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1. Cost-effectiveness of a pediatric operating room installation in Sub-Saharan Africa.

Author: Ava Yap, Salamatu I Halid, Nancy Ukwu, Ruth Laverde, Paul Park, Greg Klazura, Emma Bryce, Maija Cheung, Elliot Marseille, Doruk Ozgediz, and Emmanuel A Ameh
Subjects: Public aspects of medicine, RA1-1270
Abstract: The unmet need for pediatric surgery imposes enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of knowledge about the economic impact of improving pediatric surgical infrastructure in SSA inhibits the informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and running two dedicated pediatric operating rooms (ORs) in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of the ORs, which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital's operative registry and prior literature. We adopted an all healthcare payor's perspective including costs incurred by the local healthcare system, the installation (funded by the charity), and patients' families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation and operation were presented. One-way and probabilistic sensitivity analyses were performed. We found that installing and operating two dedicated pediatric ORs averted 538 DALYs and cost $177,527 annually. The ICER of the ORs' installation and operation was $330 per DALY averted (95% uncertainty interval [UI] 315-336) from the all healthcare payor's perspective. This ICER was well under the cost-effectiveness threshold of the country's half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional dedicated pediatric operating rooms in Nigeria with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children's global surgical infrastructure as an economically sound intervention.
Published: 2024
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2. Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Author: Charles Mock, Jonathan Lord, Monica Langer, Niyi Ade-Ajayi, Dan Poenaru, Harshjeet Singh Bal, Massimo Caputo, Damian Clarke, Fred Bulamba, Lubna Samad, David Cunningham, George Youngson, Michael Cooper, Tamara Fitzgerald, Henry Rice, Patrick Kamalo, Emily R Smith, Bistra Zheleva, David Drake, Emily Smith, Lars Hagander, Bassey Edem, Sridhar Gibikote, Jessica Ng, David Spiegel, Saurabh Saluja, Peter Ssenyonga, Thiago Augusto Hernandes Rocha, Joao Vissoci, Nubia Rocha, Mark Shrime, Henry E Rice, Mohamed Abdelmalak, Nurudeen Abdulraheem, Edna Adan Ismail, Eltayeb Ahmed, Sunday Ajike, Olugbemi Benedict Akintububo, Brendan Allen, Emmanuel Ameh, Shanthi Anbuselvan, Jamie Anderson, Theophilus Teddy Kojo Anyomih, Leopold Asakpa, Gudeta Assegie, Jason Axt, Ruben Ayala, Frehun Ayele, Rouma Bankole, Tahmina Banu, Tim Beacon, Stephen Bickler, Zaitun Bokhari, Hiranya Kumar Borah, Eric Borgstein, Nick Boyd, Jason Brill, Britta Budde-Schwartzman, Marilyn Butler, Bruce Bvulani, Sarah Cairo, Juan Francisco Campos Rodezno, Milind Chitnis, Maija Cheung, Bruno Cigliano, Tessa Concepcion, Scott Corlew, Sergio D’Agostino, Shukri Dahir, Bailey Deal, Miliard Derbew, Sushil Dhungel, Elizabeth Drum, Stella Eguma, Beda R. Espineda, Samuel Espinoza, Faye Evans, Jacques Fadhili Bake, Diana Farmer, Tatiana Fazecas, Mohammad Rafi Fazli, Graham Fieggen, Anthony Figaji, Jean Louis Fils, Randall Flick, Gacelle Fossi, George Galiwango, Mike Ganey, Zipporah Gathuya, Maryam Ghavami Adel, Vafa Ghorban Sabagh, Hetal Gohil, Laura Goodman, David Grabski, Sarah Greenberg, Russell Gruen, Rahimullah Hamid, Erik Hansen, William Harkness, Mauricio Herrera, Intisar Hisham, Andrew Hodges, Sarah Hodges, Ai-Xuan Holterman, Andrew Howard, Romeo Ignacio, Dawn Ireland, Enas Ismail, Rebecca Jacob, Anette Jacobsen, Deeptiman James, Ebor Jacob James, Adiyasuren Jamiyanjav, Kathy Jenkins, Guy Jensen, Maria Jimenez, Tarun John K Jacob, Walter Johnson, Anita Joselyn, Nasser Kakembo, Neema Kaseje, Bertille Ki, Phyllis Kisa, Peter Kim, Krishna Kumar, Rashmi Kumar, Charlotte Kvasnovsky, Ananda Lamahewage, Christopher Lavy, Colin Lazarus, Chelsea Lee, Basil Leodoro, Allison Linden, Katrine Lofberg, Jerome Loveland, Leecarlo Millano Lumban Gaol, Vrisha Madhuri, Pavrette Magdala, Luc Kalisya Malemo, Aeesha Malik, John Mathai, Marcia Matias, Bothwell Mbuwayesango, Merrill McHoney, Liz McLeod, Mubarak Mohamed, Ivan Molina, Ashika Morar, Zahid Mukhtar, Mulewa Mulenga, Bhargava Mullapudi, Jack Mulu, Byambajav Munkhjargal, Arlene Muzira, Mary Nabukenya, Mark Newton, Karissa Nguyen, Laurence Isaaya Ntawunga, Peter M. Nthumba, Alp Numanoglu, Benedict Nwomeh, Kristin Ojomo, Keith Oldham, Maryrose Osazuwa, Doruk Ozgediz, Emmanuel Owusu Abem, Shazia Peer, Norgrove Penny, Robin Petroze, Vithya Priya, Ekta Rai, Lola Raji, Vinitha Paul Ravindran, Desigen Reddy, Yona Ringo, Amezene Robelie, Jose Roberto Baratella, David Rothstein, Coleen Sabatini, Soumitra Saha, Lily Saldaña Gallo, John Sekabira, Bello B. Shehu, Ritesh Shrestha, Sabina Siddiqui, David Sigalet, Martin Situma, Adrienne Socci, Etienne St-Louis, Jacob Stephenson, Erin Stieber, Richard Stewart, Vinayak Shukla, Thomas Sims, Faustin Felicien Mouafo Tambo, Robert Tamburro, Mansi Tara, Ahmad Tariq, Reju Thomas, Leopold Torres Contreras, Stephen Ttendo, Benno Ure, Luca Vricella, Luis Vasquez, Vijayakumar Raju, Jorge Villacis, Gustavo Villanova, Catherine deVries, Amira Waheeb, Saber Waheeb, Albert Wandaogo, Anne Wesonga, Sigal Willner, Nyo Nyo Win, Hussein Wissanji, Paul Mwindekuma Wondoh, Garreth Wood, Benjamin Yapo, Yasmine Yousef, Denle'wende' Sylvain Zabsonre, Luis Enrique, Zea Salazar, and Adiyasuren Zevee
Subjects: Medicine
Abstract: Objectives The optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.Design This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participants We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measures We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).Findings There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.Conclusions We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.
Published: 2020
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3. Pediatric Surgical Waitlist in Low Middle Income Countries During the COVID-19 Pandemic

Author: Greg Klazura, Paul Park, Ava Yap, Ruth Laverde, Emma Bryce, Maija Cheung, Ernestina Bioh, Phyllis Kisa, Nasser Kakembo, Michele Ugazzi, Martin Situma, Eric Borgstein, Miliard Derbew, Samuel Negash, Amezene Tadesse, Bruce Bvulani, Bertille Ki, Tapsoba Toussaint, Zaitun Bokhary, Godfrey Sama Philipo, Emmanuel Ameh, Mulenga Mulewa, Jonathan Mwansa, Ifeanyichukwu Onah, Vanda Amado, Daniel De Ugarte, Fabian Massaga, Samwel Byabato, Wasiu Lanre Adeyemo, Olugbemiga Ogunlewe, Bip Nandi, and Doruk Ozgediz
Subjects: Surgery
Published: 2023
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4. Cost-Effectiveness of a Pediatric Operating Room Installation in Sub-Saharan Africa

Author: Ava Yap, Salamatu I. Halid, Nancy Ukwu, Ruth Laverde, Paul Park, Greg Klazura, Emma Bryce, Maija Cheung, Elliot Marseille, Doruk Ozgediz, and Emmanuel A. Ameh
Abstract: The unmet need for pediatric surgery incurs enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of economic impact data on improving pediatric surgical infrastructure in SSA precludes informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and maintaining a pediatric operating room in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of two dedicated pediatric operating rooms (ORs), which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital’s operative registry and prior literature. A societal perspective included costs incurred by the hospital system, charity, and patients’ families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation were presented from charity and societal perspectives. One-way and probabilistic sensitivity analyses were performed. We found that the installation and maintenance of two pediatric operating rooms averted 1145 DALYs and cost $155,509 annually. Annualized OR installation cost was $87,728 (56% of the overall cost). The ICER of the OR installation was $152 per DALY averted (95% uncertainty interval [UI] 147-156) from the societal perspective, and $77 per DALY averted (95% UI 75-81) from the charity perspective. These ICERs were well under the cost-effectiveness threshold of the country’s half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional pediatric operating rooms in SSA with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children’s global surgical infrastructure as an economically sound intervention.
Published: 2023
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5. Pediatric Surgical Waitlist in LMICs during the COVID-19 Pandemic

Author: Greg Klazura, Paul Park, Ava Yap, Ruth Laverde, Emma Bryce, Maija Cheung, Ernestina Bioh, Sacha Hamilton, Phyllis Kisa, Nasser Kakembo, Michele Ugazzi, Martin Situma, Eric Borgstein, Miliard Derbew, Samuel Negash, Amezene Tadesse, Bruce Bvulani, Bertille Ki, Tapsoba Toussaint, Zaitun Bokhary, Godfrey Sama, Emmanuel Ameh, Mulenga Mulewa, Jonathan Mwansa, Ifeanyichukwu Onah, Vanda Amado, Daniel Ugarte, Fabian Massaga, Samwel Byabato, Wasiu Lanre Adeyemo, Olugbemiga Ogunlewe, Bip Nandi, and Doruk Ozgediz
Abstract: Purpose: COVID-19 led to significant reduction in surgery worldwide. Studies, however, of the effect on surgical volume for pediatric patients in low- and middle-income countries (LMICs) are limited.Methods: A survey was developed to estimate waitlists in LMICs for priority surgical conditions in children. The survey was piloted and revised before it was deployed over email to 19 surgeons. Pediatric surgeons at 15 different sites in 8 countries in Sub-Saharan Africa and Ecuador completed the survey from February 2021 to June 2021. The survey included the total number of children awaiting surgery and estimates for specific conditions. Respondents were also able to add additional procedures. Results: Public hospitals had longer wait times than private facilities. The median waitlist was 90 patients and the median wait time was 2 months for elective surgeries.Conclusion: Lengthy surgical wait times affect surgical access in LMICs. COVID-19 had been associated with surgical delays around the world, exacerbating existing surgical backlogs. Our results revealed significant delays for elective, urgent and emergent cases across Sub-Saharan Africa. Stakeholders should consider approaches to scale the limited surgical and perioperative resources in LMICs, create mitigation strategies for future pandemics, and establish ways to monitor waitlists on an ongoing basis.
Published: 2022
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6. Development of an Operative Trauma Course in Uganda—A Report of a Three-Year Experience

