scholarly journals Worldwide clustering of surgical indicators and predictors of risk of catastrophic expenditure for surgical care

2017 ◽  
Vol 7 (3) ◽  
pp. 188-195
Author(s):  
Songul Cinaroglu ◽  
Onur Baser
Keyword(s):  
Medical Imaging ◽  
Low Income ◽  
General Health ◽  
Surgical Care ◽  
Low Income Countries ◽  
Total Density ◽  
Catastrophic Expenditure ◽  
Imaging Technologies ◽  
Study Results ◽  
Silhouette Index

Introduction: Better access to surgical care is crucial to improve general health status of the population. Despite studies indicate cross country differences according to the general health indicators, there is a scarcity of knowledge about the differences between countries according to the surgical indicators. This study aims to classify countries according to the surgical care indicators and to identify predictors of risk of catastrophic health expenditure for surgical care. Methods: Data came from WHO and WB statistics and totally 177 countries were selected for this study. Variable groups are determined as; total density of medical imaging technologies, workforce distribution in surgical care, number of surgical prodecures and risk of catastrophic expenditure for surgical care. K-means clustering algorithm was used to classify countries according to the surgical indicators. Optimal number of clusters determined by using within cluster sum of squares and scree plot. Silhouette index was used to examine clustering performance. Random Forest decision tree approach was used to determine predictors of the risk for catastrophic expenditure for surgical care. Results: Study results shows that there are four country groups exists according to their surgical care indicators. High and low income countries are in different clusters. The third cluster which consists of low income countries has high Silhouette index value (0.75). Surgeon density and density of the medical imaging technologies are determinators of the risk for catastrophic expenditure for surgical care (AUC=0.82). Conclusions: Study results pose that there is a need for more effective health plans to overcome the differences between countries in terms of surgical care indicators. Determining strategies about distribution of surgical workforce and medical imaging technologies considering accessibility and equality are recommendated for health policy makers.

VP135 Clustering Surgical Indicators And Predictors Of Catastrophic Expenses

2017 ◽  
Vol 33 (S1) ◽  
pp. 210-211
Author(s):  
Songul Cinaroglu ◽  
Onur Baser
Keyword(s):  
Medical Imaging ◽  
General Health ◽  
Surgical Care ◽  
The Third ◽  
Surgical Workforce ◽  
Silhouette Index ◽  
The World ◽  
Country Differences ◽  
Cross Country ◽  
Risk Predictors

INTRODUCTION:Increasing access to surgical care is crucial in improving the general health status of a population. Despite studies indicating the cross-country differences of general health indicators, there is a scarcity of knowledge focusing on the cross-country differences of surgical indicators. This study aims to classify countries according to surgical care indicators and identify risk predictors of catastrophic surgical care expenditures.METHODS:For this study, data were used from the World Health Organization and the World Bank on 177 countries. The following variable groups were chosen: total density of medical imaging technologies, surgical workforce distribution, number of surgical procedures, and risk of catastrophic surgical care expenditures. The k-means clustering algorithm was used to classify countries according to the surgical indicators. The optimal number of clusters was determined with a within-cluster sum of squares and a scree plot. A Silhouette index was used to examine clustering performance, and a random forest decision tree approach was used to determine risk predictors of catastrophic surgical care expenditures.RESULTS:The surgical care indicator results delineated the countries into four groups according to each country's income level. The cluster plot indicated that most high-income countries (for example, United States, United Kingdom, Norway) are in the first cluster. The second cluster consisted of four countries: Japan, San Marino, Marshall Islands, and Monaco. Low-income countries (for example, Ethiopia, Guatemala, Kenya) and middle-income countries (for example, Brazil, Turkey, Hungary) are represented in the third and fourth clusters, respectively. The third cluster had a high Silhouette index value (.75). The densities of both surgeons and medical imaging technology were risk determiners of catastrophic surgical care expenditures (Area Under Curve = .82).CONCLUSIONS:Our results demonstrate a need for more effective health plans if the differences between countries surgical care indicators are to be overcome. We recommend that health policymakers reconsider distribution strategies for the surgical workforce and medical imaging technology in the interest of accessibility and equality.

