scholarly journals Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey

2021 ◽  
Vol 33 (2) ◽  
pp. 73-81
Author(s):  
Carlos Varela ◽  
Asgaut Viste ◽  
Sven Young ◽  
Reinou S. Groen ◽  
Leonard Banza ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Traffic Accidents ◽  
Surgical Care ◽  
Household Survey ◽  
Nationwide Survey ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Conditions ◽  
Surgical Condition

BackgroundUntreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need.AimTo estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries.MethodsA cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. ResultsThere were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. ConclusionAn extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.

scholarly journals Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Carlos Varela ◽  
Sven Young ◽  
Reinou S. Groen ◽  
Leonard Banza ◽  
Nyengo Mkandawire ◽  
...  
Keyword(s):  
Health Care ◽  
Health Facility ◽  
Scale Up ◽  
Surgical Care ◽  
Household Survey ◽  
Abdominal Distension ◽  
African Countries ◽  
Cross Sectional ◽  
Middle Income ◽  
Surgical Conditions

Abstract Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.

scholarly journals Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241553
Author(s):  
Paul Truche ◽  
Rachel E. NeMoyer ◽  
Sara Patiño-Franco ◽  
Juan P. Herrera-Escobar ◽  
Myerlandi Torres ◽  
...  
Keyword(s):  
Surgical Care ◽  
Healthcare Facility ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Publicly Funded ◽  
Cross Sectional ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Timely Access ◽  
Surgical Conditions

Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.

scholarly journals HUBUNGAN ANTARA KEPEMILIKAN SIM C DAN KEIKUTSERTAAN DALAM TES PEMBUATAN SIM DENGAN PENGETAHUAN BERKENDARA DAN KECELAKAAN LALU LINTAS DI KABUPATEN SIDOARJO

2018 ◽  
Vol 12 (2) ◽  
pp. 167 ◽  
Author(s):  
Fadilah Andy Nastiti
Keyword(s):  
Traffic Accident ◽  
Traffic Accidents ◽  
Cross Sectional Study ◽  
School Students ◽  
Chi Square ◽  
Cross Sectional ◽  
Middle Income ◽  
Exact Test ◽  
Driving License ◽  
The World

Traffic accidents are one of the biggest causes of death in the world. WHO states that 90% of deaths that caused by traffic accident in the world occur in low and middle income countries. Indonesia is ranked first with the highest percentage of deaths that caused by traffic accident in Asia. Most t raffic accidents involve motorcyclist with an average age of 15–29 years old. The purpose of this study is to determine the correlation between ownership of driving license and participation in driving license tests with driving k nowledge and t raffic accidents in h igh school students of Xi grade in Kabupaten Sidoarjo in 2017. This research was an observational analytic with cross sectional study design. The population of this study was all senior h igh school students of XI grade in Kabupaten Sidoarjo in 2017. The number of respondents was 204 students that drawn from the population by using two stage cluster random sampling method. Results of analysis using chi square and fisher’s exact test (α = 5%) indicate that the ownership of driving license (p = 0.259; RR 1.533) and participation in driving license test (p = 1.00; RR 0.586) did not have correlation with t raffic accidents in h igh school students of XI grade in Kabupaten Sidoarjo in 2017 and the ownership of driving license (p = 1.00; RR 1.008) and participation in driving license test (p = 1,00; RR 0.983) did not have correlation too with driving k nowledge in h igh school students of XI grades in Kabupaten Sidoarjo in 2017.

The burden of selected congenital anomalies amenable to surgery in low and middle-income regions: cleft lip and palate, congenital heart anomalies and neural tube defects

2014 ◽  
Vol 100 (3) ◽  
pp. 233-238 ◽  
Author(s):  
Hideki Higashi ◽  
Jan J Barendregt ◽  
Nicholas J Kassebaum ◽  
Thomas G Weiser ◽  
Stephen W Bickler ◽  
...  
Keyword(s):  
South Asia ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Burden Of Disease ◽  
Congenital Anomalies ◽  
Congenital Heart ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Low And Middle Income

ObjectiveTo quantify the burden of selected congenital anomalies in low and middle-income countries (LMICs) that could be reduced should surgical programmes cover the entire population with access to quality care.DesignBurden of disease and epidemiological modelling.SettingLMICs from all global regions.PopulationAll prevalent cases of selected congenital anomalies at birth in 2010.Main outcome measuresDisability-adjusted life years (DALYs).Interventions and methodsSurgical programmes for three congenital conditions were analysed: clefts (lip and palate); congenital heart anomalies; and neural tube defects. Data from the Global Burden of Disease 2010 Study were used to estimate the combination of fatal burden that could be addressed by surgical care and the additional long-term non-fatal burden associated with increased survival.ResultsOf the estimated 21.6 million DALYs caused by these three conditions in LMICs, 12.4 million DALYs (57%) are potentially addressable by surgical care among the population born with such conditions. Neural tube defects have the largest potential with 76% of burden amenable by surgery, followed by clefts (59%) and congenital heart anomalies (49%). Sub-Saharan Africa and South Asia have the greatest proportion of surgically addressable burden for clefts (68%), North Africa and Middle East for congenital heart anomalies (73%), and South Asia for neural tube defects (81%).ConclusionsThere is an important and neglected role surgical programmes can play in reducing the burden of congenital anomalies in LMICs.

scholarly journals Prevalence of thoracic surgical care need in a developing country: Results of a cluster-randomized, cross-sectional nationwide survey

2015 ◽  
Vol 13 ◽  
pp. 1-7 ◽  
Author(s):  
Cheryl K. Zogg ◽  
Thaim B. Kamara ◽  
Reinou S. Groen ◽  
Benedetto Mungo ◽  
Adam L. Kushner ◽  
...  
Keyword(s):  
Developing Country ◽  
Surgical Care ◽  
Nationwide Survey ◽  
Cross Sectional ◽  
Cluster Randomized

scholarly journals Decentralization and Regionalization of Surgical Care as a Critical Scale-up Strategy in Low- and Middle-Income Countries Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

