title: Challenges of training and delivery of pediatric surgical services in Africa.
abstract: BACKGROUND
  The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa.
  
  
  METHODS
  A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL).
  
  
  RESULTS
  Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty.
  
  
  CONCLUSIONS
  The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international community and donor agencies, if the African child is to have access to essential pediatric surgical services like his or her counterpart in other developed parts of the world.
authors.affiliation: Pediatric Surgery Unit, Department of Surgery, Jos University Teaching Hospital, Jos, PMB 2076, Jos, Nigeria. lohfab@yahoo.com
authors.forename: Lohfa B
authors.initials: LB
authors.lastname: Chirdan
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Ameh
authors.forename: Francis A
authors.initials: FA
authors.lastname: Abantanga
authors.forename: Daniel
authors.initials: D
authors.lastname: Sidler
authors.forename: Essam A
authors.initials: EA
authors.lastname: Elhalaby
mesh_terms: D000349:Africa; D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000193:education*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000193:education*; D011795:Surveys and Questionnaires; D000078329:Workforce