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Otoki K, Parker AS, Many HR, Parker RK. Gender Disparities in Complications, Costs, and Mortality After Emergency Gastrointestinal Surgery in Kenya. J Surg Res 2024; 295:846-852. [PMID: 37543494 DOI: 10.1016/j.jss.2023.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Little is known about the impact of gender on emergency surgery within Kenya. Therefore, we aimed to investigate the association of gender on outcomes of postoperative complications, health care costs, and mortality. METHODS We evaluated an established cohort of patients undergoing emergency gastrointestinal surgery in rural Kenya between January 1st, 2016 and June 30th, 2019. Utilizing logistic regression, we examined the association between self-reported patient gender and the outcomes of postoperative complications and mortality. A generalized linear model was created for total hospital costs, inflation-adjusted in international dollars purchasing power parity, to examine the impact of gender. Confounding factors were controlled by Africa Surgical Outcomes Study Surgical Risk Score. RESULTS Among 484 patients reviewed, 149 (30.8%) were women. 165 (34.1%) patients developed complications, with women experiencing more than men (40.9% versus 31.0%; P = 0.03) and longer hospital stays (median 6 days (4-9) versus 5 (4-7); P = 0.02). After controlling for Africa Surgical Outcomes Study Surgical Risk Score, odds of developing complications for women were 1.67 (95% confidence interval: 1.09-2.55; P = 0.019) times higher than men, and the odds of death were 2.38 (95% confidence interval: 1.12-5.09; P = 0.025) times greater for women than men, despite similar failure-to-rescue rates and intensive care unit utilization. Total hospital costs were increased for women by 531 international dollars purchasing power parity (117-946; P = 0.012) when compared to men, attributed to longer lengths of stay. CONCLUSIONS These findings demonstrate that a discrepancy exists between men and women undergoing emergency gastrointestinal surgery in our setting. Further exploration of the underlying causes of this inequity is necessary for quality improvement for women in rural Kenya.
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Affiliation(s)
- Kemunto Otoki
- Department of Surgery, Tenwek Hospital, Bomet, Kenya. https://twitter.com/kemuntootoki
| | - Andrea S Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya. https://twitter.com/AP_the_surgeon
| | - Heath R Many
- Department of Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
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Leke AZ, Malherbe H, Kalk E, Mehta U, Kisa P, Botto LD, Ayede I, Fairlie L, Maboh NM, Orioli I, Zash R, Kusolo R, Mumpe-Mwanja D, Serujogi R, Bongomin B, Osoro C, Dah C, Sentumbwe–Mugisha O, Shabani HK, Musoke P, Dolk H, Barlow-Mosha L. The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001850. [PMID: 37379291 PMCID: PMC10306220 DOI: 10.1371/journal.pgph.0001850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/17/2023] [Indexed: 06/30/2023]
Abstract
The aim of this scoping review was to determine the scope, objectives and methodology of contemporary published research on congenital anomalies (CAs) in sub-Saharan Africa (SSA), to inform activities of the newly established sub-Saharan African Congenital Anomaly Network (sSCAN). MEDLINE was searched for CA-related articles published between January 2016 and June 2021. Articles were classified into four main areas (public health burden, surveillance, prevention, care) and their objectives and methodologies summarized. Of the 532 articles identified, 255 were included. The articles originated from 22 of the 49 SSA countries, with four countries contributing 60% of the articles: Nigeria (22.0%), Ethiopia (14.1%), Uganda (11.7%) and South Africa (11.7%). Only 5.5% of studies involved multiple countries within the region. Most articles included CA as their primary focus (85%), investigated a single CA (88%), focused on CA burden (56.9%) and care (54.1%), with less coverage of surveillance (3.5%) and prevention (13.3%). The most common study designs were case studies/case series (26.6%), followed by cross-sectional surveys (17.6%), retrospective record reviews (17.3%), and cohort studies (17.2%). Studies were mainly derived from single hospitals (60.4%), with only 9% being population-based studies. Most data were obtained from retrospective review of clinical records (56.1%) or via caregiver interviews (34.9%). Few papers included stillbirths (7.5%), prenatally diagnosed CAs (3.5%) or terminations of pregnancy for CA (2.4%).This first-of-a-kind-scoping review on CA in SSA demonstrated an increasing level of awareness and recognition among researchers in SSA of the contribution of CAs to under-5 mortality and morbidity in the region. The review also highlighted the need to address diagnosis, prevention, surveillance and care to meet Sustainable Development Goals 3.2 and 3.8. The SSA sub-region faces unique challenges, including fragmentation of efforts that we hope to surmount through sSCAN via a multidisciplinary and multi-stakeholder approach.
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Affiliation(s)
- Aminkeng Zawuo Leke
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Helen Malherbe
- Research & Epidemiology, Rare Diseases South Africa NPC, Bryanston, Sandton, South Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Phylis Kisa
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Lorenzo D. Botto
- Division of Medical Genetics, University of Utah, Salt Lake City, Utah, United States of America
- International Center on Birth Defects, University of Utah, Salt Lake City, Utah, United States of America
| | - Idowu Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Lee Fairlie
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkwati Michel Maboh
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Ieda Orioli
- Genetics Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- ReLAMC: Latin American Network for Congenital Malformation Surveillance, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rebecca Zash
- The Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Ronald Kusolo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Robert Serujogi
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bodo Bongomin
- Gulu University Faculty of Medicine: Gulu, Gulu, UG/ World Health Organization, Kampala, Uganda
| | - Caroline Osoro
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Helen Dolk
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
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Endeshaw AS, Kumie FT, Molla MT, Zeru GA, Abera KM, Zeleke ZB, Lakew TJ. Incidence and predictors of perioperative mortality in a low-resource country, Ethiopia: a prospective follow-up study. BMJ Open 2023; 13:e069768. [PMID: 37142313 PMCID: PMC10163475 DOI: 10.1136/bmjopen-2022-069768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and identify predictors of perioperative mortality among the adult age group at Tibebe Ghion Specialised Hospital. DESIGN A single-centre prospective follow-up study. SETTING A tertiary hospital in North West Ethiopia. PARTICIPANTS We enrolled 2530 participants who underwent surgery in the current study. All adults aged 18 and above were included except those with no telephone. PRIMARY OUTCOME MEASURES The primary outcome was time to death measured in days from immediate postoperative time up to the 28th day following surgery. RESULT A total of 2530 surgical cases were followed for 67 145 person-days. There were 92 deaths, with an incidence rate of 1.37 (95% CI 1.11 to 1.68) deaths per 1000 person-day observations. Regional anaesthesia was significantly associated with lower postoperative mortality (adjusted hazard ratio (AHR) 0.18, 95% CI 0.05 to 0.62). Patients aged ≥65 years (AHR 3.04, 95% CI 1.65 to 5.75), American Society of Anesthesiologist (ASA) physical status III (AHR 2.41, 95% CI 1.1.13 to 5.16) and IV (AHR 2.74, 95% CI 1.08 to 6.92), emergency surgery (AHR 1.85, 95% CI 1.02 to 3.36) and preoperative oxygen saturation <95% (AHR 3.14, 95% CI 1.85 to 5.33) were significantly associated with a higher risk of postoperative mortality. CONCLUSION The postoperative mortality rate at Tibebe Ghion Specialised Hospital was high. Age ≥65, ASA physical status III and IV, emergency surgery, and preoperative oxygen saturation <95% were significant predictors of postoperative mortality. Patients with the identified predictors should be offered targeted treatment.
