Safety First - Voices of One Surgery - Issue 4: December 2018

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In spite of this, only a small body of literature exists to evaluate the potential of surgical interventions in addressing this global burden. It is estimated that paediatric surgery has the potential to avert more than 67 percent of the disease burden associated with congenital anomalies (7) . What’s more is that paediatric surgical care is cost-effective. This is especially the case for birth defects in which the condition is surgically curative or the associated disability substantially improved. For example, a 2015 study on birth defects in Uganda (8) saw paediatric inguinal hernia repairs costing only US$12.41 per DALY averted compared with the US$41 per DALY averted by insecticidetreated bednets for malaria prevention. Treatment for congenital anomalies such as congenital diaphragmatic hernias (9) and anorectal malformations (10) have also been shown to have favourable cost-effectiveness. The crucial role of paediatric surgery is especially needed in LMICs, where the greatest burden lies, with 94 percent of severe congenital anomalies occurring there. Despite this, there is a stark scarcity of studies from LMICs, with the majority of research originating from highincome countries. Why GlobalPaedSurg? The inspiration behind Global PaedSurg was simple: to address the vacuous deficiencies in paediatric surgical research in LMICs, beginning with congenital anomalies. Data from highincome countries would be used as direct comparisons whilst encouraging the involvement of more children’s surgical care providers in the growing force that is global surgical research. Indeed, large-scale data from high-income countries may also provide useful insights in these regions too. However, the aims of Global PaedSurg are not to just shed light on the present issues, but to also lay the trajectory for future global paediatric surgical studies. Our objectives are thus threefold: VOICES • FOUR • SURGERY • 29 1. To define the current management and outcomes of congenital anomalies in low-,middle-, and highincome countries globally and to identify factors affecting outcomes that can be modified to improve care. This information will be used to advocate for much needed resources for neonatal surgical care in LMICs, in addition to establishing congenital anomalies as a priority on the global health agenda. 2. To enhance the research capacity amongst collaborators through participation in the study and the associated research training fellowship, which is running alongside the main study. We hope that this will help to combat the disparity in research outputs between the global north and global south at present. Mitigating the paucity of global paediatric surgical research is an ambitious undertaking necessitating international collaboration. 3. To form a global paediatric surgical research collaboration, enabling future large-scale research and interventional studies to improve outcomes of congenital anomalies. After all, collaboration begets further collaboration. Already, data from the pioneering collaborative PaedSurg Africa study is being used to develop a multi-centre interventional study across seven tertiary paediatric centres in Sub- Saharan Africa, aimed at reducing mortality from gastroschisis. Global PaedSurg will continue to build on this.
VOICES • FOUR • SURGERY • 30 The Strategy Behind Global PaedSurg Global PaedSurg aims to be the first large-scale, geographically comprehensive prospective cohort study on the management and outcomes of anomalies in low-, middle (LMICs), and highincome countries (HICs) across the globe. To do this, we need to create a comprehensive dataset on congenital anomalies, a feat dependent on having collaborators from across the globe working together. The first step was the formation of the Global PaedSurg Research Collaboration, consisting of children’s surgical care providers from around the world. Participation is open to any healthcare professional involved in the care of infants presenting primarily with congenital anomalies e.g. surgeons, anaesthetists, neonatologists, paediatricians, trainees, medical students and nurses. Currently, Global PaedSurg stands at over 1300 collaborators, drawn from 408 hospitals across 110 different countries, with all collaborators to be listed as co-authors of the resulting presentations and publications. Unbelievably (and excitingly), that number only continues to grow - a process streamlined by our invaluable Steering and Organising Committees as well as a dedicated group of Regional, Continent and Country Leads. Global PaedSurg Collaborator Map
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Safety First - Voices of One Surgery - Issue 4: December 2018

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