Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 16;11(6):e045981.
doi: 10.1136/bmjopen-2020-045981.

Global and regional overview of the inclusion of paediatric surgery in the national health plans of 124 countries: an ecological study

Kelsey Landrum #  1 , Cesia F Cotache-Condor #  2 , Yingling Liu  3 , Paul Truche  4 , Julia Robinson  2 , Nealey Thompson  2 , Ryann Granzin  2 , Emmanuel Ameh  5 , Steve Bickler  6   7 , Lubna Samad  8 , John Meara  4   9 , Henry E Rice  1   10 , Emily R Smith  11   2 ; Global Initiative for Children's Surgery
Affiliations

Global and regional overview of the inclusion of paediatric surgery in the national health plans of 124 countries: an ecological study

Kelsey Landrum et al. BMJ Open. .

Abstract

Objective: This study evaluates the priority given to surgical care for children within national health policies, strategies and plans (NHPSPs).

Participants and setting: We reviewed the NHPSPs available in the WHO's Country Planning Cycle Database. Countries with NHPSPs in languages different from English, Spanish, French or Chinese were excluded. A total of 124 countries met the inclusion criteria.

Primary and secondary outcome measures: We searched for child-specific and surgery-specific terms in the NHPSPs' missions, goals and strategies using three analytic approaches: (1) count of the total number of mentions, (2) count of the number of policies with no mentions and (3) count of the number of policies with five or more mentions. Outcomes were compared across WHO regional and World Bank income-level classifications.

Results: We found that the most frequently mentioned terms were 'child*', 'infant*' and 'immuniz*'. The most frequently mentioned surgery term was 'surg*'. Overall, 45% of NHPSPs discussed surgery and 7% discussed children's surgery. The majority (93%) of countries did not mention selected essential and cost-effective children's procedures. When stratified by WHO region and World Bank income level, the West Pacific region led the inclusion of 'pediatric surgery' in national health plans, with 17% of its countries mentioning this term. Likewise, low-income countries led the inclusion of surg* and 'pediatric surgery', with 63% and 11% of countries mentioning these terms, respectively. In both stratifications, paediatric surgery only equated to less than 1% of the total terms.

Conclusion: The low prevalence of children's surgical search terms in NHPSPs indicates that the influence of surgical care for this population remains low in the majority of countries. Increased awareness of children's surgical needs in national health plans might constitute a critical step to scale up surgical system in these countries.

Keywords: health policy; paediatrics; surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of data search process. NHPSP, national health policies, strategies and plan.
Figure 2
Figure 2
Percentage of countries from each WHO region that mention the search terms in their national health policies, strategies and plans at least once. Weighted per cent was used to facilitate comparison across regions. AF, African region; AM, Americas; EM, Eastern Mediterranean region; EU, European region; SEA, South East Asia region; WP, Western Pacific region.
Figure 3
Figure 3
Percentage of countries from each World Bank income level that mention the search terms in their national health policies, strategies and plans at least once. Weighted per cent was used to facilitate comparison across income levels. HIC, high-income country; LIC, low-income country; LMIC, low-income and middle-income country; UMIC, upper-middle-income country.
Figure 4
Figure 4
Example in Nigeria: inclusion of children’s surgical care within national health plans.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mullapudi B, Grabski D, Ameh E, et al. . Estimates of number of children and adolescents without access to surgical care. Bull World Health Organ 2019;97:254–8. 10.2471/BLT.18.216028 - DOI - PMC - PubMed
    1. Meara JG, Leather AJM, Hagander L, et al. . Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 2015;386:569–624. 10.1016/S0140-6736(15)60160-X - DOI - PubMed
    1. Botman M, Meester RJ, Voorhoeve R, et al. . The Amsterdam Declaration on essential surgical care. World J Surg 2015;39:1335–40. 10.1007/s00268-015-3057-x - DOI - PubMed
    1. Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg 2015;39:2115–25. 10.1007/s00268-015-3153-y - DOI - PubMed
    1. Smith ER, Vissoci JRN, Rocha TAH, et al. . Geospatial analysis of unmet pediatric surgical need in Uganda. J Pediatr Surg 2017;52:1691–8. 10.1016/j.jpedsurg.2017.03.045 - DOI - PubMed

LinkOut - more resources