Cost-effectiveness ratios for many surgical procedures are comparable to those for accepted global public health strategies.
While moral arguments have been made to bring surgical treatments to resource-poor countries, researchers from Boston Children’s Hospital have discovered that it also may be cost-effective.
Traditionally, global health initiatives have focused on infectious disease or HIV/AIDS outreach. However, more recent data, including a 2012 study in The Lancet, show a growing global burden of noncommunicable diseases, such as cancer, that require surgical treatment.
Surgical disease was previously thought to comprise at least 11 percent of the total global burden of disease, but the Lancet paper showed approximately 25 percent of people requiring surgical assessment, based on a widespread survey in Sierra Leone. Additional research has revealed that up to 85 percent of pediatric patients in Africa have a surgical condition by the age of 15 years.
“However, the prevailing perception is that surgical care is too expensive and not cost-effective enough to bring to developing countries,” states Tiffany E. Chao, MD, a Paul Farmer Global Surgery Fellow in the Plastic and Oral Surgery Department at Boston Children’s. Full story »
Babies with newborn jaundice need phototherapy. In the developed world that's easy; in the developing world, not so much. (Bruce R. Wahl/Beth Israel Deaconess Medical Center)
Family lore has it that when I was born, I had to spend a couple of extra days in the hospital for jaundice, the distinctive yellow tint to the skin that shows that a baby’s liver isn’t fully up and running yet. For me—and most of the newborns that develop jaundice every year in the developed world—the treatment was simple: spending some time lying under bright blue lights (aka phototherapy).
Note that I said “developed world.” The story in the developing world is quite different. Sometimes the nearest hospital with phototherapy equipment is hours’ or days’ travel away. Even though it’s simple, phototherapy is power intensive; no power, no treatment.
And untreated jaundice can have devastating consequences. The yellow pigment, called bilirubin, can accumulate in the brain and cause permanent brain damage or death.
The best solution for regions with few resources would have to be small and portable, run on batteries or other off-grid power sources, cost little, but still be safe and deliver the right wavelength and intensity of light. This is where Donna Brezinski, MD, wants to make a difference. And the Bili-Hut is her answer. Full story »
Diseases like malaria strike children harder than adults, but clinical trials for these diseases rarely include or focus on children. Why? (WHO/P. Virot)
We’re pretty focused on the safety of the things around us. Our drinking water gets checked for chemicals, bacteria and other things that could make us sick. Kids’ car seats are tested to make sure they’ll keep children safe in an accident.
But there’s one surprising arena where this focus on safety and testing often falls short: the medications we give our children. Not just in the United States, but globally.
There are lots of reasons why fewer drugs get tested for safety and efficacy in children than in adults. It’s time-consuming, expensive and, frankly, risky. The ethics of testing new medications in children are pretty thorny.
And, overall, the market for pediatric drugs is much, much smaller than that for drugs for adults, since children fortunately don’t get sick as often as us grown-ups.
But for some diseases like asthma and diarrheal diseases, children bear a greater burden than adults—one that’s not matched by the amount of research done on drugs for kids. Full story »
Efforts to create a malaria vaccine have had limited success. Springer and colleagues solved the 3D structure of a key protein on the parasite -- and found a fragment which they'll soon test as a vaccine. (Photos_by_Angela/Flickr)
From the perspective of a wealthy country, malaria is a problem that is solved. It’s like smallpox. We ask, Who gets it? Who cares? Isn’t it better to invest in diabetes?
In truth, malaria is more infectious than ever, endemic to 106 nations, threatening half the world’s population and stalling economic development and prosperity.
That’s part of the reason why Timothy A. Springer, PhD, an investigator in the Program in Cellular and Molecular (PCMM) Medicine at Boston Children’s Hospital and the Immune Disease Institute (IDI), took on Plasmodium falciparum, the parasite that causes malaria. Another is that he likes solving problems in immunology – and has made his name discovering molecules that both promote and fight infections, in part by understanding their structures. Full story »
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Can the inventors of Watson help save sick children in the developing world? A “cloud-based” pediatric learning module, conceived by Children’s Hospital Boston and built by IBM Interactive, is being beta-tested this year in 20 countries. Provisionally called OpenPediatrics, it will give 1,000 doctors and nurses on five continents the next best thing to hands-on training. (Above is just a preview). Full story »
Benjamin Warf, MD, director of Neonatal and Congenital Anomalies Neurosurgery at Children’s Hospital Boston, developed a new treatment for infant hydrocephalus, or “water on the brain,” while a medical missionary in Africa, where hydrocephalus is common and usually untreated. His innovation, which has saved the lives of thousands of children, is minimally invasive, relatively inexpensive and has been taught to other surgeons in developing countries. The post below is adapted from Warf’s testimony last week before the House Subcommittee on Africa, Global Health and Human Rights (viewable on C-SPAN; jump to 17:54). John Mugamba, MD, whom Warf trained and who is currently medical director at CURE Children’s Hospital of Uganda, gave testimony in video form.
In 2000, my family and I moved to Uganda as medical missionaries to help start a specialty hospital for pediatric neurosurgery, the CURE Children’s Hospital of Uganda. At the time, there were no pediatric neurosurgical hospitals and few trained neurosurgeons in all of Africa. Full story »
Hiep Nguyen (L) and two of his Kenyan colleagues during one of the 41 procedures they performed together in five days. (Photo: Kelly Kristof and Hiep Nguyen)
For over a decade, Hiep Nguyen, MD, FAAP has been traveling the world as part of a nonprofit surgical and education team, dedicated to improving pediatric urology in developing countries. Nguyen’s recent experiences leading a surgical team in Kenya highlighted the need for a better way to keep his international colleagues up to date on the rapidly evolving field of pediatric urologic surgery.
Once a year, I lead a group of dedicated volunteers from International Volunteers in Urology (or IVUmed) to a remote part of the world to help train local physicians to care for children with urological problems, in particular congenital anomalies of the genitourinary tract. Despite these conditions being common – they affect between two and 15 percent of all children – very few physicians are specifically trained to take care of children who have them. The ways in which we diagnose and care for congenital urological problems are evolving rapidly and, consequently, such care is increasingly delivered by full-time specialists – specialists who are often in limited supply, especially outside of the United States.
On a trip to Kenya last month, our IVUmed team, assisted by the local surgeons, operated on 41 patients in five days. In the process, the physicians there got their first exposure to many aspects of diagnosing and managing congenital genitourinary malformations. They soaked up the knowledge with enthusiasm and demanded more, but unfortunately, our time there was limited, and it will be another year before we return and resume their education.
Despite the success of these trips, I always sense that we could do a better job if we could work with our colleagues overseas more consistently and expose them more constantly to the urologic techniques and concepts we teach. But it is impossible to be there with them every day.