title: Quantifying the Disability from Congenital Anomalies Averted Through Pediatric Surgery: A Cross-Sectional Comparison of a Pediatric Surgical Unit in Kenya and Canada.
abstract: BACKGROUND
  Pediatric surgical practice is different in low- and middle-income countries as compared to North America. While resources are limited, the impact of pediatric surgical procedures is significant. The objective of this study was to calculate and compare disability-adjusted life years (DALYs) averted in a Kenyan and Canadian surgical unit for a subset of pediatric congenital anomalies.
  
  
  METHODS
  Medical records of children having undergone surgical procedures for 13 congenital conditions in both surgical units were collected over 12 months. DALYs for each condition were calculated using previously obtained disability weights derived in each country. Age-adjusted life expectancy rates from the WHO were used to determine years of life lost. Risk of permanent disability without surgery and probability of successful treatment values were obtained from the literature and included in the DALY calculation.
  
  
  RESULTS
  The conditions accounting for the largest total number of averted DALYs in Kenya were hydrocephalus (60.8%) and spina bifida (18.1%), whereas in Canada they were hydrocephalus (24.2%) and undescended testes (19.2%). A total of 23,169 DALYs were averted through 1042 surgical procedures (22.2 DALYs per procedure) during the study period in Kenya, compared to 5497 DALYs through 373 procedures (14.7 DALYs per procedure) in Canada.
  
  
  CONCLUSIONS
  Using recent developments in burden of disease measurement, the results point to the significant impact of pediatric surgical centers in addressing the global burden of congenital surgical disease. The study carries significant implications for resource allocation and training.
authors.affiliation: Department of Surgery, McMaster University MUMC 4E, Hamilton, ON, L8S 4K1, Canada, dpoenaru@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Poenaru
authors.forename: J
authors.initials: J
authors.lastname: Pemberton
authors.forename: C
authors.initials: C
authors.lastname: Frankfurter
authors.forename: B H
authors.initials: BH
authors.lastname: Cameron
mesh_terms: D002170:Canada; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000601:surgery*; D003430:Cross-Sectional Studies; D003456:Cryptorchidism / Q000601:surgery; D019049:Developed Countries; D003906:Developing Countries; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000151:congenital / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008017:Life Expectancy; D008297:Male; D010372:Pediatrics; D011336:Probability; D019057:Quality-Adjusted Life Years; D016135:Spinal Dysraphism / Q000601:surgery; D013503:Surgery Department, Hospital