Fecal contamination and Microcystis in drinking-water sources of rural Cambodia using PCR and culture-based methods

2016 ◽  
Vol 6 (3) ◽  
pp. 353-361 ◽  
Author(s):  
Audrey R. Matteson ◽  
Alexandria K. Graves ◽  
Ann M. Hall ◽  
Dina Kuy ◽  
Matthew L. Polizzotto
Keyword(s):  
Drinking Water ◽  
Surface Water ◽  
Low Income ◽  
Water Sources ◽  
Low Income Countries ◽  
Gene Marker ◽  
Biological Contamination ◽  
Drinking Water Sources ◽  
Study Results ◽  
Rain Barrels

Rural communities within low-income countries frequently rely on a range of drinking-water sources, and each water source varies in its potential for biological contamination. The extent and source of biological contamination in primary drinking sources within Kien Svay, Kandal, Cambodia, were determined by fecal indicator bacteria (FIB) measurements, 16S rDNA genetic markers for human and bovine fecal Bacteroides, presence of the bloom-forming Microcystis species, and the microcystin toxin mcyD gene marker. Thirteen wells, 11 rain barrels, 10 surface-water sites, and five sediment samples were examined during the dry and wet seasons. Surface water was commonly contaminated with FIB, with up to 1.02 × 105Enterococcus sp., 6.13 × 104E. coli, and 2.91 × 104 total coliforms per 100 mL of water. Human and bovine Bacteroides were detected in 100 and 90% of the surface water samples, respectively. Concentrations of FIB in rain-barrels varied by site, however 91% contained human Bacteroides. Microcystis cells were found in 90% of surface water sites, with many also containing microcystin gene mcyD, representing the first report of microcystin-producing cyanobacteria in surface waters of Cambodia. The study results show that many potential drinking-water sources in Cambodia contain harmful bacterial and algal contaminants, and care should be taken when selecting and monitoring water options.

scholarly journals Real-time assessment of COVID-19 impact on global surgical case volumes

2020 ◽  
Author(s):  
Vikas N. O’Reilly-Shah ◽  
Wil Van Cleve ◽  
Dustin R. Long ◽  
Vanessa Moll ◽  
Faye M. Evans ◽  
...  
Keyword(s):  
Real Time ◽  
Low Income ◽  
Mobile Application ◽  
Surgical Care ◽  
Low Income Countries ◽  
Surgical Volume ◽  
Case Volume ◽  
Surgical Case ◽  
The Impact ◽  
Usage Data

AbstractImportanceThe COVID-19 pandemic has disrupted global surgical capacity. The impact of the pandemic in low and middle income countries has the potential to worsen already strained access to surgical care. Timely assessment of surgical volumes in these countries remains challenging.ObjectiveTo determine whether usage data from a globally used anesthesiology calculator mobile application can serve as a proxy for global surgical case volume and contribute to monitoring of the impact of the COVID-19 pandemic, particularly in World Bank low income countries where official data collection is not currently practical.DesignSubset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020.SettingThe mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices.ParticipantsNo user data was excluded from the study.Exposure(s)Events with impacts on surgical case volumes, including weekends, holidays, and the COVID-19 pandemic.Main Outcome(s) and Measure(s)It was previously noted that application usage was decreased on weekends and during winter holidays. We subsequently hypothesized that more detailed analysis would reveal impacts of country-specific or region-specific holidays on the volume of app use.Results4,300,975 data points from 92,878 unique users were analyzed. Physicians and other anesthesia providers comprised 85.8% of the study population. Application use was reduced on holidays and weekends and correlated with fluctuations in surgical volume. The COVID-19 pandemic was associated with substantial reductions in app use globally and regionally. There was strong cross correlation between COVID-19 case count and reductions in app use. By country, there was a median global reduction in app use to 58% of baseline (interquartile range, 46%-75%). Application use in low-income continues to decline but in high-income countries has stabilized.Conclusions and RelevanceApplication usage metadata provides a real-time indicator of surgical volume. This data may be used to identify impacted regions where disruptions to surgical care are disproportionate or prolonged. A dashboard for continuous visualization of these data has been deployed.Key PointsQuestionCan usage data from a globally used anesthesiology calculator mobile application contribute to monitoring of the impacts to global surgical case volume caused by the COVID-19 pandemic, particularly in resource-limited environments such as World Bank low income countries?FindingsIn this ongoing observational cohort study, application usage data from 92,878 unique users in 221 countries was found to serve well as a qualitative proxy for surgical case volume, with clear impacts to app use during weekend, holidays, and during the COVID-19 pandemic.MeaningThis proxy of surgical volume will provide insight into the impact of and recovery from the COVID-19 pandemic where official data collection is not currently practical. A real time dashboard tracking this proxy of global surgical volume is live and under continued development.