Author: Matthew M. Fleming, Doruk Ozgediz, Sarah Ullrich, Jackie Mabweijano, Martha Namugga, Moses Galukande, Whitney Fu, Ronald Kabuye, Gideon K. Kurigamba, Kevin Y. Pei, Michael P. DeWane, and Maija Cheung
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Young Adult, 03 medical and health sciences, Skills training, Injury Severity Score, 0302 clinical medicine, Surveys and Questionnaires, Laparotomy, Case log, Health care, medicine, Humans, Uganda, In patient, Child, Surgeons, business.industry, Significant difference, Internship and Residency, Middle Aged, Additional research, Interdisciplinary Placement, Treatment Outcome, Traumatology, Child, Preschool, Surgical Procedures, Operative, 030220 oncology & carcinogenesis, Cohort, Physical therapy, Health Resources, Wounds and Injuries, Female, 030211 gastroenterology & hepatology, Surgery, Clinical Competence, Curriculum, business
Abstract: Trauma is a leading cause of morbidity and mortality in low-income countries. Improved health care systems and training are potential avenues to combat this burden. We detail a collaborative and context-specific operative trauma course taught to postgraduate surgical trainees practicing in a low-resource setting and examine its effect on resident practice.Three classes of second year surgical residents participated in trainings from 2017 to 2019. The course was developed and taught in conjunction with local faculty. The most recent cohort logged cases before and after the course to assess resources used during initial patient evaluation and operative techniques used if the patient was taken to theater.Over the study period, 52 residents participated in the course. Eighteen participated in the case log study and logged 117 cases. There was no statistically significant difference in patient demographics or injury severity precourse and postcourse. Postcourse, penetrating injuries were reported less frequently (40 to 21% P 0.05) and road traffic crashes were reported more frequently (39 to 60%, P 0.05). There was no change in the use of bedside interventions or diagnostic imaging, besides head CT. Of patients taken for a laparotomy, there was a nonstatistically significant increase in the use of four-quadrant packing 3.4 to 21.7%) and a decrease in liver repair (20.7 to 4.3%).The course did not change resource utilization; however, it did influence clinical decision-making and operative techniques used during laparotomy. Additional research is indicated to evaluate sustained changes in practice patterns and clinical outcomes after operative skills training.
Published: 2020
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7. Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries

Author: Gideon K. Kurigamba, Doruk Ozgediz, John Sekabira, Maija Cheung, Daniel Semakula, Vivian Valin Akello, David F. Grabski, James M. Healy, and Nasser Kakembo
Subjects: Male, Pediatrics, medicine.medical_specialty, business.industry, Mortality rate, Infant, General Medicine, Disease, Evidence-based medicine, medicine.disease, Tertiary referral hospital, Intussusception (medical disorder), Pediatrics, Perinatology and Child Health, Pediatric surgery, medicine, Humans, Female, Uganda, Surgery, Prospective Studies, Presentation (obstetrics), business, Intussusception, High income countries
Abstract: Purpose In high-income countries the presentation and treatment of intussusception is relatively rapid, and most cases are correctable with radiographically-guided reduction. In low-income countries, many delays affect outcomes and surgical intervention is required. This study characterizes the burden and outcome of pediatric intussusception in Uganda. Methods Prospective case series of intussusception cases from May 2015 to July 2016 at a tertiary referral hospital in Uganda. Results Forty patients were included in the study. Male to female ratio was 3:2. Average duration of symptoms before presentation was 4.5 days. Median duration of symptoms in referred patients was 4 days and 2 days in non-referred patients (P value 0.0009). All 40 patients underwent surgical treatment: 25% had resection and enterostomy, 15% had resection and primary anastomosis, 2.5% had resection, primary anastomosis and enterostomy and 57.5% underwent manual reduction. Mortality was 32% and febrile patients on admission were 20 times more likely to die (P value 0.040). Conclusion Intussusception carries a high operative and mortality rate in Uganda. Referred patients presented later than non-referred patients to health facilities. Fever on examination at admission was positively associated with mortality. This disease remains a target for quality metrics in global pediatric surgery. Type of study Diagnostic study. Level of Evidence III
Published: 2020
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8. Burden of Surgical Infections in a Tertiary-Care Pediatric Surgery Service in Uganda

Author: Doruk Ozgediz, Tamara N. Fitzgerald, Maija Cheung, Nasser Kakembo, Phyllis Kisa, Arlene Muzira, David F. Grabski, and John Sekabira
Subjects: Male, Microbiology (medical), medicine.medical_specialty, Disease, Infections, Tertiary care, Tertiary Care Centers, Delayed presentation, Intervention (counseling), Pediatric surgery, Humans, Medicine, Uganda, Hospital Mortality, Prospective Studies, Child, Intensive care medicine, Developing Countries, Service (business), business.industry, Infant, Newborn, Infant, Infectious Diseases, Child, Preschool, Female, Surgery, business, Surgical Infections
Abstract: Background: Delayed presentation of surgical disease often leads to infection in low- and middle-income countries (LMICs). In addition, many primary infections require surgical intervention. The bu...
Published: 2020
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9. Development of a Post-Operative Mortality Calculator for Pediatric Surgical Patients in Low- And Middle- Income Countries Using Machine Learning

Author: Lauren Eyler Dang, Gregory Klazura, Ava Yap, Doruk Ozgediz, Maija Cheung, Emma Bryce, and Emmanuel A. Ameh
Subjects: History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published: 2022
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10. Navigating the COVID-19 Pandemic

Author: Martha Namugga, Sarah Ullrich, Maija Cheung, Doruk Ozgediz, Melanie Kay Sion, and Peter S. Yoo
Subjects: medicine.medical_specialty, Food security, Evidence-based practice, Poverty, business.industry, Health equity, Surgery, 03 medical and health sciences, 0302 clinical medicine, Geography, 030220 oncology & carcinogenesis, Health care, medicine, Global health, 030211 gastroenterology & hepatology, Social media, Social determinants of health, business
Abstract: Many hospitals in HIC rely on just-in-time inventory management, which can be an effective method to cut down on costs, as it calls for minimal reserves of healthcare supplies However, the widespread use of such strategies, which are reliant on consistent and tightly controlled supply chains, have made HIC vulnerable to PPE and supply shortages should demand sharply increase, as has been seen with the COVID-19 pandemic In some HIC hospitals, healthcare workers facing PPE shortages have already had to adopt common practices from LMIC, such as using bin liners instead of gowns and wearing reusable cloth masks HIC providers have also implemented evidence based adaptations, such as creating reusable elastomeric respirators, the development of open source ventilators, and reprocessing N95 masks using the hydrogen peroxide vapor sterilization technique Learning how LMIC providers manage resource limitations through global surgery collaborations can give surgeons working in HIC valuable perspective that has become increasingly relevant during the COVID-19 pandemic The rapid expansion of social media has facilitated such collaborations, and is a valuable tool for networking, mentorship, and information sharing Additionally, the rapid sharing of research findings via social media is enhancing our ability as a global health community to respond to this pandemic in a strong evidence based manner However, it is essential that social media be used responsibly, and that precautions are taken to prevent the spread of misinformation The most vulnerable populations, often linked to the underlying social determinants of health such as poverty, food security, literacy, sex, and racial and ethnic factors, are most at risk of adverse outcomes during these health and social shocks There is already data demonstrating that racial and ethnic minorities in the US and UK are at increased risk of death from COVID-19 Difficulty in accessing care for emergent conditions exists at baseline for these populations, and extensive backlogs for essential operations are commonplace, especially in LMIC This is likely only to get worse during the current crisis and underscores the importance of our professional commitment to health equity - regardless of geography New estimates of the "collateral damage" caused by the pandemic are very concerning and also illustrate the urgent need to mitigate this impact through local and global coordinated action
Published: 2020
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11. Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

Author: Sarah Ullrich, Nensi Rizgar, Arlene Muzira, Phyllis Kisa, Maija Cheung, Nasser Kakembo, John Sekabira, Doruk Ozgediz, and David F. Grabski
Subjects: Male, medicine.medical_specialty, Pediatrics, Disease, Infections, Tertiary referral hospital, Congenital Abnormalities, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, 030225 pediatrics, Intussusception (medical disorder), Epidemiology, Pediatric surgery, medicine, Humans, Uganda, Hospital Mortality, Prospective Studies, Omphalocele, Gastroschisis, business.industry, Mortality rate, Infant, Newborn, Infant, General Medicine, medicine.disease, Hospitalization, Child, Preschool, Pediatrics, Perinatology and Child Health, Wounds and Injuries, Female, 030211 gastroenterology & hepatology, Surgery, business
Abstract: The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited. Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016. 2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung’s, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%). There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.
Published: 2019
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12. Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda

Author: Monica Langer, Peter Ssenyonga, Doreen Birabwa-Male, Norgrove Penny, Arlene Muzira, Gustavo A. Villalona, Bindi Naik-Mathuria, Phyllis Kisa, Innocent Okello, Martin Situma, Martin Ogwang, Bruno Cigliano, David Cunningham, Brian H. Cameron, Doruk Ozgediz, Mary T. Nabukenya, Domenico Gerolmini, Eleanor Reimer, Maija Cheung, Faye M. Evans, Coleen S. Sabatini, Jolly Nankunda, Gillian Barker, David F. Grabski, Doreen Nakku, Damian Duffy, John Sekabira, Tamara N. Fitzgerald, George Galiwango, Moses Muhumuza, Joyce Kambugu, Robert Baird, Marcello Gerolmini, Nasser Kakembo, Margaret Ajiko, Geoffrey K. Blair, Kokila Lakhoo, Janat Tumukunde, Sergio D’Agostino, and Raffaele Aspide
Subjects: medicine.medical_specialty, Perioperative nursing, Service delivery framework, Child Health Services, education, 030230 surgery, Specialties, Surgical, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Multidisciplinary approach, Health care, Humans, Medicine, Uganda, Cooperative Behavior, Child, Developing Countries, business.industry, Attendance, Surgery, Outreach, 030220 oncology & carcinogenesis, Anesthesia, Workforce, business, Pediatric anesthesia
Abstract: There is a significant unmet need for children’s surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children’s surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders’ meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. The stakeholders’ meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and short-term objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. Collaborations between disciplines, both within LMICs and with international partners, are required to advance children’s surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children’s surgical capacity. Such a process may prove useful in other LMICs with a wide range of children’s surgery stakeholders.
Published: 2019
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13. The Role of Positron Emission Tomography in Bariatric Surgery Research: a Review

Author: Mathieu Norcross, Maija Cheung, Jason Bini, and Andrew J. Duffy
Subjects: medicine.medical_specialty, Food intake, Malabsorption, Endocrinology, Diabetes and Metabolism, Incretin, Bariatric Surgery, Weight loss, Weight Loss, medicine, Radioligand, Humans, Obesity, Receptor, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, digestive, oral, and skin physiology, Pet imaging, medicine.disease, Surgery, Obesity, Morbid, Positron emission tomography, Positron-Emission Tomography, medicine.symptom, business
Abstract: Bariatric surgery, initially understood as restricting or bypassing the amount of food that reaches the stomach to reduce food intake and/or increase malabsorption of food to promote weight loss, is now recognized to also affect incretin signaling in the gut and promote improvements in system-wide metabolism. Positron emission tomography (PET) is an imaging technique whereby patients are injected with picomolar concentrations of radioactive molecules, below the threshold of having physiological effects, to measure spatial distributions of blood flow, metabolism, receptor, and enzyme pharmacology. Recent advances in both whole-body PET imaging and radioligand development will allow for novel research that may help clarify the roles of peripheral and central receptor/enzyme systems in treating obesity with bariatric surgery.
Published: 2021

14. Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective

Author: Maija Cheung, Doruk Ozgediz, Reza Yaesoubi, Phyllis Kisa, Ava Yap, George G. Youngson, David Cunningham, John Sekabira, Nasser Kakembo, Arlene Muzira, and James M. Healy
Subjects: Counterfactual thinking, Comparative Effectiveness Research, Operating Rooms, Cost effectiveness, Cost-Benefit Analysis, out-of pocket, wages, infrastructure, outcomes, Medical and Health Sciences, Pediatrics, Gross domestic product, 0302 clinical medicine, Models, cost, Per capita, Medicine, Uganda, Child, health care economics and organizations, Pediatric, DALY, disability-adjusted life year, expenditure, cost-effectiveness analysis, Health Services, Investment (macroeconomics), Models, Economic, operating room, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Public Health, medicine.medical_specialty, Economic, Article, 03 medical and health sciences, Clinical Research, pediatric surgery, Disability-adjusted life year, Humans, Operations management, Government, business.industry, Public health, charity, Good Health and Well Being, Cost Effectiveness Research, Surgery, installation, business
Abstract: OBJECTIVE: To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective. BACKGROUND: Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children. METHODS: In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%. FINDINGS: In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country’s gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses. CONCLUSION: Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.
Published: 2021

15. Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

Author: Bruno Cigliano, Peter Kayima, Martin Ogwang, David F. Grabski, Damian Duffy, John Sekabira, Mary T. Nabukenya, Tamara N. Fitzgerald, Margaret Ajiko, Phyllis Kisa, Janat Tumukunde, Sergio D’Agostino, Maija Cheung, Robert Baird, Monica Langer, Doruk Ozgediz, David Nyeko, Nensi M. Ruzgar, and Nasser Kakembo
Subjects: Male, medicine.medical_specialty, Referral, Hospitals, Rural, 030230 surgery, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Pediatric surgery, Medicine, Humans, Hernia, Uganda, Hospital Mortality, Prospective Studies, Child, Surgeons, Case volume, business.industry, Surgical care, Infant, Newborn, Infant, Surgical procedures, medicine.disease, Hospitals, Pediatric, Surgical access, Anesthesiologists, 030220 oncology & carcinogenesis, Anesthesia, Child, Preschool, Surgical Procedures, Operative, Surgery, Female, Rural area, business, Follow-Up Studies
Abstract: Background Significant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children’s surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity. Methods Two years of a prospective clinical database of children’s surgery admissions at 2 regional referral hospitals in Uganda were reviewed. Primary outcomes included case volume and clinical outcomes of children at each hospital. Additionally, the disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Using a value of statistical life calculation, we also estimated the economic benefit of the pediatric surgical care currently being delivered. Results From 2016 to 2019, more than 300 surgical procedures were performed at each hospital per year. The majority of cases were standard general surgery cases including hernia repairs and intussusception as well as procedures for surgical infections and trauma. In-hospital mortality was 2.4% in Soroti and 1% in Lacor. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted life-years averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society. Conclusion This investigation demonstrates that lifesaving pediatric procedures are safely performed by general surgeons in Uganda. General surgeons who perform pediatric surgery significantly increase surgical access to rural regions of the country and add a large economic benefit to Ugandan society. Overall, the results of the study support increasing pediatric surgical capacity in rural areas of low- and middle-income countries through support and training of general surgeons and anesthesia providers.
Published: 2021

16. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Author: Naomi Jane Wright, Andrew J.M. Leather, Niyi Ade-Ajayi, Nick Sevdalis, Justine Davies, Dan Poenaru, Emmanuel Ameh, Adesoji Ademuyiwa, Kokila Lakhoo, Emily Rose Smith, Abdel Douiri, Maria Elstad, Marcus Sim, Cristiana Riboni, Bruno Martinez-Leo, Melika Akhbari, Stephen Tabiri, Ashrarur Mitul, Dayang Anita Abdul Aziz, Camila Fachin, Alliance Niyukuri, Muhammad Arshad, Fowzia Ibrahim, Natalie Moitt, Mohamed Fahmy Doheim, Hannah Thompson, Harmony Ubhi, Isabelle Williams, Sophia Hashim, Godfrey Sama Philipo, Laura Herrera, Aayenah Yunus, Dominique Vervoort, Samuel Parker, Yousra-Imane Benaskeur, Osaid H. Alser, Nana Adofo-Ansong, Ahmad Alhamid, Hosni khairy Salem, Mahmoud Saleh, Safa Abdal Elrais, Sadi Abukhalaf, Patricia Shinondo, Ibrahim Nour, Emrah Aydin, Agota Vaitkiene, Kelly Naranjo, Andile Maqhawe Dube, Sodumisa Ngwenya, Mina A. Yacoub, Henang Kwasau, Gabriella Hyman, Shrouk Mahmoud Elghazaly, Ibrahim Al-Slaibi, Intisar Hisham, Helena Franco, Hana Arbab, Lubna Samad, Aqil Soomro, Muhammad Amjad Chaudhry, Safina Karim, Muhammad Adnan Khan Khattak, Shireen Anne Nah, Doris Mae Dimatatac, Candy SC Choo, Niveshni Maistry, Ashrarur Rahman Mitul, Samiul Hasan, Sabbir Karim, Hina Yousuf, Taimur Qureshi, Ibrahim Rabi Nour, Raed Nael Al-Taher, Osama Abdul Kareem Sarhan, Luis Garcia-Aparicio, Jordi Prat, Eva Blazquez-Gomez, Xavier Tarrado, Martí Iriondo, Paolo Bragagnini, Segundo Rite, Lars Hagander, Emma Svensson, Sheila Owusu, Alhassan Abdul-Mumin, Dominic Bagbio, Vijay Anand Ismavel, Ann Miriam, Shajin T, Marlene Anaya Dominguez, Monica Ivanov, Andreea Madalina Serban, Miliard Derbew, Mahmoud Elfiky, Maricarmen Olivos Perez, Marcia Abrunhosa Matias, Alexis P Arnaud, Ahmed Negida, Sebastian King, Mohamad Rafi Fazli, Nadia Hamidi, Souhem Touabti, Rossana Francisco Chipalavela, Pablo Lobos, Brendan Jones, Damir Ljuhar, Georg Singer, Annelien Cordonnier, Lorena Jáuregui, Zlatan Zvizdic, Janice Wong, Etienne St-Louis, Qiang Shu, Yang Lui, Catalina Correa, Lucie Pos, Elvyn Alcántara, Erick Féliz, Luis Enrique Zea-Salazar, Liza Ali, Matthieu Peycelon, Nzanzu Kipata Anatole, Cherno S. Jallow, Judith Lindert, Dhruv Ghosh, Cathline Freya Adhiwidjaja, Ahmad Khaleghnejad Tabari, Saran Lotfollahzadeh, Haidar Mohammad Mussein, Fabrizio Vatta, Noemi Pasqua, David Kihiko, Hetal Gohil, Ibrahim R. Nour, Muhammed Elhadi, Suad Ahmed Almada, Gilvydas Verkauskas, Toni Risteski, Alejandro Peñarrieta Daher, Oumaima Outani, James Hamill, Taiwo Lawal, Jack Mulu, Benjamin Yapo, Lily Saldaña, Beda Espineda, Krystian Toczewski, Eugene Tuyishime, Isaac Ndayishimiye, Enaam Raboe, Philip Hammond, Gregor Walker, Ivona Djordjevic, Milind Chitnis, Joonhyuk Son, Sanghoon Lee, Muaad Hussien, Sawazen Malik, Enas Musa Ismail, Ampaipan Boonthai, Nesrine Ben Hadj Dahman, Nigel Hall, Fabiola Ruth Castedo Camacho, Helena Sobrero, Marilyn Butler, Aliev Makhmud, Nathan Novotny, Ahmad G. Hammouri, Maisara Al-Rayyes, Bruce Bvulani, Qais Muraveji, Muhammad Yousuf Murzaie, Ajmal Sherzad, Sayed Aman Haidari, Abdul Baqi Monawar, Dr. Ahmad Zia Samadi, Jesh Thiessen, Ntakarutimana Venant, Sonia Inamuco Hospital, Niyonkuru Jérémie, Jean Claude Mbonicura, Butoyi Jean Marie Vianney, Amezene Tadesse, Samuel Negash, Charles A. Roberts, John N. Jabang, Abdoulie Bah, Kajali Camamra, Armandou Correa, Babucarr Sowe, A. Gai, Musa Jaiteh, Kwizera Jean Raymond, Jean Paul Mvukiyehe, Innocent Itangishaka, Emmanuel Kayibanda, Emery Manirambona, Joseph Lule, Ainhoa Costas-Chavarri, Ian Shyaka Gashugi, Albert Ndata, Georges Gasana, Yves Castar Nezerwa, Turatsinze Simeon, Jean De Dieu Muragijimana, Sakina Rashid, David Msuya, Joseph Elisante, Meghna Solanki, Emmanuel Manjira, Jay Lodhia, Mubashir Jusabani, Murad Tarmohamed, Sengua Koipapi, Touabti Souhem, Nabti Sara, Brahimi Sihem, Bouguermouh Dania, Iaiche Achour Toufik, Baghdadi Nour el islam Mounira, Alouani Habiba, Liliana Aragão, Victor Gonçalves, Marcelo Mauricio Lino Urquizo, Maria Florencia Varela, Pedro Mercado, Bonavia Horacio, Andrea Damiani, Carlos Mac, Daniel Putruele, Karen Liljesthrom, Marianela Bernaus, Cesar Jauri, Alejandrina Cripovich, Ezequiel Bianchin, Maria Gabriela Puig, Lorna Andreussi, Susana Iracelay, Dolores Marcos, Carina Herrera, Nelly Palacios, Romina Avile, Belen Serezo, Debora Montoya, Rodrigo Cepeda, Justo Vaquila, Sofficci Veronica, Liliana Pardo, Pelussi Valeria, Lapalma Julio, Aranda Diego Martin, Palazzi Lucio, Comba Gabriel, Depetrini Marianella, José Alfredo Calderón Arancibia, Enrique Huespe, Gabriela Natalia Losa, Elsa Arancibia Gutiérrez, Humberto Scherl, Daniel Emilio Gonzalez, Valentina Baistrocchi, Yanina Silva, Marcelo Galdeano, Pablo Medard, Ines Sueiras, Enrique Romero Manteola, Victor Hugo Defago, Carlos Mieres, Carlos Alberto, Fabio Cornelli, Marcelo Molina, Pablo Ravetta, Celeste Carolina Patiño Gonzalez, Maria Belen Dallegre, Maria Tatiana Szklarz, Marcos Federico Leyba, Nahuel Ignacio Rivarola, Maria Delia Charras, Adriana Morales, Paloma Caseb, Luzia Toselli, Carolina Millán, Maria del Carmen Junes, Oscar Di Siervi, Jose Gilardi, Soledad Simon, Carla Sofia Contreras, Nair Rojas, Lucia Beatriz Arnoletto, Otilia Eva Blain, Mauro Nicolas Bravo, Nancy Sanchez, Luciana Martina Herrera Pesara, Maria Eugenia Moreno, Carlos Ariel Sferco, Umama Huq, Tamanna Ferdousi, Abdullah Al-Mamun, Sadia Sultana, Refoyez Mahmud, Khalid Mahmud, Fatema Sayeed, Alexander Svirsky, Denisse Sempertegui, Amalia Negrete, Araceli Teran, Mariana Sadagurschi, Nusret Popovic, Kenan Karavdic, Emir Milisic, Asmir Jonuzi, Amira Mesic, Sabina Terzic, Nejra Dendusic, Elna Biber, Anesa Sehic, Nada Zvizdic, Emina Letic, Adna Saracevic, Ajla Hamidovic, Nejra Selak, Dzan Horozic, Lamija Hukic, Amila Muhic, Nedim Vanis, Emir Sokolovic, Adnan Sabic, Karin Becker, Elis Novochadlo Klüppel, André Iván Bradley dos Santos Dias, Miguel Angelo Agulham, Cristiano Bischoff, Stella Sabbatini, Rachel Fernandes de Souza, Ana Beatriz Souza Machado, Juliana Werneck Raposo, Maria Lucia da Silva Augusto, Bianca M.R. Martins, Mariana de Souza Santos Ferreira, Darli Fernandes de Oliveira, Carla Silva dos Santos, Fernanda Ribeiro de Fernández y Alcázar, Érika Alves Dutra da Silva, Mariana Furtado, Horácio Tamada, Marília Silva Ferreira dos Santos, Thayná Lopes de Almeida, Susy Oliveira de Andrade, Antonio Cipriano Gurgel do Amaral, Lais Sartori Giovanoni, Kamila de Deus Passos Leles, Eduardo Corrêa Costa, Leticia Feldens, Luciano Ferraz Schopf, José Carlos Soares de Fraga, Felipe Colombo de Holanda, Paola Maria Brolin Santis Isolan, Julia Loyola Ferreira, Carla Luisa Bruxel, Danielle Lopes Teixeira Ferdinando, Fabricio Zottis Barcelos, Natalia Baseggio, Nicole Knorr Brenner, Rafael Trindade Deyl, Carolina Dure, Iuri Nunes Kist, Rafael Bueno Mazzuca, Sarah Bueno Motter, Yna Ramos, Cristine Suzana Trein, Bianca Rezende Rosa, Murilo de Assis Silva, Flavio Augusto Menin, Isabela Cristina Semensato Carloni, Juliana Antinarelli Norberto da Silva, Adriano Luis Gomes, Mariana Girão Tauffer, Paulo César Bassan Gonçalves, Geraldo Magela Nogueira Marques, Eliane Moriya, Carla Labonia, Ana Lucia Carrasco, Karine Furtado Meyer, Luiz Farion-Aguiar, Fernando Amado, Amanda Antunes, Elisângela Silva, Leila Telles, Giovana Almeida, Aluísio Augusto Belmino Gadelha, Flavia de Azevedo Belesa, Acimar Gonçalves da Cunha, Jr, Beatriz Souza Barros, Josiane Bernartt Zanellato, Patricia Guimarães, Karina Ilheu da Silva, Bianca Ribas, Cristina Reuter, Francis Tanise Casado, Mila Torii Correa Leite, Daniela Testoni, Ruth Guinsburg, Simone de Campos Vieira Abib, Edson Khodor Cury, Suely Dornellas do Nascimento, Arthur Almeida Aguiar, Rodrigo Melo Gallindo, Carolina Gonçalves Borges, Yang Liu, Cai Duote, Jinhu Wang, Zhigang Gao, Liang Liang, Wenjuan Luo, Xiaoxia Zhao, Rui Chen, Peng Wang, Yijiang Han, Ting Huang, Hu Donglai, Guo Xiaodong, Chen Junjie, Libin Zhu, Guowei Wu, Xiaozhou Bao, Haijing Li, Junying Lv, Zhongrong Li, Feng Yong, Zhou Chong Gao, Qiang Bai, Weibing Tang, Hua Xie, Jethishka Motee, Jianming Zhu, Gang Wen, Weiwei Ruan, Shungen Li, Lulu Chen, Shungen Huang, Zhibao Lv, Jinjing Lu, Liuming Huang, Mengnan Yu, Wang Dajia, Yu Zuo Bai, Luis Carlos Rincon, Juliana Mancera, Edgar Alzate Gallego, Laura Torres-Canchala, Nathalia Silva Beltrán, Ghordana Osorio Fory, Daniela Castaño Avila, Angelica Maria Forero Ladino, Juanita Gomez, Martha Jaramillo, Otto Morales, Beatriz Sanchez, Nestor Julien Tinoco Guzmán, Sergio Castañeda Espinosa, Osbaldo Prieto Vargas, Lina Maria Pardo, Eliana Toral, Freud Cáceres Aucatoma, Daniel Hinostroza, Santiago Valencia, Vicente Salinas, Enrique Landivar Cino, Gabriela Yulissa Ponce Fajardo, Miguel Astudillo, Virginia Garcia, Guillermo Muñoz, Leonardo Verduga, Ivan Verduga, Ericka Murillo, Elena Bucaram, Marisol Guayelema, Monica Marmol, Janina Sanchez, Carolina Vergara, Adriana Mena, Junior Velaña, Karla Salazar, Sandra Lara, Elena Chiriboga, Julian Silva, Dalia Gad, Doaa Samy, Menan Ahmed Elsadek, Hanan Mahmoud Mohammed, Mohamed Abouheba, Karim Osamy Ali, Hayssam Rashwan, Omar Moustafa Fawzy, Tarek mohamed Kamel, Rawan Nemer, Mohamed Abada Hassan, Eyad Hassan Falah, Dina Sobhy Abdelhady, Mostafa Zain, Eman Abouzeid Abouzeid Ibrahim, Omar Ossama Elsiraffy, Ahmed Aboelela, Eman mohamed Farag, Ahmed Mohamed Oshiba, Omar Sameh Emam, Alaa Mobarak Attia, Moustafa A. Laymouna, Islam Abdelmonem Ghorab, Mansour Mkayed Mohammed, Nourhan Akram Soliman, Khaled Abd elrahman Ghaly, Kareem Sadek, Mohamed Elsherbiny, Amr Saleh, Hesham Sheir, Tamer Wafa, Mohamed Abd Elmenam, Sherif Abdelmaksoud, Ahmed Reda, Islam Mansour, Mohamed Elzohiri, Basma Waseem, Mohamed Elewaily, Mohammed El-Ghazaly, Ahmad Elhattab, Amr Shalaby, Adham Elsaied, Ahmad Adawy, Mirna Sadek, Mahmoud Abdelfattah Ahmed, Mohamed Omar Herdan, Gena Mohamed Hamed Elassall, Azhar Arabi Mohammed, Mohammed Hamada Takrouney, Tarek Mohamed Essa, Ahmed Mokhtar Mahmoud, Alshaimaa M. Saad, Mariam Albatoul Nageh Fouly, Mahmoud abdelshakour Ibrahim, Mohammad Nageh, Mahmoud M. Saad, Helmy Badr, Mohamed Fayez Fouda, Ahmed Hassan Nofal, Hisham Almohamady, Mohamed Ahmed Arafa, Mohamed Amad, Mohamed Awad Mansour, Jennifer O'Connor, Zachary O'Connor, Nzanzu Anatole, Elysé Nkunzimana, Solomon Machemedze, Lemfuka Dieudonné, William Appeadu-Mensah, Theophilus Teddy Kojo Anyomih, Priscilla Alhassan, Francis A. Abantanga, Vishal Michael, Roshine Mary Koshy, Ankit Raj, Vijay Kumar, Sundeep PT, P Santosh Prabhu, Armin Vosoughi, Ali Farooq Al-Mayoof, Muhamed Jassim Fadhle, Ali Egab Joda, Hayder Nadhim Obaid Algabri, Sultan S. Abdelhamid, Hashem M. Al-Momani, Marzouq Amarin, Louay Y. Zaghlol, Nijmeh Nasser Alsaadi, Yasmeen Z. Qwaider, Hibah Qutishat, Ahmad Hasan Aliwisat, Esraa Arabiat, Isam Bsisu, Raghad M. Murshidi, Mohammad S. Jabaiti, Ziad A. Bataineh, Husam Aldean Abuhayyeh, Thekraiat M. Al Quran, Faris J. Abu Za'nouneh, Mohanad Mutasem Alebbini, Hamzah Abullah Qudah, Omar Ghazi Hussein, Amir M.I. Murad, Justin Z. Amarin, Haya H. Suradi, Sayel H. Alzraikat, Rand Y. Omari, Bashar M. Matour, Layana Al-Halbouni, Rajai O. Zurikat, Ahmad H. Yanis, Sara Al Hussein, Ali Shoubaki, Waleed H. Ghanem, Kuria David, Soita Wycliffe Chitiavi, Moraa Mose, Robert Mugo, James Ndungu, Timothy Mwai, Swaleh Shahbal, Janan Malik, Nirav Chauhan, Francisa Syovata, Kevin Ochieng, Polycarp Omendo Liyenzero, Syeda Ra'ana Hussain, Stanley Mugambi, Roseline Ochieng, Ebtesam Othman Abdulsalam Elkhazmi, Ala Khaled, Aya Albozidi, Manal Ben Enbaya, Mala Elgammudi, Enas Soula, Wegden ibrahim almabrouk Khalel, Yasmine Ali Elhajjaji, Nouriyah Ali Alwaggaa, Sumayyah Ghayth, Dafer abdulhakim .S. Zreeg, Sara Abobaker Tantush, Fatma Bibas, Tesneem Layas, Randa Alamen M Sharif, Wesal Omar F. Saied Aljadidi, Ahmed Tarek, Hazem Ahmed, Kamila Almabrouk Mohammed Essamilghi, Mabroka Alfoghi, Ma'aly A. Abuhlega, Saddam Arrmali, Fatima Mousa Abduljawad, Hasan Mustafa Alosta, Abdulsalam Abuajaila, Fakereldeen Abdelmutalib, Fatma Bashir, Inas Almengar, Mohammad hasan Annajjar, Abdelaziz Deyab, Fathi Elzowawi, Yousef Krayem, Weam Drah, Asma Meftah, Abobaker Mohammed, Lina Ali Arrmalli, Hajir Aljaboo, Abdallah Elayeb, Mohamed Altomi, Ahmed Altaweel, Mohamed Tumi, Hana Milad Bazozi, Aisha Shaklawoon, Mohammed Meftah Alglaib, Abdullahn Abdousalam Elkaloush, Sara Trainba, Hisham Swessi, Ali Alnaeri, Aya Essam Shnishah, Hamassat Mustufa, Sondas Ali Gargum, Sara Ali Tarniba, Hawa Ahmed Shalluf, Hajer Ali Shokri, Taher L. Sarkaz, Osama Tababa, Ahmed Elhadi, Vesna Cvetanovska Naunova, Laze Jovcheski, Marjan Kamilovski, Aleksandra Gavrilovska-Brzanov, Zarina Abdul Latiff, Siti Farhan Moh Pauzi, Marjmin Osman, Felicia Lim, Ainal Huda Abu Bakar, Azrina SK Zaman, Shareena Ishak, Rufinah Teo, Dr. Tammy Teoh Han Qi, Mohd Yusran Bin Othman, Dato' Dr Zakaria bin Zahari, Zulfitri bin Md Hassan, Cheah Hui Shan, Abhirrami Lechmiannandan, Hafatin Fairos bt Tamaddun, Mohd Fitri Shukri bin Mohamed Adanan, Mohd Yusof bin Abdullah, Wang Junyi, Mohd. Tarmizi Mohd Nor, Wan Ruzaimie Noor, Mohd Razin bin Hassan, Noor Fa'izatul Rahil Ambok Dalek, Hidayah Hayati binti Hashim, Ahmad Zulhisyam bin Zarwawi, V Muthualhagi M Vellusamy, Quah Soong Yuen, Hemasutha a/p Kannessan, Najua binti Ramli, Ahmad Shafiee bin Bujarimin, Jessmine Anntinea, Anthony Dass, Hazlina Mohd. Khalid, Nur Atiqah binti Mohd Hanifah, Keily Wong Yue Jyun, Rahilah binti Abd Razak, Nur Atifah binti Mohd Naim, Siti Nur Aien binti Hamid Hamzah, Cristian R. Zalles Vidal, Eduardo Bracho Blanchet, Roberto Dávila Perez, Emilio Fernandez Portilla, Raúl Villegas Silva, Daniel Ibarra, Antonio Calderon Moore, Cesar Carrasco-Ortega, Monica Noguez Castillo, Dorihela Herappe Mellado, Guillermo Yanowsky Reyes, Luis Fernando Gonzalez Cortez, Rafael Santana Ortiz, Jamie Orozco