International pediatric surgery partnerships in sub-Saharan Africa: a scoping literature review

ABSTRACT

Background

Sub-Saharan Africa (SSA) faces a critical shortage of pediatric surgical providers. International partnerships can play an important role in pediatric surgical capacity building but must be ethical and sustainable.

Objective

The purpose of this study is to perform a scoping literature review of international pediatric surgery partnerships in SSA from 2009 to 2019. We aim to categorize and critically assess past partnerships to aid in future capacity-building efforts.

Methods

We performed a scoping literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. We searched the PubMed and Embase databases for articles published from 2009 to 2019 using 24 keywords. Articles were selected according to inclusion criteria and assessed by two readers. Descriptive analyses of the data collected were conducted in Excel.

Results

A total of 2376 articles were identified. After duplicates were removed, 405 articles were screened. In total, 83 articles were assessed for eligibility, and 62 were included in the review. The most common partnership category was short-term surgical trip (28 articles, 45%). A total of 35 articles (56%) included education of host country providers as part of the partnership. Only 45% of partnerships included follow-up care, and 50% included postoperative outcomes when applicable.

Conclusions

To increase sustainability, more partnerships must include education of local health-care providers, and short-term surgical trips must be integrated into long-term partnerships. More partnerships need to report postoperative outcomes and ensure follow-up care. Educating peri-operative providers, training general surgeons in common pediatric procedures, and increasing telehealth use are other goals for future partnerships.

KEYWORDS:

• Global health
• capacity building
• education
• academic medicine
• sustainable

Responsible editor

Jennifer Stewart Williams

Responsible editor

Jennifer Stewart Williams

Acknowledgments

We would like to thank Dr. Tina Slusher (University of Minnesota) and Dr. Burton Lee (University of Pittsburgh) for their edits and guidance. We would also like to thank Dr. Mary Carter (University of Louisville) for her help in inspiring this project and for her excellent mentorship.

Disclosure statement

There was no funding source for this paper, and we have no conflicts of interest to disclose.

Paper context

Only two prior review articles have been published on this topic to date. One was a systematic review of articles from 1990 to 2012. Another was a general review about pediatric surgery in LMICs which did not report any methods. This study focuses on more recent literature to provide an updated review following PRISMA guidelines. It provides a more detailed categorization of pediatric surgery partnerships and previously unreported data about education, post-operative follow-up, outcomes, and funding sources.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Charles Shofner

AW performed the initial database searches and data extraction. AW and CS evaluated all articles to determine eligibility for inclusion. BH resolved any conflicts over article inclusion. AW drafted the text of the manuscript and all tables and figures. CS and BH critically revised the manuscript. All three authors approved of the final version and are accountable for all aspects of the work.