Unmet surgical needs in children: a household survey in Nepal

Purpose While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low- and middle-income countries. Our study aims to assess pediatric surgical needs in Nepal. Methods A countrywide cross-sectional study was perf...

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Bibliographic Details
Published in:Pediatric surgery international 2015-04, Vol.31 (4), p.389-395
Main Authors: Nagarajan, Neeraja, Gupta, Shailvi, Shresthra, Sunil, Varadaraj, Varshini, Devkota, Sagar, Ranjit, Anju, Kushner, Adam L., Nwomeh, Benedict C.
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Cross-Sectional Studies
Developing Countries
Female
General Surgery - statistics & numerical data
Health Services Accessibility
Humans
Infant
Infant, Newborn
Male
Medicine
Medicine & Public Health
Nepal
Original Article
Pediatric Surgery
Pediatrics
Public Health
Surgery
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Summary:Purpose While an estimated two billion people lack access to surgical care, little data are available on surgical conditions for pediatric populations in low- and middle-income countries. Our study aims to assess pediatric surgical needs in Nepal. Methods A countrywide cross-sectional study was performed in 15 randomly chosen districts; 3 clusters (2 rural; 1 urban) per district were selected. The prevalence of surgical conditions, unmet surgical needs, and barriers to care were analyzed among children (0–18 years of age). Results Overall, 1,350 households and 2,695 individuals were surveyed (response rate: 97 %); 800 respondents (29.7 %, 95 % CI 27.9–31.4 %) were pediatric; 59.8 % (95 % CI 56.3–63.2 %) were male; median age was 10 years (IQR 5–15). Of them, 84 (10.5 %, 95 % CI 8.5–12.8 %) had a surgical condition; 48 (6.0 %, 95 % CI 4.5–7.9 %) reported an unmet need for surgical care. Based on this, we estimate that 706,076 (95 % CI 529,557–929,666) children live with untreated surgical conditions. Barriers to care included limited availability of services (31.3 %), funds (22.9 %), time (4.2 %), and fear/mistrust of medical services (16.7 %). Conclusion Close to 700,000 children in Nepal are estimated to need surgical consultation. Programs to address this should be developed alongside efforts by policy makers and donors to rectify the lack of care, bolster limited funds, and strengthen healthcare systems.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-015-3684-1