title: Can Economic Performance Predict Pediatric Surgical Capacity in Sub-Saharan Africa?
abstract: The relationship between economic status and pediatric surgical capacity in low- and middle-income countries (LMICs) is poorly understood. In sub-Saharan Africa (SSA), Nigeria accounts for 20 % of the population and has the highest Gross Domestic Product (GDP), but whether this economic advantage translates to increased pediatric surgical capacity is unknown. This study compares the pediatric surgical capacity between Nigeria and other countries within the region.
  
  
  
  The Pediatric Personnel, Infrastructure, Procedures, Equipment and Supplies (PediPIPES) survey, a recent tool that is useful in assessing and comparing the capacity of health facilities to deliver essential and emergency surgical care (EESC) to children in LMICs, was used for this evaluation.
  
  
  
  Data from hospitals in Nigeria (n = 24) and hospitals in 17 other sub-Saharan African countries (n = 25) were compared. The GDP of Nigeria was approximately twenty-five times the average GDP of the 17 other countries represented in our survey. Running water was unavailable in 58 % of the hospitals in Nigeria compared to 20 % of the hospitals in the other countries. Most hospitals in Nigeria and in the other countries did not have a CT scan (67 and 60 %, respectively). Endoscopes were unavailable in 58 % of the hospitals in Nigeria and 44 % of the hospitals in the other countries.
  
  
  
  Despite better economic indicators in Nigeria, there were no distinct advantages over the other countries in the ability to deliver EESC to children. Our findings highlighted the urgent need for specific allocation of more resources to pediatric surgical capacity building efforts across the entire region.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, USA. mokoye@jhmi.edu.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mokoye@jhmi.edu.
authors.forename: Mekam T
authors.initials: MT
authors.lastname: Okoye
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Evelyn T
authors.initials: ET
authors.lastname: Nguyen
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Columbia University College of Physicians And Surgeons, New York, NY, USA.|Surgeons OverSeas (SOS), New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: National Hospital, Abuja, FCT, Nigeria.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Ameh
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA.|Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D017954:Africa South of the Sahara; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000600:supply & distribution; D019723:Endoscopes / Q000600:supply & distribution; D059066:Gross Domestic Product; D006295:Health Resources / Q000600:supply & distribution*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009549:Nigeria; D010372:Pediatrics / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015898:Tomography Scanners, X-Ray Computed / Q000600:supply & distribution; D014881:Water Supply / Q000706:statistics & numerical data; D000078329:Workforce
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