Surgical Care of Birth Defects in Low‐ and Middle‐Income Countries: Bangladesh Perspective

BACKGROUND: Birth defects are a major cause of childhood morbidity and mortality, with a disproportionate burden in low- and middle-income countries (LMICs). Many are surgically treatable, yet access to surgical care remains limited in LMICs by inadequate infrastructure, shortages of specialized healthcare professionals, delayed diagnosis and referral, financial barriers, and sociocultural challenges. OBJECTIVE: To synthesize evidence on surgical care for birth defects in LMICs, with a focus on Bangladesh, and provide a child surgeon's perspective on challenges, context-appropriate innovations, and opportunities to strengthen surgical services. METHODS: A narrative review of published literature was conducted, focusing on the burden of birth defects, pediatric surgical management, and context-appropriate innovations in LMICs, with particular emphasis on Bangladesh. The literature was complemented by clinical observations illustrating challenges and outcomes in resource-limited settings. RESULTS: Studies from Bangladesh demonstrated a substantial burden of birth defects, with distributions varying by setting and discipline. Pediatric surgical studies predominantly reported gastrointestinal and genitourinary anomalies, while other studies identified cardiac, central nervous system, and orofacial defects. Context-appropriate innovations improved feasibility, affordability, and access, while staged surgery, follow-up, and family support were associated with favorable functional and quality-of-life outcomes, including school participation. CONCLUSION: Timely, accessible, and affordable pediatric surgical care can improve outcomes for children with surgically treatable birth defects in LMICs. Strengthening pediatric surgical capacity, neonatal and perioperative care, surveillance systems, and context-appropriate innovations should be prioritized to reduce preventable mortality and disability and advance universal health coverage.