Essential surgery at the district hospital

a retrospective descriptive analysis in three African countries.

Moses Galukande, Johan von Schreeb, Andreas Wladis, Naboth Mbembati, Helder de Miranda, Margaret E. Kruk, Sam Luboga, Alphonsus Matovu, Colin McCord, S. Khady Ndao-Brumblay, Doruk Ozgediz, Peter C. Rockers, Ana Quinones, Fernando Vaz, Haile T. Debas, Sarah B. Macfarlane

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalNature Methods
Volume7
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

District Hospitals
Surgery
Africa South of the Sahara
Cesarean Section
Mozambique
Uganda
Tanzania
Herniorrhaphy
Live Birth
Rural Population
Obstetrics
Hospital beds
Primary Health Care
Emergencies
Retrospective Studies
Public Health
Public health
Interviews
Morbidity
Catchments

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Galukande, M., von Schreeb, J., Wladis, A., Mbembati, N., de Miranda, H., Kruk, M. E., ... Macfarlane, S. B. (2010). Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. Nature Methods, 7(3). https://doi.org/10.1371/journal.pmed.1000243

Essential surgery at the district hospital : a retrospective descriptive analysis in three African countries. / Galukande, Moses; von Schreeb, Johan; Wladis, Andreas; Mbembati, Naboth; de Miranda, Helder; Kruk, Margaret E.; Luboga, Sam; Matovu, Alphonsus; McCord, Colin; Ndao-Brumblay, S. Khady; Ozgediz, Doruk; Rockers, Peter C.; Quinones, Ana; Vaz, Fernando; Debas, Haile T.; Macfarlane, Sarah B.

In: Nature Methods, Vol. 7, No. 3, 2010.

Research output: Contribution to journalArticle

Galukande, M, von Schreeb, J, Wladis, A, Mbembati, N, de Miranda, H, Kruk, ME, Luboga, S, Matovu, A, McCord, C, Ndao-Brumblay, SK, Ozgediz, D, Rockers, PC, Quinones, A, Vaz, F, Debas, HT & Macfarlane, SB 2010, 'Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.', Nature Methods, vol. 7, no. 3. https://doi.org/10.1371/journal.pmed.1000243
Galukande, Moses ; von Schreeb, Johan ; Wladis, Andreas ; Mbembati, Naboth ; de Miranda, Helder ; Kruk, Margaret E. ; Luboga, Sam ; Matovu, Alphonsus ; McCord, Colin ; Ndao-Brumblay, S. Khady ; Ozgediz, Doruk ; Rockers, Peter C. ; Quinones, Ana ; Vaz, Fernando ; Debas, Haile T. ; Macfarlane, Sarah B. / Essential surgery at the district hospital : a retrospective descriptive analysis in three African countries. In: Nature Methods. 2010 ; Vol. 7, No. 3.
@article{f1ceceec3c6441129cc9f384c7b186cf,
title = "Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.",
abstract = "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.",
author = "Moses Galukande and {von Schreeb}, Johan and Andreas Wladis and Naboth Mbembati and {de Miranda}, Helder and Kruk, {Margaret E.} and Sam Luboga and Alphonsus Matovu and Colin McCord and Ndao-Brumblay, {S. Khady} and Doruk Ozgediz and Rockers, {Peter C.} and Ana Quinones and Fernando Vaz and Debas, {Haile T.} and Macfarlane, {Sarah B.}",
year = "2010",
doi = "10.1371/journal.pmed.1000243",
language = "English (US)",
volume = "7",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Essential surgery at the district hospital

T2 - a retrospective descriptive analysis in three African countries.

AU - Galukande, Moses

AU - von Schreeb, Johan

AU - Wladis, Andreas

AU - Mbembati, Naboth

AU - de Miranda, Helder

AU - Kruk, Margaret E.

AU - Luboga, Sam

AU - Matovu, Alphonsus

AU - McCord, Colin

AU - Ndao-Brumblay, S. Khady

AU - Ozgediz, Doruk

AU - Rockers, Peter C.

AU - Quinones, Ana

AU - Vaz, Fernando

AU - Debas, Haile T.

AU - Macfarlane, Sarah B.

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=77952747462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952747462&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1000243

DO - 10.1371/journal.pmed.1000243

M3 - Article

VL - 7

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 3

ER -