/j.sempedsurg.2015.09.009. pmid:26831138
    OpenUrlCrossRefPubMed
  61. 61.↵
    1. Hamad D,
    2. Yousef Y,
    3. Caminsky NG, et al
    . Defining the critical pediatric surgical workforce density for improving surgical outcomes: a global study. J Pediatr Surg. 2020;55(3):493–512. doi:10.1016/j.jpedsurg.2019.11.001. pmid:31839371
    OpenUrlCrossRefPubMed
  62. 62.↵
    1. Meara JG,
    2. Leather AJM,
    3. Hagander L, et al
    . Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth. 2016;25:75–78. doi:10.1016/j.ijoa.2015.09.006. pmid:26597405
    OpenUrlCrossRefPubMed
  63. 63.↵
    About Us. Network for Improving Quality of Care for Maternal, Newborn and Child Health website. Accessed April 6, 2020. http://qualityofcarenetwork.org/about
  64. 64.↵
    DHIS2 home page. DHIS2 website. Accessed May 29, 2020. https://www.dhis2.org/
  65. 65.↵
    1. Sheffel A,
    2. Karp C,
    3. Creanga AA
    . Use of Service Provision Assessments and Service Availability and Readiness Assessments for monitoring quality of maternal and newborn health services in low-income and middle-income countries. BMJ Glob Heal. 2018;3(6):e001011. doi:10.1136/bmjgh-2018-001011. pmid:30555726
    OpenUrlAbstract/FREE Full Text
  66. 66.↵
    Lancet Commission on Global Surgery, World Health Organization (WHO), Program in Global Surgery and Social Change (PGSSC), Harvard Medical School. WHO-PGSSC Surgical Assessment Tool (SAT) Hospital Walkthrough. Accessed July 30, 2018. https://b6cf2cfd-eb09-4859-92a9-a8f002c3bcef.filesusr.com/ugd/346076_b9d8e8796eb945fe9bac7e7e35c512b1.pdf
  67. 67.↵
    1. Poenaru D,
    2. Seyi-Olajide JO
    . Developing metrics to define progress in children’s surgery. World J Surg. 2019;43(6):1456–1465. doi:10.1007/s00268-018-4868-3. pmid:30498890
    OpenUrlCrossRefPubMed
  68. 68.↵
    1. Peters AW,
    2. Pyda J,
    3. Menon G,
    4. Suzuki E,
    5. Meara JG
    . The World Bank Group: innovative financing for health and opportunities for global surgery. Surgery. 2019;165(2):263–272. doi:10.1016/j.surg.2018.07.040. pmid:30274731
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 8 (2)
Global Health: Science and Practice
Vol. 8, No. 2
June 30, 2020
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care
Isaac Wasserman, Alexander W. Peters, Lina Roa, Farhana Amanullah, Lubna Samad
Global Health: Science and Practice Jun 2020, 8 (2) 183-189; DOI: 10.9745/GHSP-D-20-00009

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care
Isaac Wasserman, Alexander W. Peters, Lina Roa, Farhana Amanullah, Lubna Samad
Global Health: Science and Practice Jun 2020, 8 (2) 183-189; DOI: 10.9745/GHSP-D-20-00009
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • INTRODUCTION
    • BURDEN OF CHILDHOOD SURGICAL DISEASE
    • INADEQUATE SURGICAL WORKFORCE
    • OVERLAPPING GOALS: PEDIATRIC AND GLOBAL SURGERY COMMUNITIES
    • RECOMMENDATIONS FOR IMPROVING GLOBAL CHILD HEALTH
    • CONCLUSION
    • Notes
    • REFERENCES
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • At-Risk Newborns: Overlooked in Expansion From Essential Newborn Care to Small and Sick Newborn Care in Low- and Middle-Income Countries
  • Do Children With Congenital Zika Syndrome Have Cerebral Palsy?
  • Equitable Open Access Publishing: Changing the Financial Power Dynamics in Academia
Show more VIEWPOINT

Similar Articles

Subjects

  • Cross-Cutting Topics
    • Surgery
  • Health Topics
    • Maternal, Newborn, and Child Health
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire