Need for Paediatric Surgery Care in an Urban Area of the Gambia

2003 ◽  
Vol 33 (2) ◽  
pp. 91-94 ◽  
Author(s):  
Stephen W Bickler ◽  
Michelle L Telfer ◽  
Boto Sanno-Duanda
Keyword(s):  
Urban Area ◽  
Cumulative Risk ◽  
Surgical Care ◽  
Presentation Rate ◽  
Sub Saharan Africa ◽  
Paediatric Surgery ◽  
Surgical Infections ◽  
Sub Saharan ◽  
Surgical Conditions ◽  
Health Programmes

The report evaluates the need for paediatric surgical care in an urban area of sub-Saharan Africa. Seven hundred and forty-one children were treated for surgical problems from January through December 1997. The most common surgical problems were injuries (67.1%), congenital anomalies (15.0%) and surgical infections (6.7%). Forty-six per cent of children presenting with a surgical problem required a surgical procedure, 68.2% of which were classified as minor. The annual presentation rate for all surgical conditions was 543 per 10 000 children aged 0–14 years. The estimated cumulative risk for all surgical conditions is 85.4% by age 15 years. Our data suggest surgical diseases commonly affect children living in Banjul. Surgical care should be an essential component of child health programmes in developing countries.

scholarly journals Paediatric surgical outcomes in sub-Saharan Africa: a multicentre, international, prospective cohort study

2021 ◽  
Vol 6 (9) ◽  
pp. e004406
Author(s):  
Keyword(s):  
Cohort Study ◽  
Inguinal Hernia ◽  
Prospective Cohort Study ◽  
Surgical Outcomes ◽  
Prospective Cohort ◽  
Anorectal Malformation ◽  
Sub Saharan Africa ◽  
Paediatric Surgery ◽  
Sub Saharan ◽  
Surgical Conditions

IntroductionAs childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).MethodsA multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant.Results1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis.ConclusionMortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres.

scholarly journals Surgical ambulance referrals in sub-Saharan Africa – financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martilord Ifeanyichi ◽  
Henk Broekhuizen ◽  
Mweene Cheelo ◽  
Adinan Juma ◽  
Gerald Mwapasa ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Financial Reports ◽  
Study Approach ◽  
Hospital Managers ◽  
District Hospitals ◽  
Sub Saharan ◽  
Microsoft Office ◽  
Patient Referrals

Abstract Background An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. Methods We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. Results At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. Conclusion Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case – besides equitable access to healthcare – for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.

Community Education in New HIV Prevention Technologies Research

2009 ◽  
pp. 328-338
Author(s):  
Busi Nkala
Keyword(s):  
Hiv Infection ◽  
Community Involvement ◽  
New Technologies ◽  
Community Education ◽  
Sub Saharan Africa ◽  
Contributing Factors ◽  
Survival Sex ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Health Programmes

An estimated 39.5 million people are living with HIV worldwide. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these occurring in sub-Saharan Africa with important increases in Eastern Europe and Central Asia, where there are some indications that infection rates have risen by more than 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses (UNAIDS, 2006). The continued increase in new HIV infection is a call for concern. It is imperative that more innovative ways of combating the infections are found sooner. There is an enormous body of evidence that HIV infection is caused mainly by sexual contact. There is also undisputed evidence that there are other contributing factors such as extreme poverty, survival sex, gender inequality, lack of education, fatalism, religious barriers and others. This chapter seeks to support the need to do more research in finding new technologies and innovative ways of dealing with the spread of HIV. The chapter suggests that the involvement of researched communities be effectively involved. Involving communities in finding solutions will help, in that research protocols and health programmes will take into account the cultural acceptability of the new technologies and systems and ensure that recipients of health services become effective organs of change. The chapter seeks to highlight the fact that, if the recipients are involved in all stages of development of health programmes, including technologies, we may begin to see changes in how new technologies are taken up or may shift toward getting technologies that are acceptable. There are various suggested and implemented ways which aid in achieving the protection for individuals and communities; such as community involvement, community participation and community education (Collins, 2002; Gupta 2002), this chapter will focus on community education and a proposal for a community principle.

