Should We Offer Surgery for Biliary Atresia in Low-Resource Settings? Surgical Outcomes in Rwanda

Hong, Philip; Igiraneza, Deborah; Davis, James R.; Nsengiyumva, Alice; Riner, Andrea N.; Petroze, Robin T.; Ntaganda, Edmond

doi:10.1016/j.jss.2020.08.004

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…While LMICs including Ethiopia, Rwanda, Sierra Leone, and Uganda have benefited from investments in pediatric surgical care, DPRK is not known to have made this investment. [22][23][24][25] This may be in part because DPRK's efforts to strengthen surgical care have remained limited due to international sanctions. 26 27 Despite these sanctions, DPRK is prioritizing strengthening surgical capacity.…”

Section: Open Accessmentioning

confidence: 99%

Understanding pediatric surgical needs in North Korea: a modeling analysis

Hsu,

Yoon,

Park

2024

World Jnl Ped Surgery

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BackgroundSixty-five percent of children worldwide lack access to surgical care, the majority of whom live in low-income and middle-income countries (LMICs). Developing surgical infrastructure requires information on surgical need; however, this information is often limited in LMICs. North Korea (Democratic People’s Republic of Korea, DPRK) has a low amount of publicly available data. Here, we analyzed available modeled data to understand the causes of pediatric deaths due to conditions treatable with surgery in DPRK.MethodsWe used World Bank data and models from the Institute for Health Metrics and Evaluation to identify causes of pediatric deaths affecting pediatric patients (age <20 years). We compared mortality of disease between DPRK and countries with similar economic status.ResultsBetween 1990 and 2019, the number of overall pediatric deaths has decreased. In 2019, 32.2% of all pediatric deaths in DPRK were caused by surgical conditions. The leading categories of surgical conditions were injuries (53.9%), congenital conditions (34.2%), tumors (8.8%), and abdominal conditions (3.2%). DPRK has a lower relative rate of pediatric deaths compared with other LMICs with similar gross domestic product per capita. However, it has a higher relative rate of pediatric deaths due to conditions requiring treatment with surgery. Transport injuries contribute significantly to the high rate of pediatric deaths in DPRK.ConclusionsAlthough DPRK may be allocating overall resources toward pediatric healthcare more efficiently than economic peers, DPRK may benefit from improvement in pediatric surgical capacity. Improved availability of data and close international collaboration could be potential solutions to bridge this gap.

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Section: Open Accessmentioning

confidence: 99%

Understanding pediatric surgical needs in North Korea: a modeling analysis

Hsu,

Yoon,

Park

2024

World Jnl Ped Surgery

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Biliary atresia in Uganda: Current ethical challenges and advancement of public policy

Kakembo,

Loy,

Fitzgerald

et al. 2024

World j. surg.

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Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high‐income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low‐ and middle‐income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low‐resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient‐physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.

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Should We Offer Surgery for Biliary Atresia in Low-Resource Settings? Surgical Outcomes in Rwanda

Cited by 2 publications

References 22 publications

Understanding pediatric surgical needs in North Korea: a modeling analysis

Understanding pediatric surgical needs in North Korea: a modeling analysis

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy

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