Paediatric surgery in Uganda: current challenges and opportunities

Abstract

Over half of the Ugandan population is under 18-years-old. Surgical care is provided by district general hospitals, whose activity is coordinated by fourteen regional referral hospitals. Mulago National Referral Hospital in Kampala is the main tertiary centre for paediatric surgery. The paediatric surgical need is vast and unmet, with around 15% of Ugandan children having an untreated surgical condition. Most paediatric surgical procedures are performed for neonatal emergencies and trauma, with widespread task-sharing of anaesthesia services. Facilities face shortages of staff, drugs, theatre equipment, and basic amenities. Surgical treatment is delayed by the combination of delays in seeking care due to factors such as financial constraints, gender inequality and reliance on community healers, delays in reaching care due to long distances, and delays in receiving care due to overcrowding of wards and the sharing of resources with other specialties. Nonetheless, initiatives by the Ugandan paediatric surgical community over the last decade have led to major improvements. These include an increase in capacity thanks to the opening of dedicated paediatric theatres at Mulago and in regional hospitals, the start of a paediatric surgical fellowship at Mulago by the College of Surgeons of East, Central and Southern Africa (COSECSA) and development of surgical camps and courses on management of paediatric surgical emergencies to improve delivery of paediatric surgical care in rural areas.