Epidemiology of Pediatric Surgical Conditions Observed in a First-Level Hospital in Burundi

Background: Little is known about the surgical conditions affecting the pediatric population in low-income countries. In this article we describe the epidemiology of pediatric surgical diseases observed in Mutoyi hospital, a first-level hospital in Burundi.Methods and Findings: We retrospectively reviewed the records of all children (0–14 years) admitted to the Surgery ward from January 2017 to December 2017. We also reviewed the records of all the patients admitted to the Neonatology ward in 2017 and among them we selected the ones in which a surgical diagnosis was present. Five hundred twenty-eight children were admitted to the surgical ward during the study period. The most common conditions requiring hospitalization were abscesses (29.09%), fractures (13.59%), osteomyelitis (9.76%), burns (5.40%) and head injuries (4.36%). The average length of stay was 16 days. Fifty-six newborns were admitted to the Neonatology ward for a surgical condition; 29% of them had an abscess.Conclusions: Conditions requiring surgical care are frequent in Burundian children and have a completely different spectrum from the western ones. This is due on one side to an under-diagnosis of certain conditions caused by the lack of diagnostic tools and on the other to the living conditions of the population. This difference should lead to intervention plans tailored on the actual necessities of the country and not on the western ones.

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Socioeconomic restraints and brain tumor surgery in low-income countries

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18258 ◽

2018 ◽

Vol 45 (4) ◽

pp. E11 ◽

Cited By ~ 2

Author(s):

Ahmed E. Helal ◽

Heba Abouzahra ◽

Ahmed Abdelaziz Fayed ◽

Tarek Rayan ◽

Mahmoud Abbassy

Keyword(s):

Low Income ◽

Average Length ◽

Tumor Resection ◽

Healthcare Spending ◽

Low Income Countries ◽

Morbidity Rate ◽

Average Length Of Stay ◽

Intraoperative Management ◽

Serious Disease ◽

Craniotomy For Tumor Resection

Healthcare spending has become a grave concern to national budgets worldwide, and to a greater extent in low-income countries. Brain tumors are a serious disease that affects a significant percentage of the population, and thus proper allocation of healthcare provisions for these patients to achieve acceptable outcomes is a must.The authors reviewed patients undergoing craniotomy for tumor resection at their institution for the preceding 3 months. All the methods used for preoperative planning, intraoperative management, and postoperative care of these patients were documented. Compromises to limit spending were made at each stage to limit expenditure, including low-resolution MRI, sparse use of intraoperative monitoring and image guidance, and lack of dedicated postoperative neurocritical ICU.This study included a cohort of 193 patients. The average cost from diagnosis to discharge was $1795 per patient (costs are expressed in USD). On average, there was a mortality rate of 10.5% and a neurological morbidity rate of 14%, of whom only 82.2% improved on discharge or at follow-up. The average length of stay at the hospital for these patients was 9.09 days, with a surgical site infection rate of only 3.5%.The authors believe that despite the great number of financial limitations facing neurosurgical practice in low-income countries, surgery can still be performed with reasonable outcomes.

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Child Migrant Health: The Role of Pediatric Surgery in the Migrants' Route across Balkan Countries to North-West Europe

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1673707 ◽

2018 ◽

Vol 29 (05) ◽

pp. 475-480

Author(s):

Zoran Marjanovic ◽

Maja Raicevic ◽

Andjelka Slavkovic ◽

Dragoljub Zivanovic ◽

Ivan Filipovic ◽

...

Keyword(s):

