Surgical Care for Children | Guidelines for the primary referral hospital

Details

The surgical care of children is one of the most neglected aspects of child health in low- and middle-income countries. Poor surgical care has not been without consequences. In many of these countries, congenital anomalies go untreated, children die of easily correctable surgical problems, and injuries result in lifelong disabilities.

The surgical care of children in low- and middle-income countries presents many challenges. Not only must the correct diagnosis be made, but resources must be available for treatment. Moreover, paediatric surgical patients come from low-income families and often have multiple social, cultural and health issues.

The most common surgical problems affecting children in settings of limited resources are injuries, congenital anomalies and surgical infections; these three categories account for approximately 90% of paediatric surgical admissions. Injuries occurring at home, on the roads, along with blast injuries from wars and conflicts, are a growing problem.


Most children with surgical problems in low- and middle-income countries will first present to the primary referral hospital. Surgeons with a specialized knowledge of paediatric surgical conditions are rarely available at this level; there is therefore a need for a concise guide to the management of the most common childhood surgical conditions. The majority of surgical conditions in children require relatively simple procedures and can be managed at the primary referral hospital. For children with problems that cannot be managed at this level, there is still a need to properly assess and stabilize the child before transferring or referring to a specialist centre.

Several excellent publications within the past 5 years have addressed the surgical care
of children at the primary referral hospital. Foremost are two published by the World Health Organization:


● Surgical care at the District Hospital
● Pocket Book of Hospital Care for Children: Guidelines for the Management of Common
         Illnesses with Limited Resources.

Surgical care for Children has been written to complement these publications and fills some of the gaps.

This handbook describes a limited number of surgical procedures, selected for the doctor who does not have formal paediatric surgical training. Procedures that require specialist skills have largely not been included, although we have included some procedures that may appear technically difficult because they may off er the best chance for saving a child’s life.

It is our hope that this handbook will help improve the care of infants and children who might otherwise die because of poor access to quality care.

Stephen W Bickler & Emmanuel A Ameh