2020 ◽  
Author(s):  
Jaymie A. Henry
Keyword(s):  
Scale Up ◽  
Surgical Care ◽  
Lessons Learned ◽  
Optimal Distribution ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Services ◽  
Obstetric Services ◽  
Surgical Conditions ◽  
Low And Middle Income

As global attention to improve the quality, safety and access to surgical care in low- and middle-income countries (LMICs) increases, the need for evidence-based strategies to reliably scale-up the quality and quantity of surgical services becomes ever more pertinent. Iversen et al discuss the optimal distribution of surgical services, whether through decentralization or regionalization, and propose a strategy that utilizes the dimensions of acuity, complexity and prevalence of surgical conditions to inform national priorities. Proposed expansion of this strategy to encompass levels of scale-up prioritization is discussed in this commentary. The decentralization of emergency obstetric services in LMICs shows promising results and should be further explored. The dearth of evidence of regionalization in LMICs, on the other hand, limits extrapolation of lessons learned. Nevertheless, principles from the successful regionalization of certain services such as trauma care in high-income countries (HICs) can be adapted to LMIC settings and can provide the backbone for innovation in service delivery and safety.

scholarly journals Deaths From Surgical Conditions In Malawi A Randomised Cross-sectional Nationwide Household Survey

2019 ◽  
Author(s):  
Carlos Gomes Varela ◽  
Sven Young ◽  
Reinou Groen ◽  
Leonard Ngoe Banza ◽  
Nyengo Mkandawire ◽  
...  
Keyword(s):  
Data Collection ◽  
Health Facility ◽  
Low Income ◽  
Health Centre ◽  
Household Survey ◽  
Abdominal Distension ◽  
African Countries ◽  
Cross Sectional ◽  
Surgical Conditions ◽  
At Home

Abstract Back ground The prevalence of untreated surgical conditions in Malawi has been estimated at 35% with 24% of the deaths associated with untreated surgical conditions. In SSA, the primary emphasis for health research has been on communicable diseases, and relatively little is known about deaths from surgical conditions in most middle- to low-, income African countries, including Malawi. This study aimed to address this knowledge gap by quantifying and describing the deaths from surgical conditions in Malawi. Methods To access the deaths associated with surgical conditions in Malawi, a randomised multi-stage cross-sectional national household survey was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48 233 settlements, using 50 villages from each district as data collection sites. Two to four household were randomly selected from each village. Two members of each selected household were interviewed. 1487 households were involved in the survey. Data collection was done using an electronic questionnaire. Results The total number of reported deaths from all causes was 616 in the 1479 households, ranging from 0 to 9 dead household members. Further data related to the deaths were available for 558 persons, with 294 (52.7%) males and 259 (46.4%) females. A total of 13 women died during pregnancy (5% of deceased women). Non-surgical conditions accounted for 408 (73.5%) of all the total deaths. Symptoms such as body swelling, abdominal distension and injuries were among the common associations of deaths: (6.0%, 5.3% and 4.6%). Almost half of the deaths occurred at home (234 persons - 41.9%) while 288 (51.6%) died at a health facility. Thirty persons died on their way to a health facility. Seventy-two persons (12.9%) who died had sought care from a traditional herbalist prior to attending a health facility. Conclusion In Malawi, body swelling, abdominal distension and injuries were the main conditions reported to be related to surgical causes of death. These occurred while the patients were either waiting at home or at health centre. Some patients initially consult a traditional herbalist prior to seeking modern health care. This delayed the possibility of timely surgical intervention.

scholarly journals Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

2020 ◽  
Author(s):  
Anita Gadgil ◽  
Geetu Bhandoria ◽  
Monty Khajanchi ◽  
Bhakti Sarang ◽  
Deepa Kizhakke Veetil ◽  
...  
Keyword(s):  
Health Care Services ◽  
Emergency Services ◽  
Care Delivery ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Care Services ◽  
Research Consortium

Abstract Background The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected global health care services to varying extent. Emergency Services were also affected along with elective surgeries, which were deferred to accommodate the added burden of COVID 19 affected patients, on the healthcare systems. We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic.Methodology A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low- and Middle-Income countries (LMIC), India, conducted this retrospective cross-sectional study with 12 recruited centers. All surgeries performed during the months of April 2020 were compared with those performed in April 2019. These surgeries were stratified into emergency and elective, and further categorized based on NHS surgery prioritization documents. Results A total of 4396 surgeries were performed at these centers in April 2019 and 1216 surgeries were performed in same month during 2020, yielding a fall of 72.3% (1216 /4396).We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries. Number of cesarean sections reduced by 29.7% and fracture surgeries declined by 85.3% Laparotomies and surgeries for local soft tissue infections with necrotic tissue reduced by 71.7% and 69.5% respectively.Conclusion Our study quantifies the effects of COVID 19 pandemic on surgical care delivery in India and documents that the overall surgical volume reduced by three fourths in the pandemic period. Emergency surgeries reduced to half when compared with pre-pandemic period. Cesarean section surgeries were affected the least by pandemic, whereas the fracture surgeries and laparotomies were affected the most.

scholarly journals Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

2017 ◽  
Vol 29 (3) ◽  
pp. 231 ◽  
Author(s):  
Carlos Varela ◽  
Sven Young ◽  
Reinou Groen ◽  
Leonard Banza ◽  
Nyengo C. Mkandawire ◽  
...  
Keyword(s):  
Household Survey ◽  
Cross Sectional ◽  
Surgical Conditions
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