Systematic Review of Met and Unmet Need of Surgical Disease in Rural Sub‐Saharan Africa

Abstract

District hospitals are not meeting the surgical needs of the populations they serve. Urgent intervention is required to build up their capacity, to train healthcare personnel in safe surgery and anesthesia, and to overcome obstacles to timely emergency care.

Quantifying the disparity in outcome between urban and rural patients with acute appendicitis in South Africa

“…[15] These difficulties are referred to as 'barriers to care' and authors have suggested various systems to classify these. [16] The classification scheme described by Grimes et al [16] defines 3 categories: cultural (acceptability), financial (affordability) and structural (accessibility). For pragmatic and quality-improvement reasons it is useful to divide barriers to care into pre-contact (with the health system) and postcontact factors.…”

Surgery and the global health agenda

“…For hernias alone, there is an estimated unmet need of 175 untreated hernias per 100,000 per year in rural sub-Saharan Africa. 5 Such estimates are reinforced by measurements of district hospital surgical and anaesthetic capacity. These suggest that few rural state-run hospitals are adequately equipped.…”

“…Estimates suggest that this burden of unmet need is enormous. 3,5 A survey of 1875 households in Sierra Leone suggested that 25% of respondents were in need of surgical intervention, and that 25% of deaths in the previous year might have been averted by timely surgical intervention. 6 Other estimates suggest that the incidence of non-fatal injury in sub-Saharan Africa is at least 1690 per 100,000 population per year and mortality as a result of injury estimated to be 50-92 per 100,000 population annually.…”

Surgical outreach in rural South Africa: Are we managing to impart surgical skills?

“…[2,3] It would appear that in the region as a whole, caesarean section is the most commonly performed operation and despite a high prevalence of trauma, burns and intestinal obstruction in the region, the number of fracture reductions, laparotomies and skin grafts is small. Most of the procedures performed are in the so-called miscellaneous category and include incision and drainage of abscesses and wound management and suturing, many of which, if performed in the outpatient department, would not have been formally recorded in the surgical registers.…”

“…However, access to surgical services is unevenly distributed across the world and across regions within the same country. [1][2][3][4][5][6] Currently, less than one-third of the estimated 234 million operations that take place each year are performed in the developing world. Lack of access to surgical services results in significant morbidity and mortality.…”