Paediatric urology in Sub-Saharan Africa: challenges and opportunities.
LMIC
Sub-Saharan Africa
Urolink
frugal innovation
global surgery
paediatric urology
three delays
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
pubmed:
20
7
2022
medline:
26
8
2022
entrez:
19
7
2022
Statut:
ppublish
Résumé
The need for paediatric urological care in low- and middle-income countries in sub-Saharan Africa (SSA) is enormous due to a burgeoning paediatric-aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long-term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high- and low-income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low- and high-income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource-poor environment and the involvement of trainees from both income settings can help perpetuate long-term collaborations.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
277-284Informations de copyright
© 2022 BJU International.
Références
The World Bank. Land Area (sq. km.). 2022. Available at: https://data.worldbank.org/indicator/AG.LND.TOTL.K2. Accessed 7 November 2021
Economist T. Pocket World in Figures. London: Profile Books Ltd., 2020
Kakembo N, Godier-Furnemont A, Nabirye A et al. Barriers to pediatric surgical care in low-income countries: the three delays' impact in Uganda. J Surg Res 2019; 242: 193-9
Payne SR, Chalwe M. Understanding the needs of low-income countries: how urologists can help. BJU Int 2022; 129: 9-16
Lackner C, Milanovic B. Global Income Distribution - From the Fall of the Berlin Wall to the Great Recession. Oxford: Oxford Academic, 2013
Yap A, Cheung M, Kakembo N et al. From procedure to poverty: out-of-pocket and catastrophic expenditure for pediatric surgery in Uganda. J Surg Res 2018; 232: 484-91
Abdur-Rahman LO. The perils of bladder exstrophy repairs in Africa. Ann Afr Med 2014; 13: 232-3
Faustin Felicien MT, Nwaha Makon AS, Kamadjou C et al. Our experience of proximal hypospadias repair using the Cloutier-Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon. Afr J Paediatr Surg 2016; 13: 193-5
The World Bank. Rural population (% of total population). 2022. Available at: https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS. Accessed 7 November 2021
Council on Foreign Relations. Global Conflict Tracker. 2022. Available at: https://www.cfr.org/global-conflict-tracker/?category=us. Accessed 8 November 2021
SAHAM Foundation. 2022. Available at: https://sahamfoundation.com/en/. Accessed 7 November 2021
UNHCR. Refugee Data Finder. Available at: https://www.unhcr.org/refugee-statistics/. Accessed March 2022
Connor P, Krogstad JM. Record Number of Forcibly Displaced People Lived in sub-Saharan Africa in 2017. Washington: Policy common, Coherent digital, 2018
UNHCR Standing Committee. Note on Resettlement of Refugees with Special Needs EC/48/SC/CRP.28. 1998. Available at: https://www.unhcr.org/uk/excom/standcom/3ae68d0b1c/note-resettlement-refugees-special-needs.html. Accessed 1 April 2022
Terna Yawe K-D. Faculty of Surgery. Training Programmes and Curricula. Nigeria: West African College of Surgeons, 2014
COSECSA. College of Surgeons of East, Central and Southern Africa: Regulations and Syllabus Relating to Fellowship Examination in Paediatric Surgery. Arusha, Tanzania: COSECSA, 2016
COSECSA. College of Surgeons of East, Central and Southern Africa: Regulations and Syllabus Relating to Fellowship Examination in Urology. Arusha, Tanzania: COSECSA, 2016
Wiersma R. Overview of bladder exstrophy: a third world perspective. J Pediatr Surg 2008; 43: 1520-3
Reed CR, Commander SJ, Sekabira J et al. Comparison of Ugandan and North American pediatric surgery fellows' operative experience: opportunities for global training exchange. J Surg Educ 2020; 77: 606-14
Kisa P, Scotland K, Afshar K, MacNeily AE. Surveying unmet pediatric urological needs in low- and middle-income countries. J Pediatr Urol 2021; 17: 171.e1-9
Cunningham AJ, Stephens CQ, Ameh EA, Mshelbwala P, Nwomeh B, Krishnaswami S. Ethics in global pediatric surgery: existing dilemmas and emerging challenges. World J Surg 2019; 43: 1466-73
Kisa P, Grabski DF, Ozgediz D et al. Unifying children's surgery and anesthesia stakeholders across institutions and clinical disciplines: challenges and solutions from Uganda. World J Surg 2019; 43: 1435-49
Ezomike UO, Modekwe VI, Ekenze SO. Paediatric nephrectomy: patterns, indications and outcome in a developing country. Malawi Med J 2018; 30: 94-8
Regional Office for Africa WHO. Strategic Plan to Reduce the Double Burden of Malnutrition in the African Region (2019-2025). Brazaville, Republic of Congo: Regional Office for Africa WHO, 2019
Peiffer S, Ssentongo AE, Keeney L et al. Predictors of poor postoperative outcomes in pediatric surgery patients in rural Ghana. BMC Surg 2020; 20: 211
Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14: 2361-70
World Health Organization, Joint United Nations Programme on HIV/AIDS. Joint Strategic Action Framework to Accelerate the Scale-up of Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa: 2012-2014. Geneva: United Nations, WHO, 2011
Kim HH, Goldstein M. High complication rates challenge the implementation of male circumcision for HIV prevention in Africa. Nat Clin Pract Urol 2009; 6: 64-5
Wilcken A, Keil T, Dick B. Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications. Bull World Health Organ 2010; 88: 907-14