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Affiliation(s)
- Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Tarekegn Kumie
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganew Terefe Molla
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gashaw Abebe Zeru
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kassaw Moges Abera
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zebenay Bitew Zeleke
- Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tigist Jegnaw Lakew
- Department of Statistics, College of Natural and Computational Science, University of Gondar, Gondar, Ethiopia
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Pérez-Soto RH, Trolle-Silva AM, Valdés GABR, Sánchez-Morales GE, Velázquez-Fernández D, la Medina ARD, Herrera MF. Timely Access to Essential Surgery, Surgical Workforce, and Surgical Volume: Global Surgery Indicators in Mexico. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-21-00745. [PMID: 36853648 PMCID: PMC9972376 DOI: 10.9745/ghsp-d-21-00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/02/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Lancet Commission on Global Surgery seeks to improve surgical care outcomes and equity for the world population through 6 indicators outlined in its 2030 Global Surgery Report. Our study aimed to estimate the percentage of the Mexican population with access to surgical care within the 2-hour distance range (indicator 1), the surgical workforce density (indicator 2), and the number of surgical procedures performed per 100,000 inhabitants (indicator 3) during the year 2020. Knowing these indicators can help to design and implement policies to increase surgical care access coverage and equity in our country. METHODS Data related to population distribution, local referral hospitals, and surgical volume were obtained from the 2020 Mexican National Census. Information relating to hospital characteristics and surgical specialists was collected from the Secretariat of Health's public records. We calculated travel time between health care facilities and municipalities using the TrueWay Matrix API and R Studio. RESULTS Taking into consideration the health care system affiliation, the proportion of the Mexican population with timely access to essential surgery was 81.7%, with 29.3 specialists per 100,000 inhabitants and 726.9 annual procedures performed per 100,000 inhabitants. We identified clusters of municipalities where a low proportion of the population has timely access to essential surgery. CONCLUSION These findings illustrate that changes in Mexican policy are required to facilitate more equitable and timely access to essential surgical care among the population.
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Affiliation(s)
- Rafael H. Pérez-Soto
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.,Correspondence to Rafael H. Pérez-Soto ()
| | - Alicia Maybi Trolle-Silva
- Department of Anatomical Pathology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Germán Esteban Sánchez-Morales
- General Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | | | - Miguel F. Herrera
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Wild H, Stewart BT, LeBoa C, Jewell T, Mehta K, Wren SM. Perioperative Risk Assessment in Humanitarian Settings: A Scoping Review. World J Surg 2023; 47:1092-1113. [PMID: 36631590 DOI: 10.1007/s00268-023-06893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND No validated perioperative risk assessment models currently exist for use in humanitarian settings. To inform the development of a perioperative mortality risk assessment model applicable to humanitarian settings, we conducted a scoping review of the literature to identify reports that described perioperative risk assessment in surgical care in humanitarian settings and LMICs. METHODS We conducted a scoping review of the literature to identify records that described perioperative risk assessment in low-resource or humanitarian settings. Searches were conducted in databases including: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, World Health Organization Catalog, and Google Scholar. RESULTS Our search identified 1582 records. After title/abstract and full text screening, 50 reports remained eligible for analysis in quantitative and qualitative synthesis. These reports presented data from over 37 countries from public, NGO, and military facilities. Data reporting was highly inconsistent: fewer than half of reports presented the indication for surgery; less than 25% of reports presented data on injury severity or prehospital data. Most elements of perioperative risk models designed for high-resource settings (e.g., vital signs, laboratory data, and medical comorbidities) were unavailable. CONCLUSION At present, no perioperative mortality risk assessment model exists for use in humanitarian settings. Limitations in consistency and quality of data reporting are a primary barrier, however, can be addressed through data-driven identification of several key variables encompassed by a minimum dataset. The development of such a score is a critical step toward improving the quality of care provided to populations affected by conflict and protracted humanitarian crises.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Barclay T Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Christopher LeBoa
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, CA, USA
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Sherry M Wren
- Stanford University School of Medicine, Stanford, CA, USA
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Changes in Surgical Volume and Outcomes During the Coronavirus Disease 2019 Pandemic at Two Tertiary Hospitals in Ethiopia: A Retrospective Cohort Study. Anesth Analg 2022; 134:1297-1307. [PMID: 35171877 DOI: 10.1213/ane.0000000000005946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data exist concerning how the coronavirus disease 2019 (COVID-19) pandemic has affected surgical care in low-resource settings. We sought to describe associations between the COVID-19 pandemic and surgical care and outcomes at 2 tertiary hospitals in Ethiopia. METHODS We conducted a retrospective observational cohort study analyzing perioperative data collected electronically from Ayder Comprehensive Specialized Hospital (ACSH) in Mekelle, Ethiopia, and Tibebe Ghion Specialized Hospital (TGSH) in Bahir Dar, Ethiopia. We categorized COVID-19 exposure as time periods: "phase 0" before the pandemic (November 1-December 31, 2019, at ACSH and August 1-September 30, 2019, at TGSH), "phase 1" starting when elective surgeries were canceled (April 1-August 3, 2020, at ACSH and March 28-April 12, 2020, at TGSH), and "phase 2" starting when elective surgeries resumed (August 4-August 31, 2020, at ACSH and April 13-August 31, 2020, at TGSH). Outcomes included 28-day perioperative mortality, case volume, and patient district of origin. Incidence rates of case volume and patient district of origin (outside district yes or no) were modeled with segmented Poisson regression and logistic regression, respectively. Association of the exposure with 28-day mortality was assessed using logistic regression models, adjusting for confounders. RESULTS Data from 3231 surgeries were captured. There was a decrease in case volume compared to phase 0, with adjusted incidence rate ratio (IRR) of 0.73 (95% confidence interval [CI], 0.66-0.81) in phase 1 and 0.90 (95% CI, 0.83-0.97) in phase 2. Compared to phase 0, there were more patients from an outside district during phase 1 lockdown at ACSH (adjusted odds ratio [aOR], 1.63 [95% CI, 1.24-2.15]) and fewer patients from outside districts at TGSH (aOR, 0.44 [95% CI, 0.21-0.87]). The observed 28-day mortality rates for phases 0, 1, and 2 were 1.8% (95% CI, 1.1-2.8), 3.7% (95% CI, 2.3-5.8), and 2.9% (95% CI, 2.1-3.9), respectively. A confounder-adjusted logistic regression model did not show a significant increase in 28-day perioperative mortality during phases 1 and 2 compared to phase 0, with aOR 1.36 (95% CI, 0.62-2.98) and 1.54 (95% CI, 0.80-2.95), respectively. CONCLUSIONS Analysis at 2 low-resource referral hospitals in Ethiopia during the COVID-19 pandemic showed a reduction in surgical case volume during and after lockdown. At ACSH, more patients were from outside districts during lockdown where the opposite was true at TGSH. These findings suggest that during the pandemic patients may experience delays in seeking or obtaining surgical care. However, for patients who underwent surgery, prepandemic and postpandemic perioperative mortalities did not show significant difference. These results may inform surgical plans during future public health crises.
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Twahirwa I, Niyonshuti N, Uwase C, Rickard J. Comparison of Outcomes of Emergency Laparotomies Performed During Daytime Versus Nights and Weekends in Rwandan University Teaching Hospitals. World J Surg 2021; 46:61-68. [PMID: 34581844 DOI: 10.1007/s00268-021-06327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting. METHODS A retrospective study was conducted in 2 university teaching hospitals in Rwanda. Patient characteristics, time of laparotomy, operative details and postoperative outcomes were recorded. Chi-square and Wilcoxon rank sum tests were used to determine factors and outcomes associated with time of surgery. Logistic regression was used to determine factors associated with mortality. RESULTS In 309 patients, who underwent emergency laparotomy, 147 (48%) patients were operated during the daytime, 123 (40%) patients were operated during the night shift and 39 (12%) patients were operated on the weekend. Common diagnoses were intestinal obstruction (n = 141, 46%), peritonitis (n = 101, 33%) and abdominal trauma (n = 40, 13%). The overall mortality rate was 16% with 14% in patients operated during day and 17% in patients operated during night and weekends (p = 0.564). Overall, the morbidity rate was 30% with 27% in patients operated during the day compared with 32% in patients operated during night/weekends (p = 0.348). After controlling for confounding factors, there was no association between time of operation and mortality or morbidity. CONCLUSION Morbidity and mortality associated with emergency laparotomy are high but the time of day for emergency laparotomy did not affect outcome in Rwandan referral hospitals.
