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Specialized pediatric healthcare with limited resources: Surgery, anesthesia and oncology for children in low- and middle-income countries

Hagander, Lars LU (2013) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2013:96.
Abstract
Aim: This thesis serves two purposes. First, it informs specialists in global public health to consider a broader spectrum of pediatric disease. Second, it informs specialists in pediatric hospital care of how the feasibility of their clinical practice depends on a functioning health care system.



Methods: The papers contextualize pediatric disease entities that so far have received relatively sparse global health attention, including examples from oncology, surgery, and anesthesia in low- and middle-income countries. Specialized healthcare is broadly defined as referral level hospital care, which often involves interdisciplinary collaboration of specialized personnel, sophisticated diagnostic methods and advanced... (More)
Aim: This thesis serves two purposes. First, it informs specialists in global public health to consider a broader spectrum of pediatric disease. Second, it informs specialists in pediatric hospital care of how the feasibility of their clinical practice depends on a functioning health care system.



Methods: The papers contextualize pediatric disease entities that so far have received relatively sparse global health attention, including examples from oncology, surgery, and anesthesia in low- and middle-income countries. Specialized healthcare is broadly defined as referral level hospital care, which often involves interdisciplinary collaboration of specialized personnel, sophisticated diagnostic methods and advanced therapeutic modalities. The study populations come from low- and middle-income countries from different parts of the world. The analyses benefit from a range of statistical methods and study designs.



The thesis explores how children and families experience barriers to adequate hospital care, both before (I–Surgery case-series, Haiti) and after arriving at the hospital (II–Oncology cohort-study, Vietnam). The thesis also researches how limited resources influences doctors, both in terms of clinical decision-making (III–Anesthesia cohort, Bangladesh) and as a cause of migration and workforce shortage (IV–Survey, US). Finally, an integrated health system perspective is applied, determining to what extent certain evidence-based treatment strategies from high-income countries are applicable to a low-and middle-income setting (V–Markov model decision analysis).



Results: Children seem to experience greater geographical barriers to surgical care than adults (I). Interventions that increase adherence to cancer treatment may have greater impact on childhood cancer survival than medical care improvement (II). Major neonatal surgery is often performed without general anesthesia, and health care systems must respond to the pandemic of anesthetic mortality (III). Surgeon migration can be addressed by providing adequate domestic surgical infrastructure, training, and career pathways (IV). State-of-the-art management algorithms from high-income countries can be suboptimal when applied to the health care systems of low- and middle-income countries (V).



Conclusion: Specialized pediatric healthcare benefits from a health system perspective and attention to the social context of patients, and should be part of a continuum of integrated care for children also in low- and middle-income countries. (Less)
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author
supervisor
opponent
  • Professor Konradsen, Flemming, Copenhagen School of Global Health
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Pediatric surgery. Pediatric anesthesiology. Pediatric oncology. Global Health. Developing countries. Health system strengthening. Access to care. Child mortality. Perioperative mortality. Decision analysis. Markov Model.
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2013:96
pages
139 pages
publisher
Paediatrics, Faculty of Medicine, Lund University
defense location
Segerfalksalen, BMC, Sölvegatan 17, Lund.
defense date
2013-09-21 09:00
ISSN
1652-8220
ISBN
978-91-87449-68-0
language
English
LU publication?
yes
id
1296170e-44d7-4b10-8d9e-a911b3ecc52d (old id 4015922)
date added to LUP
2013-09-03 14:28:17
date last changed
2019-05-22 04:42:34
@phdthesis{1296170e-44d7-4b10-8d9e-a911b3ecc52d,
  abstract     = {Aim: This thesis serves two purposes. First, it informs specialists in global public health to consider a broader spectrum of pediatric disease. Second, it informs specialists in pediatric hospital care of how the feasibility of their clinical practice depends on a functioning health care system. <br/><br>
<br/><br>
Methods: The papers contextualize pediatric disease entities that so far have received relatively sparse global health attention, including examples from oncology, surgery, and anesthesia in low- and middle-income countries. Specialized healthcare is broadly defined as referral level hospital care, which often involves interdisciplinary collaboration of specialized personnel, sophisticated diagnostic methods and advanced therapeutic modalities. The study populations come from low- and middle-income countries from different parts of the world. The analyses benefit from a range of statistical methods and study designs.<br/><br>
<br/><br>
The thesis explores how children and families experience barriers to adequate hospital care, both before (I–Surgery case-series, Haiti) and after arriving at the hospital (II–Oncology cohort-study, Vietnam). The thesis also researches how limited resources influences doctors, both in terms of clinical decision-making (III–Anesthesia cohort, Bangladesh) and as a cause of migration and workforce shortage (IV–Survey, US). Finally, an integrated health system perspective is applied, determining to what extent certain evidence-based treatment strategies from high-income countries are applicable to a low-and middle-income setting (V–Markov model decision analysis). <br/><br>
<br/><br>
Results: Children seem to experience greater geographical barriers to surgical care than adults (I). Interventions that increase adherence to cancer treatment may have greater impact on childhood cancer survival than medical care improvement (II). Major neonatal surgery is often performed without general anesthesia, and health care systems must respond to the pandemic of anesthetic mortality (III). Surgeon migration can be addressed by providing adequate domestic surgical infrastructure, training, and career pathways (IV). State-of-the-art management algorithms from high-income countries can be suboptimal when applied to the health care systems of low- and middle-income countries (V). <br/><br>
<br/><br>
Conclusion: Specialized pediatric healthcare benefits from a health system perspective and attention to the social context of patients, and should be part of a continuum of integrated care for children also in low- and middle-income countries.},
  author       = {Hagander, Lars},
  isbn         = {978-91-87449-68-0},
  issn         = {1652-8220},
  keyword      = {Pediatric surgery. Pediatric anesthesiology. Pediatric oncology. Global Health. Developing countries. Health system strengthening. Access to care. Child mortality. Perioperative mortality. Decision analysis. Markov Model.},
  language     = {eng},
  pages        = {139},
  publisher    = {Paediatrics, Faculty of Medicine, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Specialized pediatric healthcare with limited resources: Surgery, anesthesia and oncology for children in low- and middle-income countries},
  volume       = {2013:96},
  year         = {2013},
}