BMJ Open (Mar 2020)

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

  • Charles Mock,
  • Jonathan Lord,
  • Monica Langer,
  • Niyi Ade-Ajayi,
  • Dan Poenaru,
  • Harshjeet Singh Bal,
  • Massimo Caputo,
  • Damian Clarke,
  • Fred Bulamba,
  • Lubna Samad,
  • David Cunningham,
  • George Youngson,
  • Michael Cooper,
  • Tamara Fitzgerald,
  • Henry Rice,
  • Patrick Kamalo,
  • Emily R Smith,
  • Bistra Zheleva,
  • David Drake,
  • Emily Smith,
  • Lars Hagander,
  • Bassey Edem,
  • Sridhar Gibikote,
  • Jessica Ng,
  • David Spiegel,
  • Saurabh Saluja,
  • Peter Ssenyonga,
  • Thiago Augusto Hernandes Rocha,
  • Joao Vissoci,
  • Nubia Rocha,
  • Mark Shrime,
  • Henry E Rice,
  • Mohamed Abdelmalak,
  • Nurudeen Abdulraheem,
  • Edna Adan Ismail,
  • Eltayeb Ahmed,
  • Sunday Ajike,
  • Olugbemi Benedict Akintububo,
  • Brendan Allen,
  • Emmanuel Ameh,
  • Shanthi Anbuselvan,
  • Jamie Anderson,
  • Theophilus Teddy Kojo Anyomih,
  • Leopold Asakpa,
  • Gudeta Assegie,
  • Jason Axt,
  • Ruben Ayala,
  • Frehun Ayele,
  • Rouma Bankole,
  • Tahmina Banu,
  • Tim Beacon,
  • Stephen Bickler,
  • Zaitun Bokhari,
  • Hiranya Kumar Borah,
  • Eric Borgstein,
  • Nick Boyd,
  • Jason Brill,
  • Britta Budde-Schwartzman,
  • Marilyn Butler,
  • Bruce Bvulani,
  • Sarah Cairo,
  • Juan Francisco Campos Rodezno,
  • Milind Chitnis,
  • Maija Cheung,
  • Bruno Cigliano,
  • Tessa Concepcion,
  • Scott Corlew,
  • Sergio D’Agostino,
  • Shukri Dahir,
  • Bailey Deal,
  • Miliard Derbew,
  • Sushil Dhungel,
  • Elizabeth Drum,
  • Stella Eguma,
  • Beda R. Espineda,
  • Samuel Espinoza,
  • Faye Evans,
  • Jacques Fadhili Bake,
  • Diana Farmer,
  • Tatiana Fazecas,
  • Mohammad Rafi Fazli,
  • Graham Fieggen,
  • Anthony Figaji,
  • Jean Louis Fils,
  • Randall Flick,
  • Gacelle Fossi,
  • George Galiwango,
  • Mike Ganey,
  • Zipporah Gathuya,
  • Maryam Ghavami Adel,
  • Vafa Ghorban Sabagh,
  • Hetal Gohil,
  • Laura Goodman,
  • David Grabski,
  • Sarah Greenberg,
  • Russell Gruen,
  • Rahimullah Hamid,
  • Erik Hansen,
  • William Harkness,
  • Mauricio Herrera,
  • Intisar Hisham,
  • Andrew Hodges,
  • Sarah Hodges,
  • Ai-Xuan Holterman,
  • Andrew Howard,
  • Romeo Ignacio,
  • Dawn Ireland,
  • Enas Ismail,
  • Rebecca Jacob,
  • Anette Jacobsen,
  • Deeptiman James,
  • Ebor Jacob James,
  • Adiyasuren Jamiyanjav,
  • Kathy Jenkins,
  • Guy Jensen,
  • Maria Jimenez,
  • Tarun John K Jacob,
  • Walter Johnson,
  • Anita Joselyn,
  • Nasser Kakembo,
  • Neema Kaseje,
  • Bertille Ki,
  • Phyllis Kisa,
  • Peter Kim,
  • Krishna Kumar,
  • Rashmi Kumar,
  • Charlotte Kvasnovsky,
  • Ananda Lamahewage,
  • Christopher Lavy,
  • Colin Lazarus,
  • Chelsea Lee,
  • Basil Leodoro,
  • Allison Linden,
  • Katrine Lofberg,
  • Jerome Loveland,
  • Leecarlo Millano Lumban Gaol,
  • Vrisha Madhuri,
  • Pavrette Magdala,
  • Luc Kalisya Malemo,
  • Aeesha Malik,
  • John Mathai,
  • Marcia Matias,
  • Bothwell Mbuwayesango,
  • Merrill McHoney,
  • Liz McLeod,
  • Mubarak Mohamed,
  • Ivan Molina,
  • Ashika Morar,
  • Zahid Mukhtar,
  • Mulewa Mulenga,
  • Bhargava Mullapudi,
  • Jack Mulu,
  • Byambajav Munkhjargal,
  • Arlene Muzira,
  • Mary Nabukenya,
  • Mark Newton,
  • Karissa Nguyen,
  • Laurence Isaaya Ntawunga,
  • Peter M. Nthumba,
  • Alp Numanoglu,
  • Benedict Nwomeh,
  • Kristin Ojomo,
  • Keith Oldham,
  • Maryrose Osazuwa,
  • Doruk Ozgediz,
  • Emmanuel Owusu Abem,
  • Shazia Peer,
  • Norgrove Penny,
  • Robin Petroze,
  • Vithya Priya,
  • Ekta Rai,
  • Lola Raji,
  • Vinitha Paul Ravindran,
  • Desigen Reddy,
  • Yona Ringo,
  • Amezene Robelie,
  • Jose Roberto Baratella,
  • David Rothstein,
  • Coleen Sabatini,
  • Soumitra Saha,
  • Lily Saldaña Gallo,
  • John Sekabira,
  • Bello B. Shehu,
  • Ritesh Shrestha,
  • Sabina Siddiqui,
  • David Sigalet,
  • Martin Situma,
  • Adrienne Socci,
  • Etienne St-Louis,
  • Jacob Stephenson,
  • Erin Stieber,
  • Richard Stewart,
  • Vinayak Shukla,
  • Thomas Sims,
  • Faustin Felicien Mouafo Tambo,
  • Robert Tamburro,
  • Mansi Tara,
  • Ahmad Tariq,
  • Reju Thomas,
  • Leopold Torres Contreras,
  • Stephen Ttendo,
  • Benno Ure,
  • Luca Vricella,
  • Luis Vasquez,
  • Vijayakumar Raju,
  • Jorge Villacis,
  • Gustavo Villanova,
  • Catherine deVries,
  • Amira Waheeb,
  • Saber Waheeb,
  • Albert Wandaogo,
  • Anne Wesonga,
  • Sigal Willner,
  • Nyo Nyo Win,
  • Hussein Wissanji,
  • Paul Mwindekuma Wondoh,
  • Garreth Wood,
  • Benjamin Yapo,
  • Yasmine Yousef,
  • Denle'wende' Sylvain Zabsonre,
  • Luis Enrique,
  • Zea Salazar,
  • Adiyasuren Zevee

DOI
https://doi.org/10.1136/bmjopen-2019-034253
Journal volume & issue
Vol. 10, no. 3

Abstract

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Objectives The optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.Design This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participants We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measures We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).Findings There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.Conclusions We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.