Summary
Introduction
Access to pediatric urological surgery is low in low-and-middle income countries (LMICs).
Pediatric Urological missions have often been undertaken without best practice guidelines.
Many strides have been made in pediatric general surgery and other surgery but little
in pediatric urology as a component of global surgery.
Study aims
The purpose of this study was to identify challenges to delivery of pediatric urological
care in LMICs and make recommendations for its advancement.
Study design
An internet search for reports and websites was undertaken. Published surveys from
Global Initiative for Children Surgery (GICS) and American Pediatric Surgical Association
(APSA) were evaluated. We developed and administered an additional questionnaire.
Respondents included LMIC pediatric surgeons, HIC pediatric surgeons and HIC pediatric
urologists and LMIC urologists and general surgeons.
Results
Most global surgical visits were short one-time visit, and respondents citing complex
pediatric urologic patients as most neglected in LMICs with the main challenge reported
as a lack of specialist surgeons, poor communication between groups and poor infrastructure.
Local specialist training was universally recommended as the most effective way to
address unmet needs, although the form of training was not clear.
Discussion
Most published work has looked at global general surgery or pediatric general surgery
[1] [2] [3] [6] [8] [11] [13] but little on pediatric urology. Most of the information provided was blog posts
of social engagements but rarely did these websites provide information on the surgical
experience, challenges and solutions gleaned overtime[41] [43][44] [45][56] It is recognised by pediatric urologists, general urologists and pediatric surgeons
that complex urologic anomalies are the most neglected among children's surgical conditions
with a higher disability weight attributed to urologic conditions compared to anorectal
conditions. [6] [8] [14] [27] [31][36] [46], yet there's little expertise on ground and many challenges to its advancement.
This study was limited by the number of questions we could explore due to the need
to make questions fewer and more concise.
Conclusions
Summary Table
| Survey and responses: Vancouver survey (69 HIC Pediatric urologists and LMIC urologists and general surgeons),
APSA survey (131 American pediatric surgeons), GICS survey (41 LMIC children's surgeons) Most neglected conditions: Hypospadias, Bladder/cloacal exstrophy, Neurogenic bladder, Hernias and hydroceles, DSD Challenges: Infrastructure deficiencies, Socio- cultural, Lack of consumables, Inadequate Training, Lack of data repository, Lack of communication between HIC teams |
Keywords
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References
- Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.Lancet. 2015; 386: 569-624
- Global surgery: defining an emerging global health field.Lancet. 2014; 384: 2245-2247
- Congenital anomalies in the context of global surgery.Semin Pediatr Surg. 2016; 25 (february): 15-18
- Congenital Anomalies: fact sheet No. 370.2012
- Data and statistics: birth defects.([Online] Available at:)
- The burden of pediatric surgical conditions in low and middle income countries: a call to action.J Pediatr Surg. 2012; 47: 2305-2311
- Children in Africa: key statistics on child survival, protection, and development.2015 (Available at:)https://data.unicef.org/wp-content/uploads/2015/12/Children-in-Africa-Brochure-Nov-23-HR_245.pdfDate accessed: April 5, 2019
- Pediatric surgery as an essential component of global child health.Semin Pediatr Surg. 2016; 25 (February): 3-9
- Global health: a lasting partnership in paediatric surgery.Afr J Paediatr Surg. 2015; 12 (april): 114-118
- Global general pediatric surgery partnership: the UCLA–Mozambique experience.J Pediatr Surg. 2017; 52: 1528-1533
- Pediatric surgical camps as one model of global surgical partnership: a Way Forward.J Pediatr Surg. 2014; 49: 786-790
- The pediatric surgery workforce in low- and middle-income countries: problems and priorities.Semin Pediatr Surg. 2015; 25: 32-42
- Global comparison of pediatric surgery workforce and training.J Pediatr Surg. 2015; 50: 1180-1183
- Bladder exstrophy: an epidemiologic study from the international clearinghouse for birth defects surveillance and research, and an overview of the literature.Am J Med Genet C Semin Med Genet. 2011; 157C (15): 321-332
- Birth defects in south-east Asia a public health challenge: situation analysis.2013 (Available at:)
Global Initiative for Children's Surgery: Newsletters and publications. Available at https://www.globalchildrenssurgery.org.
Global Pediatric Surgery Network. Available at https://apsapedsurg.org.
What we do. Kids Operating Room. Available at https://www.kidsor.org . [Accessed january 2019].
Who we are, What we do. Surgery For Children. Available at https://www.surgeryforchildren.org.