Perez, Jorge Román Corona C.Rivera, Juan Jose Cardenas Ruiz Velasco, Moises Quiles Corona, Christian Peña Padilla, Lucina Bobadilla Morales, Alfredo Corona Rivera, Izabel Maryalexandra Rios Flores, Cristian Irela Aranda Sánchez, Gabriela Ambriz-González, Nestor Martínez Hernández Magro, Francisco Javier León Frutos, José de Jesús Cárdenas Barón, Alejandro González Ojeda, Jessica Yarza Fernández, Juan Domingo Porras, Pastor Aguirre-Lopez, Vicente Sánchez Paredes, Arturo Montalvo Marin, Jose Manuel Diaz Gomez, Lorenzo Juvencio Caamal, David Bulnes Mendizabal, Pablo Sanchez Valladares, Humberto Garcia Martinez, Opeoluwa Adesanya, Moses Olanrewaju, Rilwan Adegboyega, Nurudeen Abdulraheem, Anuoluwapo Aremo, Florence Dedeke, Anyanwu Lofty-John Chukwuemeka, Mohammad Aminu Mohammad, Abdullahi Lawalbarau, Nwokoro Collins, Ogundele Ibukunolu, Amo Shonubi, Oluwaseun Ladipo-Ajayi, Olumide Abiodun Elebute, Justina Seyi-Olajide, Felix Alakaloko, George Ihediwa, Kayode Olayade, Christopher Bode, Olakayode Ogundoyin, Dare I. Olulana, Ifeanyichukwu Kelvin Egbuchulem, Felix O. Kumolalo, Ikechukwu Ulasi, Uchechukwu Obiora Ezomike, Sebastian Okwuchukwu Ekenze, Elochukwu Perpetua Nwankwo, Emmanuel Ifeanyi Nwangwu, Isaac Chukwu, Christopher Chim Amah, Nene Elsie Obianyo, Omolara Williams, Roland Iheanyichukwu Osuoji, Omolara Moronkeji Faboya, Olalekan Temitope Ajai, Moruf Adekunle Abdulsalam, Titiloye Hannah Agboola, Bolarinwa Bolanle Temilade, Maryrose Osazuwa, Morayo Monsurat Salawu, Eze Chukwuemeka Ejinkeonye, Mariya Mukhtar Yola, Amsa B. Mairami, Adekunle T. Otuneye, Matthias Igoche, Adebayo Gbenga Tanimola, Emmanuel Akinlabi Ajao, Efeturi Agelebe, Samson Olori, Philip Mari Mshelbwala, Olabisi Osagie, Adewale Oyinloye, Auwal M Abubakar, Lateef Oyebanji, Ibrahim Shehu, Cyril Cletus, Ahmed Bamanga, Faruk Suleiman, Sani Adamu, David C.Nwosu, Yahya S.Alkali, Iliya Jalo, Aliu Rasaki, Yusuf T.Sambo, Kalakwa A.Mohammed, Abubakar M.Ballah, Victor Modekwe, Okechukwu Hyginus Ekwunife, Ugochukwu S Ezidiegwu, Andrew N Osuigwe, Jideofor O Ugwu, Chuka A Ugwunne, Nadeem Akhter, Mudassir Fayaz Gondal, Rafee Raza, Ali Raza Chaudary, Hassan Ali, Muhammad Umar Nisar, Muhammad Umer Jamal, Ghuri Shankar Pandit, Uzma Mumtaz, Muhammad Bin Amjad, Nabila Talat, Wajeeh ur Rehman, Muhammad Saleem, Muhammad Bilal Mirza, Imran Hashim, Naveed Haider, Soban Hameed, Ayesha Saleem, Sohail Dogar, Muhammad Sharif, Muhammad Kashif Bashir, Fatima Naumeri, Zarqa Rani, Muath A.M. Baniowda, Basheer Ba'baa', Majd Yousef Mohammed Hassan, Ammar Darwish, Abrar Shaheen Sehwiel, Mohammed Shehada, Abrar ghassan Balousha, Yara Ajrami, Ainaa Ata Mohammad Alzamari, Bashar Yaghi, Hasan Subhi Hasan Abu Al-saleem, Mervat Sufian Abu Farha, Mohammad Omar Mohammad Abdelhafez, Firas Anaya, Asef belal Qadomi, Abd Al-Naser Bany Odi, Muath Abdelrahem Fuad Assi, Fadwa Sharabati, Ahmad Abueideh, Doha mustafa saleh Beshtawi, Hasan Arafat, Lara Zahi Adel Khatatba, Safa' Jamal Abatli, Hiba Al-Tammam, Dania Jaber, Yara Imad Omar Kayed, Ali Abdelhay Abumunshar, Rami Anwar Misk, Asmahan Mohammad Suliman Alzeer, Mutassem Sharabati, Ihsan Ghazzawi, Osama Majed Darras, Mahmoud M.Qabaja, Ma'alem sameer Hajajreh, Yasmeen Ahmad Samarah, Dua Hasan Yaghi, Moradallah Asad Fahmi Qunaibi, Abdelrazzaq Abu Mayaleh, Sharehan Joubeh, Annan Ebeido, Samer Adawi, Ihda Adawi, Mohammad Omar Ibrahim Alqor, Ahmad Samih Arar, Hadeel Awad, Fawzi Abu-Nejmah, Osaid Shaher Shabana, Firas Alqarajeh, Tareq Z. Alzughayyar, Jomana Madieh, Mahmoud Fuad Sbaih, Raghad mohammad abdu Alkareem, Raghad abdullateef Lahlooh, Yasmeen Adly Halabi, Wisam Baker, Tasneem Fathi Hasan Almusleh, Abdulraheem Adnan Abdulraheem Tahyneh, Yazid yousef mahmoud Atatri, Najlaa Abu Jamie, Nasrallah Ashraf Al Massry, Walaa Lubbad, Ayoub A.Nemer, Mohammed Alser, Aya Azmi Shehda Salha, Khaled Alnahhal, Aya Mahmoud Elmzyyen, Amir Talat Sheda Ghabayen, Abdulwhhab Ayman Abu Alamrain, Samar H. Al-Shwaikh, Omar Adly Elshaer, Nureddin Shaheen, Jehad Fares, Hisham Dalloul, Anas Qawwash, Mustafa abu Jayyab, Dina Ayman Ashour, Ahmad Ashraf Shaheen, Samy Rafat Ramadan Naim, Eman Abu Shiha, Nagham Mohammed Al Dammagh, Walaa Almadhoun, Ashraf Ayman Al-Salhi, Abdalkarim Yhya Hammato, Jamal Mohammed Salim, Doaa Khalil Hasanain, Soha Marwan Salem Alwadia, Ismail Nassar, Hala M. Al-Attar, Haya Abdulnasser Ali Alshaikhkhalil, Yasmin Mohammed Khalil Abu Jamie, Yara shareef Ashour, Sharif S. Alijla, Mohamed Anwer El Tallaa, Adham Ashraf Abuattaya, Bisan D.M. Wishah, MOHAMMED A.M. ALDIRAWI, Ahmed S Darwish, Sulaiman T. Alzerei, Nidal Wishah, Sharif Alijla, Isidora Garcia, Marlene Diaz Echegaray, Veronica Raquel Cañapataña Sahuanay, Fernando Trigoso Mori, Jackelyne Alvarado Zelada, Juan Jose Salinas Barreto, Porfirio Rivera Altamirano, Cesar Torres Miranda, Rocio Anicama Elias, Julio Rivera Alvarez, Juan Pedro Vasquez Matos, Fernando Ayque Rosas, Jesmarina Ledesma Peraza, Andrea Gutarra Palomino, Stephany Vega Centen, Victor Casquero, María Rosa Ortiz Argomedo, Francisco Lapouble, Genaro Llap Unchón, Florangel Patricia Delgado Malaga, Luis Ortega Sotelo, Segundo Gamboa Kcomt, Araceli Villalba Villalba, Nancy Rossana Mendoza Leon, Loreley Raquel Cardenas Alva, Maria Susana Loo Neyra, Cathy Lee Alanguia Chipana, Cintya Maria de Jesus Torres Picón, Natalia Huaytalla Quiroz, Danny Dominguez, Carlos Segura Calle, Jenny Arauco, Luis Ormeño Calderón, Ximena Ghilardi Silva, Miriam Daniela Fernandez Wilson, Joan Elizabeth Gutierrez Maldonado, Cesar Diaz Leon, Waldo Berrocal Anaya, Patricia Chavez Galvez, Prince Pamela Aguilar Gargurevich, Flor de Maria Diaz Castañeda, Carmen Guisse, Erika Ramos Paredes, Jose Luis Apaza Leon, Faye Aguilar Aguilar, Raul Ramirez De La Cruz, Lenny Flores Carbajal, Carlos Mendoza Chiroque, Gladys Johana Sulca Cruzado, Natalia Tovar Gutierrez, Jennifer Sotelo Sanchez, Carolina Paz Soldan, Karina Hernández Córdova, Edgar Fernando Delgado Quinteros, Luz Mery Brito Quevedo, Juan Jose Mendoza Oviedo, Angel Samanez Obeso, Patricia Paredes Espinoza, Johann de Guzman, Raisa Yu, Vlad Cosoreanu, Sebastian Ionescu, Aurel Mironescu, Lucian Vida, Adrian Papa, Roxana Verdeata, Bogdan Gavrila, Liviu Muntean, Marija Lukac, Miona Stojanovic, Djordje Toplicic, Milan Slavkovic, Andjelka Slavkovi, Dragoljub Zivanovic, Ana Kostic, Maja Raicevic, Delphine Nkuliza, Daniel Sidler, Corné de Vos, Elmarie vd Merwe, David Tasker, Omar Khamag, Cecilia Rengura, Thozama Siyotula, Uzair Jooma, Dirk von Delft, Marion Arnold, Hansraj Mangray, Shamaman Harilal, Sanele Madziba, Naveen Wijekoon, Tharanga Gamage, Benedict Paul Bright, Alaa Abdulrahman, Ola Ahmed Abdulmjeed Mohammed, Mohammed Salah, Ahmad Elian Abu Ajwa, Mohammed Morjan, Mohammad Mohannad Batal, Vivian Faks, Mohamad Bassel Mouti, Ahmadfateh Assi, Ahmad Al-Mouakeh, Ahmad Sankari Tarabishi, Ziad Aljarad, Aos Alhamid, Jiraporn Khorana, Wannisa Poocharoen, Sirima Liukitithara, Anan Sriniworn, Wasun Nuntasunti, Monawat Ngerncham, Ratiyaporn Phannua, Kanokrat Thaiwatcharamas, Patchareeporn Tanming, Lassaad Sahnoun, Nahla Kchiche, Roua Abdelmoumen, Egemen Eroğlu, Mehmet Ali Ozen, Hatice Sonay Yalçın Cömert, Mustafa İmamoğlu, Haluk Sarıhan, Şebnem Kader, Mehmet Mutlu, Yakup Aslan, Ahmet Beşir, Şükran Geze, Bahanur Çekiç, Ali Yalcinkaya, Kaan Sönmez, Ramazan Karabulut, Zafer Türkyılmaz, Kıvanç Şeref, Merve Altın, Merve Aykut, M.Eren Akan, Melisa Erdem, Ebru Ergenekon, Canan Türkyılmaz, Elif Keleş, Ali Canözer, Aslı Öztürk Yeniay, Elif Eren, İlknur Banlı Cesur, Zerrin Özçelik, Gökmen Kurt, Mustafa Kurthan Mert, Hatice Kaya, Müge Çelik, Suleyman Cuneyt Karakus, Nazile Erturk, Alev Suzen, Nilay Hakan, Fatih Akova, Mehmet Pasaoglu, Shukurali Eshkabilov, Rustam Z. Yuldashev, Dekhkonboev Avazjon Abdunomonovich, Aliev Makhmudjan Muslimovich, Azad Patel, Chisengo Kapihya, Nicholas Ensar, Ramesh M Nataraja, Mithila Sivasubramaniam, Matthew Jones, Warwick Teague, Sharman Tan Tanny, Gordon Thomas, Kiera Roberts, Soundappan Sannappa Venkatraman, Holger Till, Manon Pigeolet, Martine Dassonville, Anas Shikha, Win Sabai Phyu Win, Zahidah Adlynee Haji Ahmad, Léamarie Meloche-Dumas, Louise Caouette-Laberge, Dickens St-Vil, Ann Aspirot, Nelson Piché, Shahrzad Joharifard, Nadia Safa, Jean-Martin Laberge, Sherif Emil, Pramod Puligandla, Kenneth Shaw, Hussein Wissanji, Eileen Duggan, Elena Guadagno, Maria Consuelo Puentes, Paola Osses Leal, Carolina Mendez Benavente, Michal Rygl, Barbora Trojanová, Klára Berková, Tereza Racková, Ladislav Planka, Jan Škvařil, Radek Štichhauer, Shahad Sabti, Alex Macdonald, Nordeen Bouhadiba, Dorothy Kufeji, Caroline Pardy, Simon Mccluney, Alireza Keshtgar, Rebecca Roberts, Hannah Rhodes, Kate Burns, Robin Garrett-Cox, Kat Ford, Hannah Cornwall, Krithi Ravi, Felicity Arthur, Paul Losty, Tony Lander, Ingo Jester, Suren Arul, Oliver Gee, Giampiero Soccorso, Michael Singh, Max Pachl, Benjamin Martin, Afnan Alzubair, Arun Kelay, Jonathan Sutcliffe, Thomas Middleton, Amy Hughes Thomas, Merina Kurian, Fraser Cameron, Jayaram Sivaraj, Mark C Thomas, Dean Rex, Ceri Jones, Kate Bradshaw, Arnaud Bonnard, Xavier Delforge, Camille Duchesne, Caroline Le Gall, Coralie Defert, Samia Laraqui Hossini, Florent Guerin, Géraldine Hery, Virginie Fouquet-Languillat, Jules Kohaut, Aline Broch, Thomas Blanc, Luke Harper, Thomas Delefortrie, Quentin Ballouhey, Laurent Fourcade, Céline Grosos, Benoit Parmentier, Guillaume Levard, Maria Giovanna Grella, Mariette Renaux Petel, Lucie Grynberg, Olivier Abbo, Sofia Mouttalib, Mélodie Juricic, Aurelien Scalabre, Elodie Haraux, Anke Rissmann, Hardy Krause, Peter Goebel, Ludwig Patzer, Udo Rolle, Andrea Schmedding, Alexandra Antunez-Mora, Bernd Tillig, Sylvester von Bismarck, Patricia Reis Barbosa, Christian Knorr, Domitille Stark, Marco Brunero, Luigi Avolio, Francesco Manni, Matilde Molinelli, Marinella Guazzotti, Alessandro Raffaele, Piero Giovanni Romano, Silvia Cavaiuolo, Gian Battista Parigi, Laszlo Juhasz, Anna Rieth, Arunas Strumila, Rūta Dagilytė, Arunas Liubsys, Pranas Gurskas, Dalius Malcius, Agne Mikneviciute, Asta Vinskaite, Vidmantas Barauskas, Liam Vierboom, Timothy Hall, Spencer Beasley, Lucy Goddard, Mark Stringer, Naveen Weeratunga, Stephen Adams, Jitoko Cama, Marilyn Wong, Sridharan Jayaratnam, Askar Kukkady, Udaya Samarakkody, Sylwester Gerus, Dariusz Patkowski, Agnieszka Wolny, Tomasz Koszutski, Szymon Tobor, Marta Osowicka, Piotr Czauderna, Dariusz Wyrzykowski, Hanna Garnier, Stefan Anzelewicz, Osowicka Marta, Agata Knurowska, Alicja Weiszewsk, Andrzej Grabowski, Wojciech Korlacki, Michal Pasierbek, Przemyslaw Wolak, Aneta Piotrowska, Anna Roszkiewicz, Piotr Kalicińsk, Agata Trypens, Grzegorz Kowalewsk, David Sigalet, Amer Alsaied, Mansour Ali, Ameen Alsaggaf, Alaa Ghallab, Yazeed Owiwi, Ali Zeinelabdeen, Mohamed Fayez, Ahmed Atta, Mazen Zidan, Asaad saleh Radwan, Hanin Shalaby, Reem Abdelbaqi, Khalid Alattas, Yar Kano, Omar Sindi, Abdullah Alshehri, Tariq Altokhais, Fahad Alturki, Mohammad Almosaibli, Dasha Krisanova, Wisam Abbas, Hee-Beom Yang, Hyun-Young Kim, Joong Kee Youn, Jae Hee Chung, Seok Hyeon Cho, In ji Hwang, Ju yeon Lee, Eung song Song, Jenny Arboleda, Mercedes Ruiz de Temiño Bravo, Alexander Siles Hinojosa, Miriam García, Isabel Casal Beloy, Detlef Oliu San Miguel, Maria Elena Molina Vazquez, Verónica Alonso, Alberto Sanchez, Oscar Gomez, Isabel Carrillo, Tomas Wester, Carmen Mesas Burgos, Martin Salö, Erik Omling, Niclas Rudolfson, Christina Granéli, Helena Arnadóttir, Emma Grottling, Kate Abrahamsson, Vladimir Gatzinsky, Michaela Dellenmark Blom, Daniel Borbonet, Paul Puglia, Vinicio Jimenez Morejon, Gaston Acuna, Mario Moraes, Jonathan Chan, Pavan Brahmamdam, Alan Tom, Karen Sherer, Brandy Gonzales, Aaron Cunningham, Sanjay Krishnaswami, Reto Baertschiger, Mary Leech, Regan Williams, Lauren Camp, Ankush Gosain, Maria Mora, Bailey D. Lyttle, Jeremy Chang, Lydia McColl Makepeace, Kathryn L Fowler, Sara Mansfield, Erica Hodgman, Chukwubinyelum Amaechi, Alana Beres, Mark N. Pernik, Luke J. Dosselman, Murad Almasri, Sunil Jain, Varun Modi, Marianelly Fernandez Ferrer, John Coon, Joann Gonzalez, Medhavi Honhar, Nensi Ruzgar, Griffin Coghill, Sarah Ullrich, Maija Cheung, Katrine Løfberg, Jodie Greenberg, Kate Davenport, Samir Gadepalli, Sarah Fox, Stephanie Johnson, Mercedes Pilkington, April Hamilton, Nicole Lin, Juan Sola, Yang Yao, Jenna Kylene Davis, Monica Langer, Jonathan Vacek, Fizan Abdullah, Julie Khlevner, William Middlesworth, Marc Levitt, Hira Ahmad, Sabina M Siddiqui, Alex Bowder, Terry Derks, Afua Amoabin Amoabin, Brooke Pinar, Frank Owusu-Sekyere, Benmanseur Saousen, Rasika Naidoo, Azra Karamustafic, Danielle Paula de Oliveira, Jerhy Andrade, Antonín Šafus, Jason Langley, Alexandra Wilke, Corazone Deya, Habib Mansour Murtadi, Mindaugas Berzanskis, Nwachukwu Calistus, Olalekan S. Ajiboye, Michael Felix, Osagie O Olabisi, Seçil Erçin, Teymursha Muradi, Stephen S. Burks, Sergio Lerma, Jillian Jacobson, Calin Calancea, Rafael Valerio-Vazquez, Guigui Sikwete, Owusu Sekyere, Akhona Mbonisweni, Shahnoor Syed, Cho Seok Hyeon, Fatemeh Pajouhandeh, Sheba Mary Pognaa Kunfah, Global PaedSurg Research Collaboration, and Tıp Fakültesi
Subjects: Male, Pediatrics, medicine.medical_specialty, Adolescent, Gastrointestinal Diseases, Psychological intervention, Disease, Global Health, Specialties, Surgical, Congenital Abnormalities, Cohort Studies, medicine, Humans, Prospective Studies, Prospective cohort study, Child, Developing Countries, business.industry, Gastroschisis, Developed Countries, Intestinal atresia, Infant, Newborn, Gestational age, Congenital diaphragmatic hernia, Infant, Articles, General Medicine, medicine.disease, Gastrointestinal Tract, Atresia, Child, Preschool, Female, business
Abstract: Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p
Published: 2020