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Affiliation(s)
- Isaie Twahirwa
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Norbert Niyonshuti
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Clement Uwase
- University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University of Rwanda, Kigali, Rwanda.
- University Teaching Hospital of Kigali, Kigali, Rwanda.
- University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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Odinkemelu DS, Sonah AK, Nsereko ET, Dahn BT, Martin MH, Moon TD, Niconchuk JA, Walters CB, Kynes JM. An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola. Anesth Analg 2021; 132:1727-1737. [PMID: 33844659 DOI: 10.1213/ane.0000000000005456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014-2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country's maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). METHODS Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible. RESULTS Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1-3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided. CONCLUSIONS Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.
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Affiliation(s)
- Didi S Odinkemelu
- From the Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aaron K Sonah
- Phebe Nurse Anesthesia Program, Phebe Paramedical Training Program and School of Nursing, Suakoko, Liberia
| | - Etienne T Nsereko
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bernice T Dahn
- College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Marie H Martin
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Troy D Moon
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jonathan A Niconchuk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Camila B Walters
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J Matthew Kynes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Perioperative pediatric mortality in Ethiopia: A prospective cohort study. Ann Med Surg (Lond) 2021; 67:102396. [PMID: 34168866 PMCID: PMC8209180 DOI: 10.1016/j.amsu.2021.102396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background There was recording of excellent outcomes for pediatric surgery in developed countries of the world when it was carried out by an experienced pediatric surgeon and anesthetists with availabilities of equipment. However, this circumstance was not the ordinary for developing countries. The main objective of our study was to launch a pediatric perioperative mortality rate reference point and determination of associated factors under general or regional anesthesia in Ethiopia. Materials and methods the prospective electronic based data collection was done at Tibebe Ghion Specialized Teaching Hospital, Ethiopia with case specific of perioperative data for age less than 18 years old. We computed patients with mortality at 24 h, 48 h and 7 days in the form of percentages. Logistic regression was used for evaluation of mortality at different predictor variables. Results from 849 cases analyzed, there were mortality rate of 0.59%, 1.42%, and 2.58% within 24 h, 48 h and 7 days of surgery, respectively. The emergency surgeries (OR = 2.80 [95% CI, 1.78-3.82]; p < 0.03) were associated with an increased risk of mortality within 7 days of post-surgery. Conclusion Despite the progresses reached in the pediatric anesthesia and surgical safety in Tibebe Ghion Specialized Teaching Hospital, the pediatric perioperative mortality rates were still high or comparable to other low income African countries. Emergency surgeries were associated with an increased risk of perioperative mortality within 7 days of surgical intervention.Tibebe Ghion Specialized Teaching Hospital should emphasis on evaluation and monitoring of outcome for reduction of mortality with the emergency surgeries younger than 18 years old. We also suggested doing this research work at larger sample sizes for more actual information.
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Watters DA, Wilson L. The Comparability and Utility of Perioperative Mortality Rates in Global Health. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00432-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Blaise Pascal FN, Malisawa A, Barratt-Due A, Namboya F, Pollach G. General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo. BMC Anesthesiol 2021; 21:60. [PMID: 33622245 PMCID: PMC7901086 DOI: 10.1186/s12871-021-01280-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Background General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo in the Democratic Republic of the Congo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods This was a retrospective descriptive and analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients files, anaesthesia registries and were analysed with SPSS 26. Results From a total of 921 patients, 539 (58.5%) were male and 382 (41.5%) female patients. A total of 83 (9.0%) patients died representing an overall perioperative mortality rate of 90 per 1000. Out of the 83 deaths, 38 occurred within 24 h representing GA related mortality of 41 per 1000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were: being a neonate or a senior adult, emergency operation, ASA physical status > 2 and a single deranged vital sign preoperatively, presenting any complication during GA, anaesthesia duration > 120 minutes as well as visceral surgeries/laparotomies. Ketamine was the most employed anaesthetic. Conclusion GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, improved infrastructure, better equipment and drugs procurement and considering regional anaesthesia whenever possible.
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Affiliation(s)
- Furaha Nzanzu Blaise Pascal
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi. .,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Agnes Malisawa
- Matanda Hospital of Butembo, Butembo, Democratic Republic of the Congo
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Felix Namboya
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gregor Pollach
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
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Shahbaz S, Zakar R, Fischer F. Anesthesia Health System Capacities in Public Hospitals of Punjab, Pakistan. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211059740. [PMID: 34894837 PMCID: PMC8671656 DOI: 10.1177/00469580211059740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: This study intends to outline the capacity of anesthesia health system in public hospitals of Punjab, Pakistan. Methods: A cross-sectional survey among public hospitals of Punjab was carried out that provide emergency and elective surgical care. We measured capacity in terms of infrastructure; surgical, anesthetic, and obstetric (SAO) workforce; surgical interventions; information management; equipment; and medication which was accomplished between October 2020 and February 2021. Results: Out of 106 public hospitals in Punjab, almost 40% had only one anesthesia provider. Only 50% of the hospitals reported round the clock availability of anesthesia providers for surgical cases. While caesarean sections were carried out in more than 90% of health facilities, general surgery, pediatric surgery, and open fracture surgery were conducted only in 50% of the hospitals. Although local and general anesthetic agents were available in the majority of hospitals, essential medicines for safe anesthesia were not available in all hospitals. Conclusion: This first comprehensive assessment of anesthesia health system capacity exposed a crucial deficiency of critical supplies and workforce for providing safe anesthesia and, hence, safe surgery. The surveyed facilities had an uneven division of resources.
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Affiliation(s)
- Sumbal Shahbaz
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Rubeena Zakar
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Fischer
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
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Abahuje E, Niyongombwa I, Karenzi D, Bisimwa JDA, Tuyishime E, Ntirenganya F, Rickard J. Malnutrition in Acute Care Surgery Patients in Rwanda. World J Surg 2020; 44:1361-1367. [PMID: 31897691 DOI: 10.1007/s00268-019-05355-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Malnutrition is prevalent in hospitalized surgical patients and has been shown to significantly alter outcomes including length of hospital stay, complications, and mortality. Different tools for nutrition assessment were developed and are being used. The aim of this study was to characterize the nutritional status of acute care surgery patients, determine risk factors for malnutrition, and describe outcomes in patients with malnutrition. METHODS This was a prospective, descriptive study of malnutrition in acute care surgery patients at CHUK. Over a 6-month time period, we collected data on demographics, diagnosis, operation, and patient outcomes. We assessed the incidence of malnutrition using the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines and Subjective Global Assessment (SGA). We reported frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. RESULTS We analyzed data for 279 acute care surgery patients. Most (n = 209, 73%) patients were male. The median duration of symptoms was 5 days (IQR 2, 14). The most common diagnoses were trauma (n = 83, 30%), intestinal obstruction (n = 76, 27%), and peritonitis (n = 49, 18%). Most (n = 210, 73%) patients underwent operation. The median length of hospital stay was 6 days (IQR 4, 11). Using ASPEN guidelines, 99 (35%) patients had evidence of malnutrition on hospital admission and 76 (27%) had evidence of malnutrition using SGA. After 1 week of hospital stay, 48 (41%) patients had evidence of malnutrition. Overall mortality was 3%, with higher mortality seen in patients with malnutrition (8% vs. 0.6%, p = 0.001). The length of hospital stay was longer in patients with malnutrition on hospital admission (6 days vs. 5 days, p = 0.044). CONCLUSIONS Acute care surgical patients present to the hospital at high-risk for malnutrition. Efforts are needed to ensure that surgical patients receive adequate nutrition support to improve patient outcomes and minimize complications.