Average Length ◽

Head Injuries ◽

Migrant Health ◽

Migrant Children ◽

Outpatient Clinics ◽

North West ◽

Surgical Conditions ◽

Child Migrant ◽

Level Hospital

Introduction Child migrants are the most vulnerable population, prone to various health conditions due to trauma and the bad living conditions that they experience during their migration. The objective of this study was to determine the pediatric surgical conditions of migrant children treated in our hospital on their way toward North-West Europe. Materials and Methods A retrospective analysis was performed on all admitted migrants in one tertiary and one secondary level hospital from 2016 to 2018. Only migrant children with surgical issues who had been hospitalized or treated in outpatient clinics were included in the study. Results There were 47 migrants admitted to hospitals and outpatient clinics; 32 from Afghanistan, 11 from Iraq, 1 from Syria, 2 from Iran, and 1 from Algeria. There were 27 boys and 20 girls, average age 7.96 years (range: 3 months–17 years). The average length of hospitalization was 14.1 days (range: 1–48), and average stay in the intensive care unit (ICU) was 7.4 days (range: 1–15). There were 29 migrants treated in outpatient clinics, and 18 were hospitalized. The cause of seeking surgical treatment was trauma in 33 and non-traumatic surgical problems in 14. The most common types of trauma were isolated fractures which occurred in one, followed by isolated head injury in eight. Polytrauma occurred in five. A lethal outcome occurred in one 9-year-old boy from Afghanistan due to severe polytrauma. Conclusion Trauma, predominantly fractures and head injuries, was the leading cause of morbidity in migrant children treated in these two hospitals.

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Global surgery: Improving health in low-income countries

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i3.52789 ◽

2021 ◽

Vol 20 (3) ◽

pp. 483-486

Author(s):

Orhan Alimoglu ◽

Nuray Colapkulu

Keyword(s):

Low Income ◽

Medical Science ◽

Surgical Care ◽

Global Surgery ◽

Low Income Countries ◽

Middle Income ◽

Resource Limited ◽

Surgical Workforce ◽

Surgical Conditions ◽

Definition Of

The aim of this report is to examine the definition of global surgery, discuss the problems and propose some suggestions. Global surgery aims to improve the surgical conditions to maintain a standard and equal surgical care, especially in low- and middle-income countries where burden of surgical diseases are increasing over the years. According to Lancet Commission on Global Surgery, 1.27 million more surgical healthcare workers will be required to provide minimal surgical workforce, by 2030. In resource-limited settings of the world-wide where medical education and post-graduation training programs are disrupted due to brain drain, instable conditions and economic reasons, sustaining a standard and accessible surgical care are possible by training surgeons. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.483-486

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1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1885 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S836-S837

Author(s):

Juliana Mejia- Mertel ◽

Juan P Rojas -Hernandez

Keyword(s):

Virus Type ◽

Low Income ◽

Pacific Coast ◽

Vision Loss ◽

Pediatric Population ◽

Clinical Manifestations ◽

Low Income Countries ◽

Nutritional Deficiencies ◽

Type I ◽

T Lymphotropic Virus

Abstract Background The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients. Methods Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020. Results Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies. None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies. Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis. Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation. Summary features HTLV-1 patients Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular. Conclusion It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries. Disclosures All Authors: No reported disclosures

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Fingertip Injuries in Children: Epidemiology, Financial Burden, and Implications for Prevention

Hand ◽

10.1177/1558944716670139 ◽

2016 ◽

Vol 12 (4) ◽

pp. 342-347 ◽

Cited By ~ 9

Author(s):

Rachel R. Yorlets ◽

Kathleen Busa ◽

Kyle R. Eberlin ◽

Mohammad Ali Raisolsadat ◽

Donald S. Bae ◽

...

Keyword(s):

Average Length ◽

Medical Center ◽

Pediatric Population ◽

Financial Burden ◽

International Classification Of Diseases ◽

Hospital Charges ◽

Average Length Of Stay ◽

Significant Burden ◽

Classification Of Diseases

Background: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center. Methods: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed. Frequency statistics were generated for 1807 patients with fingertip injuries who presented to the emergency department (ED) at Boston Children’s Hospital (BCH) between 2005 and 2011. Billing records were analyzed for financial data. Results: A total of 1807 patients were identified for this study; 59% were male, and the mean age at time of injury was 8 years. Most commonly, injuries occurred when a finger was crushed (n = 831, 46%) in a door or window. Average length of stay in the ED was 3 hours 45 minutes, 25% of cases needed surgery, and, on average, patients had more than 1 follow-up appointment. About one-third of patients were referred from outside institutions. The average ED charge for fingertip injuries was $1195 in 2014, which would amount to about $320 430 each year (in 2014 dollars) for fingertip injuries presenting to BCH. Conclusion: Fingertip injuries in children are common and result in significant burden, yet are mostly preventable. Most injuries occur at home in a door or window. Although these patients generally heal well, fingertip injuries pose a health, time, and financial burden. Increased awareness and education may help to avoid these injuries.

