Overcoming Political Upheaval to Deliver Pediatric Surgical Care in Afghanistan: A Prospective Analysis of 1000 Cases
*Dunya Moghul MD2, *Emma Bryce MPH3, *Yalda Obaidy MD5, *Philip Hsu MD, PhD4, *Ajmal Sherzad MD5, Maija Cheung MD1
1Surgery, Yale University, Branford, CT; 2Medicine and Health Sciences, McGill University, Montreal, QC, Canada; 3Research, Kids Operating Room, Edinburgh, United Kingdom; 4Surgery, University of Michigan, Ann Arbor, MI; 5Surgery, Ataturk Hospital, Kabul, Afghanistan
Background: Political conflicts often have the unintended consequence of worsening the barriers to health care faced by vulnerable populations. This study shows the impact of an NGO providing access to pediatric surgery in Afghanistan after the political upheaval in 2021 through the installation of a dedicated pediatric operating room in 2023 in a public hospital and the importance of providing access to surgical care despite challenges. It is the first study of this kind in Afghanistan and details the process of site selection and installation in Afghanistan in the context of post-political upheaval as well as the analysis of the first 1000 cases.
Study Design: Authors participated in site selection and created the case for investment in Afghanistan; we speak from personal experience regarding this process. Perioperative clinical data was collected prospectively from March to December 2023 at the Ataturk Hospital in Kabul, Afghanistan. Data came from all patients (age <14y) who underwent a surgical procedure in a newly built operation room sponsored by the NGO. Data was stored on REDCap, and descriptive analysis performed using Excel.
Results: In total, 1014 pediatric patients (age <14 years) underwent surgical procedures at the study hospital. Patients came from many areas of Afghanistan, with the majority (73%) coming from the Kabul Province. Mean patient age was 6.0 years; 80% were male. 65% of cases were elective and 34% of cases were emergent. The most common types of procedures were appendectomy (18%), inguinal hernia repair (17%), and orchiopexy (13%). The most common diagnoses were genitourinary/renal conditions (33%), gastrointestinal conditions (20%), hernias (18%), central nervous system pathologies (6%), and congenital malformations (5%). 60% of patients had an ASA class of 1, while 17% had an ASA class of 5. Post-op sepsis and surgical site infection rates were both <0.3%.
Conclusions: Here, we show that it is possible to effectively create an infrastructure for surgical capacity amidst complex political situations in low-resource settings. These efforts led to high quality pediatric surgical care. Future research is needed to study the extent of untreated pediatric surgical disease to enable advocacy efforts towards resource allocation and public health initiatives.
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