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CHAPTER 1

Paediatric Surgery Specialty

and its Relevance to Africa

Philip M. Mshelbwala
Benedict C. Nwomeh

Introduction aged 0–14 years, of which 46% required surgical procedures. Using
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In Africa, children constitute more than half of the population, and age-specific incidences, the authors estimated the cumulative risk for
therefore much effort is devoted to the prevention and treatment of all surgical conditions at 85.4% by age 15 years (Figure 1.1). 5,6
childhood diseases. Emphasis is placed on diseases that cause the great- Despite sparse epidemiologic data, there is increasing recognition
est morbidity and mortality, such as communicable diseases (especially of the value of surgery as a component of basic health care and an
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human immunodeficiency virus/acquired immune deficiency syndrome important means of providing both preventive and curative treatment.
(HIV/AIDS), malaria, and respiratory infections), maternal and perina- As such, it is imperative that paediatric surgical care be integrated into
2
tal conditions, and nutritional deficiencies. In many African countries, a comprehensive strategy to reduce the burden of disease in Africa.
scarce health care resources have been concentrated on the provision of Table 1.1: Surgical conditions seen among children (n = 1200) treated at
immunisation, HIV control, malaria eradication, and other public health elective surgery at Komfo Anokye Teaching Hospital, Kumasi, Ghana.
concerns. As a result, diseases for which surgical intervention offers
the only hope for prevention, palliation, or cure usually do not come Disease entity Number of Percentage
within the radar of health policy makers. Given that surgical diseases children of total
have not been considered significant health care problems in Africa, the Inguinal hernia and hydrocele 611 51
3
paediatric surgical speciality has not received the attention it deserves.
Paediatric surgeons have been described as the only true general Undescended testis 93 8
4
surgeons; this is especially the case in Africa, where paediatric Umbilical hernia 63 5
subspecialisation is rare in orthopedics, urology, otolaryngology, Extra digits 58 5
thoracic surgery, plastic surgery and neurosurgery. The paediatric Neoplasms 44 4
surgeon in Africa, therefore, provides cost-effective care at a Cystic hygroma/hemangioma 36 3
considerable bargain for these impoverished countries. A detailed list Anorectal malformations 34 3
of paediatric surgical diagnoses encountered in an urban hospital in
Africa is provided in Table 1.1. Unaccounted for in most studies are Uncircumcised penis 28 2
those children for whom treatment is inaccessible due to distance, cost, Hirschsprung’s disease 27 2
or lack of qualified personnel. Bickler et al. analyzed all paediatric Enlarged lymph nodes 26 2
visits at the main urban hospital in Banjul, The Gambia, and estimated Rectal polyp 14 1
the incidence of paediatric surgical problems at 543 per 10,000 children
Thyroglossal and branchial cysts 11 0.9
Oesophageal stricture 10 0.8
All surgical conditions Epigastric and incisional hernia 10 0.8
Injuries Wilms’ tumour 9 0.8
Congenital anomalies Thyroglossal cysts 9 0.8
Surgical infections Rectovaginal fistulas 8 0.7
Sacrococcygeal teratoma 8 0.7
Miscellaneous
Spina bifida 5 0.4
Ambiguous genitalia 3 0.3
Anal stenosis 3 0.3
Enterocutaneous fistula 3 0.3
Hypersplenism with splenomegaly 3 0.3
Popliteal cyst 3 0.3
Pyloric stenosis 2 0.2
Patent urachus 2 0.2
Miscellaneous other 74 7

Source: Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Source: Adapted from: Abantanga FA, Amaning EP. Paediatric elective surgical conditions as
Health Organ 2002; 80(10):829–835. seen at a referral hospital in Kumasi, Ghana. ANZ J Surg 2002 72(12):890–892.
Figure 1.1: Estimated risk of requiring surgical care in a paediatric population
living in Banjul, The Gambia. Cumulative risk was estimated by using age-
specific incidences.