World Journal of Surgery

, Volume 42, Issue 10, pp 3432–3442 | Cite as

A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia

  • Laura F. Goodman
  • Erdenetsetseg Chuluun
  • Burmaa Sanjaa
  • Sanchin Urjin
  • Sarnai Erdene
  • Narantuya Khad
  • Adiyasuren Jamiyanjav
  • Jacob Stephenson
  • Diana L. Farmer
Original Scientific Report



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.

Ethical approval

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).


  1. 1.
    The World Bank Group (2017) World Bank Data: The World Bank. Accessed 22 July 2017
  2. 2.
    Child Mortality Estimates (2014) Accessed 22 July 2017
  3. 3.
    Liu L, Oza S, Hogan D et al (2015) Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385(9966):430–440CrossRefPubMedGoogle Scholar
  4. 4.
    Mulligan J-A, Fox-Rushby, JA, Taghreed, A, et al (2003) Unit costs of health care inputs in low and middle income regions. Disease control priorities project working paper no 9Google Scholar
  5. 5.
    Gunsentsoodol B, Nachin B, Dashzeveg T (2006) Surgery in Mongolia. Arch Surg 141(12):1254–1257CrossRefPubMedGoogle Scholar
  6. 6.
    Tsolmongerel T, Evlegsuren SO, Bulganchimeg B et al (2013) Mongolia health systems review. Health Syst Trans 3(2):184Google Scholar
  7. 7.
    UNICEF Annual Report 2012 for Mongolia, EAPRO (2012) Accessed 10 Feb 2017
  8. 8.
    World Health Organization, Global Health Observatory Data Repository (2015). Accessed 22 July 2017
  9. 9.
    World Health Organization (2015) Congenital anomalies fact sheet, number 370 Accessed 22 July 2017
  10. 10.
    Apfeld JC, Wren SM, Macheka N et al (2015) Infant, maternal, and geographic factors influencing gastroschisis related mortality in Zimbabwe. Surgery 158(6):1475–1480CrossRefPubMedGoogle Scholar
  11. 11.
    Chirdan LB, Ngiloi PJ, Elhalaby EAE (2012) Neonatal surgery in Africa. Semin Ped Surg 21(2):151–159CrossRefGoogle Scholar
  12. 12.
    Badrinath R, Kakembo N, Kisa P et al (2014) Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda. J Ped Surg 49(12):1825–1830CrossRefGoogle Scholar
  13. 13.
    Farmer DL, Sitkin N, Lofberg K, Surgical Interventions for Congenital Anomalies et al (2015) Essential surgery disease control priorities, vol 1. International Bank for Reconstruction and Development/The World Bank, Washington, pp 129–149CrossRefGoogle Scholar
  14. 14.
    Gonzalez LP, Pignaton W, Kusano PS et al (2012) Anesthesia-related mortality in pediatric patients: a systematic review. Clinics 67(4):381–387CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Henry JA, Orgoi S, Govind S et al (2012) Strengthening surgical services at the soum (first-referral) hospital: the WHO emergency and essential surgical care (EESC) program in Mongolia. World J Surg 36(10):2359–2370. CrossRefPubMedGoogle Scholar
  16. 16.
    Spiegel DA, Choo S, Cherian M et al (2011) Quantifying surgical and anesthetic availability at primary health facilities in Mongolia. World J Surg 35(2):272–279. CrossRefPubMedGoogle Scholar
  17. 17.
    Groen RS, Kamara TB, Dixon-Cole R et al (2012) A tool and index to assess surgical capacity in low-income countries: an initial implementation in Sierra Leone. World J Surg 36(8):1970–1977. CrossRefPubMedGoogle Scholar
  18. 18.
    Markin A, Barbero R, Leow JJ et al (2014) Inter-rater reliability of the PIPES tool: validation of a surgical capacity index for use in resource-limited settings. World J Surg 38(9):2195–2199. CrossRefPubMedGoogle Scholar
  19. 19.
    Okoye MT, Ameh EA, Kushner AL et al (2015) A pilot survey of pediatric surgical capacity in West Africa. World J Surg 39(3):669–676. CrossRefPubMedGoogle Scholar
  20. 20.
    Meara JG, Leather AJ, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery 158(1):3–6CrossRefPubMedGoogle Scholar
  21. 21.
    Mongolian Statistical Information Service (2017) Statistical database by sector, population. Accessed 9 June 2017
  22. 22.
    Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381CrossRefPubMedGoogle Scholar
  23. 23.
    Mongolian Statistical Information Service (2015) Public health of population data. Accessed 29 July 2017
  24. 24.
    Goodman LF, St-Louis E, Yousef Y et al (2018) The global initiative for children’s surgery: optimal resources for improving care. Eur J Ped Surg 28(1):51–59CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Laura F. Goodman
    • 1
  • Erdenetsetseg Chuluun
    • 2
  • Burmaa Sanjaa
    • 2
  • Sanchin Urjin
    • 2
  • Sarnai Erdene
    • 2
  • Narantuya Khad
    • 3
  • Adiyasuren Jamiyanjav
    • 4
  • Jacob Stephenson
    • 5
    • 6
  • Diana L. Farmer
    • 7
  1. 1.Department of SurgeryUniversity of California Davis HealthSacramentoUSA
  2. 2.Mongolian National University of Medical SciencesUlaanbaatarMongolia
  3. 3.Department for Statistics and Information TechnologyCenter for Health DevelopmentUlaanbaatarMongolia
  4. 4.Department of Pediatric SurgeryNational Center for Maternal and Child HealthUlaanbaatarMongolia
  5. 5.Uniformed Services University of the Health SciencesBethesdaUSA
  6. 6.Division of Pediatric Surgery, Department of SurgeryUniversity of California Davis HealthSacramentoUSA
  7. 7.Department of SurgeryUniversity of California Davis HealthSacramentoUSA

Personalised recommendations