Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries

English version České info

Background:
Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries.

Methods and Findings:
In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population.

Conclusion:
The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries. PLoS Med 7(3): e32767. doi:10.1371/journal.pmed.1000243
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000243

Souhrn

Zdroje

1. BicklerSW

SpiegelDA

2008 Global surgery–defining a research agenda. Lancet 372 90 92

2. LubogaS

MacfarlaneSB

von SchreebJ

KrukME

CherianMN

2009 Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6 e1000200 doi:10.1371/journal.pmed.1000200

3. BicklerSW

TelferML

Sanno-DuandaB

2003 Need for paediatric surgery care in an urban area of The Gambia. Trop Doct 33 91 94

4. WeiserTG

RegenbogenSE

ThompsonKD

HaynesAB

LipsitzSR

2008 An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372 139 144

5. NabembeziJS

NordbergE

2001 Surgical output in Kibaale district, Uganda. East Afr Med J 78 379 381

6. NordbergE

MwobobiaI

MuniuE

2002 Major and minor surgery output at district level in Kenya: review and issues in need of further research. Afr J Health Sci 9 17 25

7. NordbergEM

1984 Incidence and estimated need of caesarean section, inguinal hernia repair, and operation for strangulated hernia in rural Africa. Br Med J (Clin Res Ed) 289 92 93

8. BlanchardRJ

BlanchardME

ToussignantP

AhmedM

SmytheCM

1987 The epidemiology and spectrum of surgical care in district hospitals of Pakistan. Am J Public Health 77 1439 1445

9. LavyC

TindallA

SteinlechnerC

MkandawireN

ChimangeniS

2007 Surgery in Malawi - a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl 89 722 724

10. OzgedizD

GalukandeM

MabweijanoJ

KijjambuS

MijumbiC

2008 The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32 1208 1215

11. Ouro-Bang'na MamanAF

KaboreRA

ZoumenouE

GnassingbeK

ChobliM

2009 Anesthesia for children in Sub-Saharan Africa–a description of settings, common presenting conditions, techniques and outcomes. Paediatr Anaesth 19 5 11

12. MockCN

nii-Amon-KoteiD

MaierRV

1997 Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 42 504 511; discussion 511–503

13. Justin-TemuM

RimoyG

PremjiZ

MatemuG

2008 Causes, magnitude and management of burns in under-fives in district hospitals in Dar es Salaam, Tanzania. East Afr J Public Health 5 38 42

14. TayeM

MunieT

2003 Trauma registry in Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Ethiop Med J 41 221 226

15. KobusingyeOC

LettRR

2000 Hospital-based trauma registries in Uganda. J Trauma 48 498 502

16. MockC

LormandJ

GoosenJ

JoshipuraM

PedenM

2004 Guidelines for essential trauma care. Geneva World Health Organization

17. KobusingyeO

GuwatuddeD

LettR

2001 Injury patterns in rural and urban Uganda. Inj Prev 7 46 50

18. HofmeyrGJ

2004 Obstructed labor: using better technologies to reduce mortality. Int J Gynaecol Obstet 85 S62 S72

19. PetersonHB

2008 Sterilization. Obstet Gynecol 111 189 203

20. ClelandJ

BernsteinS

EzehA

FaundesA

GlasierA

2006 Family planning: the unfinished agenda. Lancet 368 1810 1827

21. WallLL

2006 Obstetric vesicovaginal fistula as an international public-health problem. Lancet 368 1201 1209

22. FentonPM

WhittyCJ

ReynoldsF

2003 Caesarean section in Malawi: prospective study of early maternal and perinatal mortality. BMJ 327 587

23. WalkerIA

MortonNS

2009 Pediatric healthcare–the role for anesthesia and critical care services in the developing world. Paediatr Anaesth 19 1 4

24. HaynesAB

WeiserTG

BerryWR

LipsitzSR

BreizatAH

2009 A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360 491 499

25. US Central Intelligence Agency (CIA) 2008 The World Factbook online. Washington (D.C) CIA Available: https://www.cia.gov/library/publications/the-world-factbook/

26. WHO 2008 World Health Organization Statistical Information System: Core Health Indicators. Available: http://www3.who.int/whosis/core/core_select_process.cfm