Paediatric Surgical Care in a Resource-Constrained setting: Case-Mix, Workforce Adaptation, and Early Outcomes Over the First Five Years.

Abstract

Background: The upsurge in the migration of trained health workforce from Sub-Saharan Africa (SSA) has further depleted the already inadequate paediatric surgical and anaesthesia workforce. Data on paediatric surgical operations and workforce adaptation will be invaluable in the immediate and long-term planning for adequate budgeting and personnel training for this group of patients.

Objective: To describe the case-mix of paediatric surgical procedures, workforce adaptation, and early outcomes over the first five years in a new tertiary hospital in southwestern Nigeria.

Materials and methods: A hospital based retrospective review conducted from 2014 to 2019 in the paediatric surgery unit whose workforce consists of one consultant paediatric surgeon, one consultant anaesthetist who also service other surgical units. Data was analyzed using SPSS version 23.

Results: A total of 368 operations were performed during the study period, with M: F = 3.6:1. The age ranged from 0 to 156 months. Neonates were 12.8% while 33.9% and 33.1% were older infants and age 1 - 5 years respectively. Elective cases were 64.4% and over 60% of all cases were classified as diseases of the digestive system, followed by developmental anomalies (20.1%). The consultant anaesthetist anaesthesized 41.3% of all cases and we found no statistically significant difference in the patients' outcome among the different cadres of anaesthetists.

Conclusion: Diseases of the gastrointestinal tract are the most common reason for pediatric surgical operations in our hospital. The concept of task shifting/sharing should be explored for highly specialized sections of the health workforce including paediatric anaesthesia in the interim in SSA.