The burden of orthopaedic disease presenting to a referral hospital in
                        northern Tanzania

Premkumar, Ajay; Massawe, Honest; Mshabaha, David J.; Foran, Jared R.H.; Sheth, Neil P.

doi:10.1016/j.aogh.2016.04.489

Cited by 5 publications

(8 citation statements)

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“…The Orthopaedic department at KCMC alone sees over 11,000 admitted and outpatient patients per year. Of the annual inpatient census, over 95% require surgical intervention of which less than 60% actually receive surgical care, with the average time to surgical intervention being greater than 10 days [6]. It is evident that a discrepancy exists between supply and demand; however, the specific reasons for this are currently not well understood.…”

Section: Introductionmentioning

confidence: 99%

“…Patient financial burden has also been shown to play a major role in adequate care delivery in similar settings, such as Uganda [8]. Data from KCMC has previously quantified the orthopaedic burden of disease as well as the ability of patients in the surrounding region to access orthopaedic care, but little is known about the overall operating theater efficiency and utilization [4, 6]. In addition, operating theater case mix (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Rajaguru

Jusabani

Massawe

et al. 2019

glob health res policy

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BackgroundAccess to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.MethodsThe 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.ResultsIn 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).ConclusionWhile surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Rajaguru

Jusabani

Massawe

et al. 2019

glob health res policy

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“…Vast majority of patients admitted come from within the Nairobi Metropolitan area consisting of Nairobi, Kajiado, Machakos and Kiambu counties. This compares with a review of orthopedic admissions in KCMC in Northern Tanzania showed 65.7% of the patients came from state of Kilimanjaro where the hospital is located, 12.7% from Arusha,6.4% from Tanga, 5.9% from Manyara and 1.5% from Singida (11).A similar study done in Muhimbili National Hospital in Tanzania showed only 0.8% of admissions were from outside Dar Es Salaam (32).…”

Section: Discussionmentioning

confidence: 50%

“…However, it contrasted with studies done on orthopedic admissions in Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania showed the three most common occupations were farmers, businessman, professional drivers, students (11,12). This is could be because KCMC is a private facility as opposed to KNH which is a public health facility.…”

Section: Discussionmentioning

confidence: 83%

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Omondi

Mwangi

Sitati

et al. 2022

Preprint

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Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region

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“…Granted that increased risk of infection with use of internal fixation as a first line treatment in open fractures may be one reason for this practice, the other major reason is unavailability of implants which are prohibitively expensive 39 , 40 ; even closed fractures requiring surgical fixation are commonly managed conservatively for this reason. 14 , 41 This study reveals that surgical debridement plus conservative treatment (US$1177) is in fact more costly than ORIF (US$618) as a result of this prolonged ward stay. Although the ORIF cost here excludes the cost of implants (about US$134 14 ), since they were not captured in the routine hospital cost records, it includes the costs of prolonged pre-operative clinic visits.…”

Section: Discussionmentioning

confidence: 89%

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

Ifeanyichi¹,

Broekhuizen²,

Juma

et al. 2021

Int J Health Policy Manag

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Background: Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Methods: Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. Results: The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Conclusion: Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.

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The burden of orthopaedic disease presenting to a referral hospital in northern Tanzania

Cited by 5 publications

References 0 publications

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

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