Pediatric surgical capacity in Africa: Current status and future needs.
BACKGROUND
African pediatric surgery (PS) faces multiple challenges. Information regarding existing resources is limited. We surveyed African pediatric surgeons to determine available resources and clinical, educational, and collaborative needs.


METHODS
Members of the Pan-African Pediatric Surgical Association (PAPSA) and the Global Pediatric Surgery Network (GPSN) completed a structured email survey covering PS providers, facilities, resources, workload, education/training, disease patterns, and collaboration priorities.


RESULTS
Of 288 deployed surveys, 96 were completed (33%) from 26 countries (45% of African countries). Median PS providers/million included 1 general surgeon and 0.26 pediatric surgeons. Median pediatric facilities/million included 0.03 hospitals, 0.06 ICUs, and 0.17 surgical wards. Neonatal ventilation was available in 90% of countries, fluoroscopy in 70%, TPN in 50%, and frozen section pathology in 35%. Median surgical procedures/institution/year was 852. Median waiting time was 40days for elective procedures and 7 days? for emergencies. Weighted average percent mortality for key surgical conditions varied between 1% (Sierra Leone) and 54% (Burkina Faso). Providers ranked collaborative professional development highest and direct clinical care lowest priority in projects with high-income partners.


CONCLUSIONS
The broad deficits identified in PS human and material resources in Africa suggest the need for a global collaborative effort to address the PS gaps.


METHODS
Level 5, expert opinion without explicit critical appraisal.
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Asra
A
Toobaie
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Sherif
S
Emil
Department of Surgery, Yale University, New Haven, CT, USA.
Doruk
D
Ozgediz
Department of Surgery, Oregon Health and Sciences University, Portland, Oregon, USA.
Sanjay
S
Krishnaswami
Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: DPoenaru@gmail.com.
Dan
D
Poenaru
D000293:Adolescent; D000328:Adult; D000349:Africa; D057191:Capacity Building; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data / Q000600:supply & distribution*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D020380:Needs Assessment; D010372:Pediatrics / Q000193:education / Q000458:organization & administration / Q000706:statistics & numerical data; D013043:Specialties, Surgical / Q000193:education / Q000458:organization & administration / Q000706:statistics & numerical data; D066231:Surgeons / Q000193:education / Q000706:statistics & numerical data / Q000600:supply & distribution*; D000078329:Workforce; D016526:Workload
Africa; Facilities; Pediatric surgery; Training program; Workforce