Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

BackgroundUnderstanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.FindingsWe identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.InterpretationOur findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care

Invasive Iguanas as Airstrike Hazards at Luis Munoz Marin International Airport, San Juan, Puerto Rico

Green iguanas are large lizards exotic to Puerto Rico, but abundant around Luis Munoz Marin International Airport (SJU) in metropolitan San Juan, where we assessed their potential as an airstrike hazard. During our two month sampling period, operations on portions of the airfield had to be halted on six occasions due to hazards presented by iguana incursions to aircraft traffic areas. All 5 records of collisions with iguanas in the FAA airstrike database were from SJU. Body size comparisons between mature iguanas and terrestrial mammals known as aircraft collision hazards indicated that iguanas present airstrike hazards. Application of a predictive equation previously developed to relate body mass to a relative hazard score for airstrikes indicated that iguanas could rank with such damaging species as ducks, pelicans and eagles. We recommend that a wildlife hazard assessment be conducted at SJU, and we suggest some possible remediation measures

RELATIONSHIP OF RACCOON ROAD-KILL DATA TO HIGH-DENSITY MARINE TURTLE NESTING

Four ycars of data from a hiyh-density n~arine turtle nesting hcach at John D. MacArthur Beach Statc Park, Florida wcrc examined along with data on raccoon (Procyon lotor.) ruad-kills from adjaccnt roads, and data on park attendance (as an index of local traffic) to make infcrcnces about raccoon activity patterns relative to turtle ncsting. Raccoon road-kills were found Lo diminish subsiantially during turtle nesting, even though local traffic was constant or increasing. Opossums (Didelphis virginiana). the only other maminal consistcntly foluid as road-kills, did not show a decrease during ti~rtlen esting season, but they are not known as a primary predator of turtle nests. We concluded that duriny turtlc nestiny raccoons are drawn to the beach to prey on the abundant food resource of turtle eggs, and they do not leave the beach until the end of turtle nesting season. High nu~nbcrso f raccoon road-kills during the fall-wintcr, followed by a decrease in the spring around the start of turtle nesting season, might be ured as indicators to initiate management actions to protect turtle nests

Use of roadkill data to index and relate raccoon activity at a heavily predated, high-density marine turtle nesting beach

Four years of data from a high-density marine turtle nesting beach at John D. MacArthur Beach State Park, Florida were examined along with data on raccoon road-kills from adjacent roads, and data on park attendance (as an index of local traffic) to make inferences about raccoon activity patterns relative to turtle nesting. Raccoon road-klls were found to diminish substantially during turtle nesting, even though local traffic was constant or increasing. Opossums, the only other mammal consistently found as road-kills, did not show a decrease during turtle nesting season, but they are not known as a primary predator of turtle nests. We concluded that during turtle nesting raccoons are drawn to the beach to prey on the abundant nesting raccoons food resource of turtle eggs, and they do not leave the beach until the end of turtle nesting season. High numbers of raccoon road-kills during the fall-winter, followed by a decrease in the spring around the start of turtle nesting season, might be used as indicators to initiate management actions to protect turtle nests