District-level surgery in Uganda: Indications, interventions and perioperative mortality

Löfgren, Jenny; Kadobera, Daniel; Forsberg, Birger C; Mulowooza, Jude; Wladis, Andreas; Nordin, Pär

doi:10.1016/j.surg.2015.03.022

Cited by 18 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At Mulago National Referral Hospital, previous cesarean section was the most common indication for emergency cesarean section 11 . In a study in two first‐level hospitals in Eastern Uganda, the most common indication for cesarean section was prolonged or obstructed labor (39.6%) 12 …”

Section: Discussionmentioning

confidence: 99%

Predictors of immediate neonatal outcome after cesarean section in Uganda

Båvenäs

Möller

Bhandarkar

et al. 2021

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

Child health is a priority in global health and United Nations Sustainable Development Goal 3 states that preventable deaths of newborns and children under five must end by 2030. In addition, all countries should reduce the neonatal mortality rate to at most 12 per 1000 live births by 2030. 1 The past few decades have seen a substantial decline of the mortality rate in under-5s, but with little progress for the youngest children. The risk of dying during childhood is highest in the first month of life, with an average of 18 deaths per 1000 live births. In 2017, this translated into 2.5 million deaths of children less than 1 month old. Three-quarters of these children die during the first week after birth and a third die the same day they are born. 2 Stillbirth rates have declined more slowly than the maternal mortality ratio and the under-5 mortality rate. In 2009, there were an estimated 2.6 million stillbirths, of which 98% occurred in low-or middle-income countries. 3 Half of the 7200 stillbirths that occur every day are often preventable intrapartum stillbirths. 3,4 Cesarean sections are, when medically justified,

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of immediate neonatal outcome after cesarean section in Uganda

Båvenäs

Möller

Bhandarkar

et al. 2021

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

show abstract

“…Given the success of political advocacy and the commitment of health system leaders, cesarean section is now the most widely available major operative procedure [2]. In Uganda, a first-referral hospital’s surgical output is predominantly limited to cesarean sections, herniorrhaphies, and emergency laparotomies [3]. But capacity is challenged by a shortage of surgical providers and lack of infrastructure to support safe surgery [456].…”

Section: Introductionmentioning

confidence: 99%

Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions

Butler

Tran

Fuller

et al. 2019

Annals of Global Health

View full text Add to dashboard Cite

Background: Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce. Objective: In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda. Methods: In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda). Findings: Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated. Conclusions: Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor.

show abstract

“…Because of a history of patients with conditions that need surgical intervention being referred to higher‐level hospitals and the perception that higher‐level hospitals should provide surgery, surgical care is often viewed as expensive compared with the medical management of other diseases2 3, 7. However, a systematic review3 of the cost‐effectiveness of surgical care showed that most essential surgical interventions, such as general surgery, caesarean sections and orthopaedic surgery, are cost‐effective in LMICs.…”

Section: Introductionmentioning

confidence: 99%

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

View full text Add to dashboard Cite

BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

show abstract

District-level surgery in Uganda: Indications, interventions and perioperative mortality

Cited by 18 publications

References 22 publications

Predictors of immediate neonatal outcome after cesarean section in Uganda

Predictors of immediate neonatal outcome after cesarean section in Uganda

Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

Contact Info

Product

Resources

About