Improving Access to Pediatric Surgery in LMICs Through Capacity-Building: A Systematic Review
Bibliographic record
Abstract
OBJECTIVE: Pediatric surgical conditions are a significant source of morbidity and mortality in low- and middle-income countries (LMICs), where children with surgically treatable conditions lack access to care owing to an insufficient number of pediatric surgeons, poor and limited training, and financial barriers. There is a growing shift from charitable missions to capacity-strengthening projects, which strengthen the skills and resources of communities. The objective of this study was to synthesize the literature to identify capacity-strengthening projects, their methods and outcomes, and their limitations and barriers. METHODS: MEDLINE, EMBASE, Cochrane, and Web of Science were searched until May 5, 2023. Eligibility criteria were as follows: (1) inclusion of pediatric surgery patients; (2) designation as capacity-strengthening interventions; (3) outcomes of improved access defined through Lancet Commission on Global Surgery Indicators; and (4) designation as an LMIC defined by the World Bank. Two independent reviewers conducted screening and extraction. RESULTS: A total of 80 studies met inclusion criteria. Interventions were implemented in 69 LMICs and used 19 different methods of capacity strengthening. Common capacity-strengthening methods included the following: international surgical visits, training programs, partnerships, mobile clinics and camps, infrastructure enhancements, and telemedicine. Common methods used included the following: training of local providers, continuous contact between both countries after the visit was completed, improved access for rural families, and economic support for low-income families. A total of 1 357 077 pediatric surgeries were performed through these interventions. Limitations included the fact that only peer-reviewed studies were included. Included studies were mainly case series or small observational studies with qualitative data. CONCLUSIONS: This review identifies methods to implement capacity-strengthening interventions in LMICs, including their successes and barriers. Future research should report ethical concerns and quantitative outcomes to determine effectiveness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".