Surgical care in district hospitals in sub-Saharan Africa: a scoping review

Abstract

ObjectiveTo provide a general overview of the reported current surgical capacity and delivery in order to advance current knowledge and suggest targets for further development and research within the region of sub-Saharan Africa.DesignScoping review.SettingDistrict hospitals in sub-Saharan Africa.Data sourcesPubMed and Ovid EMBASE from January 2000 to December 2019.Study selectionStudies were included if they contained information about types of surgical procedures performed, number of operations per year, types of anaesthesia delivered, cadres of surgical/anaesthesia providers and/or patients’ outcomes.ResultsThe 52 articles included in analysis provided information about 16 countries. District hospitals were a group of diverse institutions ranging from 21 to 371 beds. The three most frequently reported procedures were caesarean section, laparotomy and hernia repair, but a wide range of orthopaedics, plastic surgery and neurosurgery procedures were also mentioned. The number of operations performed per year per district hospital ranged from 239 to 5233. The most mentioned anaesthesia providers were non-physician clinicians trained in anaesthesia. They deliver mainly general and spinal anaesthesia. Depending on countries, articles referred to different surgical care providers: specialist surgeons, medical officers and non-physician clinicians. 15 articles reported perioperative complications among which surgical site infection was the most frequent. Fifteen articles reported perioperative deaths of which the leading causes were sepsis, haemorrhage and anaesthesia complications.ConclusionDistrict hospitals play a significant role in sub-Saharan Africa, providing both emergency and elective surgeries. Most procedures are done under general or spinal anaesthesia, often administered by non-physician clinicians. Depending on countries, surgical care may be provided by medical officers, specialist surgeons and/or non-physician clinicians. Research on safety, quality and volume of surgical and anaesthesia care in this setting is scarce, and more attention to these questions is required.

Emergency and essential surgical capacity assessment in Gimbichu district: cross-sectional study

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The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa

“…While we did not measure time to care, other studies have demonstrated DH surgical care to be more timely than transfer to tertiary hospitals. [18] Secondly, it offloads the trauma burden that would otherwise be treated at the tertiary hospital, which is often overburdened with long waiting lists for complex and elective orthopaedic operations. KDH therefore plays a massive role in releasing this bottleneck, strengthening district trauma services, and delivering definitive orthopaedic care.…”

Incidence and predictors of postoperative complications in Sub-Saharan Africa: a systematic review and meta-analysis

“…PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar were searched from January 2010 to November 2022 for completed studies that reported the incidence and risk factors of postoperative complications among patients undergoing Emergency & essential surgery in SSA. The year 2010 marked a pivotal period where significant attention was drawn to the burden of surgical disease in sub-Saharan Africa, as highlighted in existing literature ( 13 ). Additional studies were searched manually from reference lists of some important articles.…”