A geospatial evaluation of timely access to surgical care in seven countries

Abstract

Abstract:ObjectiveTo assess the consistent availability of basic surgical resources at selected facilities in seven countries.MethodsIn 2010–2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (n = 14), the Plurinational State of Bolivia (n = 18), Ethiopia (n = 19), Guatemala (n = 20), the Lao People's Democratic Republic (n = 12), Liberia (n = 12) and Rwanda (n = 25). Hospital sites were selected by pragmatic sampling. Data were geocoded and then analysed using an online data visualization platform. Each hospital’s catchment population was defined as the people who could reach the hospital via a vehicle trip of no more than two hours. A hospital was only considered to show consistent availability of basic surgical resources if clean water, electricity, essential medications including intravenous fluids and at least one anaesthetic, analgesic and antibiotic, a functional pulse oximeter, a functional sterilizer, oxygen and providers accredited to perform surgery and anaesthesia were always available.FindingsOnly 41 (34.2%) of the 120 study hospitals met the criteria for the provision of consistent basic surgical services. The combined catchments of the study hospitals in each study country varied between 3.3 million people in Liberia and 151.3 million people in Bangladesh. However, the combined catchments of the study hospitals in each study country that met the criteria for the provision of consistent basic surgical services were substantially smaller and varied between 1.3 million in Liberia and 79.2 million in Bangladesh.ConclusionMany study facilities were deficient in the basic infrastructure necessary for providing basic surgical care on a consistent basis.

Validating the Global Surgery Geographical Accessibility Indicator: Differences in Modeled Versus Patient‐Reported Travel Times

“…However, most of sub-Saharan Africa does require the health center-to-hospital referral for surgical care and we posit that the failure to account for this in model estimates will result in systematic underestimates even if the exact parameters are not generalizable. We note that we only modeled one set of travelling speed assumptions, chosen due to its predominance in the literature [9,[13][14][15][16] but that in theory a Rwanda-specific set of speeds could be generated and could yield more accurate results. Further, self-reported travel time may contain recall bias or rounding errors, but were collected within days of the trip.…”

Epidemiology of hypertension among Bangladeshi adults using the 2017 ACC/AHA Hypertension Clinical Practice Guidelines and Joint National Committee 7 Guidelines

“…Although the increase in burden of hypertension may cause a strain on the health care system, readjusting the diagnostic criteria of hypertension to lower cut-off points following the 2017 ACC/AHA may lead to a strong focus on prevention of CVDs as hypertension will be diagnosed at an earlier stage (12, 26). Timely access and availability of treatment for CVDs, such as cardiac stents, thrombolysis, or surgical interventions, is limited in Bangladesh; prevention is key to reducing the burden and mortality due to NCDs in a resource-limited setting(27). However, availability of preventive treatment and access to primary care services through well-coordinated intervention strategies and efforts will need to be prioritized for successful roll-out of updated Bangladeshi guidelines(9).…”

What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

“…Approximately 70% of deaths following emergency general surgery occur within LMICs, with such regions reporting fewer than one operating theatre per 100 000 inhabitants (compared with >14 per 100 000 in some HICs) 41. Basic infrastructure for surgery is frequently in short supply, limiting the consistency with which healthcare facilities can provide basic surgical care42 ; as an example, running water was only available in 50% of Gambian health facilities,43 and oxygen supplies with masks and tubing were available in only 26% of Rwandan health facilities 44. High rates of delayed or cancelled procedures in LMICs have been shown to arise through both poor infrastructure45 46 and equipment shortages 46…”