{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:05:37Z","timestamp":1778216737904,"version":"3.51.4"},"reference-count":67,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032542","name":"CapaCare","doi-asserted-by":"crossref","award":["90369500"],"award-info":[{"award-number":["90369500"]}],"id":[{"id":"10.13039\/100032542","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,12,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Access to paediatric surgical care remains severely limited in many low-income countries. In 2012, the unmet need for paediatric surgery in Sierra Leone was 88%, and there were no Sierra Leonean paediatric surgeons nationwide. Task-sharing has emerged as a promising strategy to address workforce shortages and geographic disparities, yet its impact on paediatric surgery remains underexplored. This study examines national trends in paediatric surgical care and evaluates the effects of task-sharing over a decade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide repeated cross-sectional study was conducted using surgical logbook data from all eligible facilities in 2012, 2017 and 2023. Data included patient age and sex, procedure type, provider cadre and facility characteristics. The annual surgical volumes and rates per 100\u2009000 children were calculated. Inguinal hernia repair served as a proxy to estimate met and unmet paediatric surgical needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Paediatric surgical volume increased from 2381 procedures in 2012 to 3307 in 2017 and 3564 in 2023, representing a 49.7% rise overall, with the surgical rate increasing from 85 to 94 per 100\u2009000 children. The unmet need remained consistently high, reaching 93.4% in 2023. Task-sharing contributed substantially to surgical provision: associate clinicians (ACs), healthcare workers who are not physicians or nurses but trained specifically to manage certain surgical conditions, performed 18.6% of all paediatric surgeries in 2023, up from 5.5% in 2012. In rural areas, ACs performed nearly half of all surgeries by 2023. Despite this progress, over two-thirds of procedures remained concentrated in the Western Area, where only 20% of children reside.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Task-sharing has expanded paediatric surgical capacity in Sierra Leone, particularly in rural areas. However, persistent geographic disparities and high unmet need underscore the importance of strengthening local surgical training, addressing systemic barriers and implementing equity-focused health policies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004007","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:25:19Z","timestamp":1769772319000},"page":"e004007","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Development of paediatric surgical care in Sierra Leone: a repeated nationwide cross-sectional study from 2012 to 2023"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5589-042X","authenticated-orcid":false,"given":"Sara Aakre","family":"Faradonbeh","sequence":"first","affiliation":[{"name":"University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4112-3029","authenticated-orcid":false,"given":"Anniken","family":"H\u00f8eg Halvorsen","sequence":"additional","affiliation":[{"name":"University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Ashley","sequence":"additional","affiliation":[{"name":"Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"},{"name":"CapaCare, Masanga, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiah","family":"Lebbie","sequence":"additional","affiliation":[{"name":"Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"},{"name":"Connaught Hospital, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustapha S","family":"Kabba","sequence":"additional","affiliation":[{"name":"Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lena","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Global Health Section, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e5kon","family":"Angell Bolkan","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Department of Surgery, St Olav\u2019s Hospital HF, Trondheim, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6943-0100","authenticated-orcid":false,"given":"Alex J van","family":"Duinen","sequence":"additional","affiliation":[{"name":"Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"},{"name":"Department of Surgery, St Olav\u2019s Hospital HF, Trondheim, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003250834000_4.1.e004007.1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.216028"},{"key":"2026013003250834000_4.1.e004007.2","unstructured":"World Health Organization . 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