Kisspeptin (Kiss1) signaling to GnRH neurons is widely acknowledged to be a prerequisite for puberty and reproduction. Animals lacking functional genes for either kisspeptin or its receptor exhibit low gonadotropin secretion and infertility. Paradoxically, a recent study reported that genetic ablation of nearly all Kiss1-expressing neurons (Kiss1 neurons) does not impair reproduction, arguing that neither Kiss1 neurons nor their products are essential for sexual maturation. We posited that only minute quantities of kisspeptin are sufficient to support reproduction. If this were the case, animals having dramatically reduced Kiss1 expression might retain fertility, testifying to the redundancy of Kiss1 neurons and their products. To test this hypothesis and to determine whether males and females differ in the required amount of kisspeptin needed for reproduction, we used a mouse (Kiss1-CreGFP) that has a severe reduction in Kiss1 expression. Mice that are heterozygous and homozygous for this allele (Kiss1(Cre/+) and Kiss1(Cre/Cre)) have ∼50% and 95% reductions in Kiss1 transcript, respectively. We found that although male Kiss1(Cre/Cre) mice sire normal-sized litters, female Kiss1(Cre/Cre) mice exhibit significantly impaired fertility and ovulation. These observations suggest that males require only 5% of normal Kiss1 expression to be reproductively competent, whereas females require higher levels for reproductive success.

Investing in surgery has been highlighted as integral to strengthening overall health systems and increasing economic prosperity in low‐income and middle‐income countries (LMICs). The provision of surgical care in LMICs not only affects economies on a macro‐level, but also impacts individual families within communities at a microeconomic level. Given that children represent 50% of the population in LMICs and the burden of unmet surgical needs in these areas is high, investing pediatric‐specific components of surgical and anesthesia care is needed. Implementation efforts for pediatric surgical care include incorporating surgery‐specific priorities into the global child health initiatives, improving global health financing for scale‐up activities for children, increasing financial risk protection mechanisms for families of children with surgical needs, and including comprehensive pediatric surgical models of care into country‐level plans.

Key Points Question What is the prevalence of pediatric surgical conditions in Somaliland? Findings In this cross-sectional study that included 1503 children in Somaliland, the prevalence of pediatric surgical conditions was 12.2%. Only 23.7% of surgical conditions had been corrected at the time of this study. Meaning A scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in low- and middle-income countries is warranted.