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Affiliation(s)
- Egide Abahuje
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
- Kigali University Teaching Hospital, Kigali, Rwanda.
| | - Irenee Niyongombwa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - David Karenzi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Eugene Tuyishime
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Faustin Ntirenganya
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
- Kigali University Teaching Hospital, Kigali, Rwanda
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Postoperative Complications and Risk of Mortality after Laparotomy in a Resource-Limited Setting. J Surg Res 2020; 260:428-435. [PMID: 33272596 DOI: 10.1016/j.jss.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite increases in surgical capacity in Malawi, minimal data exist on postoperative complications. Identifying surgical management gaps and targeting quality improvement requires detailed, longitudinal complications, and outcome data that assess surgical safety and efficacy. METHODS We conducted a 6-mo prospective, observational study of patients >12 y after laparotomy at a tertiary hospital in Lilongwe, Malawi. Outcomes included postoperative complications and mortality. The seniormost rounding physician determined complication diagnoses. Bivariate and Poisson regression analyses identified predictors of mortality. RESULTS Only patients undergoing emergent laparotomy (77.8%) died before discharge, so analysis excluded elective cases. Of 189 patients included, the median age was 33.5 y (IQR 22-50.5), 22 (12.2%) had prior abdominal surgery, and 11 (12.1%) were human immunodeficiency virus-positive. Gastrointestinal perforation was the most common diagnosis (35.5%). The most common procedures were primary gastrointestinal repair (24.9%), diverting ostomy (21.2%), and bowel resection with anastomosis (16.4%). Overall postoperative mortality was 14.8%. Intra-abdominal complication occurred in 17 (9.0%) patients, of whom 8 (47.1%) died. Older age (RR 1.05, 95% CI 1.02-1.08, P < 0.001) and intra-abdominal complication (RR 2.88, 95% CI 1.28-6.46, P = 0.01) increased the relative risk of mortality. Preoperative diagnosis, surgical intervention type, and symptom-to-surgery time did not increase the relative risk of mortality. CONCLUSIONS The incidence of complications and mortality after laparotomy at a large referral hospital in Malawi is high. Older age and intra-abdominal complications increase the risk of death. Strategies to improve operative mortality in Malawi should prioritize postoperative surveillance and management and continued outcomes reporting.
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Rickard J, Pohl L, Abahuje E, Kariem N, Englbrecht S, Kloppers C, Malatji S, Sibomana I, Robbins AJ, Chu K. Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA. World J Surg 2020; 45:668-677. [PMID: 33225391 DOI: 10.1007/s00268-020-05862-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non-trauma EL. METHODS This was a prospective study of patients undergoing non-trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR. RESULTS Over one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value < 0.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, p value < 0.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, p value < 0.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, p value < 0.001), high ASA score (score ≥ 3) (aOR: 3.95, 95% CI: 3.03, 5.15, p value < 0.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, p value < 0.001), age > 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009). CONCLUSIONS Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.
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Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
| | - Linda Pohl
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Egide Abahuje
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.,Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Nazmie Kariem
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Surita Englbrecht
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Christo Kloppers
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Sekoaere Malatji
- Department of Surgery, New Somerset Hospital, Cape Town, South Africa
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Alexandria J Robbins
- Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa.,Department of Surgery, New Somerset Hospital, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Dworkin M, Cyuzuzo T, Hategekimana JDD, Katabogama J, Ntirenganya F, Rickard J. Barriers to Surgical Care at a Tertiary Hospital in Kigali, Rwanda. J Surg Res 2020; 250:148-155. [DOI: 10.1016/j.jss.2019.12.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/02/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
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Adamou H, Amadou Magagi I, Adakal O, Doutchi M, Habou O, Boukari M, James Didier L, Sani R. Perioperative management of gastrointestinal surgery in a resource-limited hospital in Niger: Cross-sectional study. Ann Med Surg (Lond) 2020; 54:10-15. [PMID: 32322389 PMCID: PMC7163210 DOI: 10.1016/j.amsu.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Perioperative management in digestive surgery is a challenge in sub-Saharan Africa. Objective: To describe the process and outcomes of perioperative management in gastrointestinal surgery. Materials and methods This was a single center cross-sectional study over a 4-month period from June 1 to September 30, 2017, in a Nigerien hospital (West Africa). This study included caregivers and patients operated on gastrointestinal surgery. Results We collected data for 56 caregivers and 253 patients underwent gastrointestinal surgery. The average age of caregivers was 38.6 ± 8.7. The median length of professional practice was 9 years. Almost 52% of caregivers (n = 29) did not know the standards of perioperative care. The median age of patients was 24 years, and male gender constituted 70% of cases (n = 177) with a sex ratio of 2.32. Patients came from rural areas in 78.2% (n = 198). Emergency surgery accounted for 60% (n = 152). The most surgical procedure was digestive ostomies performed in 28.9% (n = 73), followed by hernia repair and appendectomy in 24.5% (n = 62) and 13.9% (n = 35) respectively. The postoperative course was complicated in 28.1% (n = 71) among which 13 deaths. In the group of caregivers, the poor practice of perioperative management was associated with poor professional qualification, insufficient equipment, insufficient motivation (p < 0.05). The ASA3&ASA4 score, undernutrition, emergency surgery, poor postoperative monitoring, and poor psychological preparation were associated with complicated postoperative outcomes (p < 0.05). Conclusion The inadequacy of the technical platform and the lack of continuous training for healthcare staff represented the main dysfunctions of our hospital. The risk factors for complications found in this study need appropriate perioperative management to improve prognosis in gastrointestinal surgery. Perioperative care in gastrointestinal surgery in a challenge in Sub-Saharan countries. This setting is characterised by the difficulty of geographical access to hospital, lack of equipment. Risk factors for complications are multifactorial. This study can be a draft for improvement the quality of care in low resource settings.
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Affiliation(s)
- Harissou Adamou
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
- Corresponding author. surgeon at the Zinder National Hospital. Faculty of Health Sciences, University of Zinder, PO BOX: 656, Zinder, Niger.
| | - Ibrahim Amadou Magagi
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Ousseini Adakal
- Surgery Department, Maradi Hospital Center, Faculty of Health Sciences, University of Maradi, Niger
| | - Mahamadou Doutchi
- Infectiology Department - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Oumarou Habou
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Mamane Boukari
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Lassey James Didier
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Niamey, Niger
| | - Rachid Sani
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Niamey, Niger
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Meadows JW, Al Imran TMT, LeBrun DG, Mannan MI, Sharraf S, Gaznavee ZZ, McQueen KKA. Anesthesia Infrastructure and Resources in Bangladesh. Anesth Analg 2020; 130:233-239. [PMID: 31688078 DOI: 10.1213/ane.0000000000004493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Monitoring improvements in nationwide anesthesia capacity over time is critical to ensuring that population anesthesia needs are being met and identifying areas for targeted health systems interventions. Anesthesia resources in Bangladesh were previously measured using a cross-sectional nationwide hospital-based survey in 2012. No follow-up studies have been conducted since then. METHODS A follow-up cross-sectional study was performed in 16 public hospitals; 8 of which are public district hospitals, and 8 are medical college (tertiary) hospitals in Bangladesh. A survey tool assessing hospital anesthesia capacity, developed by Vanderbilt University Medical Center, was utilized. Nationwide data were obtained from the Ministry of Health and Family Welfare and from the Bangladesh Society of Anaesthesiologists. Institutional Review Board approvals were obtained in the United States and Bangladesh, and informed consent was waived. RESULTS Bangladesh has 952 anesthesiologists (0.58 anesthesiologists per 100,000 people), which represents a modest increase from 850 anesthesiologists in 2012. Significant improvements in electricity and clean water availability have occurred since the 2012 survey. Severe deficiencies in patient safety and monitoring equipment (eg, pulse oximetry, electrocardiography, blood pressure, anesthesia machines, and intubation materials) were noted, primarily at the district hospital level. CONCLUSIONS Despite modest improvements in certain anesthesia metrics over the past several years, the public health care system in Bangladesh still suffers from substantial deficiencies in anesthesia care.
