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Eur J Pediatr Surg 2021; 31(02): 199-205
DOI: 10.1055/s-0040-1705130
Original Article

A Nationwide Enumeration of Operations Performed for Pediatric Patients in Ghana

Adam Gyedu
1   Department of Surgery, Kwame Nkrumah University of Science and Technology College of Health Sciences, Kumasi, Ghana
,
Barclay Stewart
2   Department of Surgery, University of Washington, Seattle, Washington, United States
,
Cameron Gaskill
2   Department of Surgery, University of Washington, Seattle, Washington, United States
,
Emmanuella Salia
3   Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
,
Raymond Wadie
3   Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
,
Francis Abantanga
4   Department of Surgery, University for Development Studies, Tamale, Northern, Ghana
,
Peter Donkor
3   Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
,
Charles Mock
2   Department of Surgery, University of Washington, Seattle, Washington, United States
› Author Affiliations Funding 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.
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Abstract

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.

Keywords

pediatric - operation rate - enumeration - Ghana - LMIC

Authors' Contributions

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.




Publication History

Received: 02 October 2019

Accepted: 21 January 2020

Article published online:
02 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Meara JG, Leather AJ, Hagander L. et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery 2015; 158 (01) 3-6
    CrossrefPubMedGoogle Scholar
  • 2 Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW. Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health 2015; 3 (Suppl. 02) S13-S20
    CrossrefPubMedGoogle Scholar
  • 3 Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 2015; 3 (Suppl. 02) S8-S9
    CrossrefPubMedGoogle Scholar
  • 4 Weiser TG, Haynes AB, Molina G. et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ 2016; 94 (03) 201-209F
    CrossrefPubMedGoogle Scholar
  • 5 Alkire BC, Raykar NP, Shrime MG. et al. Global access to surgical care: a modelling study. Lancet Glob Health 2015; 3 (06) e316-e323
    CrossrefPubMedGoogle Scholar
  • 6 The World Bank Group. World Development Indicators. Accessed February 10, 2020 at: https://data.worldbank.org/country/ghana?view=chart
    PubMed
  • 7 Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results. Institute of Health Metrics and Evaluation (IHME). Accessed September 20, 2019 at: http://ghdx.healthdata.org/gbd-results-tool
    PubMed
  • 8 Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ 2002; 80 (10) 829-835
    PubMedGoogle Scholar
  • 9 Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg 2015; 39 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 10 Ankomah J, Stewart BT, Oppong-Nketia V. et al. Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana. J Pediatr Surg 2015; 50 (11) 1922-1927
    CrossrefPubMedGoogle Scholar
  • 11 Krishnaswami S, Nwomeh BC, Ameh EA. The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 2016; 25 (01) 32-42
    CrossrefPubMedGoogle Scholar
  • 12 Hider P, Wilson L, Rose J, Weiser TG, Gruen R, Bickler SW. The role of facility-based surgical services in addressing the national burden of disease in New Zealand: An index of surgical incidence based on country-specific disease prevalence. Surgery 2015; 158 (01) 44-54
    CrossrefPubMedGoogle Scholar
  • 13 Stewart BT, Quansah R, Gyedu A, Ankomah J, Donkor P, Mock C. Strategic assessment of trauma care capacity in Ghana. World J Surg 2015; 39 (10) 2428-2440
    CrossrefPubMedGoogle Scholar
  • 14 Gyedu A, Baah EG, Boakye G, Ohene-Yeboah M, Otupiri E, Stewart BT. Quality of referrals for elective surgery at a tertiary care hospital in a developing country: an opportunity for improving timely access to and cost-effectiveness of surgical care. Int J Surg 2015; 15: 74-78
    CrossrefPubMedGoogle Scholar
  • 15 Gyedu A, Stewart B, Gaskill C. et al. Improving benchmarks for global surgery: nationwide enumeration of operations performed in Ghana. Ann Surg 2018; 268 (02) 282-288
    CrossrefPubMedGoogle Scholar
  • 16 Ministry of Health; National Assessment for Emergency Obstetric and Newborn Care. Accra: Ministry of Health, Ghana; 2011
  • 17 Jamison DT, Summers LH, Alleyne G. et al. Global health 2035: a world converging within a generation. Lancet 2013; 382 (9908): 1898-1955
    CrossrefPubMedGoogle Scholar
  • 18 Ministry of Health New Zealand. National Minimum Dataset (hospital events). Accessed June 3, 2017 at: https://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/national-minimum-dataset-hospital-events
    PubMed
  • 19 Debas H, Donkor P, Gawande A, Jamison D, Kruk M, Mock C. eds. Essential Surgery. Disease Control Priorities. 3rd edition. Washington, DC: World Bank; 2015. ; No. 1
  • 20 Shortage of Paediatric Surgeons [press release]. Wellington: Association of Salaried Medical Specialists, New Zealand, 26 June; 2015
    PubMed
  • 21 Walker IA, Obua AD, Mouton F, Ttendo S, Wilson IH. Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bull World Health Organ 2010; 88 (12) 897-906
    CrossrefPubMedGoogle Scholar
  • 22 Burgos CM, Bolkan HA, Bash-Taqi D, Hagander L, von Schreeb J. The met needs for pediatric surgical conditions in Sierra Leone: estimating the gap. World J Surg 2018; 42 (03) 652-665
    CrossrefPubMedGoogle Scholar
  • 23 Kyu HH, Pinho C, Wagner JA. et al; Global Burden of Disease Pediatrics Collaboration. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: findings from the Global Burden of Disease 2013 Study. JAMA Pediatr 2016; 170 (03) 267-287
    CrossrefPubMedGoogle Scholar
  • 24 Gyedu A, Debrah S, Agbedinu K. et al. In-country training by the Ghana College of Physicians and Surgeons: an initiative that has aided surgeon retention and distribution in Ghana. World J Surg 2018
    PubMedGoogle Scholar
  • 25 Bolkan HA, Hagander L, von Schreeb J. et al. The surgical workforce and surgical provider productivity in Sierra Leone: a countrywide inventory. World J Surg 2016; 40 (06) 1344-1351
    CrossrefPubMedGoogle Scholar
  • 26 Qureshi JS, Young S, Muyco AP. et al. Addressing Malawi's surgical workforce crisis: a sustainable paradigm for training and collaboration in Africa. Surgery 2013; 153 (02) 272-281
    CrossrefPubMedGoogle Scholar
  • 27 Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in Sub-Saharan Africa. PLoS Med 2009; 6 (05) e1000078
    CrossrefPubMedGoogle Scholar