Delay of emergency surgical interventions in Ethiopia: Patient and health system factors

Abstract

Background: The objectives of this study were to evaluate outcomes among patients with acute abdomen and abdominal trauma who presented at either of 2 referral hospitals in Addis Ababa, Ethiopia, and to determine the factors associated with delay as well as the effects of prehospital and in-hospital delay on outcome. Methods: We conducted a 1-year prospective cross-sectional study, which included all cases of surgically treated acute abdomen and abdominal trauma admitted to St Paul General Specialized Hospital, Addis Ababa, Ethiopia and Gondar University Hospital, Gondar, Ethiopia. Standardized data collection forms were completed for all cases from 1 May 2008 to 30 April 2009. Data were analyzed using Epi Info version 6 and SPSS version 13. Results: A total of 504 patients were studied. Diagnoses were: intestinal obstruction (34.6 %), appendicitis (33 %), and perforated peptic ulcer (3.6 %). Sixty-six percent of patients over 45 years of age, 60% of females, and 61% of intestinal obstruction cases were operated on within 3 days of illness onset. The 35% of patients who were operated on more than 3 days after the development of symptoms had a mortality of 67%. Fifty-four percent of the cases with a total prehospital and in-hospital time of more than 3 days had initially visited other health institutions. Conclusions: Delay of surgical intervention of more than 3 days for acute abdomen or abdominal trauma adversely affected outcomes. Women, patients older than 45 years of age, patients with intestinal obstruction, and those who were referred from other health facilities were delayed and had adverse outcomes. Keywords: delay in surgery; acute abdomen; abdominal trauma; surgical systems improvement

Epidemiology and causes of intestinal obstruction in Ethiopia: A systematic review

“…Accordingly, in the Oromia Region, it ranges from 21.8% to 40%, 17,35,37 28% to 49.3% in the Southern Nation, Nationalities, and People Region, 23,34 18.6% to 37.3% in the Tigray Region. 10,21,25 In the Amhara Region, only one study reported the prevalence of intestinal obstruction of 50.7% among patients with the acute abdomen, 40 37.8% in the Dire Dawa city administration, 30 and 34.6% reported by a study conducted at Addis Ababa city and Amhara Region 36 (Table 4).…”

“…21,34 However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. 22,36 The highest prevalence of intestinal obstruction, 50.7%, was reported from the Debre Berhan Referral Hospital, Amhara Region, 40 and the lowest prevalence, 18.6%, was reported from Suhul General Hospital, Tigray Region 21 among patients with acute abdomen. According to the administrative regions and cities, in Addis Ababa, the reported prevalence of intestinal obstruction among total surgical admission ranges from 4.3% 22 to 17.1%.…”

Organizational peer support to enable rehabilitating surgical services in Northern Ethiopia

“…A recent report suggested that on average patients travel 284.3 km, or 28.4 h to access services at specialized hospitals in Ethiopia [16]. Surgical patients are confronted with high rates of catastrophic expenditure due to a lack of financial risk protection, further contributing to delayed care seeking behavior [21,22] and causing a substantial unmet need (approximately 5 million people) [20], with high levels of mortality and disability linked to conditions treatable through surgery. Considering this baseline, the situation was worsened by the COVID-19 pandemic.…”