Researchers identify lack of surgical care for rural Ugandan children

Over half of the population in Uganda is under the age of 18 and most live in rural areas.

by Nikki Pederson

There is an urgent need to increase surgical care and access in rural areas of low-income countries, according to data collected and analyzed by a collaborative group of universities, including the University of Minnesota. 

A follow-up paper to a 2017 research survey, which was published this month, looked at the relationship between rurality, surgical condition and treatment status among Ugandan children. Approximately 5 billion people worldwide do not have timely, safe and affordable access to surgical care, with the highest estimated need in sub-Saharan Africa. In Uganda, almost 83 percent of the population lives in rural areas, and over half of the population is under the age of 18. 

“Surgical diseases and trauma have been overlooked globally when people approach the health care needs of low and middle-income countries,” said Jeffrey Chipman, a professor at the University Medical School’s Department of Surgery and collaborator on the research. 

In low and middle-income countries, approximately 85 percent of children have a surgically-treatable condition before the age of 15. According to the paper’s results, over half of the children with a surgical condition surveyed have not received surgical care and a large majority of these children live in rural areas.

It’s common for surgical care to be overlooked by international organizations trying to help health care issues in low and middle-income countries, Chipman said. Many common diseases in those countries are actually surgical diseases and trauma, he said. Trauma is the leading cause of death for individuals up to the age of 45, according to the American Association for the Surgery of Trauma.

“If you survive childhood, then you die from trauma,” Chipman said. 

A surgical condition is any type of condition that would require surgery, said Emily Smith, a professor of epidemiology at Baylor University and a collaborator on the project.

“It could be ranging from a fracture or a burn to a cleft lip or brain mass,” she said. “They definitely range in severity and how fatal they can be.”

While Smith was not involved in the original research collection, she led the sub-analysis papers that looked at the surgical needs of Ugandan children. 

“I chose the pediatric portion of that because children are vulnerable and don’t have a voice for themselves,” she said. 

The original research surveyed over 4,000 Ugandans to quantify the burden of surgically-treatable conditions. It was a collaboration between members of multiple U.S. universities, as well as the Makerere University in Kampala, Uganda.

The most frequent barrier to surgical care was a lack of financial resources. Of the 153 household deaths reported in the survey, 53 were identified to be surgically treatable, according to the paper.

Tú Trần, a medical student at the University, said he was humbled to be a part of the research in Uganda. Having the ability to collaborate and fund research is unique, he said. 

“I think it’s probably a higher priority on [Uganda’s] side to finance the direct, actual health care rather than health care research,” he added. 

The researchers agreed the project has a larger impact. Trần hopes this work will show that surgical conditions are a significant problem and worth government investment.

Smith said she hopes this study will make the case to advocate for better health care in low-income countries. 

“We see such a disparity in kids who have a surgical condition that just don’t get the care that’s needed, and a lot of that’s related to lack of money and where they live.”