scholarly journals Surgical leadership in Africa – challenges and opportunities

2019 ◽  
Vol 4 (2) ◽  
pp. 59-64
Author(s):  
Kwabena Frimpong-Boateng ◽  
Frank Edwin
Keyword(s):  
Public Health ◽  
Low Income ◽  
Health Sector ◽  
Surgical Care ◽  
Low Income Countries ◽  
Care Needs ◽  
Political Will ◽  
Development Agenda ◽  
Challenges And Opportunities ◽  
The Rich

AbstractSurgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases. In the midst of such competing health-care needs, surgical care, often viewed by policy makers as luxurious and the preserve of the rich, gets relegated to the bottom of priority lists. In the meantime, infectious disease, malnutrition, and other ailments, viewed as largely affecting the poor and disadvantaged in society, get embedded in national health plans, receiving substantial funding and public health program development. It is often stated that the main reason for this sad state of affairs in surgical care is the lack of political will to improve matters in the health sector. Indeed, in 2001, the Commission on Macroeconomics and Health concluded that the lack of political will to sufficiently increase spending on health at the sub-national, national, and international levels was perhaps the most critical barrier to improving health in low-income countries. However, at the root of this lack of political will is a lack of political priority for surgical care.

The analysis of evolution in eradicating mortalities caused by infectious diseases in East and Central African Countries coinciding with gross national income

2019 ◽  
Author(s):  
Xiao Haijun ◽  
Jean Pierre Namahoro
Keyword(s):  
Infectious Diseases ◽  
Low Income ◽  
National Income ◽  
Gross National Income ◽  
Low Income Countries ◽  
East African ◽  
African Countries ◽  
National Budget ◽  
Study Results ◽  
The Government

Abstract Background: Infectious diseases are predominantly within poor population living in low-income countries, while are either treatable or preventable with existing medicines in the first occurring. The highlighted cause is some government choose to spend national budget on several projects do not coincide the basic needs and demands of the population. The objectives of this study were to 1) compare the performance between new cases and deaths caused by diseases; 2) show the effect of gross national income (GNI) in the mortalities reduction, and 3) assess potential evolution in eradicating mortalities in East African countries. Method: WHO database contains data on several responses (new cases of Malaria, Neonates protected at birth against neonatal tetanus, mortalities from tuberculosis among HIV-negative people and new cases of leprosy) recorded from 2004 to 2015. IMB SPSS modeler and Origin 8 were used especially, One-way ANOVA and Pearson’s correlation to achieve the objectives of the study. Results: The p-values for either Levene’ and Brown-Forsythe compared with 0.05 significant level for testing the performance between countries, correlation between GNI with leprosy is -0.5 to -1.0, in five countries, with TB is closer t0 -1.0 in four countries, with deaths from Malaria, is -0.5 to -1.0 in three countries, and new cases from Malaria and protected neonates is 0.5 to 1.0. Conclusion: The relationship between GNI and new cases and deaths indicate the weak effect of GNI in the process of eradicating mortalities, therefore, the government should prioritize the healthcare and use a national budget to monitoring the all complications related to infectious diseases. Key wards: infectious diseases, eradicating mortalities, gross national income