- Pediatric surgical capacity in Africa: current status and future needs.J Pediatr Surg. 2017; 52 (may): 843-848
- Survey of african pediatric surgeons: how should international partners help?.in: American Academy of Pediatrics, Surgical section annual meeting. 2015
- Ethics in global pediatric surgery: existing dilemmas and emerging challenges.World J Surg. June 2019; 43: 1466-1473
WHO Guidelines for health care equipment donations. Available at: http://www.who.int/medical_devices/publications/en/Donation_Guidelines.pdf[Accessed july 26t2019].
- Accountability in global surgery missions.BMJ Glob Health. 2018; 3e001025
- Evaluating international global health collaborations: perspectives from surgery and anesthesia trainees in Uganda.Surgery. 2014; 155: 585-592
- Pediatric urology and global health: why now and how to build a successful global outreach program.Urol Clin. 2018; 45: 623-631
- Surgical outcomes and cultural perceptions in international hypospadias care.J Urol. 2014; 192 (august): 524-529
- The brain drain myth: retention of specialist surgical graduates in East ,central and southern Africa 1974-2013.World J Surg. 2017; 41: 3046-3053
- An approach to assessment of global pediatric surgery partnerships targeting long-term capacity building in resource-limited settings.Annals of Global Health. 2015; 81: 88-89
- Let our fellows go: a plea for allowing global surgery electives during pediatric surgical training.J Pediatr Surg. 2017; 52: 2088-2090
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 december, 15.Lancet. 2012; 380: 2197-2223
- An investment in knowledge: research in global pediatric surgery for the 21st century.Semin Pediatr Surg. 2016; 25: 51-60
- Partnership in fellowship: comparative analysis of pediatric surgical training and evaluation of a fellow exchange between Canada and Kenya.J Pediatr Surg. 2016; 51: 1704-1710
- Estimating pediatric surgical need in developing countries: a household survey in Rwanda.J Pediatr Surg. 2014; 49: 1092-1098
- Establishing disability weights for congenital paediatric surgical disease: a cross-sectional, multi-modal study.Lancet. 2013; 381
- Worldwide prevalence of hypospadias.J Pediatr Urol. 2016; 12 (e1-7): 152
- A model for sustained collaboration to address the unmet global burden of bladder exstrophy-epispadias complex and penopubic epispadias: the international bladder exstrophy consortium.JAMA Surg. 2018; 153: 618-624https://doi.org/10.1001/jamasurg.2018.0067
- The African pediatric fellowship program: training in Africa for African.Pediatrics. 2016; 137
- IVUmed: a nonprofit model for surgical training in low- resource countries.Annals of Global Health. 2015; 81: 260-264
- http://www.ivumed.org/([Accessed September 2018])Date: 2018
Urolink At British Association of Urologic Surgeons. Available at https://www.baus.org.uk
What we do. Medicins Sans Frontiere. Available at https://www.msf.org.
About us, and our stories at CURE International. Available at https://cure.org.
Our work. Mercyships. Available at https://www.mercyships.africa
- Establishing disability weights for congenital pediatric surgical conditions: a multi-modal approach.Popul Health Metrics. 2017; 15
- Guidelines and checklists for short-term missions in global pediatric surgery.Pediatr Anesth. 2018; 28: 392-410https://doi.org/10.1111/pan.13378
- International volunteerism and global responsibility.Transl Androl Urol. 2017; 6: 258-263
- Impact of global medicine on urologic education.Current Urology Reports. 2011; 12 (April): 132-136
- International surgical missions: how to approach, what to avoid.Urol Times. 2013; 41 (28-28. 3 october)
- Developing pediatric surgery in low- and middle-income countries: an evaluation of contemporary education and care delivery models.Semin Pediatr Surg. 2016; 25: 43-50
- The burden of pediatric surgical disease in low-resource settings: discovering it, measuring it, and addressing it.J Pediatr Surg. 2015; 51: 216-220
- Unifying children’s surgery and anesthesia stakeholders across institutions and clinical disciplines: challenges and solutions from Uganda.World J Surg. 2019; 43 (2019 Jun): 1435-1449https://doi.org/10.1007/s00268-018-04905-9
- Fragmented international volunteerism: need for a global pediatric surgery network.J Pediatr Surg. 2010; 45: 303-309
WHO. Workforce alliance. [Online] Available at: https//www.who.int/workforcealliance/en.
Who we are and what we do. EMERGENCY. Available at https://en.emergency.it.
Our Impact. Association for the Bladder Exstrophy Community. Available at https://www.bladderexstrophy.com.
Article info
Publication history
Published online: December 26, 2020
Accepted:
December 21,
2020
Received in revised form:
November 9,
2020
Received:
February 4,
2020
Identification
Copyright
© 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