scholarly journals The burden of urological disease in Zomba, Malawi: A needs assessment in a sub-Saharan tertiary care center

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tristan Juvet ◽  
James R. Hayes ◽  
Sarah Ferrara ◽  
Duncan Goche ◽  
Robert D. Macmillan ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Urethral Stricture ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Care Hospital ◽  
General Anesthetic ◽  
Urethral Stricture Disease ◽  
Sub Saharan

Introduction: A large part of the developing world continues to lack access to surgical care. Urology remains one of the least represented surgical subspecialties in global health. To begin understanding the burden of urological illness in sub-Saharan Africa, we sought to characterize all patients presenting to a tertiary care hospital in Malawi with a urological diagnosis or related complaint in the past year. Methods: Retrospective review of the surgical clinic and surgical theater record books at Zomba Central Hospital (ZCH) was performed over a one-year time span. Patients presenting with urological diagnoses or undergoing a urological procedure under local or general anesthetic in the operating theater were identified and entered into a database. Results: A total of 440 clinical patients were reviewed. The most common clinical presentations were for urinary retention (34.7%) and lower urinary tract symptoms (15.5%); 182 surgical cases were reviewed. The most common diagnoses for surgical patients were urethral stricture disease (22%), bladder masses (17%), and benign prostatic hyperplasia (BPH) symptoms (14.8%). Urethral stricture-related procedures, including direct visual internal urethrotomy and urethral dilatation were the most common (14.2% and 7.7%). BPH-related procedures, including simple prostatectomy and transurethral resection of the prostate were the second most common (6.7% and 8.2%). Conclusions: Urethral stricture disease, BPH, and urinary retention represent the clinical diagnoses with the highest burden of visits. Despite these numbers, few definitive procedures are performed annually. Further focus on urological training in sub-Saharan Africa should focus on these conditions and their surgical management.

scholarly journals Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa

2019 ◽  
Vol 19 (3) ◽  
pp. 2565-2570
Author(s):  
Claude Kasereka Masumbuko ◽  
Edward Gakuya Mutheke ◽  
Benjamin Mbindyo ◽  
Michael T Hawkes
Keyword(s):  
Surgical Care ◽  
Elbow Flexion ◽  
Operative Management ◽  
Humeral Fractures ◽  
Sub Saharan Africa ◽  
Delayed Surgery ◽  
Flexion Extension ◽  
Supracondylar Humeral Fractures ◽  
Sub Saharan

Background: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health.Methods: This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab.Results: Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°-118° vs 120° 108°-124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization.Conclusion: In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention.Keywords: Delayed surgery, reduced elbow range, supracondylar humeral fractures, sub-Saharan Africa.

scholarly journals A geospatial analysis of two-hour surgical access to district hospitals in South Africa

2020 ◽  
Author(s):  
Kathryn Chu ◽  
Angela J Dell ◽  
Harry Moultrie ◽  
Candy Day ◽  
Megan Naidoo ◽  
...  
Keyword(s):  
South Africa ◽  
District Hospital ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Surgical Capacity ◽  
Surgical Access ◽  
District Hospitals ◽  
Government Hospitals ◽  
Sub Saharan ◽  
Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

scholarly journals Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Praveen Paul Rajaguru ◽  
Mubashir Alavi Jusabani ◽  
Honest Massawe ◽  
Rogers Temu ◽  
Neil Perry Sheth
Keyword(s):  
Surgical Care ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Surgical Volume ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Emergency Procedures ◽  
Sub Saharan ◽  
Improve Access ◽  
Main Operating

Abstract Background Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa. Methods The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed. Results In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients). Conclusion While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.

Providing Safe Surgery for Neonates in Sub-Saharan Africa

2003 ◽  
Vol 33 (3) ◽  
pp. 145-147 ◽  
Author(s):  
Emmanuel A Ameh ◽  
Nkeiruka Ameh
Keyword(s):  
Neonatal Intensive Care ◽  
Surgical Care ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Neonatal Surgery ◽  
Emergency Situations ◽  
Neonatal Transport ◽  
Sub Saharan ◽  
Delayed Referral ◽  
And Training

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.

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