Partnerships for developing pediatric surgical care in low-income countries

2008 ◽  
Vol 43 (12) ◽  
pp. 2273-2274 ◽  
Author(s):  
Georges Azzie ◽  
Stephen Bickler ◽  
Diana Farmer ◽  
Spencer Beasley
Keyword(s):  
Low Income ◽  
Surgical Care ◽  
Low Income Countries

scholarly journals Education in ear and hearing care in remote or resource-constrained environments

2018 ◽  
Vol 133 (1) ◽  
pp. 3-10 ◽  
Author(s):  
M P A Clark ◽  
B D Westerberg ◽  
D Nakku ◽  
P Carling
Keyword(s):  
Low Income ◽  
Surgical Care ◽  
Low Income Countries ◽  
Resource Poor Setting ◽  
Training Methods ◽  
Open Approach ◽  
Care Needs ◽  
Ear Surgery ◽  
Training Requirements ◽  
Primary Means

AbstractBackgroundAt the heart of surgical care needs to be the education and training of staff, particularly in the low-income and/or resource-poor setting. This is the primary means by which self-sufficiency and sustainability will ultimately be achieved. As such, training and education should be integrated into any surgical programme that is undertaken. Numerous resources are available to help provide such a goal, and an open approach to novel, inexpensive training methods is likely to be helpful in this type of setting.The need for appropriately trained audiologists in low-income countries is well recognised and clearly goes beyond providing support for ear surgery. However, where ear surgery is being undertaken, it is vital to have audiology services established in order to correctly assess patients requiring surgery, and to be able to assess and manage outcomes of surgery. The training requirements of the two specialties are therefore intimately linked.ObjectiveThis article highlights various methods, resources and considerations, for both otolaryngology and audiology training, which should prove a useful resource to those undertaking and organising such education, and to those staff members receiving it.

scholarly journals Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis

2018 ◽  
Vol 3 (3) ◽  
pp. e000810 ◽  
Author(s):  
Joshua S Ng-Kamstra ◽  
Sumedha Arya ◽  
Sarah L M Greenberg ◽  
Meera Kotagal ◽  
Catherine Arsenault ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Low Income ◽  
Meta Analysis ◽  
Surgical Care ◽  
Low Income Countries ◽  
Perioperative Mortality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range

IntroductionThe Lancet Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs. We also describe how POMR is defined and reported in the LMIC literature to provide recommendations for future monitoring in resource-constrained settings.MethodsWe did a systematic review of studies from LMICs published from 2009 to 2014 reporting POMR for any surgical procedure. We extracted select variables in duplicate from each included study and pooled estimates of POMR by type of procedure using random-effects meta-analysis of proportions and the Freeman-Tukey double arcsine transformation to stabilise variances.ResultsWe included 985 studies conducted across 83 LMICs, covering 191 types of surgical procedures performed on 1 020 869 patients. Pooled POMR ranged from less than 0.1% for appendectomy, cholecystectomy and caesarean delivery to 20%–27% for typhoid intestinal perforation, intracranial haemorrhage and operative head injury. We found no consistent associations between procedure-specific POMR and Human Development Index (HDI) or income-group apart from emergency peripartum hysterectomy POMR, which appeared higher in low-income countries. Inpatient mortality was the most commonly used definition, though only 46.2% of studies explicitly defined the time frame during which deaths accrued.ConclusionsEfforts to improve access to surgical care in LMICs should be accompanied by investment in improving the quality and safety of care. To improve the usefulness of POMR as a safety benchmark, standard reporting items should be included with any POMR estimate. Choosing a basket of procedures for which POMR is tracked may offer institutions and countries the standardisation required to meaningfully compare surgical outcomes across contexts and improve population health outcomes.

Access to Safe Obstetric Surgical Care in Low-Income Countries

2016 ◽  
Vol 40 (9) ◽  
pp. 2289-2290 ◽  
Author(s):  
Jeffrey J. Leow ◽  
Robert Riviello ◽  
Stephen Rulisa
Keyword(s):  
Low Income ◽  
Surgical Care ◽  
Low Income Countries
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