Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries.

Alicia G Sykes; Justina Seyi-Olajide; Emmanuel A Ameh; Doruk Ozgediz; Alizeh Abbas; Simone Abib; Adesoji Ademuyiwa; Abdelbasit Ali; Tasmiah Tahera Aziz; Tanvir Kabir Chowdhury; +15 more... Hafeez Abdelhafeez; Romeo C Ignacio; Benjamin Keller; Greg Klazura; Karen Kling; Benjamin Martin; Godfrey Sama Philipo; Hariharan Thangarajah; Ava Yap; John G Meara; Donald AP Bundy ORCID logo; Dean T Jamison; Charles N Mock; Stephen W Bickler; On behalf of the Global Initiative for Children’s Surgery; (2022) Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries. World Journal of Surgery, 46 (9). pp. 2114-2122. ISSN 0364-2313 DOI: 10.1007/s00268-022-06622-w
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BACKGROUND: Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS: Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS: An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS: Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.


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