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Title Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.
Full text https://escholarship.org/uc/item/0wc9288c
Date 2010
Author(s) Galukande, Moses; von Schreeb, Johan; Wladis, Andreas; Mbembati, Naboth; de Miranda, Helder; Kruk, Margaret E; Luboga, Sam; Matovu, Alphonsus; McCord, Colin; Ndao-Brumblay, S Khady; Ozgediz, Doruk; Rockers, Peter C; Quiñones, Ana Romàn; Vaz, Fernando; Debas, Haile T; Macfarlane, Sarah B
Abstract BackgroundSurgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries.Methods and findingsIn a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population.ConclusionThe findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality. Please see later in the article for the Editors' Summary.
Subject(s) Humans; Cesarean Section; Retrospective Studies; Demography; Age Distribution; Pregnancy; Surgery Department; Hospital; Hospitals; District; Africa South of the Sahara; Female; Male; Herniorrhaphy; Health Workforce; Clinical Research; Health Services; 8.1 Organisation and delivery of services; Health and social care services research; Generic health relevance; Good Health and Well Being; Health Manpower; Medical and Health Sciences; General & Internal Medicine
Coverage e1000243
Publisher eScholarship, University of California
Type of publication article
Format application/pdf
Source PLoS medicine, vol 7, iss 3
Rights public
Identifier qt0wc9288c
Repository Berkeley - University of California
Added to C-A: 2022-07-20;10:41:38