GANDHI’s Child and Adolescent-focused team will present, “Pediatric Post-Surgical Community Resource Geospatial Mapping in Uganda,” as an oral presentation at AcademyHealth’s 2017 Annual Research Meeting June 25-27th in New Orleans, Louisiana.
Project Abstract: Pediatric Post-Surgical Community Resource Geospatial Mapping in Uganda
There is a striking unmet need for surgical intervention in low and middle income countries, where 85% of children develop a surgical need by 15 years of age. According to previous geospatial analyses in Uganda, the need for surgery among children is highest in the Northern and Western regions. Many pediatric surgical conditions carry the risk of lifelong disability often requiring post-surgical care. However, even if surgery is provided, the availability of resources to successfully transition school-aged children (5-15 years) from hospital to home after acute surgical care in Uganda is poorly understood. Therefore, the objective of this study was to geospatially analyze the distribution of post-surgical, community-based services for school-aged children in Uganda.
We utilized a geographic information system analysis of children in the nationwide household survey that assessed surgical need in Uganda (Surgeons OverSeas Assessment of Surgical Need (SOSAS)), and post-surgical community resources (ArcGIS software). Identification of post-surgical community resources took place between June and October 2016 through database and google searches, which yielded four major domains for post-surgical community resources for school-aged children in Uganda. In an effort to provide clear policy directions for gaps in the provision of postoperative care among children needing surgery in low-income countries, geospatial analyses of pediatric surgical needs and community-based rehabilitation resources may demonstrate areas in need. The objective of this study was to determine the geographic distribution of available community-based rehabilitations services for school-aged children in Uganda. In addition, we analyzed spatial data to evaluate the correlation between geographic access to rehabilitation services and surgical needs among school-aged children in Uganda.
SOSAS Uganda interviewed a random sample of 1,082 children 5 to 15 years (median age 9.5 years, interquartile range 7.1, 12.0) and collected met and unmet surgical need for each child. Additionally, all service providers for each of the four domains were eligible.
We identified 129 resources in including: 43 rehabilitation service centers, 10 assistive device and technology providers, 28 social and family support services, and 48 school re-entry programs. Services were more prevalent in urban locations than in remote areas and are clustered in the Central region, with the majority in Kampala. Layered with SOSAS data, the highest unmet surgical need and unmet community reintegration services were found in the Northern region.
Uganda is a low-resource setting with vast opportunities for healthcare providers to connect children with available rehabilitation and recovery services post-surgery. Enhanced transitional care can provide specific support to maximize community, family, and school reintegration. The lack of pediatric post-surgical community reintegration services in the Northern and Western regions where unmet surgical needs are highest are promising areas for future research and health systems strengthening.
Implications for Policy or Practice:
In order to strengthen hospital-to-home transitional care for pediatric post-surgical patients, healthcare providers, social workers, and government officials entrusted with decision- making on behalf of this population must be aware of where community resources are available and where to target future initiatives for improving community re-integration.