LAUSR

Remarkable gains have been made in global health over the past 25 years, including reduction in child mortality in many lowand middle-income countries (LMICs) [1]. However, the provision of high-quality surgical care for children continues to present a critical global health challenge. Children with surgical needs represent a high burden of disease, and the lack of access to surgical care continues to threaten the health of millions of children around the world as well as limit economic growth and development [2]. Several high-profile initiatives have focused attention on gaps in surgical care for adults across LMICs, including the third edition of the Disease Control Priorities project [3], the Lancet Commission on Global Surgery (LCoGS) [4], and the World Health Assembly Resolution A68/15 [5]. Despite these outstanding efforts, the surgical care for children continues to be largely overlooked within the global health agenda. Over recent years, there have been several attempts to improve attention to the surgical care for children in LMICs. In 2014, the Seminars in Pediatric Surgery published a series of reports which proposed that improvements in surgical care for children in LMICs are technically feasible and that childhood mortality related to surgical conditions could be reduced through improvements in health systems [6]. In this current issue of the World Journal of Surgery, we assess interval progress in the surgical care for children and reflect on the future of surgical care for children within the context of the Sustainable Development Goals (SDG), particularly SDG 3.2 which aims to end preventable deaths of newborns and children under the age of five by 2030 [7]. Much progress has been made over recent years to improve the surgical care of children around the world. The Global Initiative for Children’s Surgery (GICS) is an international consortium of providers from across specialties committed to improving the surgical care of children in LMICs [8]. Advances in national datasets, informatics, and training programs [9] have improved workforce and research gaps in surgical care for children. Several policy leaders and donor groups, such as Kids OR, have made investment in surgical infrastructure for children a global health priority [10]. As detailed in the following reports, surgical conditions in children continue to represent a high burden of disease in the world’s poorest regions. In the absence of accessible surgical care, case fatality rates for children remain high for common, easily treatable surgical conditions, including appendicitis, hernia, fractures, and congenital anomalies [11]. The lack of surgical care threatens the function of robust health systems for children [12]. Major research gaps continue in surgical care for children, such as understanding of the role of health system strengthening on mortality related to surgical disease. This slow progress underscores the need to improve research capacity and metrics, identify underperforming countries in surgical care for children, and assist providers and health systems to scale up surgical infrastructure, training, and new health technologies. In this symposium, we have brought together reports from new and established leaders in the field of global children’s surgery. These reports highlight the following: