Skip to main content

Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study

Abstract

Purpose

Characterize pediatric surgical capacity in the eastern Democratic Republic of Congo (DRC) to identify areas of potential improvement.

Methods

The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey was used in two representative eastern DRC provinces to assess existing surgical infrastructure and capacity. We compared our results to previously published reports from other sub-Saharan African countries.

Results

Fourteen hospitals in the eastern DRC and 37 in 19 sub-Saharan African (SSA) countries were compared. The average PediPIPES index for the DRC was 7.7 compared to 13.5 for SSAs. The greatest disparities existed in the areas of personnel and infrastructure. Running water was reportedly available to 57.1% of the hospitals in the DRC, and the majority of hospitals (78.6%) were dependent on generators and solar panels for electricity. Only two hospitals in the DRC (14.3%) reported a pediatric surgeon equivalent on staff, compared to 86.5% of facilities sampled in SSA reporting ≥ 1 pediatric surgeon.

Conclusions

Significant barriers in personnel, infrastructure, procedures, equipment, and supplies impede the provision of adequate surgical care to children. Further work is needed to assess allocation and utilization of existing resources, and to enhance training of personnel with specific attention to pediatric surgery.

This is a preview of subscription content, access via your institution.

References

  1. Gosselin R, Ozgediz D, Poenaru D (2013) A square peg in a round hole? Challenges with DALY-based burden of disease calculations in surgery and a call for alternative metrics. World J Surg 37(11):2507–2511

    Article  PubMed  Google Scholar 

  2. McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81(1):83–92

    CAS  Article  PubMed  Google Scholar 

  3. Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5(6):e121

    Article  PubMed  PubMed Central  Google Scholar 

  4. Forrester JD, Forrester JA, Kamara TB et al (2016) Self-reported determinants of access to surgical care in 3 developing countries. JAMA Surg 151(3):257–263

    Article  PubMed  Google Scholar 

  5. Malemo Kalisya L, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH (2015) Patterns of congenital malformations and barriers to care in Eastern Democratic Republic of Congo. PLoS One 10:e0132362

    Article  PubMed  PubMed Central  Google Scholar 

  6. Congolese Refugee Health Profile (2016) https://www.cdc.gov/immigrantrefugeehealth/pdf/congolese-health-profile.pdf. Accessed 2017

  7. International Human Development Indicators (2016) The Democratic Republic of Congo. http://hdr.undp.org/en/countries/profiles/COD. Accessed 2017

  8. Ahuka OL, Toko RM, Omanga FU, Tshimpanga BJ (2006) Congenital malformations in the North-Eastern Democratic Republic of Congo during civil war. East Afr Med J 83(2):95–99

    CAS  Article  PubMed  Google Scholar 

  9. Meara JG, Greenberg SL (2015) Global surgery as an equal partner in health: no longer the neglected stepchild. Lancet Glob Health 3(Suppl 2):S1–S2

    Article  PubMed  Google Scholar 

  10. Fuller AT, Butler EK, Tran TM et al (2015) Surgeons overseas assessment of surgical need (SOSAS) Uganda: update for household survey. World J Surg 39(12):2900–2907

    Article  PubMed  Google Scholar 

  11. Groen R, Kamara T, Dixon-Cole R, Kwon S, Kingham T, Kushner A (2012) A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. SpringerLink. World J Surg 36:1970

    Article  Google Scholar 

  12. Okoye M, Ameh E, Kushner A, Nwomeh B (2015) A pilot survey of pediatric surgical capacity in West Africa. SpringerLink. World J Surg 39:669–676

    Google Scholar 

  13. Meara JG, Leather AJ, Hagander L et al (2016) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78

    Article  PubMed  Google Scholar 

  14. Chao TE, Sharma K, Mandigo M et al (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2(6):e334–e345

    Article  PubMed  Google Scholar 

  15. Bickler S, Weiser T, Kassebaum N et al (2015) The international bank for reconstruction and development, the world bank. In: Bank TIBfRaDTW (eds) Essential surgery: disease control priorities, vol 1, 3rd edn, chap 2. Washington, DC

  16. Ozgediz D, Poenaru D (2012) The burden of pediatric surgical conditions in low and middle income countries: a call to action. J Pediatr Surg 47(12):2305–2311

    Article  PubMed  Google Scholar 

  17. Badrinath R, Kakembo N, Kisa P, Langer M, Ozgediz D, Sekabira J (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda. J Pediatr Surg 49(12):1825–1830

    Article  PubMed  Google Scholar 

  18. Black RE, Cousens S, Johnson HL et al (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730):1969–1987

    Article  PubMed  Google Scholar 

  19. Rosano A, Botto LD, Botting B, Mastroiacovo P (2000) Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health 54(9):660–666

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Morse T, Haller J, B O (1976) Checklist for a children’s trauma room. J Trauma 16(10):763–765

    Google Scholar 

  21. Kushner AL, Cherian MN, Noel L, Spiegel DA, Groth S, Etienne C (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159

