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Unmet surgical needs in children: a household survey in Nepal

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Abstract

Purpose

While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low- and middle-income countries. Our study aims to assess pediatric surgical needs in Nepal.

Methods

A countrywide cross-sectional study was performed in 15 randomly chosen districts; 3 clusters (2 rural; 1 urban) per district were selected. The prevalence of surgical conditions, unmet surgical needs, and barriers to care were analyzed among children (0–18 years of age).

Results

Overall, 1,350 households and 2,695 individuals were surveyed (response rate: 97 %); 800 respondents (29.7 %, 95 % CI 27.9–31.4 %) were pediatric; 59.8 % (95 % CI 56.3–63.2 %) were male; median age was 10 years (IQR 5–15). Of them, 84 (10.5 %, 95 % CI 8.5–12.8 %) had a surgical condition; 48 (6.0 %, 95 % CI 4.5–7.9 %) reported an unmet need for surgical care. Based on this, we estimate that 706,076 (95 % CI 529,557–929,666) children live with untreated surgical conditions. Barriers to care included limited availability of services (31.3 %), funds (22.9 %), time (4.2 %), and fear/mistrust of medical services (16.7 %).

Conclusion

Close to 700,000 children in Nepal are estimated to need surgical consultation. Programs to address this should be developed alongside efforts by policy makers and donors to rectify the lack of care, bolster limited funds, and strengthen healthcare systems.

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Acknowledgments

This study was financially supported by the Association for Academic Surgery Global Surgery Research Fellowship Award and Surgeons OverSeas

Conflict of interest

Authors have none to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neeraja Nagarajan

  2. Surgeons OverSeas, New York, NY, USA

    Shailvi Gupta, Adam L. Kushner & Benedict C. Nwomeh

  3. Department of Surgery, University of California San Francisco, East Bay, San Francisco, CA, USA

    Shailvi Gupta

  4. Department of Surgery, Nepal Medical College, Kathmandu, Nepal

    Sunil Shresthra

  5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Varshini Varadaraj

  6. Om Saibaba Memorial Hospital, Kathmandu, Nepal

    Sagar Devkota

  7. Department of Surgery, Harvard Medical School, Boston, MA, USA

    Anju Ranjit

  8. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adam L. Kushner

  9. Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA

    Benedict C. Nwomeh

Authors
  1. Neeraja Nagarajan
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  2. Shailvi Gupta
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  3. Sunil Shresthra
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  4. Varshini Varadaraj
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  5. Sagar Devkota
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  6. Anju Ranjit
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  7. Adam L. Kushner
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  8. Benedict C. Nwomeh
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Corresponding author

Correspondence to Benedict C. Nwomeh.

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Nagarajan, N., Gupta, S., Shresthra, S. et al. Unmet surgical needs in children: a household survey in Nepal. Pediatr Surg Int 31, 389–395 (2015). https://doi.org/10.1007/s00383-015-3684-1

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  • DOI: https://doi.org/10.1007/s00383-015-3684-1

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