Geospatial Mapping of Pediatric Surgical Capacity in North Kivu, Democratic Republic of Congo
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Geospatial Mapping of Pediatric Surgical Capacity in North Kivu, Democratic Republic of Congo Sarah B. Cairo1,2 • Qiang Pu3 • Luc Malemo Kalisya4 • Jacques Fadhili Bake4 Rene Zaidi4 • Dan Poenaru5 • David H. Rothstein1,6
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Despite recent attention to the provision of healthcare in low- and middle-income countries, improvements in access to surgical services have been disproportionately lagging. Methods This study analyzes the geographic variability in access to pediatric surgical services in the province of North Kivu, Democratic Republic of Congo (DRC). On-site data collection was conducted using the Global Assessment of Pediatric Surgery tool. Spatial distribution of providers was mapped using the Geographical Information System and open-sourced spatial data to determine distances traveled to access surgical care. Results Forty facilities were evaluated across 32 health zones; 68.9% of the provincial population was within 15 km of these facilities. Eleven facilities met a minimum World Health Organization safety score of 8; 48.1% of the population was within 15 km of corresponding facilities. The majority of children were treated by someone with specific pediatric surgery training in only 4 facilities; one facility had a trained pediatric anesthesia provider. Fiftyseven percent of the population was within 15 km of a facility with critical care and emergency medicine (EM) capabilities. There was one pediatric critical care provider and no pediatric EM providers identified within the province. Location-allocation assessment is needed to combine geographic area with potential for greatest impact and facility assessment. Conclusions Limitations in access to surgical care in the DRC are multifactorial with poor resources, few formally trained surgical providers, and near-absent access to pediatric anesthesiologists. The study highlights the deficits in the capacity for surgical care while demonstrating a reproducible model for assessment and identification of ways to improve access to care.
& Sarah B. Cairo [email protected] 1
Department of Pediatric Surgery, John R. Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USA
2
Department of Surgery, Maine Medical Center, Portland, ME, USA
3
Department of Geography, University At Buffalo, The State University of New York, Buffalo, NY, USA
4
HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
5
Department of Pediatric Surgery, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
6
Department of Surgery, University At Buffalo, The State University of New York, Buffalo, NY, USA
123
World J Surg
Abbreviations LMICs Low- and Middle-Income Countries HICs High-Income Countries DRC Democratic Republic of Congo
Introduction Since the establishment of the Lancet Commission on Global Surgery in 2014 and the publication of the commission’s report in 2015, surger
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