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Histoplasmosis caused by Histoplasma capsulatum var. duboisii: a comprehensive review of cases from 1993 to 2019

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1304 ◽

2020 ◽

Author(s):

M Develoux ◽

F M Amona ◽

C Hennequin

Keyword(s):

Low Income ◽

Endemic Area ◽

Histoplasma Capsulatum ◽

Case Reports ◽

Bone Infection ◽

Low Income Countries ◽

Diagnostic Tools ◽

Cutaneous Lesions ◽

Comprehensive Search ◽

Therapeutic Alternatives

Abstract Background Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management Methods Using a comprehensive search on different internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological, clinical charts and therapeutic strategies were analyzed Results We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/sub-cutaneous lesions, bone infection, and lymphadenopathies, isolated or combined, were the most frequent presentations. The human immunodeficiency virus (HIV) co-infection rate was at 20.8% with fever, lymphadenopathies and absence of bone infection being the differentiating elements from HIV-negative patients. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993 but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed nor with the HIV serologic status but with the initiation of an antifungal therapy Conclusion Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area

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Towards better diagnostic tools for liver injury in low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2019-001704 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001704 ◽

Cited By ~ 1

Author(s):

Saundria Moed ◽

Muhammad H Zaman

Keyword(s):

Chronic Hepatitis ◽

Liver Injury ◽

Low Income ◽

Liver Diseases ◽

Diagnostic Methods ◽

Low Income Countries ◽

Diagnostic Tools ◽

Middle Income ◽

Public Health Burden ◽

Middle Income Countries

Liver disease is a significant public health burden in both high-income and low-income countries, accounting for over 2 million annual, global deaths. Despite the significant mortality burden, liver diseases are historically a neglected problem due to a lack of accurate incidence and prevalence statistics, as well as national and international programmes targeting these diseases. A large portion of deaths due to liver diseases can be treated (eg, chronic hepatitis B), cured (eg, chronic hepatitis C) or prevented (eg, acute liver failure due to medications) if prompt diagnosis is made, but currently diagnostic methods fall short. Therefore, there is a critical need to fund the development of prompt, effective diagnostics for liver function, specifically in low-income and middle-income countries where the landscape for this testing is sparse. Here, we review and compare available and currently emerging diagnostic methods for liver injury in low-income and middle-income settings, while highlighting the opportunities and challenges that exist in the field.

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Real-time assessment of COVID-19 impact on global surgical case volumes

10.1101/2020.05.03.20086819 ◽

2020 ◽

Author(s):

Vikas N. O’Reilly-Shah ◽

Wil Van Cleve ◽

Dustin R. Long ◽

Vanessa Moll ◽

Faye M. Evans ◽

...

Keyword(s):

