Correspondence
Addressing paediatric school, parent and community stigma, 4 Eeson G, Birabwa-Male D, Pennington M,
and even child abandonment are rife Blair GK. Costs and cost-effectiveness of
surgical care on World for these children and families. These
pediatric inguinal hernia repair in Uganda.
Published Online
World J Surg 2015; 39: 343–49.
Birth Defects Day dimensions are poorly captured in 5 Goodman LF, St-Louis E, Yousef Y, et al. March 2, 2018
http://dx.doi.org/10.1016/
The Global Initiative for Children’s Surgery:
traditional health metrics. optimal resources for improving care. S0140-6736(18)30501-4
As we pause to reflect on the burden of Through global concerted efforts, Eur J Pediatr Surg 2018; 28: 51–59.
disease caused by birth defects during such as The Lancet Commission on
World Birth Defects Day on March 3, Global Surgery and the World Health 45
2018, we highlight the importance Assembly Resolution 68.15, the
of developing surgical systems for foundation has been set to strength 40
children, to decrease the morbidity en surgical systems worldwide, but 35
and mortality of birth defects. we must ensure the inclusion of
30
Birth defects are now the fifth children’s surgery.
leading cause of death in children The Global Initiative for Children’s
Deaths (%)
25
under 5 years of age.1 Global under-5 Surgery (GICS) was initiated in 2016 by
20
mortality has decreased by 52% since children’s surgical care providers from
1990, largely due to prevention and around the world. GICS has produced 15
treatment of infectious diseases, the landmark Optimal Resources for
10
but the proportion of death due to Children’s Surgery guidelines for safe
birth defects has continued to grow children’s surgical care in health-care 5
(figure).1,2 An estimated two-thirds of systems.5 The next challenge will be
0
the burden of disease related to birth the global implementation of these 1990 1995 2000 2005 2010 2015
defects can be averted through surgical guidelines to ensure that all children Year
Neonatal disorders
care.3 Without sufficient investment have access to safe, affordable, and HIV, AIDS, and tuberculosis
in surgical care for children, it will be timely surgical care, regardless of their Diarrhoea, lower respiratory tract infections, and other common infectious diseases
Neglected tropical diseases and malaria
impossible to meet the second tar geographic location or socioeconomic Congenital birth defects
get of the Sustainable Development status. This lofty, but achievable goal Injuries
Goal 3: to end preventable deaths of requires us to refocus our attention
Figure: Global causes of death in children under 5 years of age, 1990–20162
newborn babies and children under to this neglected area in global health. Mortality data are for both sexes.
5 years of age by 2030. We declare no competing interests. NJW and JEA
Surgical care for children is cost- contributed equally. For more on World Birth Defects
effective, particularly for birth defects Naomi J Wright, *Jamie E Anderson,
Day see http://www.
worldbirthdefectsday.org
in which the condition can be cured Doruk Ozgediz, Diana L Farmer, For more on the Global Initiative
or the associated disability can be Tahmina Banu for Children’s Surgery see http://
substantially improved. Because [email protected] www.globalchildrenssurgery.org
the intervention occurs at such a Global Initiative for Children’s Surgery, Portland,
young age, the potential effect on OR, USA (NJW, JEA, DO, DLF, TB); King’s Centre for
disability-adjusted life-years (DALYs) Global Health and Health Partnerships, School of
Population Health and Environmental Science,
is powerful. For instance, a 2015 King’s College London, London, UK (NJW); Program
study4 on birth defects in Uganda for Global Surgery and Social Change, Boston
found that a paediatric inguinal hernia Children’s Hospital, Boston, MA, USA (JEA);
Department of Surgery, University of California,
repair costs just US$12·41 per DALY Davis, Sacramento, CA 95817, USA (JEA, DLF);
averted, compared with $41 per Department of Surgery, Yale University, New
DALY averted for insecticide-treated Haven, CT, USA (DO); and Chittagong Research
Institute for Children Surgery, Chittagong,
bednets to prevent malaria. Treating Bangladesh (TB)
children with birth defects also has 1 GBD 2015 Child Mortality Collaborators. Global,
great potential economic benefits by regional, national, and selected subnational
levels of stillbirths, neonatal, infant, and under-
not only enabling the affected child to mortality, 1980–2015: a systematic analysis for
become a more productive member the Global Burden of Disease Study 2015.
of society, but also preventing the Lancet 2016; 388: 1725–74.
2 Institute for Health Metrics and Evaluation.
spiral of poverty that is a common GBD results tool. 2018. http://ghdx.healthdata.
Submissions should be
made via our electronic
result for families of these children. org/gbd-results-tool (accessed Feb 21, 2018).
submission system at
Issues such as social exclusion from 3 Debas HT, Donkor P, Gawande A, et al. Disease
http://ees.elsevier.com/
control priorities, 3rd edn—volume 1: essential
community and spiritual life, missed surgery. Washington, DC: World Bank, 2015. thelancet/
www.thelancet.com Published online March 2, 2018 http://dx.doi.org/10.1016/S0140-6736(18)30501-4 1
