A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia

World Journal of Surgery, Apr 2018

Laura F. Goodman, Erdenetsetseg Chuluun, Burmaa Sanjaa, Sanchin Urjin, Sarnai Erdene, Narantuya Khad, Adiyasuren Jamiyanjav, Jacob Stephenson, Diana L. Farmer

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A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia

A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia Laura F. Goodman 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Erdenetsetseg Chuluun 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Burmaa Sanjaa 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Sanchin Urjin 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Sarnai Erdene 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Narantuya Khad 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Adiyasuren Jamiyanjav 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Jacob Stephenson 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Diana L. Farmer 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 Sanchin Urjin 1 Burmaa Sanjaa 2 & Laura F. Goodman 3 Department of Surgery, University of California Davis Health , 2315 Stockton Boulevard OP512, Sacramento, CA 95817 , USA 4 Diana L. Farmer 5 Jacob Stephenson 6 Adiyasuren Jamiyanjav 7 Narantuya Khad 8 Department of Pediatric Surgery, National Center for Maternal and Child Health , Khuvsgalch Road, Bayangol District, Ulaanbaatar 16060 , Mongolia 9 Department for Statistics and Information Technology, Center for Health Development , Enkhtaivan Street - 13b, Sukhbaatar District, Ulaanbaatar , Mongolia 10 Mongolian National University of Medical Sciences , S. Zorig Street-3, Sukhbaatar District, P.O. Box 48/111, Ulaanbaatar 14210 , Mongolia 11 Department of Surgery, University of California Davis Health , 2221 Stockton Boulevard, Sacramento, CA 95817 , USA 12 Division of Pediatric Surgery, Department of Surgery, University of California Davis Health , 2221 Stockton Boulevard, Sacramento, CA 95817 , USA 13 Uniformed Services University of the Health Sciences , Bethesda, MD , USA Background Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity. Methods Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tool was used to collect data at all survey sites. Descriptive data analyses were completed using Excel. Studies of association were completed using Stata. All reported percentages are of the hospitals outside of the capital (n = 21). Results All provincial hospitals have general surgeons; seven (33.3%) of them have pediatric surgeon(s). One facility has no anesthesiologist. All facilities perform basic procedures and provide anesthesia. Four (19%) can treat common congenital anomalies. All facilities have basic operating room equipment. Nine hospitals do not have pulse oximetry available. Twelve hospitals do not have pediatric surgical instruments always available. Pediatric supplies are lacking. Conclusions Provincial hospitals in Mongolia can perform basic procedures. However, essential pediatric supplies are lacking. Consequently, certain life-saving procedures are not available to children outside of the capital. Only a few improvements would be amendable to low-cost process improvement adjustment, and the majority of needs require resource additions. Procedure, equipment, and supply availability should be further explored to develop a comprehensive nationwide pediatric surgical program. - This work was completed while Laura Goodman was a graduate student at the Harvard T.H. Chan School of Public Health. Background information Mongolia is a parliamentary republic of approximately three million people located between eastern Russia and the northern border of China. One-third of its population remains semi-nomadic herders. The Gross National Income is US$3550 per capita (2016) [ 1 ]. From 1990 to 2015, Mongolia reduced under-five childhood mortality by over two-thirds [ 2, 3 ]. Under-five mortality decreased from 107.8 per 1000 live births in 1990 to 22.4 per 1000 in 2015—a 79.2% decline. Infant mortality decreased from 76.9 per 1000 live births in 1990, to 19 in 2015. Neonatal (first 28 days of life) mortality rate declined from 31.8 per 1000 live births in 1990, to 11.1 per 1000 in 2015 [1]. The post-Soviet era medical system in Mongolia follows Disease Control Priorities definitions of levels of care [ 4 ]. Primary or first-level care is provided at different types of first-access centers including village hospitals (Fig. 1). Provincial center hospitals and regional diagnostic and treatment centers provide secondary-level care. These centers are frequent initial points of contact for patients [ 5, 6 ]. Tertiary care is only available in the capital. Direct self-referral is possible at all levels. Within Mongolia, infant mortality rates range from four per 1000 live births in certain areas, and up to 29 per 1000 in others [ 7 ]. The under-five mortality rates vary from 10.6 per 1000 live births in the capital city, t (...truncated)


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Laura F. Goodman, Erdenetsetseg Chuluun, Burmaa Sanjaa, Sanchin Urjin, Sarnai Erdene, Narantuya Khad, Adiyasuren Jamiyanjav, Jacob Stephenson, Diana L. Farmer. A Nationwide Assessment of Pediatric Surgical Capacity in Mongolia, World Journal of Surgery, 2018, pp. 1-11, DOI: 10.1007/s00268-018-4613-y