17. From Procedure to Poverty: Out-of-Pocket and Catastrophic Expenditure for Pediatric Surgery in Uganda

Author: John Sekabira, Phyllis Kisa, Doruk Ozgediz, Ava Yap, Arlene Muzira, Maija Cheung, and Nasser Kakembo
Subjects: medicine.medical_specialty, 03 medical and health sciences, Indirect costs, 0302 clinical medicine, Cost of Illness, Pediatric surgery, Health care, Humans, Medicine, Financial protection, 030212 general & internal medicine, Poverty, health care economics and organizations, business.industry, Public sector, Length of Stay, Child, Preschool, Surgical Procedures, Operative, 030220 oncology & carcinogenesis, Family medicine, Surgery, Health Expenditures, business, Hospital stay, Medical costs
Abstract: Background Financial protection from catastrophic health care expenditure (CHE) and patient out-of-pocket (OOP) spending are key indicators for sustainable surgical delivery. We aimed to calculate these metrics for a hospital stay requiring surgery in Uganda's pediatric population. Methods A survey was administered to family members of postoperative patients in the pediatric surgical ward at Mulago Hospital. Cost categories included direct medical costs, direct nonmedical costs, indirect costs, plus money borrowed and items sold to pay for the hospital stay. CHE was defined as spending greater than 10% of annual household expenditure. Costs were reported in Ugandan shillings and US dollars. Results One hundred and thirty-two patient families were surveyed between November 2016 and April 2017. Median direct costs were $27.55 (IQR 18.73-183.69) for diagnostics, $18.36 (IQR 9.52-41.33) for medications, $26.63 (IQR 9.19-45.92) for transportation, and $32.60 (IQR 12.85-64.29) for food and lodging. Forty-four percent of respondents were employed, and median indirect cost from productivity loss was $95.52 (IQR 55.10-243.38). Eighteen percent (16/87) borrowed money, and 9% (8/87) sold possessions to pay for the hospital stay. Total median OOP cost for patient families per hospital stay was $150.62 (IQR 65.21-339.82). Sixteen percent (21/132) of families incurred CHE from direct costs, and the proportion rose to 27% (32/132) when indirect cost was included. Conclusions Although pediatric surgical services in Uganda are formally provided for free by the public sector, families accrue substantial OOP expenditure and almost a third of households incur CHE for a pediatric surgical procedure. This study suggests that broader financial protection must be established to meet Sustainable Development Goal targets.
Published: 2018
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18. Assessing Interest and Barriers for Resident and Faculty Involvement in Global Surgery