    Article  PubMed  Google Scholar 

  22. Oldham KT (2014) Task force for children’s surgical care: optimal resources for children’s surgical care in the United States. J Am Coll Surg 218(3):480–487e

    Google Scholar 

  23. O’Neill JA, Gautam S, Geiger JD et al (2000) A longitudinal analysis of the pediatric surgeon workforce. Ann Surg 232(3):442–453

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bickler SW, Kyambi J, Rode H (2001) Pediatric surgery in sub-Saharan Africa. Pediatr Surg Int 17(5–6):442–447

    CAS  Article  PubMed  Google Scholar 

  25. Millar AJ, Rode H, Davies MR, Cywes S (1993) Paediatric surgery in the RSA—practice and training. S Afr Med J 83(2):85–88

    CAS  PubMed  Google Scholar 

  26. O’Flynn D, O’Flynn E, Deneke A, Yohannan P, da Costa A, O’Boyle C, Byrne E (2017) Training surgeons as medical educators in Africa. J Surg Educ 74(3):539–542

  27. Amado V, Martins DB, Karan A, Johnson B, Shekherdimian S, Miller LT, Taela A, DeUgarte DA (2017) Global general pediatric surgery partnership: the UCLA–Mozambique experience. J Pediatr Surg (e-pub ahead of print)

  28. UN: global child deaths down by almost half since 1990. 2017. http://www.worldbank.org/en/news/press-release/2013/09/13/un-

  29. Zoumenou E, Gbenou S, Assouto P et al (2010) Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa. Paediatr Anaesth 20(8):741–747

    Article  PubMed  Google Scholar 

  30. Bang’na Maman O, Kabore A, Zoumenou E et al. (2009) Anesthesia for children in Sub-Saharan Africa—a description of settings, common presenting conditions, techniques and outcomes. Pediatr Anaesth 19:7–11

    Google Scholar 

  31. Amponsah G (2010) Challenges of anaesthesia in the management of the surgical neonates in Africa. Afr J Paediatr Surg 7(3):134–139

    Article  PubMed  Google Scholar 

  32. Ameh EA, Chirdan LB (2001) Paediatric surgery in the rural setting: prospect and feasibility. West Afr J Med 20(1):52–55

    CAS  PubMed  Google Scholar 

  33. Ilori I, Ituen A, Eyo C (2013) Factors associated with mortality in neonatal surgical emergencies in a developing ter tiary hospital in Nigeria. Open J Pediatr 3:231–235

    Article  Google Scholar 

  34. Ford K, Poenaru D, Moulot O et al (2016) Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg 51(8):1262–1267

    Article  PubMed  Google Scholar 

  35. Chirdan LB, Uba AF, Pam SD (2004) Intestinal atresia: management problems in a developing country. Pediatr Surg Int 20(11–12):834–837

    CAS  Article  PubMed  Google Scholar 

  36. Ezomike UO, Ekenze SO, Amah CC (2014) Outcomes of surgical management of intestinal atresias. Niger J Clin Pract 17(4):479–483

    CAS  Article  PubMed  Google Scholar 

  37. Forestier C, Cox AT, Horne S (2016) Coordination and relationships between organisations during the civil–military international response against Ebola in Sierra Leone: an observational discussion. J R Army Med Corps 162(3):156–162

    Article  PubMed  Google Scholar 

  38. Taro T, Yao C, Ly S et al (2016) The global surgery partnership: an innovative partnership for education, research, and service. Acad Med 91(1):75–78

    Article  PubMed  Google Scholar 

  39. Yao CA, Taro TB, Wipfli HL et al (2016) The Tsao fellowship in global health: a model for international fellowships in a surgery residency. J Craniofac Surg 27(2):282–285

    Article  PubMed  Google Scholar 

  40. Chirdan LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA (2010) Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 45(3):610–618

    Article  PubMed  Google Scholar 

  41. Elhalaby EA, Uba FA, Borgstein ES, Rode H (2012) Training and practice of pediatric surgery in Africa: past, present, and future. Semin Pediatr Surg 21(2):103–110

    Article  PubMed  Google Scholar 

  42. Krishnaswami S, Nwomeh BC, Ameh EA (2016) The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 25(1):32–42

    Article  PubMed  Google Scholar 

  43. Central Intelligence Agency. The World Factbook (2017) Democratic Republic of Congo. Accessed 2017

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah B. Cairo.

Ethics declarations

Conflict of interest

The authors have no potential conflicts of interest, including financial interests and relationships or affiliations relevant to the subject of this manuscript and research.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cairo, S.B., Kalisya, L.M., Bigabwa, R. et al. Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study. Pediatr Surg Int 34, 343–351 (2018). https://doi.org/10.1007/s00383-017-4215-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-017-4215-z

Keywords

  • Pediatric surgery
  • Disparities
  • Global surgery
  • Africa
  • Surgical capacity
  • Needs assessment