Current Landscape of Children's Surgery in Africa: A Multicenter Analysis of 16,000 Cases

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Résumé

ABSTRACT
Background: Although prior studies have estimated the burden of pediatric surgical disease in low‐ and middle‐income
countries (LMICs) through statistical modeling and hospital‐ or household‐based surveys, few large‐scale descriptions of procedures
and outcomes have been published. We aimed to describe the epidemiology and outcomes of children's surgical care at
multiple centers across Africa.
Methods: Perioperative clinical data were collected prospectively from 2018 to 2023 at 17 hospitals in 11 African countries
using a preexisting tool. Data came from children (age < 18 years) who underwent a surgical procedure in facilities equipped by
the NGO Kids Operating Room. Data were stored on REDCap and descriptively analyzed.
Results: 16,454 procedures were performed, with a higher frequency of procedures performed in younger children than in older
children (mean age 4.5 years). Congenital malformations, acquired genitourinary conditions, and acquired gastrointestinal
conditions made up the most common diagnoses. We found a mortality rate of 3.7%, with higher mortality in neonates
compared to younger children; conditions associated with the greatest mortality included congenital conditions, intestinal
perforation, burns, and intussusception. Emergent operations were associated with much higher rates of mortality than elective
operations.
Conclusions: For the first time at this scale, we have assessed the epidemiology and outcomes of pediatric surgical care in
LMICs. Findings were consistent with studies on the burden of disease, with a larger proportion of younger children accessing
surgery, comparable mortality to other African studies, and higher mortality than in HICs. Future research and multilevel
advocacy are needed to identify gaps in care and to design more effective interventions to reduce global disparities in access to
surgical care for children.

Mots-clés

epidemiology | LMIC | outcomes | pediatric surgery