A. Gerk1,2, S. Kundu1,2, J. Seyi-Olajide1,2, D. Moghul1,2, C. Camargo3, J. Bustorff4, E. Guadagno2, D. Poenaru1,2 1McGill University, Faculty Of Medicine And Health Sciences, Montreal, QC, Canada 2Montreal Children’s Hospital, Harvey E. Beardmore Division Of Pediatric Surgery, Montreal, QUEBEC, Canada 3University of São Paulo, Plastic Surgery Department, São Paulo, São Paulo, Brazil 4State University of Campinas Medical School, Pediatric Surgery Department, Campinas, São Paulo, Brazil
Introduction: Approximately 1.75 billion children globally lack access to safe surgical care, with marginalized groups being particularly vulnerable. This review analyzes the literature on intersectionality and its impact on disparities in pediatric surgical care across low-and-lower to middle-income countries (LMICs).
Methods: A senior medical librarian searched 8 databases to retrieve citations, with no language restriction, until February 2024. We examined the relationship between the intersection of at least two marginalized social dimensions and pediatric surgical outcomes in LMICs, as defined by WorldBank. PRISMA guidelines were followed.
Results: Of the 6404 titles and abstracts screened, 141 underwent full-text review, and 8 were included in the final analysis. Most studies were from the Eastern Mediterranean and African regions (37.5% each). Studies analyzed a mean of 3.4 social aspects (range, 2-6), including socioeconomic status (24.1%), location (20.7%), gender (20.7%), education (17.2%), religion (10.3%), and race/ethnicity (6.9%). The main outcomes were lower access to surgical care (50%) and decreased quality of life (25%). Most studies were quantitative (75%), with primary analytic methods being descriptive (87.5%) and logistic regression (50%). Despite lacking an explicit intersectional framework, included studies explored complex identity intersections and systemic inequalities impacting health outcomes.
Conclusion: Children with intersectional identities face significant barriers that negatively impact their surgical access and outcomes. The adoption of an intersectional lens in clinical and research settings is currently limited but offers the potential for a comprehensive approach to addressing the surgical care disparities for children in LMICs.