Indian Journal of Public Health

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 58  |  Issue : 2  |  Page : 134--135

Objective representation of impact of pediatric surgery


Poonam Guha1, Dhananjay Vaze2,  
1 Senior Resident, Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
2 Asst. Professor, Department of Surgery, SKN Medical College, Pune, India

Correspondence Address:
Dr. Dhananjay Vaze
Asst. Professor, Department of Surgery, SKN Medical College, Pune - 411 038, Maharashtra
India




How to cite this article:
Guha P, Vaze D. Objective representation of impact of pediatric surgery.Indian J Public Health 2014;58:134-135


How to cite this URL:
Guha P, Vaze D. Objective representation of impact of pediatric surgery. Indian J Public Health [serial online] 2014 [cited 2020 Aug 6 ];58:134-135
Available from: http://www.ijph.in/text.asp?2014/58/2/134/132292


Full Text

Sir,

While expressing anxiety over the viability of pediatric surgery, some authors have gone to the extent of raising the question whether it is a "sinking branch." [1]

An improvement in these difficult circumstances requires robust governmental support which may be achieved by establishing importance of pediatric surgical services. A proper governmental support can be raised only if we as a community impress upon policy-makers the need for our services, their relevance and the ultimate impact of our interventions on the society at large.

Surgeons, by virtue of their jobs, cannot invest time towards sustained, perseverant and determined efforts to impress the policy-makers. Thus, they lag behind their public health colleagues. This is a generalized phenomenon as emphasized in a recent conference of Royal College of Surgeons (RCS) - "RCS Global Surgical Frontiers II" that surgeons have lagged behind their public health colleagues in the advocacy of their art. [2] This observation holds equally true for the pediatric surgical practice in India.

Cost-effectiveness analyses, a prerequisite for resource allocation prioritization, consider health benefits in terms of disability adjusted life years (DALYs). [3] DALYs for a health condition are calculated as the sum of the years of life lost due to premature mortality (YLL) and "healthy" years lost due to disability (YLD). A thought provoking observation outlined at the conference of RCS was that, based on calculation of WHO DALY, many surgical procedures measured up well or better than immunization or HIV treatment in terms of years of quality life saved per US$.

Multiple disorders corrected or managed by pediatric surgery are severely disabling (e.g., neural tube defects, bladder exstrophy, etc.). Others are incompatible with life without timely treatment. A sizable amount of morbidity and mortality associated with these diseases is averted/minimized by pediatric surgical interventions. Thus, the concept of disability averted by pediatric surgery (DAPS) i.e., saved YLL/YLD needs to be considered.

Pediatric surgery is peculiar because of the young age of its clientele and a variety of surgical interventions performed. Thus, the number of years of healthy life added in terms of saved YLL/YLD increases tremendously when compared with adult surgical modality. The comment by Chen that "pediatric surgeons" do everything except for "brain, bones, and heart." highlights the diverse spectrum of conditions catered to by the speciality. [4] Thus, pediatric surgeon has a prolific ability to save enormous amounts of DALY. Hence, the magnitude of DAPS is essentially high [Box 1].

[INLINE:1]

The example quoted in [Box 1] is based on certain assumptions, but it necessarily underlines the enormous impact made by pediatric surgery on the societal health care needs.

An impediment to calculation of disease burden of pediatric surgical diseases is the nonavailability of disability weights for many of the diseases. In India, another obvious hurdle to the calculation of DALY is absence of a robust data, which reflects the morbidity and mortality of individual pediatric surgical conditions. Although WHO provides disability weights for certain pediatric surgical diseases, the list is far unconsummated. Poenaru et al. [8],[9] established disability weights for 15 pediatric surgical as a part of a research project named DAPS in Kenya and Canada using a low cost multi-method approach.

A sturdy data of the exact incidence, morbidity, mortality, and disability weights for individual pediatric surgical conditions for the Indian scenario is essential to impress the effectiveness of the branch on policy-makers, which can be generated by concerted efforts of the fraternity as a whole.

References

1Chatterjee SK. Is pediatric surgery a sinking specialty? J Indian Assoc Paediatr Surg 2002;7:103.
2Grimes C. Is surgery in developing countries good value for money compared to public health? Paper Presented at RCS Global Surgical Frontiers II, 2 nd Global Surgical Frontiers Conference of the Royal College of Surgeons of England; 2013, Jan 16. (Unpublished).
3Brock DW, Wikler D. Ethical issues in resource allocation, research, and new product development. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. 2 nd ed. Washington: The World Bank and Oxford University Press; 2006. p. 259-60.
4Chen MK. Current practice in pediatric surgery. Surg Clin North Am 2006;86:xix-xx.
5Hong KS, Saver JL. Years of disability-adjusted life gained as a result of thrombolytic therapy for acute ischemic stroke. Stroke 2010;41:471-7.
6Donaldson EA, Waters HR, Arora M, Varghese B, Dave P, Modi B. A cost-effectiveness analysis of India′s 2008 prohibition of smoking in public places in Gujarat. Int J Environ Res Public Health 2011;8:1271-86.
7Dandona L, Kumar SG, Kumar GA, Dandona R. Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India. BMC Health Serv Res 2010;10:117.
8Poenaru D, Pemberton J, Frankfurter C, Cameron B. Establishing disability weights for congenital paediatric surgical disease: a cross-sectional, multi-modal study. Lancet 2013;381:S115.
9DAPS Poster. Available from: http://www.fhs.mcmaster.ca/mpsrc/documents/CCGHRPoster2012-1-26.pdf. [Downloaded on 2013 Jul 29].