The Impact of Gender on Pediatric Surgical Access and Outcomes in Africa

Introduction Girls, whose care is often affected by barriers steeped in gender inequity, may be at higher risk of poor surgical outcomes. This study explored the impact of gender on pediatric surgical care in Africa. Methods Differences in access to care and clinical outcomes for boys and girls were examined for pediatric surgical conditions that do not differ by physiological sex. A systematic review of African pediatric surgical studies ensued, followed by a random effects meta-analysis, and risk of bias assessment. Results Of the 12281 records retrieved, 54 were selected for review. Most studies were retrospective (57.4%), single-site (94.4%), from Egypt, Nigeria, Ghana, or Ethiopia (55.6%), focussed on gastrointestinal conditions (63.0%), published in 2010 or sooner (85.1%), had study durations of 5 years or less (68.5%), and cohorts of less than 200 children (57.4%). Sixty percent reported the outcome of mortality. Meta-analysis odds ratios revealed surgery was performed 3.6 times more often on boys (95% CI: 2.6, 4.9); and mortality was 1.6 times greater for girls (95% CI: 1.3, 2.0). Conclusion African girls appear to face gender inequities in pediatric surgical care. Findings will be further explored in a mixed-methods study. Level of evidence I Highlights ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was partly funded by the Montreal Children's Hospital Foundation via the Jean-Martin Laberge Fellowship in Global Pediatric Surgical Research. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data used for this systematic review are openly available on PubMed (https://pubmed.ncbi.nlm.nih.gov/). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.