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Affiliation(s)
- Jonathan W Meadows
- From the Department of Emergency Medicine, Merit Health Wesley, Hattiesburg, Mississippi
| | | | | | | | - Samin Sharraf
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Kelly K A McQueen
- Department of Anaesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Perioperative mortality at Tibebe Ghion Specialized Teaching Hospital, Ethiopia: A longitudinal study design. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Munyaneza M, Jayaraman S, Ntirenganya F, Rickard J. Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda. J Surg Res 2019; 246:236-242. [PMID: 31610351 DOI: 10.1016/j.jss.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/29/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
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Affiliation(s)
- Martin Munyaneza
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Butare, Butare, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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21
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Abahuje E, Sibomana I, Rwagahirima E, Urimubabo C, Munyaneza R, Rickard J. Development of an acute care surgery service in Rwanda. Trauma Surg Acute Care Open 2019; 4:e000332. [PMID: 31423464 PMCID: PMC6688707 DOI: 10.1136/tsaco-2019-000332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 11/04/2022] Open
Abstract
Background Acute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes. Methods This is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service. Results Data were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS. Conclusions An ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality. Level of evidence Prognostic and epidemiologic study type, level III.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Isaie Sibomana
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Elisee Rwagahirima
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Christian Urimubabo
- Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Robert Munyaneza
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.,Department of Surgery, University of Minnesota System, Minneapolis, Minnesota, USA
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Mpirimbanyi C, Abahuje E, Hirwa AD, Gasakure M, Rwagahirima E, Niyonzima C, Hakizimana AN, Ishimwe E, Ntirenganya F, Rickard J. Defining the Three Delays in Referral of Surgical Emergencies from District Hospitals to University Teaching Hospital of Kigali, Rwanda. World J Surg 2019; 43:1871-1879. [PMID: 30944958 DOI: 10.1007/s00268-019-04991-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Surgical conditions represent up to 30% of the global burden of diseases. The aim of this study was to assess the delays in patients transferred to a tertiary referral hospital from district hospitals (DHs) in Rwanda with emergency general surgery (EGS) conditions. METHODS We performed a prospective review of all EGS patients referred from DH over a 3-month period to assess delays in transfer and accessing care. We then surveyed general practitioners to define their perspective on delays in surgical care. RESULTS Over a 3-month period, there were 86 patients transferred from DH with EGS conditions. The most common diagnoses were bowel obstruction (n = 22, 26%) and trauma (n = 19, 22%). The most common performed operations were laparotomy (n = 21, 24%) and bowel resection (n = 20, 23%). The mortality rate was 12%, and the intensive care unit admission rate was 4%. In transfer to the referral hospital, 5% patients were delayed for financial reasons and 2% due to lack of insurance. After reaching CHUK, 5% patients were delayed due to laboratory and radiology issues. Other delays included no operating theater available (4%) and no surgeon available (1%). Providers' perceptions for not performing surgeries at DH were predominantly the lack of a competent surgical provider or anesthesia staff. CONCLUSION EGS patients represent a broad range of diagnoses. Delays were noted at each step in the referral process with multiple areas for potential improvement. Expanding surgical access at the DH has the potential to decrease delays and thereby improves patient outcomes.
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Affiliation(s)
- Christophe Mpirimbanyi
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.
| | - Egide Abahuje
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Aime Dieudone Hirwa
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Miguel Gasakure
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Elisee Rwagahirima
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Christian Niyonzima
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | | | - Epiphanie Ishimwe
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Faustin Ntirenganya
- College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.,University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- University Teaching Hospital of Kigali, Kigali, Rwanda.,University of Minnesota, Minneapolis, MN, USA
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Osinaike B, Ayandipo O, Onyeka T, Alagbe-Briggs O, Mohammed A, Oyedepo O, Nuhu A, Asudo F, Akanmu O, Nwokorie C, Mohammed A, Edubio M, Izuora K, Mohammed R, Nweze O, Efu M, Eguma S, Jasper A, Ewah R, Akhideno I, Nnaji C, Ado S, Ogboli-Nwasor E, Atiku M, Salisu I, Adinoyi Y, Agu E, Desalu I, Samuel L, Olorode Y, Fatungase O, Akinwonmi O, Faponle F, Idowu O, Isamade E, Aliyu A, Buba S, Hamza G, Onajin-Obembe B, Amanor-Boadu S. Nigerian surgical outcomes – Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator. Int J Surg 2019; 68:148-156. [DOI: 10.1016/j.ijsu.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/24/2019] [Accepted: 06/04/2019] [Indexed: 12/14/2022]
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Abstract
BACKGROUND Surgical care is essential to improving population health, but metrics to monitor and evaluate the continuum of surgical care delivery have rarely been applied in low-resource settings, and improved efforts at benchmarking progress are needed. The objective of this study was to measure the intraoperative mortality at a Central Referral Hospital in Malawi, evaluate whether there have been changes in intraoperative mortality between 2 time periods, and assess factors associated with intraoperative mortality. METHODS This was a retrospective cohort study of patients undergoing surgery at Kamuzu Central Hospital in Lilongwe, Malawi. Data describing daily consecutive operative cases were collected prospectively during 2 time periods: 2004-2006 (early cohort) and 2015-2016 (late cohort). The primary outcome was intraoperative mortality. Inverse probability of treatment weighting was used to analyze the association of intraoperative mortality with time using logistic regression models. Multivariable logistic models were performed to evaluate factors associated with intraoperative mortality. RESULTS There were 21,090 surgeries performed during the 2 time periods, with 15,846 (75%) and 5244 (25%) completed from 2004 to 2006 and 2015 to 2016, respectively. Intraoperative mortality in the early cohort was 57 deaths per 100,000 surgeries (95% confidence interval [CI], 26-108) and in the late cohort was 133 per 100,000 surgeries (95% CI, 56-286), with 76 per 100,000 surgeries (95% CI, 44-124) overall. After applying inverse probability of treatment weighting, there was no evidence of an association between time periods and intraoperative mortality (odds ratio [OR], 1.6; 95% CI, 0.9-2.8; P = .08). Factors associated with intraoperative mortality, adjusting for demographics, included American Society of Anesthesiology physical status III or IV versus I or II (OR, 4.4; 95% CI, 1.5-12.5; P = .006) and emergency versus elective surgery (OR, 7.7; 95% CI, 2.5-23.6; P < .001). CONCLUSIONS Intraoperative mortality in the study hospital in Malawi is high and has not improved over time. These data demonstrate an urgent need to improve the safety and quality of perioperative care in developing countries and integrate perioperative care into global health efforts.
