GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings

Yasmine Yousef¹, Sarah Cairo², Etienne St-Louis³, Laura F Goodman⁴, Doulia M Hamad⁵, Robert Baird⁶, Emily R Smith⁷, Sherif Emil³, Jean-Martin Laberge³, Mohamed Abdelmalak^{8

9}, Zipporah Gathuy¹⁰, Faye Evans¹¹, Maryam Ghavami Adel¹², Ki K Bertille¹³, Milind Chitnis¹⁴, Leecarlo Millano¹⁵, Peter Nthumba¹⁶, Sergio d'Agostino¹⁷, Bruno Cigliano¹⁸, Luis Zea-Salazar¹⁸, Emmanuel Ameh¹⁹, Doruk Ozgediz²⁰, Elena Guadagno³, Dan Poenaru³

Affiliations

¹ Joe di Maggio Children's Hospital, 1150 N 35 Ave, Suite 555, Hollywood, FL, USA. yasmine.yousef@icloud.com.
² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
³ Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
⁴ Children's Hospital of Orange County, University of California Irvine, Orange, CA, USA.
⁵ Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁶ Division of Pediatric General Surgery BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Emergency Medicine and Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA.
⁸ Nile of Hope Hospital, Alexandria, Egypt.
⁹ Alexandria University Children's Hospital, Alexandria, Egypt.
¹⁰ The Nairobi Hospital, Nairobi, Kenya.
¹¹ Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹² Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
¹³ Charles de Gaulle Pediatric Academic Hospital, Ouagadougou, Burkina Faso.
¹⁴ Frere Hospital, Walter Sisulu University, East London, South Africa.
¹⁵ Faculty of Medicine and Nursing, Krida Wacana University, Jakarta, Indonesia.
¹⁶ AIC Kijabe Hospital, Kenya and Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁷ Surgery for Children - ONLUS, Vicenza, Italy.
¹⁸ OMNI Hospital, Guayaquil, Ecuador.
¹⁹ Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
²⁰ Department of Surgery, University of California, San Francisco, CA, USA.

PMID: 38896255
DOI: 10.1007/s00383-024-05741-w

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings

Yasmine Yousef et al. Pediatr Surg Int. 2024.

. 2024 Jun 19;40(1):158.

doi: 10.1007/s00383-024-05741-w.

Authors

Affiliations

¹ Joe di Maggio Children's Hospital, 1150 N 35 Ave, Suite 555, Hollywood, FL, USA. yasmine.yousef@icloud.com.
² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
³ Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
⁴ Children's Hospital of Orange County, University of California Irvine, Orange, CA, USA.
⁵ Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁶ Division of Pediatric General Surgery BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Emergency Medicine and Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA.
⁸ Nile of Hope Hospital, Alexandria, Egypt.
⁹ Alexandria University Children's Hospital, Alexandria, Egypt.
¹⁰ The Nairobi Hospital, Nairobi, Kenya.
¹¹ Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
¹² Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
¹³ Charles de Gaulle Pediatric Academic Hospital, Ouagadougou, Burkina Faso.
¹⁴ Frere Hospital, Walter Sisulu University, East London, South Africa.
¹⁵ Faculty of Medicine and Nursing, Krida Wacana University, Jakarta, Indonesia.
¹⁶ AIC Kijabe Hospital, Kenya and Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁷ Surgery for Children - ONLUS, Vicenza, Italy.
¹⁸ OMNI Hospital, Guayaquil, Ecuador.
¹⁹ Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
²⁰ Department of Surgery, University of California, San Francisco, CA, USA.

PMID: 38896255
DOI: 10.1007/s00383-024-05741-w

Abstract

Purpose: Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organization. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings.

Methods: The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation. The resultant GAPS Version 2 underwent international pilot testing. Construct validation categorized institutions into providing basic or advanced surgical care. GAPS was further refined to Version 3 to include only questions with a > 75% response rate and those that significantly discriminated between basic or advanced surgical settings.

Results: GAPS Version 1 included 139 items, which, after expert panel feedback, was expanded to 168 items in Version 2. Pilot testing, in 65 institutions, yielded a high response rate. Of the 168 questions in GAPS Version 2, 64 significantly discriminated between basic and advanced surgical care. The refined GAPS Version 3 tool comprises 64 questions on: human resources (9), material resources (39), outcomes (3), accessibility (3), and education (10).

Conclusion: The GAPS Version 3 tool presents a validated instrument for evaluating pediatric surgical capabilities in low-resource settings.

Keywords: Children’s surgery; Global health; Global surgery; Low-income country; Middle-income country; Pediatric surgery.

PubMed Disclaimer

References

1. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Merisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W (2016) Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 25:75–78. https://doi.org/10.1016/j.ijoa.2015.09.006.ORG/ - DOI - PubMed
1. Meara JG, Hagander L, Leather AJM (2014) Surgery and global health: A lancet commission. Lancet 383:12–13. https://doi.org/10.1016/S0140-6736(13)62345-4.ORG/ - DOI - PubMed
1. Makasa EM (2014) Letter to global health agency leaders on the importance of surgical indicators. Lancet 384:1748. https://doi.org/10.1016/S0140-6736(14)62012-2.ORG/ - DOI - PubMed
1. Huber B (2015) Finding surgery’s place on the global health agenda. Lancet 385:1821–1822. https://doi.org/10.1016/S0140-6736(15)60761-9.ORG/ - DOI - PubMed
1. Dare AJ, Grimes CE, Gillies R, Greenberg SL, Hagander L, Meara JG, Leather AJ (2014) Global surgery: Defining an emerging global health field. Lancet 384:2245–2247. https://doi.org/10.1016/S0140-6736(14)60237-3.ORG/ - DOI - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings

Affiliations

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings

Authors

Affiliations

Abstract

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical