Matthew A R Stokes1,2, Glenn D Guest3,4, Perista Mamadi5, Westin Seta5, Noel Yaubihi5, Grace Karawiga5, Billy Naidi5, David A K Watters6,7. 1. School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia. marstokes@gmail.com. 2. Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia. marstokes@gmail.com. 3. School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia. 4. Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia. 5. Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea. 6. School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia. watters.david@gmail.com. 7. Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia. watters.david@gmail.com.
Abstract
BACKGROUND: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided. METHODS: We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep-Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization's Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity. RESULTS: EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies. CONCLUSIONS: Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and essential surgical care. This is despite a relatively low surgical volume and limited numbers of trained surgical anaesthesia obstetric providers, and likely underservicing. The ability of surgical care to avert disease in Papua New Guinea highlights its importance to public health in LMICs.
BACKGROUND: Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided. METHODS: We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep-Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization's Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity. RESULTS: EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies. CONCLUSIONS: Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and essential surgical care. This is despite a relatively low surgical volume and limited numbers of trained surgical anaesthesia obstetric providers, and likely underservicing. The ability of surgical care to avert disease in Papua New Guinea highlights its importance to public health in LMICs.
Authors: David A Watters; Wendy J Babidge; Andreas Kiermeier; Glenn A J McCulloch; Guy J Maddern Journal: World J Surg Date: 2016-11 Impact factor: 3.352
Authors: John Rose; Thomas G Weiser; Phil Hider; Leona Wilson; Russell L Gruen; Stephen W Bickler Journal: Lancet Glob Health Date: 2015-04-27 Impact factor: 26.763
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Hampus Holmer; Adam Lantz; Teena Kunjumen; Samuel Finlayson; Marguerite Hoyler; Amani Siyam; Hernan Montenegro; Edward T Kelley; James Campbell; Meena N Cherian; Lars Hagander Journal: Lancet Glob Health Date: 2015-04-27 Impact factor: 26.763
Authors: Lori A Bollinger; John Stover; Godfrey Musuka; Boga Fidzani; Themba Moeti; Lesego Busang Journal: J Int AIDS Soc Date: 2009-05-27 Impact factor: 5.396
Authors: Christopher J L Murray; Ryan M Barber; Kyle J Foreman; Ayse Abbasoglu Ozgoren; Foad Abd-Allah; Semaw F Abera; Victor Aboyans; Jerry P Abraham; Ibrahim Abubakar; Laith J Abu-Raddad; Niveen M Abu-Rmeileh; Tom Achoki; Ilana N Ackerman; Zanfina Ademi; Arsène K Adou; José C Adsuar; Ashkan Afshin; Emilie E Agardh; Sayed Saidul Alam; Deena Alasfoor; Mohammed I Albittar; Miguel A Alegretti; Zewdie A Alemu; Rafael Alfonso-Cristancho; Samia Alhabib; Raghib Ali; François Alla; Peter Allebeck; Mohammad A Almazroa; Ubai Alsharif; Elena Alvarez; Nelson Alvis-Guzman; Azmeraw T Amare; Emmanuel A Ameh; Heresh Amini; Walid Ammar; H Ross Anderson; Benjamin O Anderson; Carl Abelardo T Antonio; Palwasha Anwari; Johan Arnlöv; Valentina S Arsic Arsenijevic; Al Artaman; Rana J Asghar; Reza Assadi; Lydia S Atkins; Marco A Avila; Baffour Awuah; Victoria F Bachman; Alaa Badawi; Maria C Bahit; Kalpana Balakrishnan; Amitava Banerjee; Suzanne L Barker-Collo; Simon Barquera; Lars Barregard; Lope H Barrero; Arindam Basu; Sanjay Basu; Mohammed O Basulaiman; Justin Beardsley; Neeraj Bedi; Ettore Beghi; Tolesa Bekele; Michelle L Bell; Corina Benjet; Derrick A Bennett; Isabela M Bensenor; Habib Benzian; Eduardo Bernabé; Amelia Bertozzi-Villa; Tariku J Beyene; Neeraj Bhala; Ashish Bhalla; Zulfiqar A Bhutta; Kelly Bienhoff; Boris Bikbov; Stan Biryukov; Jed D Blore; Christopher D Blosser; Fiona M Blyth; Megan A Bohensky; Ian W Bolliger; Berrak Bora Başara; Natan M Bornstein; Dipan Bose; Soufiane Boufous; Rupert R A Bourne; Lindsay N Boyers; Michael Brainin; Carol E Brayne; Alexandra Brazinova; Nicholas J K Breitborde; Hermann Brenner; Adam D Briggs; Peter M Brooks; Jonathan C Brown; Traolach S Brugha; Rachelle Buchbinder; Geoffrey C Buckle; Christine M Budke; Anne Bulchis; Andrew G Bulloch; Ismael R Campos-Nonato; Hélène Carabin; Jonathan R Carapetis; Rosario Cárdenas; David O Carpenter; Valeria Caso; Carlos A Castañeda-Orjuela; Ruben E Castro; Ferrán Catalá-López; Fiorella Cavalleri; Alanur Çavlin; Vineet K Chadha; Jung-Chen Chang; Fiona J Charlson; Honglei Chen; Wanqing Chen; Peggy P Chiang; Odgerel Chimed-Ochir; Rajiv Chowdhury; Hanne Christensen; Costas A Christophi; Massimo Cirillo; Matthew M Coates; Luc E Coffeng; Megan S Coggeshall; Valentina Colistro; Samantha M Colquhoun; Graham S Cooke; Cyrus Cooper; Leslie T Cooper; Luis M Coppola; Monica Cortinovis; Michael H Criqui; John A Crump; Lucia Cuevas-Nasu; Hadi Danawi; Lalit Dandona; Rakhi Dandona; Emily Dansereau; Paul I Dargan; Gail Davey; Adrian Davis; Dragos V Davitoiu; Anand Dayama; Diego De Leo; Louisa Degenhardt; Borja Del Pozo-Cruz; Robert P Dellavalle; Kebede Deribe; Sarah Derrett; Don C Des Jarlais; Muluken Dessalegn; Samath D Dharmaratne; Mukesh K Dherani; Cesar Diaz-Torné; Daniel Dicker; Eric L Ding; Klara Dokova; E Ray Dorsey; Tim R Driscoll; Leilei Duan; Herbert C Duber; Beth E Ebel; Karen M Edmond; Yousef M Elshrek; Matthias Endres; Sergey P Ermakov; Holly E Erskine; Babak Eshrati; Alireza Esteghamati; Kara Estep; Emerito Jose A Faraon; Farshad Farzadfar; Derek F Fay; Valery L Feigin; David T Felson; Seyed-Mohammad Fereshtehnejad; Jefferson G Fernandes; Alize J Ferrari; Christina Fitzmaurice; Abraham D Flaxman; Thomas D Fleming; Nataliya Foigt; Mohammad H Forouzanfar; F Gerry R Fowkes; Urbano Fra Paleo; Richard C Franklin; Thomas Fürst; Belinda Gabbe; Lynne Gaffikin; Fortuné G Gankpé; Johanna M Geleijnse; Bradford D Gessner; Peter Gething; Katherine B Gibney; Maurice Giroud; Giorgia Giussani; Hector Gomez Dantes; Philimon Gona; Diego González-Medina; Richard A Gosselin; Carolyn C Gotay; Atsushi Goto; Hebe N Gouda; Nicholas Graetz; Harish C Gugnani; Rahul Gupta; Rajeev Gupta; Reyna A Gutiérrez; Juanita Haagsma; Nima Hafezi-Nejad; Holly Hagan; Yara A Halasa; Randah R Hamadeh; Hannah