Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: Operative capacities of 78 district hospitals in 7 low- and middle-income countries

LeBrun, Drake G.; Chackungal, Smita; Chao, Tiffany E.; Knowlton, Lisa Marie; Linden, Allison F.; Notrica, Michelle R.; Solís, Carolina; McQueen, Kelly

doi:10.1016/j.surg.2013.10.008

Cited by 107 publications

(81 citation statements)

References 44 publications

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“…The availability of health care is a component in this concept and refers to the volume and distribution of medical resources in an area (Andersen et al, 1983). Much research on global surgery has equated access of adequate surgical care with the availability of trained surgeons and nurses as well as physical facilities, such as operating theatres, autoclaves, utensils, etc., while other research papers haves focused on characteristics of the population, such as demographics, income, perceived need for surgical care, transport to a primary healthcare facility and severity of symptoms Kushner et al, 2010;LeBrun et al, 2014;Ologunde et al, 2014). However, apart from patients, staff, buildings, instruments, affordability and cultural acceptability of care there is another important component: i.e.…”

Section: Discussionmentioning

confidence: 99%

The spatial distribution of injuries in need of surgical intervention in Nepal

et al. 2016

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Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R 2 =0.27). Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources. IntroductionWith increasing empirical data globally, surgical care is gaining momentum as a public health priority Petroze et al., 2013;Gupta et al., 2015;Bae et al., 2011;Meara et al., 2014). Global estimations conclude that 73.6% of all surgical operations are carried out in the wealthiest nations, while only 3.5% of the operations are performed in the world's poorest nations (Weiser et al., 2008). Approximately 2 billion people lack access to an operating room (Funk et al., 2010). Despite the recent interest in global surgical needs, there is still a paucity of objective data needed to define which barriers make access to surgical care so difficult in the world's poorest nations, and if surgical conditions vary depending on geospatial considerations globally. Geographic information systems (GIS) are increasingly used to help model the geospatial distribution of diseases (Rocha et al., 2014;Faierman et al., 2014;Tollefson et al., 2015). Such modelling can provide an accurate, geographic representation of the spatial variation of disease burdens, which can help to guide policymakers in developing future service plans, tackling this aspect of healthcare access. In addition to planning for the location of healthcare services with the aim of providing support where the need is greatest, geospatial modelling can ...

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Section: Discussionmentioning

confidence: 99%

The spatial distribution of injuries in need of surgical intervention in Nepal

et al. 2016

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“…Medical directors provided permission for the researchers to tour relevant infrastructure, including the study hospitals’ pharmacies, operating rooms and wards. Audits were documented using an abbreviated version of the World Health Organization’s (WHO’s) Global Initiative for Emergency and Essential Surgical Care survey questionnaire 7 , 12 , 13 . More detailed descriptions of this questionnaire are included in the reports of previous country-specific investigations 4 – 8 …”

Section: Methodsmentioning

confidence: 99%

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

Knowlton

Banguti

Chackungal

et al. 2017

Bull. World Health Organ.

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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.

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“…The service of operative procedures fell short of the need because of limited capacity of infrastructure as well as HRHs. 15 Nepal is no exception.…”

Section: Special Correspondencementioning

confidence: 99%

Taking Specialist Surgical Services to the Rural District Hospitals at One Forth Cost: A Sustainable ‘Return on Investment’ Public Health Initiative of Patan Hospital, Patan Academy of Health Sciences, Nepal

Shah

2017

Kathmandu Univ. Med. J.

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The inequitable distribution and centralization of resources and services in urban area persists around the world, more so in developing countries. The challenge to meet the health needs of rural population requires health policy makers, government and concerned organization to put extra efforts. Such efforts require innovative, feasible and sustainable strategies to address the social justice of people living in districts away from capital and urban cities. At Patan Academy of Health Sciences, the medial school curriculum is designed to address these issues. Together with health professionals from Patan Hospital, the main teaching hospital on which the academy evolved, have initiated strategies to bring specialist services, starting with surgical services to remote district hospitals to serve the need of rural population. This initiative is 'desirable, doable and feasible'. Further more, this can be modified for replication and promotion by other academic institutions, central hospitals and government health system. KEY WORDSDistrict hospital, public health, return on investment, rural Nepal, specialist service, surgery.

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Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: Operative capacities of 78 district hospitals in 7 low- and middle-income countries

Cited by 107 publications

References 44 publications

The spatial distribution of injuries in need of surgical intervention in Nepal

The spatial distribution of injuries in need of surgical intervention in Nepal

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

Taking Specialist Surgical Services to the Rural District Hospitals at One Forth Cost: A Sustainable ‘Return on Investment’ Public Health Initiative of Patan Hospital, Patan Academy of Health Sciences, Nepal

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