Browsing by Author "Smith, Emily R"
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Item Open Access Availability of post-hospital services supporting community reintegration for children with identified surgical need in Uganda.(BMC health services research, 2018-09-20) Smith, Emily R; van de Water, Brittney J; Martin, Anna; Barton, Sarah Jean; Seider, Jasmine; Fitzgibbon, Christopher; Bility, Mathama Malakha; Ekeji, Nelia; Vissoci, Joao Ricardo Nickenig; Haglund, Michael M; Bettger, Janet PrvuBACKGROUND:Community services and supports are essential for children transitioning home to recover from the hospital after surgery. This study assessed the availability and geographic capacity of rehabilitation, assistive devices, familial support, and school reintegration programs for school-aged children in Uganda with identified surgical need. METHODS:This study assessed the geographic epidemiology and spatial analysis of resource availability in communities in Uganda. Participants were children with identified surgical need using the Surgeons OverSeas Assessment of Surgical need (SOSAS). Community-based resources available to children and adolescents after surgery in Uganda were identified using publicly available data sources and searching for resources through consultation with in-country collaborators We sought resources available in all geographic regions for a variety of services. RESULTS:Of 1082 individuals surveyed aged 5 to 14 yearsr, 6.2% had identified surgical needs. Pediatric surgical conditions were most prevalent in the Northern and Central regions of Uganda. Of the 151 community-based services identified, availability was greatest in the Central region and least in the Northern region, regardless of type. Assuming 30% of children with surgical needs will need services, a maximum of 50.1% of these children would have access to the needed services in the extensive capacity estimates, while only 10.0% would have access in the minimal capacity estimates. The capacity varied dramatically by region with the Northern region having much lower capacity in all scenarios as compared to the Central, Eastern, or Western regions. CONCLUSIONS:Our study found that beyond the city of Kampala in the Central region, community-based services were severely lacking for school-aged children in Uganda. Increased pediatric surgical capacity to additional hospitals in Uganda will need to be met with increased availability and access to community-based services to support recovery and community re-integration.Item Open Access Development of an Interactive Global Surgery Course for Interdisciplinary Learners.(Annals of global health, 2021-03) Fitzgerald, Tamara N; Muma, Nyagetuba JK; Gallis, John A; Reavis, Grey; Ukachukwu, Alvan; Smith, Emily R; Ogbuoji, Osondu; Rice, Henry EIntroduction
Global surgical care is increasingly recognized in the global health agenda and requires multidisciplinary engagement. Despite high interest among medical students, residents and other learners, many surgical faculty and health experts remain uniformed about global surgical care.Methods
We have operated an interdisciplinary graduate-level course in Global Surgical Care based on didactics and interactive group learning. Students completed a pre- and post-course survey regarding their learning experiences and results were analyzed using the Wilcoxon signed-rank test.Results
Fourteen students completed the pre-course survey, and 11 completed the post-course survey. Eleven students (79%) were enrolled in a Master's degree program in global health, with eight students (57%) planning to attend medical school. The median ranking of surgery on the global health agenda was fifth at the beginning of the course and third at the conclusion (p = 0.11). Non-infectious disease priorities tended to stay the same or increase in rank from pre- to post-course. Infectious disease priorities tended to decrease in rank (HIV/AIDS, p = 0.07; malaria, p = 0.02; neglected infectious disease, p = 0.3). Students reported that their understanding of global health (p = 0.03), global surgery (p = 0.001) and challenges faced by the underserved (p = 0.03) improved during the course. When asked if surgery was an indispensable part of healthcare, before the course 64% of students strongly agreed, while after the course 91% of students strongly agreed (p = 0.3). Students reported that the interactive nature of the course strengthened their skills in collaborative problem-solving.Conclusions
We describe an interdisciplinary global surgery course that integrates didactics with team-based projects. Students appeared to learn core topics and held a different view of global surgery after the course. Similar courses in global surgery can educate clinicians and other stakeholders about strategies for building healthy surgical systems worldwide.Item Open Access Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.(PLoS One, 2016) Saxton, Anthony T; Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A; Farmer, Diana; Smith, Emily R; Rice, Henry EBACKGROUND: Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs). METHODS: We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. FINDINGS: We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. INTERPRETATION: Our findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.Item Embargo "It's his cheerfulness that gives me hope:" A Qualitative Analysis of Access to Pediatric Cancer Care in Northern Tanzania(2023) Metcalf, MadelineBackground:Pediatric cancer is a significant and growing burden in low- and middle-income countries such as Tanzania. The objective of this project was to describe the barriers and facilitators to accessing pediatric cancer care in Northern Tanzania using the Three Delays Model
Methods:This was a cross-sectional qualitative study conducted between June and September 2023 at Kilimanjaro Christian Medical Center (KCMC). Parents and caregivers of children obtaining pediatric cancer care at KCMC were approached for participation in in-depth interviews (IDIs) and complimentary demographic surveys. This study is part of an ongoing collaboration between researchers from Duke Global Health Institute at Duke University and KCMC.
Results:Participants suggested significant financial barriers to accessing pediatric cancer care along the entire care continuum. Early delays were impacted by waiting for symptoms to resolve and the use of traditional medicine. Additional delays resulted from health infrastructure at mid-level health facilities, misdiagnoses, and delayed referral to KCMC for definitive treatment. Participants did not describe clinical delays after arrival to KCMC and rather offered perspective on their child’s cancer diagnosis, their concerns while obtaining care, and their hopes for the future.
Conclusions: The most significant clinical delays occurred within Delay 1 (the decision to seek care) and Delay 2 (reaching a medical facility). Advancements in clinical infrastructure and training at intermediary medical centers should be considered to support the prompt diagnosis and treatment for pediatric cancer. Lastly, financial and social schemes which limit out-of-pocket expenses should be considered.
Item Open Access Perceived barriers and supports to accessing community-based services for Uganda's pediatric post-surgical population.(Disability and rehabilitation, 2019-12-15) Barton, Sarah Jean; Sandhu, Sahil; Doan, Isabelle; Blanchard, Lillian; Dai, Alex; Paulenich, Alexandra; Smith, Emily R; van de Water, Brittney J; Martin, Anna H; Seider, Jasmine; Namaganda, Florence; Opolot, Shem; Ekeji, Nelia; Bility, Mathama Malakha; Bettger, Janet PrvuBackground: Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders.Materials and methods: This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach.Results: Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration.Conclusions: Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda.Implications for rehabilitationMultiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda.The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations.Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery.Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration.Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal.Item Open Access Population-level surgical rates and unmet need in India: a retrospective analysis of districts and states from 2011 to 2019.(International journal of surgery (London, England), 2024-03) Zadey, Siddhesh; Smith, Emily R; Staton, Catherine A; Fitzgerald, Tamara N; Vissoci, Joao Ricardo Nickenig