Evaluation of a surgical supervision model in three African countries—protocol for a prospective mixed-methods controlled pilot trial

Pittalis, Chiara; Brugha, Ruairı́; Crispino, Gloria; Bijlmakers, Leon; Mwapasa, Gerald; Lavy, Chris; Le, Grace; Cheelo, Mweene; Kachimba, John; Borgstein, Eric; Mkandawire, Nyengo; Juma, Adinan; Marealle, Paul; Chilonga, Kondo; Gajewski, Jakub

doi:10.1186/s40814-019-0409-6

Cited by 29 publications

(45 citation statements)

References 60 publications

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“…clinical officers) is being trialled in Malawi, including for hysterectomies. 60,61 However, radical hysterectomy surgery will likely require specialist gynaecology training. As of early 2019, there are six trained gynaecology surgeons providing radical hysterectomy surgery across Malawi, totally inadequate to meet current need.…”

Section: Surgerymentioning

confidence: 99%

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

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Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

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Section: Surgerymentioning

confidence: 99%

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

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“…In an earlier paper, we discuss the importance of a participatory implementation research approach that brings together local researchers, supported by external researchers, in informing the development of NSOAPs. This research team continues to work on refining and evaluating the supervisory model, under the follow-up SURG-Africa project [28] in close collaboration with the Ministry of Health in Zambia. This close collaboration, which started in 2011, increases the likelihood that the supervisory model will form part of a sustainable national programme.…”

Section: Discussionmentioning

confidence: 99%

Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia

et al. 2020

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Introduction: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to nonphysician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. Methods: Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. Results: Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. Conclusion: This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.

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“…Global surgery groups such as Mercy Ships have shown their effectiveness at promoting engagement and awareness of their mission. SurgAfrica has accordingly united global surgeons, in online platforms in WhatsApp to develop a tool to stimulate learning, facilitate decision making, and promote discussions by the future of the operating room as well as other studies have explored usage in other clinical settings [ 27 , 28 ]. Continued use of social media platforms as an opportunity and a tool to involve global surgeons and medical students worldwide could be used to disseminate research, foster partnerships, promote collaboration and awareness while refrain from self-promotion.…”

Section: Discussionmentioning

confidence: 99%

Identifying New Frontiers for Social Media Engagement in Global Surgery: An Observational Study

et al. 2020

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Background The purpose of this observational study is to characterize the use of social media content pertaining to global surgery. Methods A search for public posts on social media related to global surgery was performed over a 3-month window, from January 1st, 2019, to March 31st, 2019. Two public domains were included in the search: Instagram and Twitter. Posts were selected by filtering for one hashtag: #GlobalSurgery. A binary scoring system was used for media format, perspective of the poster, timing of the post, tone, and post content. Data were analyzed using Chi-squared tests with significance set to p < 0.05. Results Overall, 2633 posts with the hashtag #GlobalSurgery were publicly shared on these two social media platforms over the 3-month period. Of these, 2272 (86.3%) referenced content related to global surgery and were original posts. Physicians and other health professionals authored a majority (60.5%, 1083/1788) of posts on Twitter, whereas organizations comprised a majority of the posts on Instagram (59.9%, 290/484). Posts either had a positive (50.2%, 1140/2272) or neutral (49.6%, 1126/2272) tone, with only 0.3% or 6/2272 of posts being explicitly negative. The content of the posts varied, but most frequently (43.4%, 986/2272) focused on promoting communication and engagement within the community, followed by educational content (21.3%, 486/2272), advertisements (18.8%, 427/2272), and published research (13.2%, 299/2272). The majority of global surgery posts originated from the USA, UK, or Canada (67.6%, 1537/2272), followed by international organizations (11.5%, 261/2272). Chi-squared analysis comparing Instagram with Twitter performed examining media content, tone, perspective, and content, finding statistically significant differences ( p < 0.001) the two platforms for each of the categories. Conclusion The online social media community with respect to global surgery engagement is predominantly composed of surgeons and health care professionals, focused primarily on promoting dialogue within the online community. Social media platforms may provide a scalable tool that can augment engagement between global surgeons, with remaining opportunity to foster global collaboration, community engagement, education and awareness.

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Evaluation of a surgical supervision model in three African countries—protocol for a prospective mixed-methods controlled pilot trial

Cited by 29 publications

References 60 publications

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia

Identifying New Frontiers for Social Media Engagement in Global Surgery: An Observational Study

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