Espinoza Pamela, Mwakyembe Theresia, Kajoka Happiness D, Stephano Prisca Joseph, Majaliwa Esther, Mmbaga Blandina T, Staton Catherine, Vissoci Joao Ricardo Nickenig, Rice Henry E, Smith Emily R
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, North Carolina, United States of America.
PLOS Glob Public Health. 2025 Jun 27;5(6):e0004448. doi: 10.1371/journal.pgph.0004448. eCollection 2025.
Lack of access to surgical care is common in low- and middle-income countries, where children and adolescents account for up to half of the population. However, the burden of surgical conditions and resources for children in Tanzania remains poorly defined. Our cross-sectional study aims to assess the epidemiology and outcomes of pediatric surgical procedures performed over one year at the Kilimanjaro Christian Medical Centre (KCMC), a tertiary center in Moshi, Tanzania. A secondary aim was to assess the geospatial distribution of families seeking surgical care and their accessibility to surgical services at KCMC. We evaluated the surgical records of all children <16 years old who underwent surgical care between January 1st, 2022 and December 31st, 2022 at KCMC. We used descriptive statistics to compare demographic and clinical characteristics across age groups. Geospatial mapping tools were used to visualize families' district of origin and access to care. We collected data on 2031 children, 59.8% (n = 1215) of whom were male, and more than half were between 1 and 5 years old (58.6%, [n = 1191]). Families traveled from 28 out of the 31 Tanzanian regions. Overall, about half of the conditions were diseases of the respiratory system (52.9%, [n = 1074]), followed by congenital and developmental disorders (14.6%, [n = 297]) and injuries (8.4%, [n = 170]). We identified 33 (1.6%) deaths prior to discharge. Children under one year old had lower rates of insurance coverage, higher referral rates, traveled longer distances, and had worse clinical outcomes compared to other age groups (p < 0.001). Our study reveals differences in the demographic and clinical characteristics of children who access specialized surgical care at KCMC. We report a high number of elective ear, nose, and throat (ENT) procedures and low number of non-ENT procedures, suggesting barriers to care for acute, high morbidity conditions.
在低收入和中等收入国家，无法获得外科护理的情况很常见，这些国家的儿童和青少年占人口的比例高达一半。然而，坦桑尼亚儿童外科疾病的负担和相关资源仍未得到明确界定。我们的横断面研究旨在评估坦桑尼亚莫希的三级医疗中心乞力马扎罗基督教医疗中心（KCMC）在一年时间内实施的儿科外科手术的流行病学情况和手术结果。第二个目标是评估寻求外科护理的家庭的地理空间分布情况以及他们在KCMC获得外科服务的可及性。我们评估了2022年1月1日至2022年12月31日期间在KCMC接受外科护理的所有16岁以下儿童的手术记录。我们使用描述性统计方法比较不同年龄组的人口统计学和临床特征。使用地理空间绘图工具来直观展示家庭的原籍地区以及获得护理的情况。我们收集了2031名儿童的数据，其中59.8%（n = 1215）为男性，超过一半的儿童年龄在1至5岁之间（58.6%，[n = 1191]）。家庭来自坦桑尼亚31个地区中的28个。总体而言，约一半的疾病是呼吸系统疾病（52.9%，[n = 1074]），其次是先天性和发育性疾病（14.6%，[n = 297]）以及损伤（8.4%，[n = 170]）。我们确定出院前有33例（1.6%）死亡病例。与其他年龄组相比，一岁以下儿童的保险覆盖率较低、转诊率较高、就诊距离较远且临床结果较差（p < 0.001）。我们的研究揭示了在KCMC接受专科外科护理的儿童在人口统计学和临床特征方面的差异。我们报告了大量的择期耳鼻喉（ENT）手术以及少量的非ENT手术，这表明在急性、高发病率疾病的护理方面存在障碍。
