C. Ewbank1,4, A. L. Kushner2,3, C. Newton1, W. Stehr1,5 1UCSF Benioff Children’s Hospital Oakland,Surgery,Oakland, CA, USA 2Johns Hopkins Bloomberg School of Public Health,Center For Humanitarian Health,Baltimore, MD, USA 3Surgeons OverSeas,New York, NY, USA 4University Of California – San Francisco East Bay,Surgery,Oakland, CA, USA 5Presbyterian Hospital,Surgery,Albuquerque, NM, USA
Introduction:
Successful interventions by the global health community have reduced the total number of under-five deaths from 12.6 million to 5.6 million (55.6%) since 1990. Over the same time period, neonatal mortality fell from 37 deaths per 1,000 to 19 (49%). With more babies surviving childbirth and into early childhood, the incidence of life-threatening pediatric surgical diseases will likely increase. We sought to characterize this increased surgical need for children under five years old based upon the improvement in child mortality worldwide.
Methods:
The incidence of ten common emergent pediatric surgical conditions, excluding those resulting from trauma, was compared to country level data from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the 2017 United Nations World Population Prospects probabilistic projections to estimate and characterize global surgical need among children under five by 2030.
Results:
Children under five are projected to require a mean net total of 83,557 additional essential procedures/year by 2030. The majority of additional surgical need is projected to be from incarcerated inguinal hernias (48,224 mean additional procedures, 57.7% of the total increase). Hypertrophic pyloric stenosis and intussusception represent other major contributors to overall surgical need (18,543 (22.2% of total) and 7,467 (8.9% of total), respectively). The countries with the greatest projected need due to increase in under-five population were Nigeria (117,814 additional needed procedures/year (28.7% increase)), the Democratic Republic of the Congo (68,430 additional needed procedures/year (36.8%)), and the United Republic of Tanzania (45,158 additional needed procedures/year (36.3% increase)). Although the overall global surgical need was net positive, many countries are projected to have significant decreases in under-five surgical need by 2030, the largest of which were China (236,067 fewer needed procedures (20.8% decrease)), India (50,999 fewer needed procedures (3.2% decrease)), and Iran (31,841 fewer needed procedures (35.0% decrease)).
Conclusion:
Children under five will require nearly 100,000 additional life-saving procedures each year by 2030, with many developing nations and remote areas within developed nations already unable to treat the current essential pediatric surgical need. This need is overwhelmingly projected to affect the least developed nations, and particularly those in Sub-Saharan Africa, where neonatal and early childhood disease treatable by surgical intervention represent a tremendous opportunity to improve morbidity and mortality. As population growth slows in many parts of the world, continued research and clinical efforts should be directed toward children in those places where the need is the greatest.