In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa.
Background In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery. Methods Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.Results During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training. Conclusions Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.
Objective: A high mortality rate is associated with anesthesia in low and middle income countries. The provision of basic and emergency surgical services in developing countries includes safe anesthetic care. We sought to determine the resources available to deliver anesthesia care in low and middle income countries. Methods:A standard World Health Organization tool was used to collect data from 34 Low and Middle-Income Countries (LMICs) regarding infrastructure and capacity of facilities. We then performed a database query to extract information on anesthesia-related capacity.Findings: Twelve countries were excluded for providing data on less than four facilities, leaving 22 countries in our results, with a total of 590 facilities surveyed. Thirty five percent of hospitals had no access to oxygen and 40% had no anaesthesia machines; despite this, 58.5% of hospitals offered general inhalational anesthesia. All facilities reported presence of an anaesthesia provider: a nurse or clinical assistant was present in all 590 facilities. Hospitals with > 200 beds reported a range of 2-10 providers; the average number of anesthesia physicians increased from one to four as the hospital size increased from less than to greater than 300 beds. The majority of facilities were district/rural/community hospitals (34.7%), followed by health centres (23.2%), private/NGO/missions hospitals (16.6%), provincial hospitals (11.7%), and general hospitals (13.1%). Conclusion:The delivery of anesthesia is limited by deficiencies in human resources, equipment availability and system capacity in many low and middle income countries.
BackgroundIn developing countries hip osteoarthritis constitutes a major public health issue as it is highly prevalent in all age ranges of population, including the young. It often remains untreated because of the low accessibility of total hip prostheses. Hip arthrodesis still represents a major treatment option, but, for several reasons which are discussed in this paper, is nowadays infrequently performed. By means of reporting the results of a new simple technique, using a self-devised plate, the relevancy of hip arthrodesis in this particular environment is emphasized.Methods and FindingsOur series included 35 patients with painful hip osteoarthritis who underwent a hip fusion with the anterolateral arthrodesis plate. Two of them had a concurrent femoral osteotomy for correction of a vicious position of the limb and another patient had a femoral diaphysis osteotomy and placement of a Wagner elongating device in order to proceed with a limb lengthening by callotasis. The follow-up period averaged 16,9 months (9 to 34). All hips, except two, achieved solid fusion between 6 and 15 months after surgery. One failure of fusion was in the oldest patient, who presented a loosening of plate and screws due to an advanced degree of osteoporosis; the other was in a young patient who admitted having walked on his leg too soon. Patient satisfaction was high. We concluded that this technique is reliable and effective.ConclusionsThe results of this study should convince the hesitant surgeon and patient to consider hip arthrodesis an acceptable treatment option for disabling hip arthritis, compared to no treatment at all.
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