Author: Michael R. Hall, Doruk Ozgediz, Maija Cheung, and James M. Healy
Subjects: Adult, Male, medicine.medical_specialty, Faculty, Medical, Attitude of Health Personnel, International Educational Exchange, Medically Underserved Area, Global Health, Risk Assessment, Education, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Global health, Curriculum development, Humans, Medicine, 030212 general & internal medicine, Curriculum, health care economics and organizations, Medical education, business.industry, Internship and Residency, United States, Surgery, Outreach, General Surgery, 030220 oncology & carcinogenesis, Needs assessment, Global Health Initiatives, Female, Risk assessment, business, Needs Assessment, Relative value unit
Abstract: Background Multiple institutions have developed international electives and sustainable global surgery initiatives to facilitate clinical, research, and outreach opportunities with hospitals in resource-poor areas. Despite increasing interest among programs, many institutions have not successfully reached potential involvement. Objective This study evaluates the experiences of Yale residents and faculty, measures interest in the development of an international surgical elective, and enumerates barriers to developing or participating in these opportunities. This was performed to develop a formalized elective and assess interest and capacity for surgical global health initiatives, as a seemingly increasing number of trainee applicants and residents were expressing interest in working in resource-poor settings. Methods Electronic survey of Yale Surgery residents and faculty analyzed using SPSS and Graphpad Prism. Results Among residents, previous global experience correlates with current interest in international opportunities, with 100% remaining interested, and 78% of those without prior experience also expressing interest (p = 0.018). Barriers to pursuing these activities included the use of vacation time, funding, scheduling, family obligations, and concern for personal safety. Among faculty, 28% of respondents have been involved internationally, and most (86%) expressed interest in additional opportunities and all were willing to take residents. Barriers to faculty participation included funding, relative value unit target reduction, protected time, and the desire for institutional support for such activities. Conclusions A substantial proportion of residents and faculty have experience in global health and motivation to pursue additional opportunities. The main barriers to participation are not a lack of interest, but rather needs for funding support, protected time, and institutional recognition of academic contributions. These findings are being used to develop a global surgery elective and establish long-term partnerships with international colleagues.
Published: 2018
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19. Not gastroschisis or omphalocele or anything in between: a novel congenital abdominal wall defect

Author: Nasser Kakembo, Maija Cheung, Arlene Muzira, John Sekabira, and Doruk Ozgediz
Subjects: medicine.medical_specialty, Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, Pediatric surgery, medicine, Humans, Vitelline duct, Omphalocele, business.industry, Gastroschisis, Abdominal wall defect, Abdominal Wall, Infant, Newborn, General Medicine, Anatomy, medicine.disease, Hernia, Abdominal, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Female, 030211 gastroenterology & hepatology, business
Abstract: Congenital abdominal wall defects occur when normal embryonic development is interrupted and most commonly results in gastroschisis or omphalocele. Other entities, such as ruptured omphalocele, vanishing gastroschisis, and patent omphalomesenteric ducts with prolapse, have also been described and can create a confusing picture. This case of a newborn with a midline abdominal defect and a mass that was intestine-like and arose from the bowel cannot be classified, and no similar reports were found. This suggests a previously undescribed abdominal wall defect with an aberrant colonic appendage.
Published: 2017
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20. The Three Delays’ Impact in Uganda: The Disease Burden and Operative Backlog at a New Pediatric Surgery Outpatient Clinic of a Tertiary Center

Author: Nensi M. Ruzgar, Amandine Godier-Furnemont, Nasser Kakembo, Maija Cheung, Sarah Ullrich, Ann Nabirye, Harriet Nambooze, Phyllis Kisa, Arlene Muzira, John Sekabira, and Doruk Ozgediz
Subjects: Pediatrics, Perinatology and Child Health
Published: 2020
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21. Burden of emergency pediatric surgical procedures on surgical capacity in Uganda: a new metric for health system performance

Author: John Sekabira, Doruk Ozgediz, Phyllis Kisa, Martin Situma, Nasser Kakembo, Innocent Okello, Arlene Muzira, David F. Grabski, Maija Cheung, and Anne Shikanda
Subjects: Male, medicine.medical_specialty, Referral, Databases, Factual, MEDLINE, Hernia, Inguinal, Disease, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Pediatric surgery, Health care, medicine, Humans, Hernia, Uganda, Hospital Mortality, Prospective Studies, Pediatric Surgical Procedures, Prospective cohort study, Emergency Treatment, Quality Indicators, Health Care, business.industry, General surgery, Infant, Newborn, Infant, medicine.disease, Benchmarking, 030220 oncology & carcinogenesis, Child, Preschool, Surgical Procedures, Operative, Health Resources, Surgery, Female, business, Emergency Service, Hospital, Digestive System Abnormalities
Abstract: Background The significant burden of emergency operations in low- and middle-income countries can overwhelm surgical capacity leading to a backlog of elective surgical cases. The purpose of this investigation was to determine the burden of emergency procedures on pediatric surgical capacity in Uganda and to determine health metrics that capture surgical backlog and effective coverage of children’s surgical disease in low- and middle-income countries. Methods We reviewed 2 independent and prospectively collected databases on pediatric surgical admissions at Mulago National Referral Hospital and Mbarara Regional Referral Hospital in Uganda. Pediatric surgical patients admitted at either hospital between October 2015 to June 2017 were included. Our primary outcome was the distribution of surgical acuity and associated mortality. Results A combined total of 1,930 patients were treated at the two hospitals, and 1,110 surgical procedures were performed. There were 571 emergency cases (51.6%), 108 urgent cases (9.7%), and 429 elective cases (38.6%). Overall mortality correlated with surgical acuity. Emergency intestinal diversions for colorectal congenital malformations (anorectal malformations and Hirschsprung’s disease) to elective definitive repair was 3:1. Additionally, 30% of inguinal hernias were incarcerated or strangulated at time of repair. Conclusion Emergency and urgent operations utilize the majority of operative resources for pediatric surgery groups in low- and middle-income countries, leading to a backlog of complex congenital procedures. We propose the ratio of emergency diversion to elective repair of colorectal congenital malformations and the ratio of emergency to elective repair of inguinal hernias as effective health metrics to track this backlog. Surgical capacity for pediatric conditions should be increased in Uganda to prevent a backlog of elective cases.
Published: 2019

22. Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: Lessons learned and future directions

Author: Martha Namugga, Moses Galukande, Maija Cheung, Sarah Ullrich, Arlene Muzira, Naomi Kebba, Doruk Ozgediz, Cathy Kilyewala, Janat Tumukunde, Michael S Lipnick, Michael P. DeWane, Jacqueline Mabweijano, Monica Kabagambe, and Peter Muwanguzi
Subjects: Adult, Male, Referral, Databases, Factual, Long term follow up, Attitude of Health Personnel, Training course, media_common.quotation_subject, education, Head trauma, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Uganda, 030212 general & internal medicine, Developing Countries, media_common, Retrospective Studies, Training curriculum, Medical education, business.industry, General Medicine, Trauma care, Feeling, Traumatology, Education, Medical, Graduate, 030220 oncology & carcinogenesis, Context specific, Surgery, Female, Clinical Competence, Curriculum, business
Abstract: Background The Kampala Advanced Trauma Course (KATC) was developed in 2007 due to a locally identified need for an advanced trauma training curriculum for the resource-constrained setting. We describe the design, implementation and evaluation of the course. Methods The course has been delivered to over 1,000 interns rotating through surgery at Mulago National Referral Hospital. Participants from 2013 to 2016 were surveyed after completion of the course. Results The KATC was developed with local faculty and includes didactic and simulation modules. Over 50% of survey respondents reported feeling confident performing and teaching 7 of 11 course skills and felt the most relevant skill was airway management(30.2%). Participants felt least confident managing head trauma(26.4%). Lack of equipment(52.8%) was identified as the most common barrier to providing trauma care. Conclusions Providers are confident with most skill sets after taking the KATC. Minimal dependence on instructors from high-income countries has kept the course sustainable and maximized local relevance.
Published: 2019

23. Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda

Author: John Sekabira, Nasser Kakembo, Arlene Muzira, Amandine Godier-Furnemont, Ann Nabirye, Phyllis Kisa, Doruk Ozgediz, and Maija Cheung
Subjects: Male, medicine.medical_specialty, Outpatient Clinics, Hospital, Adolescent, medicine.medical_treatment, Developing country, Context (language use), Health Services Accessibility, Time-to-Treatment, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Health facility, Health care, Pediatric surgery, medicine, Outpatient clinic, Humans, Orchiopexy, Uganda, Prospective Studies, Child, Health Services Needs and Demand, business.industry, Surgical care, Infant, Newborn, Infant, Patient Acceptance of Health Care, Hospitals, Pediatric, Socioeconomic Factors, 030220 oncology & carcinogenesis, Child, Preschool, Surgical Procedures, Operative, Emergency medicine, 030211 gastroenterology & hepatology, Surgery, Female, Health Expenditures, business
Abstract: Background We sought to understand the challenges in accessing pediatric surgical care in the context of the “three delays” model at the Pediatric Surgery Outpatient Clinic (PSOPC) at a tertiary hospital in Kampala, Uganda. Materials and methods An outpatient database was established at the weekly PSOPC. A survey regarding prior healthcare visits and barriers to care was additionally administered to clinic patients and inpatients. Results Patients first sought healthcare a median of 56 d before the current visit to the PSOPC. A majority (52%) of patients first sought care at another health facility, and 17% of those surveyed had presented to the PSOPC three or more times for their current medical issue. Of 240 patients with a new issue or due for their next surgery, 10% were admitted to the ward, with only 54% receiving definitive care. Included in the most commonly needed surgeries for PSOPC patients were herniotomy (16% inguinal; 14.9% umbilical), orchiopexy (6.3%), posterior sagittal anorectoplasty (6.3%), and colostomy closure (4.4%), with the range of patient ages at the time of presentation reflecting delays in care. Patient expenditures associated with travel to the hospital showed inpatients coming from significantly further away, with higher costs of travel and need to borrow or sell assets to cover travel costs, when compared with PSOPC patients. Conclusions Patients face significant delays in accessing and receiving definitive surgical care. Associated burdens associated with these delays place patients at risk for catastrophic health expenditures. Infrastructure and capacity development are necessary for improvement in pediatric surgical care.
Published: 2019

24. 164 ESTIMATING THE EFFICACY OF REVISIONAL SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS: A NEW APPLICATION OF THE MBSAQIP RISK/BENEFIT CALCULATOR

Author: Lee Ying, Randal Zhou, Maija Cheung, John M. Morton, and Geoffrey S. Nadzam
Subjects: medicine.medical_specialty, Sleeve gastrectomy, Hepatology, business.industry, medicine.medical_treatment, Gastric bypass, Gastroenterology, medicine, business, Roux-en-Y anastomosis, Surgery
Published: 2020
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25. The Global Initiative for Children's Surgery: Optimal Resources for Improving Care

Author: Kokila Lakhoo, Emmanuel A. Ameh, Stephen W. Bickler, Maija Cheung, Yasmine Yousef, Etienne St-Louis, Keith T. Oldham, Doruk Ozgediz, Diana L. Farmer, Dan Poenaru, Laura F. Goodman, and Benno M. Ure
Subjects: medicine.medical_specialty, Referral, Service delivery framework, Population, MEDLINE, Developing country, Global Health, Pediatrics, Health Services Accessibility, Specialties, Surgical, 03 medical and health sciences, 0302 clinical medicine, Pediatric surgery, Global health, Medicine, Humans, 030212 general & internal medicine, education, Child, Developing Countries, education.field_of_study, Health Care Rationing, business.industry, Hospitals, Pediatric, Quality Improvement, Surgery, 030220 oncology & carcinogenesis, Surgical Procedures, Operative, Pediatrics, Perinatology and Child Health, business, Working group
Abstract: Background The Lancet Commission on Global Surgery reported that 5 billion people lack access to safe, affordable surgical care. The majority of these people live in low-resource settings, where up to 50% of the population is children. The Disease Control Priorities (Debas HTP, Donkor A, Gawande DT, Jamison ME, Kruk, and Mock CN, editors. Essential Surgery. Disease Control Priorities. Third Edition, vol 1. Essential Surgery. Washington, DC: World Bank; 2015) on surgery included guidelines for the improvement of access to surgical care; however, these lack detail for children's surgery. Aim To produce guidance for low- and middle-income countries (LMICs) on the resources required for children's surgery at each level of hospital care. Methods The Global Initiative for Children's Surgery (GICS) held an inaugural meeting at the Royal College of Surgeons in London in May 2016, with 52 surgical providers from 21 countries, including 27 providers from 18 LMICs. Delegates engaged in working groups over 2 days to prioritize needs and solutions for optimizing children's surgical care; these were categorized into infrastructure, service delivery, training, and research. At a second GICS meeting in Washington in October 2016, 94 surgical care providers, half from LMICs, defined the optimal resources required at primary, secondary, tertiary, and national referral level through a series of working group engagements. Results Consensus solutions for optimizing children's surgical care included the following:An “Optimal Resources” document was produced detailing the facilities and resources required at each level of care. Conclusion The Optimal Resources document has been produced by surgical providers from LMICs who have the greatest insight into the needs and priorities in their population. The document will be refined further through online GICS Working Groups and the World Health Organization for broad application to ensure all children have timely access to safe surgical care.
Published: 2017

26. Surgical Team Experiences

Author: Michael R. Hall, Doruk Ozgediz, and Maija Cheung
Subjects: Surgical team, Nursing, business.industry, Medicine, business
Published: 2017
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27. Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda

Author: Sarah B. Cairo, Nasser Kakembo, Maija Cheung, Doruk Ozgediz, John Sekabira, Phyllis Kisa, Arlene Muzira, and James M. Healy
Subjects: Male, Pediatrics, medicine.medical_specialty, Intestinal Atresia, Disease, Anastomosis, Health Services Accessibility, Duodenal atresia, Sepsis, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Epidemiology, Pediatric surgery, Intestine, Small, medicine, Humans, Uganda, Prospective Studies, Healthcare Disparities, Emergency Treatment, Retrospective Studies, business.industry, Intestinal atresia, Infant, Newborn, General Medicine, medicine.disease, 030220 oncology & carcinogenesis, Atresia, Pediatrics, Perinatology and Child Health, Surgery, Female, business
Abstract: Intestinal atresia is one of the leading causes of neonatal intestinal obstruction (NIO). The purpose of this study was to analyze the presentation and outcome of IA and compare with those from both similar and high-income country settings. A retrospective review of prospectively collected data from patient charts and pediatric surgical database for 2012–2015 was performed. Epidemiological data and patient characteristics were analyzed and outcomes were compared with those reported in other LMICs and high-income countries (HICs). Unmet need was calculated along with economic valuation or economic burden of surgical disease. Of 98 patients, 42.9% were male. 35 patients had duodenal atresia (DA), 60 had jejunio-ileal atresia (JIA), and 3 had colonic atresia. The mean age at presentation was 7.14 days for DA and 6.7 days for JIA. Average weight for DA and JIA was 2.2 and 2.12 kg, respectively. All patients with DA and colonic atresia underwent surgery, and 88.3% of patients with JIA had surgery. Overall mortality was 43% with the majority of deaths attributable to aspiration, anastomotic leak, and sepsis. 3304 DALYs were calculated as met compared to 25,577 DALYs’ unmet. Patients with IA in Uganda present late in the clinical course with high morbidity and mortality attributable to a combination of late presentation, poor nutrition status, surgical complications, and likely underreporting of associated anomalies rather than surgical morbidity alone. Level IV, Case series with no comparison group.
Published: 2017

28. Correction to: Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

Author: Nensi M. Ruzgar, Doruk Ozgediz, Nasser Kakembo, David F. Grabski, John Sekabira, Phyllis Kisa, Sarah Ullrich, Arlene Muzira, and Maija Cheung
Subjects: medicine.medical_specialty, business.industry, General surgery, General Medicine, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Pediatrics, Perinatology and Child Health, Epidemiology, Pediatric surgery, Correct name, Medicine, 030211 gastroenterology & hepatology, Surgery, Center (algebra and category theory), business
Abstract: In the original publication, the family name of one of the authors was spelt incorrectly. The correct name should read as Nensi Ruzgar.
Published: 2019
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29. When a Surgical Trainee Needs Surgery: Autonomy, Privacy, and Maintaining the Standard of Care

Author: Maija Cheung, Peter S. Yoo, Walter E. Longo, and Michael P. DeWane
Subjects: medicine.medical_specialty, Standard of care, 020205 medical informatics, media_common.quotation_subject, Guidelines as Topic, 02 engineering and technology, Education, 03 medical and health sciences, 0302 clinical medicine, Nursing, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, 030212 general & internal medicine, Occupational Health, media_common, business.industry, Internship and Residency, Standard of Care, Surgery, Privacy, Surgical Procedures, Operative, Personal Autonomy, business, Autonomy
Published: 2017
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30. Burden of Pediatric Surgical Conditions in Uganda: Epidemiology and Mortality from a Prospective Database at a Tertiary Care Center

Author: James M. Healy, Doruk Ozgediz, Nasser Kakembo, Maija Cheung, John Sekabira, and Arlene M. Nakanwagi
Subjects: medicine.medical_specialty, business.industry, Epidemiology, Emergency medicine, medicine, Surgery, Center (algebra and category theory), business, Tertiary care
Published: 2017
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31. Cost of Saving a Child's Life: A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

Author: Maija Cheung, Arlene M. Nakanwagi, Phyllis Kisa, David Cunningham, Ava Yap, Reza Yaesoubi, Nasser Kakembo, Doruk Ozgediz, James M. Healy, and John Sekabira
Subjects: medicine.medical_specialty, Pediatrics, business.industry, Cost-effectiveness analysis, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Pediatric surgery, medicine, 030211 gastroenterology & hepatology, Surgery, Medical emergency, business
Published: 2017
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32. Funding Flows for the Global Initiative for Children’s Surgery (GICS): Lessons Learned

Author: Guy Jensen, Stephen W. Bickler, D. Poenaru, Doruk Ozgediz, K. Oldham, Sarah L M Greenberg, Diana Farmer, Maija Cheung, Laura F. Goodman, E. St-Louis, Kokila Lakhoo, Emmanuel A. Ameh, Naomi J. Wright, Yasmine Yousef, A. Linden, H. Wissanji, and N. Kaseje
Subjects: 03 medical and health sciences, Medical education, 0302 clinical medicine, business.industry, 030225 pediatrics, 030220 oncology & carcinogenesis, Medicine, Infectious and parasitic diseases, RC109-216, General Medicine, Public aspects of medicine, RA1-1270, business
Published: 2017
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33. Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

Author: Ullrich, Sarah, Maija Cheung, Namugga, Martha, Sion, Melanie, Ozgediz, Doruk, and Yoo, Peter
Published: 2020
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33 results on '"Maija Cheung"'

1. Cost-effectiveness of a pediatric operating room installation in Sub-Saharan Africa.

2. Towards defining the surgical workforce for children: a geospatial analysis in Brazil

3. Pediatric Surgical Waitlist in Low Middle Income Countries During the COVID-19 Pandemic

4. Cost-Effectiveness of a Pediatric Operating Room Installation in Sub-Saharan Africa

5. Pediatric Surgical Waitlist in LMICs during the COVID-19 Pandemic

6. Development of an Operative Trauma Course in Uganda—A Report of a Three-Year Experience

7. Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries

8. Burden of Surgical Infections in a Tertiary-Care Pediatric Surgery Service in Uganda

9. Development of a Post-Operative Mortality Calculator for Pediatric Surgical Patients in Low- And Middle- Income Countries Using Machine Learning

10. Navigating the COVID-19 Pandemic

11. Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

12. Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda

13. The Role of Positron Emission Tomography in Bariatric Surgery Research: a Review

14. Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective

15. Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

16. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

17. From Procedure to Poverty: Out-of-Pocket and Catastrophic Expenditure for Pediatric Surgery in Uganda

18. Assessing Interest and Barriers for Resident and Faculty Involvement in Global Surgery

19. Not gastroschisis or omphalocele or anything in between: a novel congenital abdominal wall defect

20. The Three Delays’ Impact in Uganda: The Disease Burden and Operative Backlog at a New Pediatric Surgery Outpatient Clinic of a Tertiary Center

21. Burden of emergency pediatric surgical procedures on surgical capacity in Uganda: a new metric for health system performance

22. Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: Lessons learned and future directions

23. Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda

24. 164 ESTIMATING THE EFFICACY OF REVISIONAL SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS: A NEW APPLICATION OF THE MBSAQIP RISK/BENEFIT CALCULATOR

25. The Global Initiative for Children's Surgery: Optimal Resources for Improving Care

26. Surgical Team Experiences

27. Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda

28. Correction to: Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda

29. When a Surgical Trainee Needs Surgery: Autonomy, Privacy, and Maintaining the Standard of Care

30. Burden of Pediatric Surgical Conditions in Uganda: Epidemiology and Mortality from a Prospective Database at a Tertiary Care Center

31. Cost of Saving a Child's Life: A Cost-Effectiveness Analysis of a Pediatric Operating Room in Uganda

32. Funding Flows for the Global Initiative for Children’s Surgery (GICS): Lessons Learned

33. Navigating the COVID-19 Pandemic: Lessons From Global Surgery.

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