Burden of Surgically Correctable Disabilities Among Children in the Dadaab Refugee Camp
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Surgery is increasingly recognized as a means to reduce the morbidity and mortality of disabling impairments in resource-limited environments. We sought to estimate the burden of surgically correctable disabling impairments and the cost-effectiveness of their treatment among children in a large refugee camp.
This is a chart review of all patients aged 0–18 years from Dadaab Refugee Camp (Kenya) treated at a facility primarily responsible for providing pediatric surgical care in the region. Total disability-adjusted life years (DALYs) averted were calculated using life expectancy tables and established or estimated disability weights. A sensitivity analysis was performed using various life expectancy tables. Delayed averted DALYs caused by delay in care were also estimated. Inpatient costs were collected to perform a cost-effectiveness analysis.
Between 2005 and 2011 a total of 640 procedures were performed on 341 patients. The median age at surgery was 4.6 years, and 33 % of the children treated were female. Only 13.5 % of surgeries estimated as required for common congenital surgical conditions were actually performed. The total number of DALYs averted ranged from 4,136 to 9,529 (6.4–14.8 per patient), depending on the calculation method used. Cost-effectiveness analysis resulted in values of $40–$88 per DALY.
The burden of pediatric surgical disabling impairments in refugee camps is substantial. Surgical intervention to address this burden is both feasible and cost-effective. Such intervention can significantly decrease the burden of disability among children affected by armed conflicts.
KeywordsArmed Conflict Refugee Camp Disability Weight Refugee Child Bladder Exstrophy
The authors thank the United Nations High Commission for Refugees (UNHCR), Dadaab Sub-office, and Handicap International Kenya for their assistance in conducting this study. We also acknowledge the expert advice of Drs. Norgrove Penny (CBM International) and Doruk Ozgediz (Global Partners in Anesthesia and Surgery).
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