title: Epidemiology of pediatric surgical needs in low-income countries.
abstract: OBJECTIVE
  According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs.
  
  
  METHODS
  A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering.
  
  
  RESULTS
  A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0-18 years of age) with median age of 8 (Interquartile range [IQR]: 4-13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns.
  
  
  CONCLUSIONS
  Surgery has been elevated as an "indivisible, indispensable part of health care" in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, United States of America.
authors.forename: Elissa K
authors.initials: EK
authors.lastname: Butler
authors.affiliation: Duke University Global Health Institute, Durham, NC, United States of America.
authors.forename: Tu M
authors.initials: TM
authors.lastname: Tran
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Canner
authors.affiliation: Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America.|Duke University School of Medicine, Durham, NC, United States of America.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Fuller
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
authors.forename: Adam
authors.initials: A
authors.lastname: Kushner
authors.affiliation: Duke University Global Health Institute, Durham, NC, United States of America.|Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America.|Duke University School of Medicine, Durham, NC, United States of America.|Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Haglund
authors.affiliation: Duke University Global Health Institute, Durham, NC, United States of America.|Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics; D005260:Female; D019538:Health Care Surveys / Q000592:standards*; D006301:Health Services Needs and Demand / Q000191:economics / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010372:Pediatrics / Q000191:economics / Q000592:standards*; D012432:Rwanda / Q000453:epidemiology; D012807:Sierra Leone / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology