A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia
Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity.
Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tool was used to collect data at all survey sites. Descriptive data analyses were completed using Excel. Studies of association were completed using Stata. All reported percentages are of the hospitals outside of the capital (n = 21).
All provincial hospitals have general surgeons; seven (33.3%) of them have pediatric surgeon(s). One facility has no anesthesiologist. All facilities perform basic procedures and provide anesthesia. Four (19%) can treat common congenital anomalies. All facilities have basic operating room equipment. Nine hospitals do not have pulse oximetry available. Twelve hospitals do not have pediatric surgical instruments always available. Pediatric supplies are lacking.
Provincial hospitals in Mongolia can perform basic procedures. However, essential pediatric supplies are lacking. Consequently, certain life-saving procedures are not available to children outside of the capital. Only a few improvements would be amendable to low-cost process improvement adjustment, and the majority of needs require resource additions. Procedure, equipment, and supply availability should be further explored to develop a comprehensive nationwide pediatric surgical program.
The authors would like to thank Harvard University, the Harvard T.H. Chan School of Public Health, the UC Davis Department of Surgery, and the Fulbright Commission for support of this work. The corresponding author is indebted to Dean Michelle Williams and E. Fran Cook of the Harvard T.H. Chan School of Public Health for their guidance and support of this research. The authors thank the surgical trainees of the Second National Hospital for their assistance with data collection, and the surgeons and hospital staff at each of the provincial hospitals, who generously hosted the research team and participated in the data collection. Dr. Ray Price provided invaluable introductions and advice, and Dr. Sergelen Orgoi graciously encouraged and supported the project. We appreciate the Ger Community Mapping Center collaboration and their assistance with visualizing the data. Finally, we thank Marc Parenteau for your assistance with editing.
This research was supported by a Harvard University Frederick Sheldon Traveling Fellowship, a Harvard T. H. Chan School of Public Health Rose Traveling Fellowship, a Fulbright Fellowship, and salary support was provided by the University of California Davis Department of Surgery as well as the Mongolian National University of Medical Sciences. For the use of the REDCap data collection system, the project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through Grant UL1 TR000002. The funders had no say in the study design, conduct, or reporting.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This research was approved by the Mongolian National University of Medical Sciences Ethical Committee of Research (2016/3/2016–2017 #1). It was designated “not human subjects research” by the University of California Davis Institutional Review Board (IRB 939081-2) and by the Harvard T.H. Chan School of Public Health Office of Human Research Administration (IRB 17-0446).
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