Abstract
An unexpectedly high burden of elective paediatric surgery is being performed by the Ear, Nose and Throat (ENT) surgeons in Moshi, Tanzania.
We believe this brief survey demonstrates the capacity for elective paediatric surgery in the sub-Saharan setting, comparable to the elective operative numbers of an equivalent tertiary centre in Liverpool, UK.
Background
Accurate burden and pattern of paediatric surgery in Sub-Saharan Africa is still largely unknown. This letter draws attention to the numbers of children undergoing elective and emergency surgery in a tertiary referral hospital in Moshi, Tanzania.
Methods
A retrospective review was undertaken of Kilimanjaro Christian Medical Centre (KCMC) Hospital operating theatre records for all children under the age of 14years during a 1year period (Jan 1st 2018 – December 31st2018). Opthalmology and Obstetrics & Gynaecology procedures were not included in the analysis. This was compared to the same 1year retrospective record at an equivalent tertiary hospital; Alder Hey Children's Foundation NHS Trust in Liverpool, UK.
Results
Over a 1-year period, 1435 paediatric operations were carried out under general anaesthetic at KCMC. Of the total, 251 (17%) of these operations were general surgical procedures. 1183 operations were conducted by the Ear, Nose and throat (ENT) surgeons (82% of the paediatric total). 941 of these were on children aged under 5 years (80% of the ENT procedures).
73 (6% of ENT total) were emergency procedures (Oesophagoscopy or Bronchoscopy).
1110 (94% of ENT total) procedures involved adenotonsillar surgery.
For comparison, over the same 1-year period 1067 adenotonsillar procedures were performed at Alder Hey. 463 (43%) of these were on children under 5. The paediatric general surgeons performed 1398 elective surgeries plus 445 emergency procedures in the same period at Alder Hey.
Conclusions
There is a high burden of elective paediatric surgery being performed by the ENT surgeons in KCMC comparable to the elective operations of its UK counterpart. A greater number of ENT procedures as a proportion of total (80% vs 43%) are performed on children under 5 at KCMC than at Alder Hey. The number of paediatric emergency ENT operations exceeds the combined elective and emergency general surgery procedures in Kilimanjaro.
The ENT department at KCMC has demonstrated access to surgical care and surgical capacity at levels similar to partners in the Global North. This demonstrates the capacity for elective paediatric surgery in the sub-Saharan setting,
As per the Lancet Global Surgery 2030 recommendations, 1 we have collected, analysed and reported these data, and the next steps in surgical systems strengthening will be to demonstrate that the surgery at KCMC is safe, and then ultimately, affordable for local people, without experiencing catastrophic expenditure.
This letter serves as a call to other clinicians working in sub-Saharan Africa to document local burden of disease and surgical activity, particularly for paediatric patients. Investing in surgical services is affordable, saves lives and promotes economic development. 2 We have demonstrated that the lion's share of paediatric surgical care in this population was provided by ENT clinicians and given the number of emergency procedures performed, it is vital for similar services to establish close ENT and anaesthetic team collaboration and document outputs and outcomes.
Footnotes
Author contributions
KM made substantial contributions to the conception and design of the work, acquisition and analysis of the data and first and final drafts of the work to be published.
TH made substantial contributions to the conception and design of the work, acquisition, analysis and interpretation of the data and first and final drafts of the work to be published.
RS made substantial contributions to the design of the work and interpretation of the data, and revised the draft and final version of the work critically for content
DH made substantial contributions to the conception and design of the work and interpretation of the data, and revised the draft and final version of the work critically for content
DC made substantial contributions to the design of the work and interpretation of the data, and revised the draft and final version of the work critically for content
PS made substantial contributions to the design of the work and interpretation of the data, and revised the draft and final version of the work critically for content
All authors agree to be accountable for all aspects of the final work.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Wellcome Trust funding for TH only, no other conflicts of interest.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: T Hampton was supported by the Wellcome Trust (grant number 203919/Z/16/Z). The study overall was also supported by donations from the Rhinology and Laryngology Fund.