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Affiliation(s)
- Meghan Prin
- From the Department of Anesthesiology and Critical Care, Columbia University College of Physicians and Surgeons, New York, New York
| | - Stephanie Pan
- Department of Biostatistics, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Janey Phelps
- Department of Anesthesiology and Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Godfrey Phiri
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Cancedda C, Cotton P, Shema J, Rulisa S, Riviello R, Adams LV, Farmer PE, Kagwiza JN, Kyamanywa P, Mukamana D, Mumena C, Tumusiime DK, Mukashyaka L, Ndenga E, Twagirumugabe T, Mukara KB, Dusabejambo V, Walker TD, Nkusi E, Bazzett-Matabele L, Butera A, Rugwizangoga B, Kabayiza JC, Kanyandekwe S, Kalisa L, Ntirenganya F, Dixson J, Rogo T, McCall N, Corden M, Wong R, Mukeshimana M, Gatarayiha A, Ntagungira EK, Yaman A, Musabeyezu J, Sliney A, Nuthulaganti T, Kernan M, Okwi P, Rhatigan J, Barrow J, Wilson K, Levine AC, Reece R, Koster M, Moresky RT, O’Flaherty JE, Palumbo PE, Ginwalla R, Binanay CA, Thielman N, Relf M, Wright R, Hill M, Chyun D, Klar RT, McCreary LL, Hughes TL, Moen M, Meeks V, Barrows B, Durieux ME, McClain CD, Bunts A, Calland FJ, Hedt-Gauthier B, Milner D, Raviola G, Smith SE, Tuteja M, Magriples U, Rastegar A, Arnold L, Magaziner I, Binagwaho A. Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda. Int J Health Policy Manag 2018; 7:1024-1039. [PMID: 30624876 PMCID: PMC6326644 DOI: 10.15171/ijhpm.2018.61] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/19/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
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Affiliation(s)
- Corrado Cancedda
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phil Cotton
- Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda
| | - Joseph Shema
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Stephen Rulisa
- Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa V. Adams
- Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeanne N. Kagwiza
- Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Chrispinus Mumena
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David K. Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lydie Mukashyaka
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Esperance Ndenga
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Theogene Twagirumugabe
- Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kaitesi B. Mukara
- Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Timothy D. Walker
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Emmy Nkusi
- Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa Bazzett-Matabele
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alex Butera
- Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Kabayiza
- Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Simon Kanyandekwe
- Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Louise Kalisa
- Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Tanya Rogo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Pediatrics, BronxCare Health System, Bronx, NY, USA
| | - Natalie McCall
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Mark Corden
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rex Wong
- Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA
| | - Madeleine Mukeshimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Agnes Gatarayiha
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Egide Kayonga Ntagungira
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Attila Yaman
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | - Peter Okwi
- Clinton Health Access Initiative, Kigali, Rwanda
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jane Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Kim Wilson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca Reece
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Koster
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel T. Moresky
- sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Jennifer E. O’Flaherty
- Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Paul E. Palumbo
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Rashna Ginwalla
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Michael Relf
- Duke Global Health Institute, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Rodney Wright
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, New York City, NY, USA
- Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, New York City, NY, USA
| | - Mary Hill
- Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA
| | - Deborah Chyun
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - Robin T. Klar
- New York University Rory Meyers College of Nursing, New York City, NY, USA
| | - Linda L. McCreary
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, New York City, NY, USA
| | - Marik Moen
- Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Beth Barrows
- Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marcel E. Durieux
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Craig D. McClain
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Amy Bunts
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Forrest J. Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Danny Milner
- Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Stacy E. Smith
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Meenu Tuteja
- Global Health and Research Programs, Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA, USA
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Asghar Rastegar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Linda Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
- Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda
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Rickard JL, Ngarambe C, Ndayizeye L, Smart B, Majyambere JP, Riviello R. Risk of Catastrophic Health Expenditure in Rwandan Surgical Patients with Peritonitis. World J Surg 2018; 42:1603-1609. [PMID: 29143091 DOI: 10.1007/s00268-017-4368-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical procedures are cost-effective compared with various medical and public health interventions. While peritonitis often requires surgery, little is known regarding the associated costs, particularly in low- and middle-income countries. The aim of this study was to determine in-hospital charges for patients with peritonitis and if patients are at risk of catastrophic health expenditure. METHODS As part of a larger study examining the epidemiology and outcomes of patients with peritonitis at a referral hospital in Rwanda, patients undergoing operation for peritonitis were enrolled and hospital charges were examined. The primary outcome was the percentage of patients at risk for catastrophic health expenditure. Logistic regression was used to determine the association of various factors with risk for catastrophic health expenditure. RESULTS Over a 6-month period, 280 patients underwent operation for peritonitis. In-hospital charges were available for 245 patients. A total of 240 (98%) patients had health insurance. Median total hospital charges were 308.1 USD, and the median amount paid by patients was 26.9 USD. Thirty-three (14%) patients were at risk of catastrophic health expenditure based on direct medical expenses. Estimating out-of-pocket non-medical expenses, 68 (28%) patients were at risk of catastrophic health expenditure. Unplanned reoperation was associated with increased risk of catastrophic health expenditure (p < 0.001), whereas patients with community-based health insurance had decreased risk of catastrophic health expenditure (p < 0.001). CONCLUSIONS The median hospital charges paid out-of-pocket by patients with health insurance were small in relation to total charges. A significant number of patients with peritonitis are at risk of catastrophic health expenditure.
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Affiliation(s)
- J L Rickard
- University Teaching Hospital of Kigali, Kigali, Rwanda.
- Department of Surgery, University of Minnesota, 516 Delaware St SE, 11-145E, Minneapolis, MN, 55455, USA.
| | - C Ngarambe
- University Teaching Hospital of Butare, Butare, Rwanda
| | - L Ndayizeye
- University Teaching Hospital of Butare, Butare, Rwanda
| | - B Smart
- University of Southern California, San Diego, CA, USA
| | | | - R Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Hewitt-Smith A, Bulamba F, Olupot C, Musana F, Ochieng JP, Lipnick MS, Pearse RM. Surgical outcomes in eastern Uganda: a one-year cohort study. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2018. [DOI: 10.1080/22201181.2018.1517476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- A Hewitt-Smith
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - F Bulamba
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - C Olupot
- Mbale Regional Referral Hospital, Mbale, Uganda
| | - F Musana
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - JP Ochieng
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - MS Lipnick
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - RM Pearse
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Juran S, Broer PN, Klug SJ, Snow RC, Okiro EA, Ouma PO, Snow RW, Tatem AJ, Meara JG, Alegana VA. Geospatial mapping of access to timely essential surgery in sub-Saharan Africa. BMJ Glob Health 2018; 3:e000875. [PMID: 30147944 PMCID: PMC6104751 DOI: 10.1136/bmjgh-2018-000875] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level. METHODS Major district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level. RESULTS Overall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern. CONCLUSION The study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.
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Affiliation(s)
- Sabrina Juran
- United Nations Population Fund, Technical Division, Population and Development Branch, New York City, New York, USA
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - P Niclas Broer
- Klinikum Bogenhausen, Städtisches Klinikum München, Technische Universität München, München, Germany
| | - Stefanie J Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Rachel C Snow
- United Nations Population Fund, Technical Division, Population and Development Branch, New York City, New York, USA
| | - Emelda A Okiro
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul O Ouma
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Andrew J Tatem
- WorldPop, Geography and Environment, University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor A Alegana
- WorldPop, Geography and Environment, University of Southampton, Southampton, UK
- Flowminder Foundation, Stockholm, Sweden
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Biccard BM, Madiba TE, Kluyts HL, Munlemvo DM, Madzimbamuto FD, Basenero A, Gordon CS, Youssouf C, Rakotoarison SR, Gobin V, Samateh AL, Sani CM, Omigbodun AO, Amanor-Boadu SD, Tumukunde JT, Esterhuizen TM, Manach YL, Forget P, Elkhogia AM, Mehyaoui RM, Zoumeno E, Ndayisaba G, Ndasi H, Ndonga AKN, Ngumi ZWW, Patel UP, Ashebir DZ, Antwi-Kusi AAK, Mbwele B, Sama HD, Elfiky M, Fawzy MA, Pearse RM. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet 2018; 391:1589-1598. [PMID: 29306587 DOI: 10.1016/s0140-6736(18)30001-1] [Citation(s) in RCA: 332] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. METHODS We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). FINDINGS We recruited 11 422 patients (median 29 [IQR 10-70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000-2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2-1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65-578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1-2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4-18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. INTERPRETATION Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. FUNDING Medical Research Council of South Africa.