Hamavid; Mouhanad Hammami; Jamie Hancock; Graeme J Hankey; Gillian M Hansen; Yuantao Hao; Hilda L Harb; Josep Maria Haro; Rasmus Havmoeller; Simon I Hay; Roderick J Hay; Ileana B Heredia-Pi; Kyle R Heuton; Pouria Heydarpour; Hideki Higashi; Martha Hijar; Hans W Hoek; Howard J Hoffman; H Dean Hosgood; Mazeda Hossain; Peter J Hotez; Damian G Hoy; Mohamed Hsairi; Guoqing Hu; Cheng Huang; John J Huang; Abdullatif Husseini; Chantal Huynh; Marissa L Iannarone; Kim M Iburg; Kaire Innos; Manami Inoue; Farhad Islami; Kathryn H Jacobsen; Deborah L Jarvis; Simerjot K Jassal; Sun Ha Jee; Panniyammakal Jeemon; Paul N Jensen; Vivekanand Jha; Guohong Jiang; Ying Jiang; Jost B Jonas; Knud Juel; Haidong Kan; André Karch; Corine K Karema; Chante Karimkhani; Ganesan Karthikeyan; Nicholas J Kassebaum; Anil Kaul; Norito Kawakami; Konstantin Kazanjan; Andrew H Kemp; Andre P Kengne; Andre Keren; Yousef S Khader; Shams Eldin A Khalifa; Ejaz A Khan; Gulfaraz Khan; Young-Ho Khang; Christian Kieling; Daniel Kim; Sungroul Kim; Yunjin Kim; Yohannes Kinfu; Jonas M Kinge; Miia Kivipelto; Luke D Knibbs; Ann Kristin Knudsen; Yoshihiro Kokubo; Soewarta Kosen; Sanjay Krishnaswami; Barthelemy Kuate Defo; Burcu Kucuk Bicer; Ernst J Kuipers; Chanda Kulkarni; Veena S Kulkarni; G Anil Kumar; Hmwe H Kyu; Taavi Lai; Ratilal Lalloo; Tea Lallukka; Hilton Lam; Qing Lan; Van C Lansingh; Anders Larsson; Alicia E B Lawrynowicz; Janet L Leasher; James Leigh; Ricky Leung; Carly E Levitz; Bin Li; Yichong Li; Yongmei Li; Stephen S Lim; Maggie Lind; Steven E Lipshultz; Shiwei Liu; Yang Liu; Belinda K Lloyd; Katherine T Lofgren; Giancarlo Logroscino; Katharine J Looker; Joannie Lortet-Tieulent; Paulo A Lotufo; Rafael Lozano; Robyn M Lucas; Raimundas Lunevicius; Ronan A Lyons; Stefan Ma; Michael F Macintyre; Mark T Mackay; Marek Majdan; Reza Malekzadeh; Wagner Marcenes; David J Margolis; Christopher Margono; Melvin B Marzan; Joseph R Masci; Mohammad T Mashal; Richard Matzopoulos; Bongani M Mayosi; Tasara T Mazorodze; Neil W Mcgill; John J Mcgrath; Martin Mckee; Abigail Mclain; Peter A Meaney; Catalina Medina; Man Mohan Mehndiratta; Wubegzier Mekonnen; Yohannes A Melaku; Michele Meltzer; Ziad A Memish; George A Mensah; Atte Meretoja; Francis A Mhimbira; Renata Micha; Ted R Miller; Edward J Mills; Philip B Mitchell; Charles N Mock; Norlinah Mohamed Ibrahim; Karzan A Mohammad; Ali H Mokdad; Glen L D Mola; Lorenzo Monasta; Julio C Montañez Hernandez; Marcella Montico; Thomas J Montine; Meghan D Mooney; Ami R Moore; Maziar Moradi-Lakeh; Andrew E Moran; Rintaro Mori; Joanna Moschandreas; Wilkister N Moturi; Madeline L Moyer; Dariush Mozaffarian; William T Msemburi; Ulrich O Mueller; Mitsuru Mukaigawara; Erin C Mullany; Michele E Murdoch; Joseph Murray; Kinnari S Murthy; Mohsen Naghavi; Aliya Naheed; Kovin S Naidoo; Luigi Naldi; Devina Nand; Vinay Nangia; K M Venkat Narayan; Chakib Nejjari; Sudan P Neupane; Charles R Newton; Marie Ng; Frida N Ngalesoni; Grant Nguyen; Muhammad I Nisar; Sandra Nolte; Ole F Norheim; Rosana E Norman; Bo Norrving; Luke Nyakarahuka; In-Hwan Oh; Takayoshi Ohkubo; Summer L Ohno; Bolajoko O Olusanya; John Nelson Opio; Katrina Ortblad; Alberto Ortiz; Amanda W Pain; Jeyaraj D Pandian; Carlo Irwin A Panelo; Christina Papachristou; Eun-Kee Park; Jae-Hyun Park; Scott B Patten; George