The Impact of Gender on Pediatric Surgical Access and Outcomes in Africa

Abstract

IntroductionGirls, whose care is often affected by barriers steeped in gender inequity, may be at higher risk of poor surgical outcomes. This study explored the impact of gender on pediatric surgical care in Africa.MethodsDifferences in access to care and clinical outcomes for boys and girls were examined for pediatric surgical conditions that do not differ by physiological sex. A systematic review of African pediatric surgical studies ensued, followed by a random effects meta-analysis, and risk of bias assessment.ResultsOf the 12281 records retrieved, 54 were selected for review. Most studies were retrospective (57.4%), single-site (94.4%), from Egypt, Nigeria, Ghana, or Ethiopia (55.6%), focussed on gastrointestinal conditions (63.0%), published in 2010 or sooner (85.1%), had study durations of 5 years or less (68.5%), and cohorts of less than 200 children (57.4%). Sixty percent reported the outcome of mortality. Meta-analysis odds ratios revealed surgery was performed 3.6 times more often on boys (95% CI: 2.6, 4.9); and mortality was 1.6 times greater for girls (95% CI: 1.3, 2.0).ConclusionAfrican girls appear to face gender inequities in pediatric surgical care. Findings will be further explored in a mixed-methods study.Level of evidenceIHighlightsGender disparities in global surgical care have been documented in the African adult population. However gender specific differentials in surgical access and outcomes have yet to be documented for African pediatric populations.This study provides first-time evidence of gender inequity in pediatric surgical care in Africa.