title: Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study.
abstract: OBJECTIVE
  Pediatric surgical care in developing countries is not well studied. We sought to identify the range of pediatric surgery available, the barriers to provision, and level of safety of surgery performed for the entire pediatric population in Zambia.
  
  
  METHODS
  In cooperation with the Ministry of Health, we validated and adapted a World Health Organization instrument. During onsite visits, the availability of 32 emergency and essential surgical procedures relevant to children was surveyed. The availability of basic World Health Organization surgical safety criteria was determined.
  
  
  RESULTS
  A single interviewer visited 103 (95%) of 108 surgical hospitals in Zambia and carried out 495 interviews. An average of 68% of the 32 emergency and essential surgical procedures was available (range 32%-100%). Lack of surgical skill was the primary reason for referral in 72% of procedure types, compared with 24%, 2% and 3% due to lack of equipment, supplies and anesthesia skills, respectively (p<0.001). Minimum pediatric surgical safety criteria were met by 14% of hospitals.
  
  
  CONCLUSIONS
  The primary limitation to providing pediatric surgical care in Zambia is lack of surgical skills. Minimum safety standards were met by 14% of hospitals. Efforts to improve pediatric surgery should prioritize teaching surgical skills to expand access and providing safety training, equipment and supplies to increase safety.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. kgbowman@partners.org
authors.forename: Kendra G
authors.initials: KG
authors.lastname: Bowman
authors.forename: Goran
authors.initials: G
authors.lastname: Jovic
authors.forename: Shawn
authors.initials: S
authors.lastname: Rangel
authors.forename: William R
authors.initials: WR
authors.lastname: Berry
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
mesh_terms: D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D061214:Patient Safety / Q000706:statistics & numerical data*; D010372:Pediatrics; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015024:Zambia
keywords: Africa; Global health; Global surgery; International heath; Pediatric surgery; Safety; Zambia