Paul Truche1,2, Emily R Smith3,4, Adesoji Ademuyiwa5,6, Alexandra Buda7, Mary T Nabukenya8, Neema Kaseje9, Emmanuel A Ameh10, Sarah Greenberg11, Faye Evans12, Stephen Bickler13, John G Meara7,14, Henry E Rice3,15. 1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA. paul.truche@gmail.com. 2. Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. paul.truche@gmail.com. 3. Department of Surgery, Duke University Medical Center, Erwin Road, Box 3815, Durham, NC, 27710, USA. 4. Duke Global Health Institute, Durham, NC, USA. 5. Department of Surgery, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria. 6. Paediatric Surgery Unit, Lagos University Teaching Hospital, Lagos, Nigeria. 7. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA. 8. Department of Anaesthesia, Makerere University CHS, Mulago Hill, Kampala, Uganda. 9. London School of Hygiene & Tropical Medicine, London, United Kingdom. 10. Division of Paediatric Surgery, Department of Surgery, National Hospital, 265 Independence Ave, Central Business District, Abuja, Nigeria. 11. Division of Pediatric General & Thoracic Surgery, Seattle Children's Hospital, Point Way NE, Seattle, WA, 98105, USA. 12. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA. 13. Rady Children's Hospital, University of California San Diego, San Diego, 9500 Gilman Drive #0739, La Jolla, CA, 92093, USA. 14. Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. 15. Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, USA.
Abstract
OBJECTIVES: To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. METHODS: We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common non-surgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. RESULTS: We found that increased SAO density is associated with decreased U5MR and NMR (P < 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of < 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of < 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. CONCLUSIONS: Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.
OBJECTIVES: To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. METHODS: We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common non-surgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. RESULTS: We found that increased SAO density is associated with decreased U5MR and NMR (P < 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of < 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of < 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. CONCLUSIONS: Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.
Authors: Tessa L Concepcion; Emily R Smith; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Andrew J M Leather; Dan Poenaru; Henry E Rice Journal: World J Surg Date: 2019-11 Impact factor: 3.352
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: Emily R Smith; Tessa L Concepcion; Mark Shrime; Kelli Niemeier; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Dan Poenaru; Henry E Rice Journal: World J Surg Date: 2020-03 Impact factor: 3.352
Authors: Paul Truche; Fabio Botelho; Alexis N Bowder; Alexander W Levis; Sarah L M Greenberg; Emily Smith; Scott Corlew; Stephen Bickler; Henry E Rice; Emmanuel A Ameh; John G Meara; Dan Poenaru; David P Mooney Journal: World J Surg Date: 2021-06-10 Impact factor: 3.352