Jakub Gajewski1, Ronan Conroy2, Leon Bijlmakers3, Gerald Mwapasa4, Tracey McCauley2, Eric Borgstein4, Ruairi Brugha2. 1. Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. jakubgajewski@rcsi.ie. 2. Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland. 3. Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. 4. College of Medicine, Mahatma Gandhi, Blantyre, Malawi.
Abstract
BACKGROUND: District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians. METHODS: Baseline and 2-3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool. RESULTS: There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63-1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5), p = 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3). CONCLUSION: The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.
BACKGROUND: District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians. METHODS: Baseline and 2-3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool. RESULTS: There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63-1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5), p = 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3). CONCLUSION: The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.
Authors: Caris E Grimes; Rebekah S L Law; Eric S Borgstein; Nyeno C Mkandawire; Christopher B D Lavy Journal: World J Surg Date: 2012-01 Impact factor: 3.352
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Authors: Jakub Gajewski; Carol Mweemba; Mweene Cheelo; Tracey McCauley; John Kachimba; Eric Borgstein; Leon Bijlmakers; Ruairi Brugha Journal: Hum Resour Health Date: 2017-08-22
Authors: Leon Bijlmakers; Maike Wientjes; Gerald Mwapasa; Dennis Cornelissen; Eric Borgstein; Henk Broekhuizen; Ruairi Brugha; Jakub Gajewski Journal: Ann Med Surg (Lond) Date: 2019-06-11