Work

First Line of Childrens’ Surgical Care: Assessing Initial Management of Pediatric Surgical Conditions by General Practitioners in Rwanda

Year: 2025

Type: article

Abstract: Background Over the past decade, the development of pediatric surgical services in Rwanda has resulted in improved survival of previously fatal conditions. Because the Rwandan health model relies on a decentralized approach, children with surgical conditions are often first evaluated by general practitioners (GPs) at rural district hospitals prior to definitive transfer. Understanding knowledge gaps in the diagnosis, stabilization, and transfer of children with surgical conditions is essential to improve initial management. This study assesses modifiable knowledge gaps in GPs across Rwanda. Methods A needs assessment was developed to identify demographics and practice patterns in the care of 9 prioritized pediatric surgical conditions, as identified by a previously conducted Delphi process. GPs at 5 district and regional hospitals completed the survey via REDCap. Demographics, attitudes, and knowledge were analyzed using RStudio v1.1.4. Results Ninety-two physicians with heterogeneous experience participated (105 invited, 88% response rate). Transfers occurred due to need for specialist management, lack of equipment, and knowledge. Common barriers included unavailability of beds at referral hospitals and cost. Challenges in specific knowledge were cited by 63%–84%. Common conditions were correctly diagnosed by 78%–94% of participants, though 45.7% of participants incorrectly diagnosed at least one condition. Few participants (0%–25%) correctly answered questions assessing initial management. The decision and timing of transfer varied; a minority indicated that their hospital’s general surgery team could provide definitive treatment for select conditions. Conclusions As pediatric surgical capacity improves, timely and safe transfer is critical to improve outcomes. Knowledge gaps exist in the diagnosis, stabilization, and transfer of children with surgical conditions among GPs in Rwanda, marking an opportunity for directed training.

Source: East and Central African journal of surgery

DOI: 10.4314/ecajs.v30i4.6