Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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References
World Health Organization (2011) Health statistics and health information systems: life tables for WHO member states. World Health Organization. http://www.who.int/entity/healthinfo/statistics/LT199020002009whs2011.zip. Accessed 16 Jan 2012
Natale JE, Joseph JG, Bergen R et al (1992) Prevalence of childhood disability in a southern Indian city: independent effect of small differences in social status. Int J Epidemiol 21:367–372
Schalamon J, Bismark S, Schober PH et al (2003) Multiple trauma in pediatric patients. Pediatr Surg Int 19:417–423
Davey TM, Aitken LM, Kassulke D et al (2005) Long-term outcomes of seriously injured children: a study using the Child Health Questionnaire. J Paediatr Child Health 41:278–283
Kirpalani HM, Parkin PC, Willan AR et al (2000) Quality of life in spina bifida: importance of parental hope. Arch Dis Child 83:293–297
Maulik PK, Darmstadt GL (2007) Childhood disability in low- and middle-income countries: overview of screening, prevention, services, legislation, and epidemiology. Pediatrics 120:S1–S55
Power C, Leah L, Manor O (2000) A prospective study of limiting longstanding illness in early adulthood. Int J Epidemiol 29:131–139
Aguilar S (2011) Dadaab: Walking the fine line between helping refugees and risking lives. UNHCR—The UN Refugee Agency. http://www.unhcr.org/4ed3bc316.html. Accessed 16 Jan 2012
UNHCR (2012) 2012 UNHCR country operations profile—Kenya. UNHCR—The UN Refugee Agency. http://www.unhcr.org/cgi-bin/texis/vtx/page?page=49e483a16&submit=GO. Accessed 16 Jan 2012
Reilly R (2008) Disabilities among refugees and conflict-affected populations. Forced Migr Rev 35:8–10
Debas HT, Gosselin R, McCord C, et al. (2009) Surgery. In: Jamison DT, Breman JG, Measham AR, et al. (eds). Disease control priorities in developing countries, 2nd edn. The World Bank, Washington, pp 1245–1260
Bickler SW, Sanno-Duanda B (2000) Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ 78:1330–1336
Albertyn R, Bickler SW, van As AB et al (2003) The effects of war on children in Africa. Pediatr Surg Int 19:227–232
Azzie G, Bickler S, Farmer D et al (2008) Partnerships for developing pediatric surgical care in low-income countries. J Pediatr Surg 43:2273–2274
World Health Organization (2008) Global burden of disease: 2004 update. World Health Organization, Geneva
Bickler S, Ozgediz D, Gosselin R et al (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34:374–380. doi:10.1007/s00268-009-0261-6
Vos T (2009) Improving the quantitative basis of the surgical burden in low-income countries. PLoS Med 6:e1000149
Edejer TT, Baltussen R, Adam T et al (eds) (2003) WHO guide to cost-effectiveness analysis. World Health Organization, Geneva
Gosselin R, Heitto M (2008) Cost-effectiveness of a district trauma hospital in Battambang, Cambodia. World J Surg 32:2450–2453. doi:10.1007/s00268-008-9708-4
McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81:83–92
Toole MJ, Waldman RJ (1997) The public health aspects of complex emergencies and refugee situations. Public Health 18:283–312
Shears P, Berry AM, Murphy R et al (1987) Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985. BMJ 295:314–318
UNHCR (2009) Dadaab statistics at a glance. Pop Trends 2009:1–2
Lopez AD, Mathers CD, Ezzati M et al (eds) (2006) Global burden of disease and risk factors. Oxford University Press, New York, pp 400–402
Murray CJL (1994) Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ 72:429–445
World Health Organization (2011) Health statistics and health information systems: life tables for WHO member states. http://www.who.int/entity/healthinfo/statistics/LT199020002009whs2011.zip. 16 Jan 2012
Keren R, Pati S, Feudtner C (2004) The generation gap: differences between children and adults pertinent to economic evaluations of health interventions. Pharmacoeconomics 22:71–81
Corlew DS (2010) Estimation of impact of surgical disease through economic modeling of cleft lip and palate care. World J Surg 34:391–396. doi:10.1007/s00268-009-0198-9
Anand S, Hanson K (1997) Disability-adjusted life years: a critical review. J Health Econ 16:685–702
Gosselin R, Maldonado A, Elder G (2010) Comparative cost-effectiveness analysis of two MSF surgical trauma centers. World J Surg 34:415–419. doi:10.1007/s00268-009-0230-0
Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PloS Med 5:e121
Handicap International (2009) Supporting disabled people in the Dadaab refugee camp. http://www.handicap-international.org.uk/resources/stories/africa/kenya_disability_dadaab
Mathers CD, Salomon JA, Ezzati M, et al. (2006) Sensitivity and uncertainty analyses for burden of disease and risk factor estimates. In: Global Burden of Disease and Risk Factors. Oxford University Press, New York, pp 399–426
Acknowledgments
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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Wu, V.K., Poenaru, D. Burden of Surgically Correctable Disabilities Among Children in the Dadaab Refugee Camp. World J Surg 37, 1536–1543 (2013). https://doi.org/10.1007/s00268-012-1899-z
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DOI: https://doi.org/10.1007/s00268-012-1899-z