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Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study.

Publication ,  Journal Article
Truche, P; Smith, ER; Ademuyiwa, A; Buda, A; Nabukenya, MT; Kaseje, N; Ameh, EA; Greenberg, S; Evans, F; Bickler, S; Meara, JG; Rice, HE
Published in: World J Surg
September 2022

OBJECTIVES: To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. METHODS: We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common non-surgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. RESULTS: We found that increased SAO density is associated with decreased U5MR and NMR (P < 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of < 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of < 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. CONCLUSIONS: Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.

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Published In

World J Surg

DOI

EISSN

1432-2323

Publication Date

September 2022

Volume

46

Issue

9

Start / End Page

2262 / 2269

Location

United States

Related Subject Headings

  • Workforce
  • Sustainable Development
  • Surgery
  • Infant, Newborn
  • Infant Mortality
  • Infant
  • Humans
  • Cross-Sectional Studies
  • Child Mortality
  • Child
 

Citation

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Truche, P., Smith, E. R., Ademuyiwa, A., Buda, A., Nabukenya, M. T., Kaseje, N., … Rice, H. E. (2022). Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study. World J Surg, 46(9), 2262–2269. https://doi.org/10.1007/s00268-022-06626-6
Truche, Paul, Emily R. Smith, Adesoji Ademuyiwa, Alexandra Buda, Mary T. Nabukenya, Neema Kaseje, Emmanuel A. Ameh, et al. “Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study.World J Surg 46, no. 9 (September 2022): 2262–69. https://doi.org/10.1007/s00268-022-06626-6.
Truche, Paul, et al. “Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study.World J Surg, vol. 46, no. 9, Sept. 2022, pp. 2262–69. Pubmed, doi:10.1007/s00268-022-06626-6.
Truche P, Smith ER, Ademuyiwa A, Buda A, Nabukenya MT, Kaseje N, Ameh EA, Greenberg S, Evans F, Bickler S, Meara JG, Rice HE. Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study. World J Surg. 2022 Sep;46(9):2262–2269.
Journal cover image

Published In

World J Surg

DOI

EISSN

1432-2323

Publication Date

September 2022

Volume

46

Issue

9

Start / End Page

2262 / 2269

Location

United States

Related Subject Headings

  • Workforce
  • Sustainable Development
  • Surgery
  • Infant, Newborn
  • Infant Mortality
  • Infant
  • Humans
  • Cross-Sectional Studies
  • Child Mortality
  • Child