C Patton; Vinod K Paul; Boris I Pavlin; Neil Pearce; David M Pereira; Rogelio Perez-Padilla; Fernando Perez-Ruiz; Norberto Perico; Aslam Pervaiz; Konrad Pesudovs; Carrie B Peterson; Max Petzold; Michael R Phillips; Bryan K Phillips; David E Phillips; Frédéric B Piel; Dietrich Plass; Dan Poenaru; Suzanne Polinder; Daniel Pope; Svetlana Popova; Richie G Poulton; Farshad Pourmalek; Dorairaj Prabhakaran; Noela M Prasad; Rachel L Pullan; Dima M Qato; D Alex Quistberg; Anwar Rafay; Kazem Rahimi; Sajjad U Rahman; Murugesan Raju; Saleem M Rana; Homie Razavi; K Srinath Reddy; Amany Refaat; Giuseppe Remuzzi; Serge Resnikoff; Antonio L Ribeiro; Lee Richardson; Jan Hendrik Richardus; D Allen Roberts; David Rojas-Rueda; Luca Ronfani; Gregory A Roth; Dietrich Rothenbacher; David H Rothstein; Jane T Rowley; Nobhojit Roy; George M Ruhago; Mohammad Y Saeedi; Sukanta Saha; Mohammad Ali Sahraian; Uchechukwu K A Sampson; Juan R Sanabria; Logan Sandar; Itamar S Santos; Maheswar Satpathy; Monika Sawhney; Peter Scarborough; Ione J Schneider; Ben Schöttker; Austin E Schumacher; David C Schwebel; James G Scott; Soraya Seedat; Sadaf G Sepanlou; Peter T Serina; Edson E Servan-Mori; Katya A Shackelford; Amira Shaheen; Saeid Shahraz; Teresa Shamah Levy; Siyi Shangguan; Jun She; Sara Sheikhbahaei; Peilin Shi; Kenji Shibuya; Yukito Shinohara; Rahman Shiri; Kawkab Shishani; Ivy Shiue; Mark G Shrime; Inga D Sigfusdottir; Donald H Silberberg; Edgar P Simard; Shireen Sindi; Abhishek Singh; Jasvinder A Singh; Lavanya Singh; Vegard Skirbekk; Erica Leigh Slepak; Karen Sliwa; Samir Soneji; Kjetil Søreide; Sergey Soshnikov; Luciano A Sposato; Chandrashekhar T Sreeramareddy; Jeffrey D Stanaway; Vasiliki Stathopoulou; Dan J Stein; Murray B Stein; Caitlyn Steiner; Timothy J Steiner; Antony Stevens; Andrea Stewart; Lars J Stovner; Konstantinos Stroumpoulis; Bruno F Sunguya; Soumya Swaminathan; Mamta Swaroop; Bryan L Sykes; Karen M Tabb; Ken Takahashi; Nikhil Tandon; David Tanne; Marcel Tanner; Mohammad Tavakkoli; Hugh R Taylor; Braden J Te Ao; Fabrizio Tediosi; Awoke M Temesgen; Tara Templin; Margreet Ten Have; Eric Y Tenkorang; Abdullah S Terkawi; Blake Thomson; Andrew L Thorne-Lyman; Amanda G Thrift; George D Thurston; Taavi Tillmann; Marcello Tonelli; Fotis Topouzis; Hideaki Toyoshima; Jefferson Traebert; Bach X Tran; Matias Trillini; Thomas Truelsen; Miltiadis Tsilimbaris; Emin M Tuzcu; Uche S Uchendu; Kingsley N Ukwaja; Eduardo A Undurraga; Selen B Uzun; Wim H Van Brakel; Steven Van De Vijver; Coen H van Gool; Jim Van Os; Tommi J Vasankari; N Venketasubramanian; Francesco S Violante; Vasiliy V Vlassov; Stein Emil Vollset; Gregory R Wagner; Joseph Wagner; Stephen G Waller; Xia Wan; Haidong Wang; Jianli Wang; Linhong Wang; Tati S Warouw; Scott Weichenthal; Elisabete Weiderpass; Robert G Weintraub; Wang Wenzhi; Andrea Werdecker; Ronny Westerman; Harvey A Whiteford; James D Wilkinson; Thomas N Williams; Charles D Wolfe; Timothy M Wolock; Anthony D Woolf; Sarah Wulf; Brittany Wurtz; Gelin Xu; Lijing L Yan; Yuichiro Yano; Pengpeng Ye; Gökalp K Yentür; Paul Yip; Naohiro Yonemoto; Seok-Jun Yoon; Mustafa Z Younis; Chuanhua Yu; Maysaa E Zaki; Yong Zhao; Yingfeng Zheng; David Zonies; Xiaonong Zou; Joshua A Salomon; Alan D Lopez; Theo Vos Journal: Lancet Date: 2015-08-28 Impact factor: 79.321