Epidemiology, outcomes, and access to care for pediatric patients who underwent surgery in Northern Tanzania: A cross-sectional study

Abstract

Lack of access to surgical care is common in low- and middle-income countries, where children and adolescents account for up to half of the population. However, the burden of surgical conditions and resources for children in Tanzania remains poorly defined. Our cross-sectional study aims to assess the epidemiology and outcomes of pediatric surgical procedures performed over one year at the Kilimanjaro Christian Medical Centre (KCMC), a tertiary center in Moshi, Tanzania. A secondary aim was to assess the geospatial distribution of families seeking surgical care and their accessibility to surgical services at KCMC. We evaluated the surgical records of all children <16 years old who underwent surgical care between January 1st, 2022 and December 31st, 2022 at KCMC. We used descriptive statistics to compare demographic and clinical characteristics across age groups. Geospatial mapping tools were used to visualize families' district of origin and access to care. We collected data on 2031 children, 59.8% (n = 1215) of whom were male, and more than half were between 1 and 5 years old (58.6%, [n = 1191]). Families traveled from 28 out of the 31 Tanzanian regions. Overall, about half of the conditions were diseases of the respiratory system (52.9%, [n = 1074]), followed by congenital and developmental disorders (14.6%, [n = 297]) and injuries (8.4%, [n = 170]). We identified 33 (1.6%) deaths prior to discharge. Children under one year old had lower rates of insurance coverage, higher referral rates, traveled longer distances, and had worse clinical outcomes compared to other age groups (p < 0.001). Our study reveals differences in the demographic and clinical characteristics of children who access specialized surgical care at KCMC. We report a high number of elective ear, nose, and throat (ENT) procedures and low number of non-ENT procedures, suggesting barriers to care for acute, high morbidity conditions.

Fig 1. Geospatial distribution of pediatric surgical patients at the Kilimanjaro Christian Medical Center based on district of origin (n

= 2031). Notes: About 56.8% of children who received surgery at KCMC lived within two hours (hatched area on map). Regional and district hospitals on the map represent the ten most common referral facilities in this study. Basemap provided by ESRI (https://www.arcgis.com/home/item.html?id=2ef1306b93c9459ca7c7b4f872c070b9).

Fig 2. Median distance traveled by families to reach pediatric surgery by age and condition.

Fig 3. Type and level of referral facilities (n = 82).