{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:39:56Z","timestamp":1792352396780,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Children's surgery is increasingly recognized as a global health priority, yet pediatric anesthesia remains comparatively under\u2010recognized despite being essential for safe surgical and perioperative care.<\/jats:p>\n <\/jats:sec>\n \n The Problem<\/jats:title>\n Children require specialized expertise, age\u2010appropriate equipment, reliable monitoring, oxygen, medicines, recovery, and critical care. In many low\u2010 and middle\u2010income countries, deficiencies across these domains limit access and contribute to preventable perioperative morbidity and mortality.<\/jats:p>\n <\/jats:sec>\n \n The Central Claim<\/jats:title>\n We posit that children's surgical systems cannot be strengthened without parallel investment in pediatric anesthesia systems. Pediatric anesthesia should therefore be recognized as a cross\u2010cutting core health\u2010system function rather than a supporting clinical specialty.<\/jats:p>\n <\/jats:sec>\n \n Evidence Synthesis<\/jats:title>\n This perspective integrates the WHO Health Systems Building Blocks, the Lancet Commission on Global Surgery, National Surgical, Obstetric and Anesthesia Plans, the GICS Optimal Resources for Children's Surgery framework, and Donabedian's Structure\u2010Process\u2010Outcome model into an Integrated Pediatric Anesthesia Systems Framework (IPASF).<\/jats:p>\n <\/jats:sec>\n \n Recommendations<\/jats:title>\n Governments, professional societies, academic institutions, global surgery organizations, and development partners should integrate pediatric anesthesia into surgical\u2010system planning, workforce development, financing, service delivery, quality improvement, and research.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Safe and equitable children's surgery requires deliberate investment in the systems that enable safe anesthesia. The IPASF provides a practical framework for policy, implementation, education, research, and evaluation across the perioperative continuum.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/wjs.70610","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:02:06Z","timestamp":1792350126000},"source":"Crossref","is-referenced-by-count":0,"title":["Safe Surgery Starts With Safe Anesthesia: Positioning Pediatric Anesthesia as a Core Health\u2010System Function Within Global Children's Surgical Systems"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8049-0549","authenticated-orcid":false,"given":"Zipporah N.","family":"Gathuya","sequence":"first","affiliation":[{"name":"Department of Anaesthesia The Nairobi Hospital Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma M.","family":"Mutio","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Mbagathi County Referral Hospital Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy","family":"Mboya","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Jaramogi Oginga Teaching and Referral Hospital Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary T.","family":"Nabukenya","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Mumphansha","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia School of Medicine University of Zambia Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(15)70115\u20104"},{"key":"e_1_2_10_4_1","volume-title":"Essential Surgery","author":"Bickler S. W.","year":"2015"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(15)60465\u20102"},{"key":"e_1_2_10_6_1","unstructured":"World Health Assembly Resolution WHA68.15: Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage (2015)."},{"key":"e_1_2_10_7_1","volume-title":"Everybody\u2019s Business: Strengthening Health Systems to Improve Health Outcomes: Who\u2019s Framework for Action","author":"World Health Organization","year":"2007"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630\u2010018\u201001269\u20105"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010018\u201004888\u20107"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015\u20102741"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010023\u201007229\u20105"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sempedsurg.2023.151355"},{"key":"e_1_2_10_13_1","unstructured":"Kids Operating Room KidsOR Africa 2030 Strategy: Capacity Building in Children\u2019s Surgery (2020) https:\/\/www.kidsor.org\/.Edinbrugh."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000002258"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213\u20102600(17)30116\u20109"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-42974-0.00012-4"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010021\u201006377\u2010w"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmsa0810119"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12632"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006663"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002349"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410120089033"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70610","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70610","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70610","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T19:02:12Z","timestamp":1792350132000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,18]]},"references-count":21,"alternative-id":["10.1002\/wjs.70610"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70610","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,18]]},"article-number":"wjs.70610"}}