Real Time ◽

Low Income ◽

Mobile Application ◽

Surgical Care ◽

Low Income Countries ◽

Surgical Volume ◽

Case Volume ◽

Surgical Case ◽

The Impact ◽

Usage Data

AbstractImportanceThe COVID-19 pandemic has disrupted global surgical capacity. The impact of the pandemic in low and middle income countries has the potential to worsen already strained access to surgical care. Timely assessment of surgical volumes in these countries remains challenging.ObjectiveTo determine whether usage data from a globally used anesthesiology calculator mobile application can serve as a proxy for global surgical case volume and contribute to monitoring of the impact of the COVID-19 pandemic, particularly in World Bank low income countries where official data collection is not currently practical.DesignSubset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020.SettingThe mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices.ParticipantsNo user data was excluded from the study.Exposure(s)Events with impacts on surgical case volumes, including weekends, holidays, and the COVID-19 pandemic.Main Outcome(s) and Measure(s)It was previously noted that application usage was decreased on weekends and during winter holidays. We subsequently hypothesized that more detailed analysis would reveal impacts of country-specific or region-specific holidays on the volume of app use.Results4,300,975 data points from 92,878 unique users were analyzed. Physicians and other anesthesia providers comprised 85.8% of the study population. Application use was reduced on holidays and weekends and correlated with fluctuations in surgical volume. The COVID-19 pandemic was associated with substantial reductions in app use globally and regionally. There was strong cross correlation between COVID-19 case count and reductions in app use. By country, there was a median global reduction in app use to 58% of baseline (interquartile range, 46%-75%). Application use in low-income continues to decline but in high-income countries has stabilized.Conclusions and RelevanceApplication usage metadata provides a real-time indicator of surgical volume. This data may be used to identify impacted regions where disruptions to surgical care are disproportionate or prolonged. A dashboard for continuous visualization of these data has been deployed.Key PointsQuestionCan usage data from a globally used anesthesiology calculator mobile application contribute to monitoring of the impacts to global surgical case volume caused by the COVID-19 pandemic, particularly in resource-limited environments such as World Bank low income countries?FindingsIn this ongoing observational cohort study, application usage data from 92,878 unique users in 221 countries was found to serve well as a qualitative proxy for surgical case volume, with clear impacts to app use during weekend, holidays, and during the COVID-19 pandemic.MeaningThis proxy of surgical volume will provide insight into the impact of and recovery from the COVID-19 pandemic where official data collection is not currently practical. A real time dashboard tracking this proxy of global surgical volume is live and under continued development.

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Refill Adherence Measures and Its Association with Economic, Clinical, and Humanistic Outcomes Among Pediatric Patients: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17062133 ◽

2020 ◽

Vol 17 (6) ◽

pp. 2133

Author(s):

Brandon Chua ◽

James Morgan ◽

Kai Zhen Yap

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Low Income ◽

Pediatric Patients ◽

Electronic Monitoring ◽

Pediatric Population ◽

Self Report ◽

Low Income Countries ◽

Humanistic Outcomes ◽

Refill Adherence

Although refill adherence measures (RAMs) are widely reviewed on their use among adult patients, existing reviews on adherence among children have only focused on self-report measures and electronic monitoring. Hence, this systematic review aims to examine the use of RAMs and their association with economic, clinical, and humanistic outcomes (ECHO) among pediatric patients. A literature search was conducted in Pubmed, Embase, CINAHL, and PsycINFO. Studies published in English involving subjects aged ≤18 years were included if RAMs were analyzed with ECHO. Of the 35 included studies, the majority (n = 33) were conducted in high-income countries. Asthma was the most common condition (n = 9) studied. Overall, 60.6% of 33 clinical outcomes reported among 22 studies was positive (improved clinical outcomes with improved adherence), while 21.9% of 32 economic outcomes reported among 16 studies was positive (reduced healthcare utilization or cost outcomes with improved adherence). Only four studies evaluated the relationship of adherence with 11 humanistic outcomes, where the majority (72.7%) were considered unclear. RAMs are associated with ECHO and can be considered for use in the pediatric population. Future studies could explore the use of RAMs in low-income countries, and the association of RAMs with quality of life.

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Surgical leadership in Africa – challenges and opportunities

Innovative Surgical Sciences ◽

10.1515/iss-2018-0036 ◽

2019 ◽

Vol 4 (2) ◽

pp. 59-64

Author(s):

Kwabena Frimpong-Boateng ◽

Frank Edwin

Keyword(s):

Public Health ◽

Low Income ◽

Health Sector ◽

Surgical Care ◽

Low Income Countries ◽

Care Needs ◽

Political Will ◽

Development Agenda ◽

Challenges And Opportunities ◽

The Rich

AbstractSurgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases. In the midst of such competing health-care needs, surgical care, often viewed by policy makers as luxurious and the preserve of the rich, gets relegated to the bottom of priority lists. In the meantime, infectious disease, malnutrition, and other ailments, viewed as largely affecting the poor and disadvantaged in society, get embedded in national health plans, receiving substantial funding and public health program development. It is often stated that the main reason for this sad state of affairs in surgical care is the lack of political will to improve matters in the health sector. Indeed, in 2001, the Commission on Macroeconomics and Health concluded that the lack of political will to sufficiently increase spending on health at the sub-national, national, and international levels was perhaps the most critical barrier to improving health in low-income countries. However, at the root of this lack of political will is a lack of political priority for surgical care.

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