The Heterogeneity of Global Pediatric Surgery: Defining Needs and Opportunities Around the World
The global burden of pediatric surgical conditions continues to remain inadequately addressed, particularly in low- and middle-income countries. Among the many factors contributing to this gap are a lack of access to care secondary to resource shortages and inequitable distribution, underfinancing of healthcare systems, poor quality of care, and contextual challenges such as natural disasters and conflict. The relative contribution of these and other factors varies widely by region and even with countries of a region.
This review seeks to discuss the heterogeneity of global pediatric surgery and offer recommendations for addressing the barriers to high-quality pediatric surgical care throughout the world.
There is significant heterogeneity in pediatric surgical challenges, both between regions and among countries in the same region, although data are limited. This heterogeneity can reflect differences in demographics, epidemiology, geography, income level, health spending, historical health policies, and cultural practices, among others.
Country-level research and stakeholder engagement are needed to better understand the heterogeneity of local needs and drive policy changes that contribute to sustainable reforms. Key to these efforts will be improved financing, access to and quality of pediatric surgical care.
Compliance with ethical standards
Conflict of interest
KG has done consulting work for the World Bank on topics related to health system strengthening in the past 3 years.
- 5.Haider A, Scott JW, Gause CD et al (2017) Development of a unifying target and consensus indicators for global surgical systems strengthening: proposed by the Global Alliance for Surgery, Obstetric, Trauma, and anaesthesia Care (The G4 Alliance). World J Surg 41:2426–2434. https://doi.org/10.1007/s00268-017-4028-1 CrossRefGoogle Scholar
- 7.World Bank (2017) World development indicators. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators
- 8.United Nations, Department of Economic and Social Affairs, Population Division (2017) World population prospects: the 2017 revision, custom data acquired via website. https://population.un.org/wpp/
- 14.Observatorio en Salud Sexual y Reproductiva, Guatemala. http://osarguatemala.org
- 15.Bridges L (2018) Violent crime in El Salvador has taken a damaging toll on the country’s economy. National Public Radio. https://www.marketplace.org/2018/03/05/world/violent-crime-el-salvador-has-taken-damaging-toll-countrys-economy
- 18.International Monetary Fund, IMF Data Mapper. http://www.imf.org/external/datamapper/NGDPDPC@WEO/OEMDC/ADVEC/WEOWORLD
- 20.Institute for Health Metrics and Evaluation (2013) GBD compare: cause of disease or injury, stacked bar chart. http://viz.healthmetricsandevaluation.org/gbd-compare/
- 22.Mohammed bin Rashid Al Maktoum Foundation, UNDP Regional Bureau for Arab States (2014) Arab knowledge report 2014: youth and localisation of knowledge. http://www.undp.org/content/dam/rbas/report/UNDP-GENERAL-REPORT-ENG.pdf
- 24.Huster KM, Patterson N, Schilperoord M et al (2014) Cesarean sections among Syrian refugees in Lebanon from December 2012/January 2013 to June 2013: probable causes and recommendations. Yale J Biol Med 87:269–288Google Scholar
- 25.Rechel B, Richardson E, McKee M (2015) Trends in health systems in the former Soviet countries. Observatory studies series (35). European Observatory on Health Systems and Policies, CopenhagenGoogle Scholar
- 29.Padilla CD, Cutiongco EM, Sia JM (2003) Birth defects ascertainment in the Philippines. Southeast Asian J Trop Med Public Health 34:239–243Google Scholar
- 31.UNICEF (2017) Generation 2030 Africa 2.0 Prioritizing investments in children to reap the demographic dividend. https://www.unicef.org/publications/files/Generation_2030_Africa_2.0.pdf
- 35.Balint A (2011) Nutritional support. In: Pediatric surgery: a comprehensive text for Africa, pp 30–33Google Scholar
- 36.Nyagetuba M, Mugo R, Hansen E (2016) Management of posterior urethral valves in rural Kenya. Ann Afr Surg 13:12–14Google Scholar
- 37.World Health Organisation (2011) The Abuja declaration: ten years on. www.who.int/healthsystems/publications/abuja_report_aug_2011.pdf
- 38.Lassiter RL, Hatley RM (2017) Differences in the management of perforated appendicitis in children by race and insurance status. Am Surg 83:996–1000Google Scholar