title: Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience.
abstract: OBJECTIVE
  Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams.
  
  
  METHODS
  Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death.
  
  
  RESULTS
  Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict.
  
  
  CONCLUSIONS
  Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA. Electronic address: flynnobr@uw.edu.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Flynn-O'Brien
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: Lynette
authors.initials: L
authors.lastname: Dominguez
authors.affiliation: Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Boost General Hospital, Médecins sans Frontières, Lashkar-Gah, Afghanistan.
authors.forename: Ghulam Hiadar
authors.initials: GH
authors.lastname: Hassani
authors.affiliation: Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins sans Frontières, Lubutu, Democratic Republic of the Congo.
authors.forename: Clemence
authors.initials: C
authors.lastname: Akemani
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium; Dargai DHQ Hospital, Dargai, Pakistan.
authors.forename: Aamer
authors.initials: A
authors.lastname: Naseer
authors.affiliation: Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins sans Frontières, Masisi, Democratic Republic of the Congo.
authors.forename: Innocent Bagura
authors.initials: IB
authors.lastname: Ntawukiruwabo
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Department of Surgery, Women & Children's Hospital of Buffalo, NY, USA; Department of Surgery, University at Buffalo, SUNY, Buffalo, NY, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000533:Altruism; D002648:Child; D002983:Clinical Competence; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008493:Medical Missions; D020380:Needs Assessment; D010372:Pediatrics; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*
keywords: Crisis; Developing country; Global surgery; Humanitarian; Natural disaster; Pediatric