Larry Akoko1, Ally Mwanga1, Maria Chikawe2,3, Evelyne Lutainulwa4, Deogratius Ngoma5, Andreas Nshalla4, Upendo Mwingira2,5. 1. Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 2. National Institute for Medical Research, Dar es Salaam, Tanzania. 3. Neglected Tropical Diseases Control Secretariat, MoHDGEC, Dar es Salaam, Tanzania. 4. Maries Stopes Tanzania, Dar es Salaam, Tanzania. 5. IMA World Health, Dar es Salaam, Tanzania.
Abstract
BACKGROUND: Globally, nearly 19 million people with Lymphatic filariasis (LF) who require surgery have not been attended. To reach them needs the scaling up and expansion of surgical services. In Tanzania, hydrocele is more prevalent in the coastal belt, where surgical workforce is also scarce. Thus, scaling up hydrocele surgery services would require the use of non-physician clinicians (NPCs) that are currently based there by offering procedure specific training. With new technique of partial sac excision, constant support and mentorship would be required. We therefore sought to test if use of mobile platform would be an adjunct to supervision and support to practicing non surgeon clinicians in Tanzania. METHODS: This was a prospective cohort study done in Mtwara and Lindi regions during the period of 2014-2015. Training model followed the West African Morbidity Management protocol for hydrocele followed by practical sessions in the operating room in each locality. Subsequently, patients were screened and discussed by sharing pictures on WhatsApp created to link the hydrocele teams and the two consultant surgeons. Patients with simple hydrocele not to require scrotoplasty and with non-coexistent of hernia were recruited. Data collected included: number of cases performed, time spent per procedure, hematoma formation and adherence to local anesthesia. Descriptive statistics was used to summarize the findings. RESULTS: Fifteen NPCs were successfully trained and mentored throughout the study period and were subsequently able to perform 1,337 hydrocelectomies in 1,250 patients with 387 having bilateral hydrocele. The use of local anesthesia was successful in nearly all the patients and case selection was appropriate as can be seen with only 7/1,250 requiring additional procedures other than hydrocelectomy. The mean procedure duration was 50.2±0.24 minutes and complications rates were low at 2.16%. CONCLUSIONS: Mobile platform with instant photo and video sharing capacity can be a reliable tool in offering support and supervision in surgical service provision. 2019 mHealth. All rights reserved.
BACKGROUND: Globally, nearly 19 million people with Lymphatic filariasis (LF) who require surgery have not been attended. To reach them needs the scaling up and expansion of surgical services. In Tanzania, hydrocele is more prevalent in the coastal belt, where surgical workforce is also scarce. Thus, scaling up hydrocele surgery services would require the use of non-physician clinicians (NPCs) that are currently based there by offering procedure specific training. With new technique of partial sac excision, constant support and mentorship would be required. We therefore sought to test if use of mobile platform would be an adjunct to supervision and support to practicing non surgeon clinicians in Tanzania. METHODS: This was a prospective cohort study done in Mtwara and Lindi regions during the period of 2014-2015. Training model followed the West African Morbidity Management protocol for hydrocele followed by practical sessions in the operating room in each locality. Subsequently, patients were screened and discussed by sharing pictures on WhatsApp created to link the hydrocele teams and the two consultant surgeons. Patients with simple hydrocele not to require scrotoplasty and with non-coexistent of hernia were recruited. Data collected included: number of cases performed, time spent per procedure, hematoma formation and adherence to local anesthesia. Descriptive statistics was used to summarize the findings. RESULTS: Fifteen NPCs were successfully trained and mentored throughout the study period and were subsequently able to perform 1,337 hydrocelectomies in 1,250 patients with 387 having bilateral hydrocele. The use of local anesthesia was successful in nearly all the patients and case selection was appropriate as can be seen with only 7/1,250 requiring additional procedures other than hydrocelectomy. The mean procedure duration was 50.2±0.24 minutes and complications rates were low at 2.16%. CONCLUSIONS: Mobile platform with instant photo and video sharing capacity can be a reliable tool in offering support and supervision in surgical service provision. 2019 mHealth. All rights reserved.
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