Who's training tomorrow's pediatric surgeons? A global review of pediatric surgery postgraduate training programs in low- and middle-income countries

INTRODUCTION: Low- and Middle-Income Countries (LMICs) have significantly younger populations than High-Income Countries, with a high burden of morbidity and mortality due to operable conditions. However, access to pediatric surgical care and trained specialists remains limited. Mapping existing pediatric surgery training programs in LMICs may guide trainees seeking education and inform global surgery efforts to build capacity. METHODS: A review was conducted using an extensive grey literature search to identify pediatric surgery programs in LMICs. Searches included web browsers, medical school websites, national surgical colleges, and other relevant sources. Data were categorized by World Bank income group and World Health Organization (WHO) region. RESULTS: Of 132 LMICs, 66 (50.0 %) had at least one formal pediatric surgery program. By income group: 56.3 % (n = 31/55) of Upper-Middle-Income Countries (UMICs), 51.0 % (n = 26/51) of Low Middle-Income Countries (MICs), and 34.6 % (n = 9/26) of Low-Income Countries (LICs) had programs. Regionally, the European (n = 14/18, 77.8 %) Eastern Mediterranean (n = 12/16, 75.0 %), South-East Asia (n = 7/10, 70.0 %) regions had the highest proportion of LMICs with pediatric surgery programs. The Western Pacific Region and African Region had the lowest proportion of LMICs programs, with only 6/17 (35.3 %) and 15/47 (31.2 %) of LMICs having programs, respectively. CONCLUSION: Access to pediatric surgery programs in LMICs remains limited and decreases proportionally with country income level. There is an urgent need for sustainable, standardized training-supported by formalized accreditation initiatives-to strengthen pediatric surgical capacity globally.