Lucas TJ, Toledo C, Davis SM et al. Case series of glans injuries during voluntary medical male circumcision for HIV prevention - eastern and southern Africa, 2015-2018. BMC Urol 2020; 20: 45
Yousef Y, Lee A, Ayele F, Poenaru D. Delayed access to care and unmet burden of pediatric surgical disease in resource-constrained African countries. J Pediatr Surg 2019; 54: 845-53
Osifo OD, Mene AO. Hypospadias repair in a resource-poor region: coping with the challenges in 5 years. J Pediatr Urol 2010; 6: 60-5
Thomas DFM, Duffy PG, Rickwood AMK. Essentials of Paediatric Urology, 2nd edn. London: Informa UK Ltd., 2008
Odusina EK, Ahinkorah BO, Ameyaw EK et al. Noncompliance with the WHO's recommended eight antenatal care visits among pregnant women in Sub-Saharan Africa: a multilevel analysis. Biomed Res Int 2021; 2021: 6696829-11
Soliman NA, Rizvi SAH. Endemic bladder calculi in children. Pediatr Nephrol 2017; 32: 1489-99
Rizvi SA, Sultan S, Zafar MN, Ahmed B, Aba Umer S, Naqvi SA. Paediatric urolithiasis in emerging economies. Int J Surg 2016; 36(Pt D): 705-12
Borer JG, Vasquez E, Canning DA, Kryger JV, Mitchell ME. An initial report of a novel multi-institutional bladder exstrophy consortium: a collaboration focused on primary surgery and subsequent care. J Urol 2015; 193(5 Suppl): 1802-7
Dejene B. Bladder exstrophy management at Tikur Anbesa University Hospital, Addis Ababa. Ethiopia Ethiop Med J 2013; 51: 197-202
Alemu MH. Mainz II pouch: continent urinary diversion, for bladder extrophy epispadia complex and irreparable VVF: a 5 year comprehensive retrospective analysis. Ethiop Med J 2010; 48: 57-62
Agossou-Voyeme AK, Fiogbe MA, Goundete J, Hounnou GM, Hodonou R. Paediatric urologic pathologies at the national teaching hospital in Cotonou: a etiological and therapeutic aspects. Afr J Paediatr Surg 2013; 10: 135-9
Tambo FFM, Tolefac PN, Ngowe MN et al. Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaounde gynaeco-obstetric and paediatric hospital. BMC Urol 2018; 18: 46
Okafor HU, Ekenze SO, Uwaezuoke SN. Posterior urethral valves: determinants of outcome in a developing country. J Paediatr Child Health 2013; 49: 115-9
Lukong CS, Ameh EA, Mshelbwala PM et al. Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa. J Pediatr Urol 2014; 10: 62-6
Muller E. Transplantation in Africa - an overview. Clin Nephrol 2016; 86: 90-5
Hadley LG, Rouma BS, Saad-Eldin Y. Challenge of pediatric oncology in Africa. Semin Pediatr Surg 2012; 21: 136-41
Their Lives Matter. We Are TLM. 2021. Available at: https://www.wearetlm.org/. Accessed 14 February 2022
Yao AJ, Moreira C, Traore F et al. Treatment of Wilms tumor in Sub-Saharan Africa: results of the second French African pediatric oncology group study. J Glob Oncol 2019; 5: 1-8
Tran VT, Ravaud P. Frugal innovation in medicine for low resource settings. BMC Med 2016; 14: 102
Nyamsogoro R. Efficacy and safety of the use of infant feeding tubes as internal ureteral stents at Muhimbili National Hospital, Tanzania East and Central African. J Surg 2017; 22: 36-41
Oguike TC. The use of infant feeding tube as a combined nephrostomy and stent in Anderson-Hynes pyeloplasty. Niger J Clin Pract 2007; 10: 166-8
Van Batavia JP, Shukla AR, Joshi RS, Reddy PP. Pediatric urology and global health: why now and how to build a successful global outreach program. Urol Clin North Am 2018; 45: 623-31
Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 2015; 3(Suppl 2): S8-9
Meara JG, Leather AJ, Hagander L et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery 2015; 158: 3-6
Ullrich S, Kisa P, Ozgediz D. Global children's surgery: recent advances and future directions. Curr Opin Pediatr 2019; 31: 399-408
WHO. Congenital Anomalies. 2020. Available at: https://www.who.int/en/news-room/fact-sheets/detail/congenital-anomalies. Accessed 16 February 2022
Jedrzejko N, Margolick J, Nguyen JH et al. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg 2021; 64: E280-E8
Philipo GS, Nagraj S, Bokhary ZM, Lakhoo K. Lessons from developing, implementing and sustaining a participatory partnership for children's surgical care in Tanzania. BMJ Glob Health 2020; 5: e002118
KidsOR. Operating rooms. 2022. Available at: https://www.kidsor.org/what-we-do/operating-rooms/. Accessed 16 February 2022
Yap A, Cheung M, Muzira A et al. Best buy in public health or luxury expense? The cost-effectiveness of a pediatric operating room in Uganda from the societal perspective. Ann Surg 2021; 273: 379-86
Venn SN, Mabedi C, Ngowi BN, Mbwambo OJ, Mteta KA, Payne SR. Disseminating surgical experience for sustainable benefits - the Urolink experience. BJU Int 2022; 129: 661-7
Baird R, Kisa P, Muzira A et al. Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program. Pediatr Surg Int 2022; 38: 269-76
Ching CB, Koyle MA. Pediatric urology and international medical volunteerism: where are we? Where are we going? Urology 2021; 156: 231-7
Milford K, Rickard M, Chua M, Tomczyk K, Gatley-Dewing A, Lorenzo AJ. Medical conferences in the era of environmental conscientiousness and a global health crisis: the carbon footprint of presenter flights to pre-COVID pediatric urology conferences and a consideration of future options. J Pediatr Surg 2021; 56: 1312-6
Emil S, O'Neill J, Poenaru D. Let our fellows go: a plea for allowing global surgery electives during pediatric surgical training. J Pediatr Surg 2017; 52: 2088-90