46 Baseline assessment of pediatric surgical delivery in rural Nicaragua
Neema Kaseje1,2, Kokila Lakhoo3, Jordan Swanson4, Isobel Marks5, Vincent Were6, Sabina Siddiqui7, Emily Smith8, Dan Poenaru9, Emmanuel Ameh10, Keith Oldham7, Diana Farmer11, Doruk Ozgediz12
1Global Initiative Children's Surgery, Managua, Nicaragua. 2University Hospitals Geneva, Geneva, Switzerland. 3Oxford University, Oxford, United Kingdom. 4Operation Smile, Managua, Nicaragua. 5Academic Foundation Programme in Northwest London,, London, United Kingdom. 6KEMRI, Kisumu, Kenya. 7Medical College of Wisconsin, Milwaukee, USA. 8Duke University, Durham, USA. 9McGill University, Montreal, Canada. 10National Hospital Abuja, Abuja, Nigeria. 11UC Davis, Davis, USA. 12Yale University, New Haven, USA


Aim: Globally, access to pediatric surgical care remains poor with devastating consequences in pediatric morbidity and mortality. Our aim was to evaluate pediatric surgical delivery at 2 district hospitals in rural Nicaragua.

Methods: We performed a retrospective review of pediatric surgical volume, pediatric surgical infrastructure, equipment, and workforce, using the World Health Organization (WHO) surgical assessment tool, and the Global Initiative for Children’s Surgery (GICS) Optimal Resources for Children's Surgery tool. We analyzed descriptive data and compared the proportion of pediatric volume to the proportion of the national population < 15 years old.

Main Results: Pediatric volume represented < 10% of surgical volume despite a national pediatric population of 30%. The pediatric surgical workforce was limited: 1 out of 2 sites had a pediatric surgeon and an anesthesia provider with pediatric exposure. No site had pediatric nurses or biomedical technicians. There were no emergency rooms, operating rooms, post anesthesia recovery rooms, or wards dedicated to pediatric surgical patients. There had been no training in Pediatric Advanced Life Support (PALS) or Advanced Trauma Life Support (ATLS). Continued medical education was limited. There was no use of the WHO safety checklist; and no outcome data collection on complications and peri-operative mortality.  

Conclusion: To improve access to pediatric surgical care in rural Nicaragua, investments are needed in pediatric infrastructure, and equipment. More importantly, investments are needed in building a pediatric surgical workforce including pediatric surgeons, pediatric anesthesia providers, and pediatric nurses. Safety and quality assurance measures are needed; namely: use of the safety checklist & records of peri-operative outcomes.