Paediatric Surgery Specialty and its Relevance to Africa

Source: Adapted from: Abantanga FA, Amaning EP. Paediatric elective surgical conditions as seen at a referral hospital in Kumasi, Ghana. ANZ J Surg 2002 72(12):890–892. Introduction In Africa, children constitute more than half of the population,1 and therefore much effort is devoted to the prevention and treatment of childhood diseases. Emphasis is placed on diseases that cause the greatest morbidity and mortality, such as communicable diseases (especially human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), malaria, and respiratory infections), maternal and perinatal conditions, and nutritional deficiencies.2 In many African countries, scarce health care resources have been concentrated on the provision of immunisation, HIV control, malaria eradication, and other public health concerns. As a result, diseases for which surgical intervention offers the only hope for prevention, palliation, or cure usually do not come within the radar of health policy makers. Given that surgical diseases have not been considered significant health care problems in Africa, the paediatric surgical speciality has not received the attention it deserves.3 Paediatric surgeons have been described as the only true general surgeons;4 this is especially the case in Africa, where paediatric subspecialisation is rare in orthopedics, urology, otolaryngology, thoracic surgery, plastic surgery and neurosurgery. The paediatric surgeon in Africa, therefore, provides cost-effective care at a considerable bargain for these impoverished countries. A detailed list of paediatric surgical diagnoses encountered in an urban hospital in Africa is provided in Table 1.1. Unaccounted for in most studies are those children for whom treatment is inaccessible due to distance, cost, or lack of qualified personnel. Bickler et al. analyzed all paediatric visits at the main urban hospital in Banjul, The Gambia, and estimated the incidence of paediatric surgical problems at 543 per 10,000 children Disease entity Number of children Percentage of total