title: Outcomes and unmet need for neonatal surgery in a resource-limited environment: estimates of global health disparities from Kampala, Uganda.
abstract: OBJECTIVE
  Reported outcomes of neonatal surgery in low-income countries (LICs) are poor. We examined epidemiology, outcomes, and met and unmet need of neonatal surgical diseases in Uganda.
  
  
  METHODS
  Pediatric general surgical admissions and consults from January 1, 2012, to December 31, 2012, at a national referral center in Uganda were analyzed using a prospective database. Outcomes were compared with high-income countries (HICs), and met and unmet need was estimated using burden of disease metrics (disability-adjusted life years or DALYs).
  
  
  RESULTS
  23% (167/724) of patients were neonates, and 68% of these survived. Median age of presentation was 5days, and 53% underwent surgery. 88% survived postoperatively, while 55% died without surgery (p<0.001). Gastroschisis carried the highest mortality (100%) and the greatest mortality disparity with HICs. An estimated 5072 DALYs were averted by neonatal surgery in Uganda (met need), with 140,154 potentially avertable (unmet need). Approximately 3.5% of the need for neonatal surgery is met by the health system.
  
  
  CONCLUSIONS
  More than two thirds of surgical neonates survived despite late presentation and lack of critical care. Epidemiology and outcomes differ greatly with HICs. A high burden of hidden mortality exists, and only a negligible fraction of the population need for neonatal surgery is met by health services.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Raghav
authors.initials: R
authors.lastname: Badrinath
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Nasser
authors.initials: N
authors.lastname: Kakembo
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kisa
authors.affiliation: Maine Medical Center, Portland, ME, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA. Electronic address: doruk.ozgediz@yale.edu.
authors.forename: Doruk
authors.initials: D
authors.lastname: Ozgediz
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: John
authors.initials: J
authors.lastname: Sekabira
mesh_terms: D005260:Female; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011203:Poverty; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D014454:Uganda
keywords: Access to care; Burden of disease; Congenital anomalies; Disparities; Effective coverage; Low and middle-income countries; Mortality; Neonatal surgery; Pediatric surgery; Sub-Saharan Africa; Uganda