Tessa L Concepcion1, Emily R Smith2,3, Mubarak Mohamed4, Shugri Dahir4, Edna Adan Ismail4, Andrew J M Leather5, Dan Poenaru6, Henry E Rice1. 1. Duke Global Health Institute, Duke University, Durham, NC, USA. 2. Duke Global Health Institute, Duke University, Durham, NC, USA. Emily_R_Smith@baylor.edu. 3. Department of Public Health, Baylor University, Waco, TX, 76706, USA. Emily_R_Smith@baylor.edu. 4. Edna Adan University Hospital, Hargeisa, Somaliland, Somalia. 5. King's Centre for Global Health and Health Partnerships, King's College London, London, UK. 6. McGill University, Montreal, QC, Canada.
Abstract
BACKGROUND: Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS: We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS: Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS: We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.
BACKGROUND: Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care. METHODS: We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks. RESULTS: Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions. CONCLUSIONS: We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.
Authors: Jihad Abdelgadir; Maria Punchak; Emily R Smith; Aaron Tarnasky; Alex Muhindo; Joao Ricardo Nickenig Vissoci; Michael M Haglund; David Kitya Journal: J Clin Neurosci Date: 2017-10-20 Impact factor: 1.961
Authors: Emily R Smith; Brittney J van de Water; Anna Martin; Sarah Jean Barton; Jasmine Seider; Christopher Fitzgibbon; Mathama Malakha Bility; Nelia Ekeji; Joao Ricardo Nickenig Vissoci; Michael M Haglund; Janet Prvu Bettger Journal: BMC Health Serv Res Date: 2018-09-20 Impact factor: 2.655
Authors: Elissa K Butler; Tu M Tran; Anthony T Fuller; Alexa Brammell; Joao Ricardo Vissoci; Luciano de Andrade; Fredrick Makumbi; Samuel Luboga; Christine Muhumuza; Vincent F Ssennono; Jeffrey G Chipman; Moses Galukande; Michael M Haglund; Emily R Smith Journal: Pediatr Surg Int Date: 2016-09-10 Impact factor: 1.827
Authors: Tessa Concepcion; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Dan Poenaru; Henry E Rice; Emily R Smith Journal: JAMA Netw Open Date: 2019-01-04
Authors: Tessa L Concepcion; Shukri Dahir; Mubarak Mohamed; Kyle Hiltbrunn; Edna Adan Ismail; Dan Poenaru; Henry E Rice; Emily R Smith Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Paul Truche; Emily R Smith; Adesoji Ademuyiwa; Alexandra Buda; Mary T Nabukenya; Neema Kaseje; Emmanuel A Ameh; Sarah Greenberg; Faye Evans; Stephen Bickler; John G Meara; Henry E Rice Journal: World J Surg Date: 2022-06-25 Impact factor: 3.282
Authors: Shukri Dahir; Cesia F Cotache-Condor; Tessa Concepcion; Mubarak Mohamed; Dan Poenaru; Edna Adan Ismail; Andy J M Leather; Henry E Rice; Emily R Smith Journal: BMJ Open Date: 2020-12-29 Impact factor: 2.692