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Affiliation(s)
- Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Dolly M Munlemvo
- Anaesthesiology, University Hospital of Kinshasha, Democratic Republic of the Congo
| | - Farai D Madzimbamuto
- Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare, Zimbabwe
| | - Apollo Basenero
- Ministry of Health and Social Services Namibia, Windhoek, Namibia
| | | | | | | | - Veekash Gobin
- Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius
| | - Ahmadou L Samateh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Chaibou M Sani
- Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Republic of Niger
| | - Akinyinka O Omigbodun
- Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Tonya M Esterhuizen
- Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada
| | - Patrice Forget
- Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels, Belgium
| | | | - Ryad M Mehyaoui
- Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algeria
| | - Eugene Zoumeno
- Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin
| | - Gabriel Ndayisaba
- Kamenge Teaching Hospital, Department of Surgery, Bujumbura, Burundi
| | - Henry Ndasi
- Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon
| | | | - Zipporah W W Ngumi
- Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya
| | - Ushmah P Patel
- Anaesthesiology, University Teaching Hospital, Lusaka, Zambia
| | | | - Akwasi A K Antwi-Kusi
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernard Mbwele
- HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza, Tanzania
| | - Hamza Doles Sama
- Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO, Togo
| | | | - Maher A Fawzy
- Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rupert M Pearse
- Intensive Care Medicine, Queen Mary University of London, London, UK
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Rickard J, Ngarambe C, Ndayizeye L, Smart B, Riviello R, Majyambere JP, Ghebre RG. Antibiotic Use and Antimicrobial Resistance of Surgical Patients with Peritonitis at a Tertiary Referral Hospital in Rwanda. Surg Infect (Larchmt) 2018; 19:382-387. [PMID: 29621001 DOI: 10.1089/sur.2017.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is growing recognition of the worsening problem of antibiotic resistance and the need for antibiotic stewardship in low-resource settings. The aim of this study was to describe antibiotic use and antimicrobial resistance in patients undergoing surgery for peritonitis at a Rwandan referral hospital. PATIENTS AND METHODS All surgical patients with peritonitis at a Rwandan referral hospital were enrolled. Prospective data were collected on epidemiology, clinical features, interventions, and outcomes. Antibiotic agents were prescribed and cultures were collected according to surgeon discretion. High risk for antibiotic treatment failure or death was defined as patients with severe sepsis, older than 70 years of age, tumor, or operating room delay more than 24 hours from hospital admission. Logistic regression was used to determine factors associated with high risk of antibiotic treatment failure or death. RESULTS Over a six-month period, 280 patients underwent operation for peritonitis; 79 patients were excluded because no infectious etiology was identified at operation. Data on antibiotic usage were available for 165 patients. The most common diagnoses were intestinal obstruction (n = 43) and appendicitis (n = 36). Most patients received antibiotic agents, the most of of which being third-generation cephalosporins (n = 149; 90%) and metronidazole (n = 140; 85%). The mean duration of antibiotics was 5.1 days (range: 0-14). Overall, 80 (54%) patients were high-risk for antibiotic treatment failure or death. Risk for antibiotic treatment failure or death was associated with localized peritonitis (p = 0.001) and high American Society of Anesthesiologist score (p = 0.003). Cultures were collected from 33 patients and seven patients had an organism isolated. Escherichia coli was identified in in five surgical specimens and two 2 urine cultures. All Escherichia coli specimens showed resistance to cephalosporins. CONCLUSIONS Broad antibiotic coverage with third-generation cephalosporins and metronidazole is common in Rwandan surgical patients with peritonitis. Areas for improvement should focus on choice and duration of antibiotic agents, tailored to underlying diagnosis and risk factors for antibiotic treatment failure or death. More data are needed on antibiotic resistance patterns to guide antimicrobial therapy.
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Affiliation(s)
- Jennifer Rickard
- 1 University Teaching Hospital of Kigali , Kigali, Rwanda .,2 Department of Surgery, University of Minnesota , Minneapolis, Minnesota.,3 Human Resources for Health , Rwanda
| | - Christian Ngarambe
- 4 Department of Surgery, University Teaching Hospital of Butare , Department of Surgery, Mamba, Butare, Rwanda
| | - Leonard Ndayizeye
- 4 Department of Surgery, University Teaching Hospital of Butare , Department of Surgery, Mamba, Butare, Rwanda
| | - Blair Smart
- 5 Department of Surgery, University of Southern California , Los Angeles, California
| | - Robert Riviello
- 3 Human Resources for Health , Rwanda .,6 Center for Surgery and Public Health, Brigham and Women's Hospital , Boston, Massachusetts
| | | | - Rahel G Ghebre
- 3 Human Resources for Health , Rwanda .,8 Department of Obstetrics Gynecology and Women's Health, University of Minnesota , Minneapolis, Minnesota.,9 School of Medicine, Yale University , New Haven, Connecticut
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Marks IH, Fong ZV, Stapleton SM, Hung YC, Bababekov YJ, Chang DC. How Much Data are Good Enough? Using Simulation to Determine the Reliability of Estimating POMR for Resource-Constrained Settings. World J Surg 2018; 42:2344-2347. [DOI: 10.1007/s00268-018-4529-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ngarambe C, Smart BJ, Nagarajan N, Rickard J. Validation of the Surgical Apgar Score After Laparotomy at a Tertiary Referral Hospital in Rwanda. World J Surg 2018; 41:1734-1742. [PMID: 28255629 DOI: 10.1007/s00268-017-3951-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The surgical Apgar score (SAS) has demonstrated utility in predicting postoperative outcomes in a variety of surgical disciplines. However, there has not been a study validating the utility of the SAS in surgical patients in low-income countries. We conducted a prospective, observational study of patients undergoing laparotomy at a tertiary referral hospital in Rwanda and determined the ability of SAS to predict inpatient major complications and mortality. METHODS All adult patients undergoing laparotomy in a tertiary referral hospital in Rwanda from October 2014 to January 2015 were included. Data were collected on patient and operative characteristics. SAS was calculated and patients were divided into four SAS categories. Primary outcomes were in-hospital mortality and major complications. Rates and odds of in-hospital mortality and major complications were examined across the four SAS categories. Logistic regression modeling and calculation of c-statistics was used to determine the discriminative ability of SAS. RESULTS 218 patients underwent laparotomy during the study period. One hundred and forty-three (65.6%) were male, and the median age was 34 years (IQR 27-51 years). The most common diagnosis was intestinal obstruction (97 [44.5%]). A high proportion of patients (170 [78%]) underwent emergency surgery. Thirty-nine (18.3%) patients died, and 61 (28.6%) patients had a major complication. In-hospital mortality occurred in 25 (50%) patients in the high-risk group, 12 (16%) in the moderate-risk group, 2 (3%) in the mild-risk group and there were no deaths in the low-risk group. Major complications occurred in 32 (64%) patients in the high-risk group, 22 (29%) in the moderate-risk group, 7 (11%) in the mild-risk group and there were no complications in the low-risk group. SAS was a good predictor of postoperative mortality (c-statistic 0.79) and major complications (c-statistic 0.75). CONCLUSIONS SAS can be used to predict in-hospital mortality and major complications after laparotomy in a Rwandan tertiary referral hospital.
