title: Burden of surgically correctable disabilities among children in the Dadaab Refugee Camp.
abstract: BACKGROUND
  Surgery is increasingly recognized as a means to reduce the morbidity and mortality of disabling impairments in resource-limited environments. We sought to estimate the burden of surgically correctable disabling impairments and the cost-effectiveness of their treatment among children in a large refugee camp.
  
  
  METHODS
  This is a chart review of all patients aged 0-18 years from Dadaab Refugee Camp (Kenya) treated at a facility primarily responsible for providing pediatric surgical care in the region. Total disability-adjusted life years (DALYs) averted were calculated using life expectancy tables and established or estimated disability weights. A sensitivity analysis was performed using various life expectancy tables. Delayed averted DALYs caused by delay in care were also estimated. Inpatient costs were collected to perform a cost-effectiveness analysis.
  
  
  RESULTS
  Between 2005 and 2011 a total of 640 procedures were performed on 341 patients. The median age at surgery was 4.6 years, and 33 % of the children treated were female. Only 13.5 % of surgeries estimated as required for common congenital surgical conditions were actually performed. The total number of DALYs averted ranged from 4,136 to 9,529 (6.4-14.8 per patient), depending on the calculation method used. Cost-effectiveness analysis resulted in values of $40-$88 per DALY.
  
  
  CONCLUSIONS
  The burden of pediatric surgical disabling impairments in refugee camps is substantial. Surgical intervention to address this burden is both feasible and cost-effective. Such intervention can significantly decrease the burden of disability among children affected by armed conflicts.
authors.affiliation: BethanyKids at Kijabe Hospital, P.O. Box 20, Kijabe, Kenya.
authors.forename: Victor K
authors.initials: VK
authors.lastname: Wu
authors.forename: Dan
authors.initials: D
authors.lastname: Poenaru
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D015993:Life Tables; D008297:Male; D012036:Refugees; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery*