Assessment of Pediatric Surgery Capacity at Government Hospitals in Sierra Leone

Traditionally, efforts to reduce child mortality in low- and middle-income countries (LMICs) have focused on infectious diseases. However, surgical care is increasingly seen as an important component of primary health care. To understand the baseline surgical capacity in LMICs, a number of studies have recently been published, but none has focused on pediatric surgery. The Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey was used to collect surgical capacity data from government hospitals in Sierra Leone. The data were analyzed specifically to identify baseline needs for pediatric surgery. Nine hospitals were assessed, and all had a functioning laboratory to test blood and urine and were capable of undertaking resuscitation, suturing, wound d,bridement, incision and drainage of an abscess, appendectomy, and male circumcision. However, in only 67 % could a pediatric hernia repair be performed, and in none were more complex procedures such as cleft lip and clubfoot repairs performed. Fewer than 50 % of facilities had sufficient gloves, nasogastric tubes, intravenous cannulas, syringes, needles, sutures, urinary catheters, infusion sets, anesthesia machines, or compressed oxygen. Using the standard PIPES tool, we found severe deficiencies in the pediatric surgical capacity at government hospitals in Sierra Leone. However, a pediatric-specific tool is required to understand more accurately the pediatric surgical situation.