Paediatric Surgery and Anaesthesia in South-Western Uganda: A Cross-Sectional survey/Anesthesie et Chirurgie Pediatriques Dans le Sud-Ouest De l'Ouganda: Une Etude Transversale/ Cirugia Y Anestesia Pediatricas En El Sudoeste De Uganda: Un Estudio Transversal

Introduction Despite increasing awareness of the unmet burden of surgical conditions, little information is available on surgery and anaesthesia in children. (1) It has been estimated that 85% of children in low-income countries are likely to require treatment for a surgical condition by the age of 15 years. (2) Many surgical conditions of childhood are amenable to simple surgical intervention, but if left untreated, complications, lifelong disability or death can ensue. (3) The World Health Organization (WHO) Global Initiative for Emergency and Essential Surgical Care was established in 2005 to strengthen the delivery of surgical care in low-income countries. (4) WHO has defined the types of essential and emergency surgery that should be undertaken and the kind of surgical staff, infrastructure and supplies required in three levels of health-care facilities: level 1, small hospitals/health centres; level 2, district/provincial hospitals; and level 3, referral hospitals. (5,6) WHO has also proposed standardized metrics for global surgical surveillance. (7) Recent surveys suggest that essential resources are not in place in rural hospitals in low-income countries. (8-10) Uganda, a low-income country, faces considerable challenges in the provision of paediatric surgical care. Of its rapidly-growing population of 31.7 million, 49% is under 15 years of age and 88% lives in rural areas. Uganda's population demographics, expenditure on health care and health-care outcomes are typical of low-income countries in sub-Saharan Africa. (11,12) Postgraduate training opportunities for physicians are limited; only 10 trainees complete postgraduate training in surgery in the country each year. Whereas published surveys of surgical activity in sub-Saharan Africa have focused on single institutions, (2,3,13) this study is a regional survey of surgical activity and surgical facilities in all hospitals that were performing paediatric surgery in 2007-2008 in the south-western part of Uganda. Specific objectives were to determine the rates of surgery in children and adults and determine if the area's surgical facilities and surgical and anaesthesia workforce comply with published WHO standards for surgery. (5,6) England is a high-income country with a National Health Service that provides most of the health care for the population and where accurate data regarding surgical activity and workforce are collected. Comparisons were made between Uganda and England to gauge the magnitude of the differences in surgical activity and workforce between a high-income and a low-income country. Methods Between 6 October and 8 November 2008, we conducted a cross-sectional survey of the surgical and anaesthesia workforce and of the infrastructure and availability of drugs and equipment for surgery in all hospitals in south-western Uganda that were designated as centres for major surgery. We defined major surgery as any intervention occurring in a hospital operating theatre involving the incision, excision, manipulation of suturing of tissue and requiring regional or general anaesthesia or sedation. (1) We defined minor surgery as any procedure that did not require regional or general anaesthesia or sedation (e.g. dressing wounds, applying a castor suturing lacerations under local anaesthesia). A retrospective review of the surgical workload was performed to calculate the surgical rates for children and adults during 2007-2008, and the rates of in-patient paediatric surgery were compared to corresponding rates in England during the same time period. (14) Demographics We estimated the total population of the south-western region of Uganda in 2007 by applying the WHO population growth rate of 3.2% per year after 2002 to population data for the 14 study districts from the 2002 Uganda Population and Housing Census. (12,15) Using data from the WHO Statistical Information Service, we calculated the number of children aged [less than or equal to] 14 years (12) to allow comparison with international data sets and previous observational studies in children. …