ABSTRACT
Pediatric surgical conditions account for a significant portion of the burden of surgical disease in low-and middle-income countries (LMICs). This is partially due to regional demographics as more than half of the population is <18 years old in many countries and fertility rates remain as high as seven births per woman, even in countries with limited life expectancies. Prospective studies suggest that up to 85% of children in these settings will require surgical intervention by age 15.1
This chapter will discuss the care of selected common conditions encountered in a low-income setting; however, the reader is also referred to other subspecialty chapters in this book covering pediatric surgical conditions (e.g., urology [Chapter 43], otorhinolaryngology [Chapter 26], and orthopedics [Chapter 30]). In LMICs, all these conditions are likely to be managed by the same practitioner. Specifically, trauma comprises a large proportion of the burden of pediatric surgical conditions, and the reader is referred to Chapters 37 through 51 for the essentials of pediatric trauma care. In the North American environment, a significant portion (40% or more) of pediatric operations are for emergency conditions, and studies suggest this is comparable in LMICs.2,3 A snapshot of selected inpatients on one day of the pediatric general surgery unit at Mulago Hospital (an LMIC national referral center) in Kampala, Uganda, reflects the broad spectrum of conditions treated there, ranging from trauma to congenital anomalies, oncology, and infectious diseases, and their attendant complications (Table 31.1).
