Surgical care in low and middle-income countries: Burden and barriers

Ologunde, Rele; Maruthappu, Mahiben; Shanmugarajah, Kumaran; Shalhoub, Joseph

doi:10.1016/j.ijsu.2014.07.009

Cited by 124 publications

(135 citation statements)

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“…Low-and middleincome countries (LMIC) are facing a double burden of communicable and non-communicable diseases (Bygbjerg, 2012). Among the array of communicable and noncommunicable diseases, surgical interventions can treat acute etiologies such as infections, abscesses, and osteomyelitis or chronic diseases such as cataracts, malignancies, and congenital anomalies (WHO, 2011;Ologunde, Maruthappu, Shanmugarajah, & Shalhoub, 2014). As these incidences continue to increase, the need for surgical care will be unprecedented.…”

Section: Introductionmentioning

confidence: 99%

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

Huynh

2018

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Résumé :(traduction) À l'échelle mondiale, 4,8 milliards de personnes n'ont pas accès à des soins chirurgicaux ni à une gestion de l'anesthésie sécuritaires ou adéquats. Les soins chirurgicaux sont considérés comme « le parent pauvre de la santé mondiale »; un rappel frappant des disparités en matière de soins de santé. Les interventions chirurgicales peuvent prévenir 11 pour cent de la charge mondiale de morbidité et 1,5 million de morts annuellement. Cependant, de nombreux obstacles empêchent les pays à revenu faible et intermédiaire (PRFI) d'accéder à des soins chirurgicaux. Le premier défi consiste à offrir des soins chirurgicaux efficients malgré les restrictions financières et les bouleversements politiques. De l'aide étrangère a été mise en place pour alléger le fardeau financier et ses contributions ont été essentielles. Mais dans certains pays, en raison du climat politique, les fonds destinés au domaine de la santé sont détournés vers d'autres secteurs du gouvernement. De plus, le manque d'infrastructure, d'équipement et de personnel dans les PRFI aggrave la situation. Le second défi consiste à déterminer si une intervention chirurgicale est possible et aussi efficace qu'une intervention non chirurgicale. Les soins chirurgicaux sont essentiels et cet article vise à évaluer quels sont les obstacles qui limitent l'importance qu'on leur accorde dans les discussions portant sur la santé mondiale. Cet article abordera l'impact du financement, de l'infrastructure, de la main-d'oeuvre, de la prestation de service et de la gestion de l'information sur les soins chirurgicaux, ainsi que les solutions actuelles telles que les missions d'aide humanitaire. Mots-clés :Services de santé, pays à revenu faible et intermédiaire, chirurgie 9 Abstract:Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed "the neglected child of global health," a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low-and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the curr...

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Section: Introductionmentioning

confidence: 99%

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

Huynh

2018

RISS-IJHS

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“…Realizing where healthcare was 10 years ago and where it is now, confirms that the relief provided by institutions like Care-to-Move are very valuable and essential to improve the level of healthcare 1,6,8,12 . The foundation Careto-Move has been involved in improving the St. Joseph's orthopaedic Hospital in Effiduase-Koforidua, Ghana, since 2005.…”

Section: Discussionmentioning

confidence: 98%

“…Surgery is an indivisible, indispensable part of healthcare 3,4,5,6,7 . In Africa, surgery may be thought of as the neglected stepchild of global public health.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore it is of great importance that healthcare continues to improve. This is partially achieved by the intensive collaboration between specialized teams from Western countries (United States/ Europe/ Australia) and the local African hospital teams 1,6,8,12 . Such collaboration exists between various Dutch hospitals and St. Joseph's Hospital in Effiduase-Koforidua.…”

Section: Introductionmentioning

confidence: 99%

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Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital

et al. 2016

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Background: Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. Intervention: During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was also spent on education/ teaching operation techniques/ regional anaesthesia techniques/ scrubbing techniques/ and principles around sterility. Results: Knowledge and quality of care has improved. Nevertheless, the overall level of quality of care still lags behind compared to what we see in the Western world. This is mainly due to financial constraints; restricting the capacity to purchase good equipment, maintaining it, and providing regular education. Conclusion:The relief provided by institutions like Care-to-Move is very valuable and essential to improve the level of healthcare. The hospital has evolved to such a high level that general European teams have become redundant. Focused and dedicated teams should be the next step of support within the nearby future.

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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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Surgical care in low and middle-income countries: Burden and barriers

Cited by 124 publications

References 38 publications

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital

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

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