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A Nationwide Enumeration of Operations Performed for Pediatric Patients in GhanaFunding This study was funded in part by grants R25-TW009345 and D43-TW007267 from the Fogarty International Center, United States National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Introduction Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs.
Materials and Methods Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were categorized as “essential” (most cost-effective, highest population impact) as designated by the World Bank's Disease Control Priorities versus “other.” Estimates were then compared with pediatric operation rates in New Zealand to determine unmet pediatric surgery need in Ghana.
Results A total of 29,884 operations were performed for children <15 years, representing an annual operation rate of 284/100,000 (95% uncertainty interval: 205–364). Essential procedures constituted 66% of all pediatric operations; 12,397 (63%) were performed at district hospitals. General surgery (8,808; 29%) and trauma (6,302; 21%) operations were most common. Operations for congenital conditions were few (826; 2.8%). Tertiary hospitals performed majority (55%) of operations outside of the essential category. Compared with the New Zealand benchmark (3,806 operations/100,000 children <15 years), Ghana is meeting only 7% of its pediatric surgical needs.
Conclusion Ghana has a large unmet need for pediatric surgical care. Pediatric-specific benchmarking is needed to guide surgical capacity efforts in low- and middle-income country healthcare systems.
Study concept and design: A.G., B.S., F.A., C.M., and P.D. Acquisition, analysis, or interpretation of data: A.G., B.S., E.S., R.W., andC.G. Drafting of the manuscript; critical revision of the manuscript for important intellectual content; administrative, technical, or material support: All authors.
Received: 02 October 2019
Accepted: 21 January 2020
02 April 2020 (online)
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