Geospatial analysis of unmet pediatric surgical need in Uganda

J Pediatr Surg. 2017 Oct;52(10):1691-1698. doi: 10.1016/j.jpedsurg.2017.03.045. Epub 2017 Mar 31.


Background: In low- and middle-income countries (LMICs), an estimated 85% of children do not have access to surgical care. The objective of the current study was to determine the geographic distribution of surgical conditions among children throughout Uganda.

Methods: Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 2176 children in 2315 households throughout Uganda. At the district level, we determined the spatial autocorrelation of surgical need with geographic access to surgical centers variable.

Findings: The highest average distance to a surgical center was found in the northern region at 14.97km (95% CI: 11.29km-16.89km). Younger children less than five years old had a higher prevalence of unmet surgical need in all four regions than their older counterparts. The spatial regression model showed that distance to surgical center and care availability were the main spatial predictors of unmet surgical need.

Interpretation: We found differences in unmet surgical need by region and age group of the children, which could serve as priority areas for focused interventions to alleviate the burden. Future studies could be conducted in the northern regions to develop targeted interventions aimed at increasing pediatric surgical care in the areas of most need.

Level of evidence: Level III.

Keywords: Community survey; Disease burden; Geospatial; Global surgery; Low- and middle-income countries; SOSAS; Sub-Saharan Africa.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Developing Countries
  • Female
  • Geographic Information Systems
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand / statistics & numerical data*
  • Humans
  • Infant
  • Male
  • Medically Underserved Area*
  • Pediatrics / organization & administration
  • Poverty / statistics & numerical data
  • Prevalence
  • Surgical Procedures, Operative / statistics & numerical data*
  • Uganda / epidemiology