Background Shortages of specialist surgeons in African countries mean that the needs of rural populations go unmet. Task‐shifting from surgical specialists to other cadres of clinicians occurs in some countries, but without widespread acceptance. Clinical Officer Surgical Training in Africa (COST‐Africa) developed and implemented BSc surgical training for clinical officers in Malawi. Methods Trainees participated in the COST‐Africa BSc training programme between 2013 and 2016. This prospective study done in 16 hospitals compared crude numbers of selected numbers of major surgical procedures between intervention and control sites before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals between the COST‐Africa trainees and other surgically active cadres. Results Seventeen trainees participated in the COST‐Africa BSc training. The volume of surgical procedures undertaken at intervention hospitals almost doubled between 2013 and 2015 (+74 per cent), and there was a slight reduction in the number of procedures done in the control hospitals (–4 per cent) (P = 0·059). In the intervention hospitals, general surgery procedures were more often undertaken by COST‐Africa trainees (61·2 per cent) than other clinical officers (31·3 per cent) and medical doctors (7·4 per cent). There was no significant difference in postoperative wound infection rates for hernia procedures at intervention hospitals between trainees and medical doctors (P = 0·065). Conclusion The COST‐Africa study demonstrated that in‐service training of practising clinical officers can improve the surgical productivity of district‐level hospitals.
Purpose This study aims to develop a valid and reliable Arabic version of the Compliance Questionnaire on Rheumatology (CQR-A) and to explore the impact of demographic factors on compliance. Methods This is a descriptive cross-sectional study carried out at the outpatient clinics of rheumatology in King Fahad hospital (KFH) in Madinah, Saudi Arabia, from May 2019 to October 2019. Initially, the original version was culturally adapted to an Arabic version by forward translation, backward translation, committee review of both the Arabic and the original versions, and lastly, pre-testing. Then, seventy-two rheumatoid arthritis patients were recruited to evaluate the reliability and validity of the CQR-A. Reliability was assessed by the test–retest method with a two-week interval through the intraclass correlation coefficient (ICC). The criterion validity of the CQR-A was assessed through Pearson correlation of pharmacy refill and CQR-A. The content validity index (CVI) was used to determine content validity. Multiple regression analysis was done to evaluate the effect of demographic factors on compliance. Results The CQR-A has adequate reliability and validity. The ICC = 0.757 with a 95% CI ranging from 0.579 to 0.860, p < 0.001, Cronbach’s alpha coefficient = 0.788. Pearson correlation coefficient was found to be (r = 0.338, p = 0.013). The individual content validity index (I-CVI) ranged from 0.67 to 1.00, and the average scale content validity index (S-CVI/Ave) = 0.91. Education was the only significant predictor of compliance amongst the demographic factors with R2 of 0.158. Conclusion The Arabic version of the Compliance Questionnaire on Rheumatology (CQR-A) is a reliable and valid clinical tool to assess compliance in Arabic speaking patients.
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