Surgery in Low and Middle Income Country
Modeling the Scale-up of Surgical Services for Children with Surgically Treatable Congenital Conditions in Somaliland
Vivian S. Vigliotti, Tessa Concepcion,
Mubarak Mohamed,
Shugri Dahir,
Edna Adan Ismail,
Dan Poenaru, Henry E. Rice,
Emily R. Smith,
Tessa Concepcion
Duke Global Health Institute, Duke University, Durham, NC, USA
Search for more papers by this authorMubarak Mohamed
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorShugri Dahir
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorEdna Adan Ismail
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorHenry E. Rice
Duke Global Health Institute, Duke University, Durham, NC, USA
Search for more papers by this authorCorresponding Author
Emily R. Smith
Duke Global Health Institute, Duke University, Durham, NC, USA
Duke Department of Surgery, Duke University School of Medicine, Durham, USA
[email protected]Search for more papers by this authorVivian S. Vigliotti, Tessa Concepcion,
Mubarak Mohamed,
Shugri Dahir,
Edna Adan Ismail,
Dan Poenaru, Henry E. Rice,
Emily R. Smith,
Tessa Concepcion
Duke Global Health Institute, Duke University, Durham, NC, USA
Search for more papers by this authorMubarak Mohamed
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorShugri Dahir
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorEdna Adan Ismail
Edna Adan University Hospital, Hargeisa, Somaliland
Search for more papers by this authorHenry E. Rice
Duke Global Health Institute, Duke University, Durham, NC, USA
Search for more papers by this authorCorresponding Author
Emily R. Smith
Duke Global Health Institute, Duke University, Durham, NC, USA
Duke Department of Surgery, Duke University School of Medicine, Durham, USA
[email protected]Search for more papers by this authorAbstract
Background
Congenital conditions comprise a significant portion of the global burden of surgical conditions in children. In Somaliland, over 250,000 children do not receive required surgical care annually, although the estimated costs and benefits of scale-up of children's surgical services to address this disease burden is not known.
Methods
We developed a Markov model using a decision tree template to project the costs and benefits of scale-up of surgical care for children across Somaliland. We used a proxy set of congenital anomalies across Somaliland to estimate scale-up costs using three different scale-up rates. The cost-effectiveness ratio and net societal monetary benefit were estimated using these models, supported by disability weights in existing literature.
Results
Overall, we found that scale-up of surgical services at an aggressive rate (22.5%) over a 10-year time horizon is cost effective. Although the scale-up of surgical care for most conditions in the proxy set was cost effective, scale-up of hydrocephalus and spina bifida are not as cost effective as other conditions.
Conclusions
Our analysis concludes that it is cost effective to scale-up surgical services for congenital anomalies for children in Somaliland.
References
- 1Bhide P, Gund P, Kar A Prevalence of congenital anomalies in an Indian maternal cohort: Healthcare, prevention, and surveillance implications. PLoS ONE (2016) 11(11): e016640810.1371/journal.pone.0166408
- 2Vos T, Kyu HH, Pinho C et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013 findings from the global burden of disease 2013 study. JAMA Pediatr (2016) 170(3): 267–28710.1001/jamapediatrics.2015.4276
- 3Meara JG, Leather AJM, Hagander L et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet (2015) 386(9993): 569–62410.1016/S0140-6736(15)60160-X
- 4Mullapudi B, Grabski D, Ameh E et al. Estimates of number of children and adolescents without access to surgical care. Bull World Health Organ (2019) 97(4): 254–25810.2471/BLT.18.216028
- 5Saxton AT, Poenaru D, Ozgediz D et al. Economic analysis of children's surgical care in low- and middle-income countries: a systematic review and analysis. PLoS ONE (2016) 11(10): e016548010.1371/journal.pone.0165480
- 6Smith ER, Concepcion TL, Niemeier KJ, Ademuyiwa AO Is Global pediatric surgery a good investment?. World J Surg (2019) 43(6): 1450–145510.1007/s00268-018-4867-4
- 7Huber B Finding surgery's place on the global health agenda. Lancet (London, England) (2015) 385(9980): 1821–182210.1016/S0140-6736(15)60761-9
- 8Price R, Makasa E, Hollands M. (2015) World Health Assembly Resolution WHA68.15: “Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage”-Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World journal of surgery 39(9): 2115–25
- 9Jamison DT, Summers LH, Alleyne G et al. Global health 2035: a world converging within a generation. Lancet (London, England) (2013) 382(9908): 1898–195510.1016/S0140-6736(13)62105-4
- 10 Bank W. New World Bank GDP and Poverty Estimates for Somaliland. http://www.worldbank.org/en/news/press-release/2014/01/29/new-world-bank-gdp-and-poverty-estimates-for-somaliland. (accessed July 1 2018).
- 11 Global Health Repositoy data. World Health Organization. http://www.who.int/gho/database/en/. (accessed April 2 2018).
- 12Concepcion T, Mohamed M, Dahir S et al. Prevalence of pediatric surgical conditions across Somaliland. JAMA Netw Open (2019) 2(1): e18685710.1001/jamanetworkopen.2018.6857
- 13Concepcion TL, Dahir S, Mohamed M, et al. Barriers to Surgical Care Among Children in Somaliland: An Application of the Three Delays Framework. World journal of surgery (2020) : 1–7.
- 14Concepcion TL, Smith ER, Mohamed M, et al. Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance. World journal of surgery (2019) .
- 15Cotache-Condor CF, Moody K, Concepcion T et al. Geospatial analysis of pediatric surgical need and geographical access to care in Somaliland: a cross-sectional study. BMJ Open (2021) 11(7): e04296910.1136/bmjopen-2020-042969
- 16Dahir S, Cotache-Condor CF, Concepcion T et al. Interpreting the lancet surgical indicators in Somaliland: a cross-sectional study. BMJ Open (2020) 10(12): e04296810.1136/bmjopen-2020-042968
- 17Smith ER, Concepcion TL, Mohamed M et al. The contribution of pediatric surgery to poverty trajectories in Somaliland. PLoS ONE (2019) 14(7): e021997410.1371/journal.pone.0219974
- 18Smith ER, Concepcion TL, Shrime M et al. Waiting too long: the contribution of delayed surgical access to pediatric disease burden in Somaliland. World J Surg (2020) 44(3): 656–66410.1007/s00268-019-05239-w
- 19Smith ER CT, Mohamed Mubarak, Dahir Shugri, Adan Edna, Rice HE. Poverty Trajectories among Families with Children with Surgical Care in Somaliland (in press). PloS one (2019) .
- 20Fuller AT, Haglund MM, Lim S et al. Pediatric neurosurgical outcomes following a neurosurgery health system intervention at mulago national referral hospital in uganda. World neurosurg (2016) 95: 309–31410.1016/j.wneu.2016.07.090
- 21Smith ER, van de Water BJ, Martin A, et al. (2018) Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda. BMC health services research, 18(1): 727
- 22Smith ER, Vissoci JRN, Rocha TAH et al. Geospatial analysis of unmet pediatric surgical need in Uganda. J Pediatr Surg (2017) 52(10): 1691–169810.1016/j.jpedsurg.2017.03.045
- 23Vissoci JRN, Ong CT, Andrade L et al. Disparities in surgical care for children across Brazil: use of geospatial analysis. PLoS ONE (2019) 14(8): e022095910.1371/journal.pone.0220959
- 24Verguet S, Alkire BC, Bickler SW et al. Timing and cost of scaling up surgical services in low-income and middle-income countries from 2012 to 2030: a modelling study. Lancet Glob Health (2015) 3(Suppl 2): S28–3710.1016/S2214-109X(15)70086-0
- 25Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update From WHO CHOICE. International Journal of Health Policy and Management (2021); 10(Special Issue on WHO-CHOICE Update): 673–7.
- 26Smith ER, Concepcion T, Lim S et al. Disability weights for pediatric surgical procedures: a systematic review and analysis. World J Surg (2018) 42(9): 3021–303410.1007/s00268-018-4537-6
- 27Ameh EA, Bickler SW, Lakhoo K, Nwomeh BC, Poenaru D. Pediatric Surgery A Comprehensive Textbook for Africa: Cham Springer International Publishing 2020; (2020) .
10.1007/978-3-030-41724-6 Google Scholar
- 28Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ (2015) 93(2): 118–12410.2471/BLT.14.138206
- 29 Net Monetary Benefit - YHEC - York Health Economics Consortium. http://yhec.co.uk/glossary/net-monetary-benefit/ (accessed February 1, 2021).
- 30Abdelgadir J, Punchak M, Smith ER et al. Pediatric traumatic brain injury at mbarara regional referral hospital. Uganda J Clin Neurosci (2018) 47: 79–8310.1016/j.jocn.2017.10.004
- 31Bearden A, Fuller AT, Butler EK et al. Rural and urban differences in treatment status among children with surgical conditions in Uganda. PLoS ONE (2018) 13(11): e020513210.1371/journal.pone.0205132
- 32Butler EK, Tran TM, Fuller AT et al. Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatr Surg Int (2016) 32(11): 1075–108510.1007/s00383-016-3957-3
- 33Butler EK, Tran TM, Nagarajan N et al. Epidemiology of pediatric surgical needs in low-income countries. PLoS ONE (2017) 12(3): e017096810.1371/journal.pone.0170968
- 34Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study. BMJ Glob Health (2021); 6(9).
- 35Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet (London, England) (2021); 398(10297): 325–39.
- 36Abdul-Mumin A, Anyomih TTK, Owusu SA et al. Burden of neonatal surgical conditions in northern Ghana. World J Surg (2020) 44(1): 3–1110.1007/s00268-019-05210-9
- 37Abdul-Mumin A, Cotache-Condor C, Bimpong KA et al. Decrease in admissions and change in the diagnostic landscape in a newborn care unit in northern ghana during the COVID-19 pandemic. Front Pediatr (2021) 9: 64250810.3389/fped.2021.642508
- 38Abdul-Mumin A, Cotache-Condor C, Owusu SA, Mahama H, Smith ER Timing and causes of neonatal mortality in tamale teaching hospital, Ghana: a retrospective study. PLoS ONE (2021) 16(1): e024506510.1371/journal.pone.0245065
- 39Truche P, Botelho F, Bowder AN et al. Potentially avertable child mortality associated with surgical workforce scale-up in low- and middle-income countries: a global study. World J Surg (2021) 45(9): 2643–265210.1007/s00268-021-06181-6
- 40Mock C, Cherian M, Juillard C et al. Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg (2010) 34(3): 381–38510.1007/s00268-009-0263-4
- 41 WHO. Health systems financing: the path to universal coverage. Geneva: WHO, (2010) .
- 42Landrum K, Cotache-Condor CF, Liu Y et al. Global and regional overview of the inclusion of paediatric surgery in the national health plans of 124 countries: an ecological study. BMJ Open (2021) 11(6): e04598110.1136/bmjopen-2020-045981