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Affiliation(s)
- Christian Ngarambe
- Department of Surgery, University Teaching Hospital of Butare, Butare, Rwanda
| | - Blair J Smart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neeraja Nagarajan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 516 Delaware St SE, 11-145E, Minneapolis, MN, 55455, USA.
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Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool. Anesthesiology 2017; 127:250-271. [PMID: 28657959 DOI: 10.1097/aln.0000000000001713] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Perioperative mortality rate is regarded as a credible quality and safety indicator of perioperative care, but its documentation in low- and middle-income countries is poor. We developed and tested an electronic, provider report-driven method in an East African country. METHODS We deployed a data collection tool in a Kenyan tertiary referral hospital that collects case-specific perioperative data, with asynchronous automatic transmission to central servers. Cases not captured by the tool (nonobserved) were collected manually for the last two quarters of the data collection period. We created logistic regression models to analyze the impact of procedure type on mortality. RESULTS Between January 2014 and September 2015, 8,419 cases out of 11,875 were captured. Quarterly data capture rates ranged from 423 (26%) to 1,663 (93%) in the last quarter. There were 93 deaths (1.53%) reported at 7 days. Compared with four deaths (0.53%) in cesarean delivery, general surgery (n = 42 [3.65%]; odds ratio = 15.80 [95% CI, 5.20 to 48.10]; P < 0.001), neurosurgery (n = 19 [2.41%]; odds ratio = 14.08 [95% CI, 4.12 to 48.10]; P < 0.001), and emergency surgery (n = 25 [3.63%]; odds ratio = 4.40 [95% CI, 2.46 to 7.86]; P < 0.001) carried higher risks of mortality. The nonobserved group did not differ from electronically captured cases in 7-day mortality (n = 1 [0.23%] vs. n = 16 [0.58%]; odds ratio =3.95 [95% CI, 0.41 to 38.20]; P = 0.24). CONCLUSIONS We created a simple solution for high-volume, prospective electronic collection of perioperative data in a lower- to middle-income setting. We successfully used the tool to collect a large repository of cases from a single center in Kenya and observed mortality rate differences between surgery types.
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Abahuje E, Nzeyimana I, Rickard JL. Introducing a Morbidity and Mortality Conference in Rwanda. JOURNAL OF SURGICAL EDUCATION 2017; 74:621-629. [PMID: 28188004 DOI: 10.1016/j.jsurg.2017.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/15/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess the structure, format, and educational features of a morbidity and mortality (M&M) conference in Rwanda. To determine factors associated with adverse events and to define opportunities for improvement. DESIGN Retrospective, descriptive study of all cases presented at a surgical M&M conference over a 1-year period. Cases were reviewed for factors associated with adverse events and opportunities for improvement. Factors were characterized as delays in presentation, delays in diagnosis, delays in the operating room, errors in judgment, technical errors, advanced disease, and missing resources or malnutrition. Opportunities for improvement were categorized at the physician or hospital level. SETTING University Teaching Hospital of Kigali, a tertiary referral hospital in Rwanda. PARTICIPANTS Cases presented at the surgical M&M conference over a 1-year period. RESULTS Over a 1-year period, there were a total of 2231 operations with 131 in-hospital mortalities. There were 62 patients discussed at M&M conference. Of those discussed, there were 34 (55%) in-hospital deaths and 32 (52%) unplanned reoperations. Common diagnostic categories included 30 (48%) gastrointestinal, 15 (24%) trauma, and 10 (16%) neoplasm. Delays were commonly cited factors affecting outcomes. There were 22 (35%) delays in presentation, 23 (37%) delays in diagnosis or management, and 20 (32%) delays to the operating room. Errors in judgment occurred in 15 (24%) cases and technical errors occurred in 18 (29%) cases. Twenty-three (37%) patients had a critical resource missing and 17 (27%) patients had advanced disease. Malnutrition was associated with 11 (18%) adverse events. Participants identified opportunities for improvement in 48 (77%) cases. CONCLUSION M&M conference can be used in a low-resource setting as an educational tool to address core competencies of practice-based learning and improvement and systems-based practice. It can define factors associated with surgical adverse events and opportunities for improvement at the physician and hospital levels.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Innocent Nzeyimana
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jennifer L Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Cancedda C, Riviello R, Wilson K, Scott KW, Tuteja M, Barrow JR, Hedt-Gauthier B, Bukhman G, Scott J, Milner D, Raviola G, Weissman B, Smith S, Nuthulaganti T, McClain CD, Bierer BE, Farmer PE, Becker AE, Binagwaho A, Rhatigan J, Golan DE. Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:649-658. [PMID: 28328735 DOI: 10.1097/acm.0000000000001638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.
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Affiliation(s)
- Corrado Cancedda
- C. Cancedda is associate physician, Division of Global Health Equity, Brigham and Women's Hospital, and instructor in medicine and in global health and social medicine, Harvard Medical School, Boston, Massachusetts. R. Riviello is director of global surgery programs, Center for Surgery and Public Health, associate surgeon, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, and assistant professor of surgery and of global health and social medicine, Harvard Medical School, Boston, Massachusetts. K. Wilson is associate director, Global Pediatrics Program, and codirector, Global Pediatric Fellowship, Boston Children's Hospital, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts. K.W. Scott is a medical student, Harvard Medical School, and research assistant, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. M. Tuteja is director for global health and research programs, Brigham and Women's Hospital, Boston, Massachusetts. J.R. Barrow is assistant dean of global and community health, executive director of the initiative to integrate oral health and medicine, and lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts. B. Hedt-Gauthier is assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is director of the program in global noncommunicable diseases (NCDs) and social change, Harvard Medical School, cardiologist, Cardiovascular Division and the Division of Global Health Equity, Brigham and Women's Hospital, senior health and policy advisor on NCDs, Partners In Health, and assistant professor of medicine and assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is also co-chair, Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion. J. Scott is faculty, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, associate scientist, Division of Women's Health, Brigham and Women's Hospital, and instructor, Harvard Medical School, Boston, Massachusetts. D. Milner is associate medical director of microbiology, Brigham and Women's Hospital, and associate professor, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. G. Raviola is assistant professor of psychiatry and assistant professor of global health and social medicine, Harvard Medical School, and director of the psychiatry quality programs, Boston Children's Hospital, Boston, Massachusetts. B. Weissman is vice chair emeritus of radiology, Brigham and Women's Hospital, and professor in radiology, Harvard Medical School, Boston, Massachusetts. S. Smith is chief and Distinguished Barbara N. Weissman Chair, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, radiology lead, Rwanda Human Resources for Health Program, associate residency training director, Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, co-medical director, Orthopaedic and Arthritis Center, Brigham and Women's Hospital, assistant director, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, and associate professor, Harvard Medical School, Boston, Massachusetts. T. Nuthulaganti is director, Health Workforce, Clinton Health Access Initiative, Boston, Massachusetts. C.D. McClain is senior associate in perioperative anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, and assistant professor of anesthesia, Harvard Medical School, Boston, Massachusetts. B.E. Bierer is senior physician, Brigham and Women's Hospital, professor of medicine (pediatrics), Harvard Medical School, and faculty director, Multi-Regional Clinical Trials Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. P.E. Farmer is Kolokotrones University Professor of Global Health and Social Medicine, Harvard University, chair, Department of Global Health and Social Medicine, Harvard Medical School, and chief, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. A.E. Becker is Maude and Lillian Presley Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. A. Binagwaho is former Minister of Health of Rwanda, Kigali, Rwanda, and is currently senior lecturer, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, professor of pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and professor of the practice of global health delivery, University of Global Health Equity, Kigali, Rwanda. J. Rhatigan is associate professor of medicine and associate professor of global health and social medicine, Harvard Medical School, associate chief, Division of Global Health Equity, and director, Hiatt Global Health Equity Residency Program, Brigham and Women's Hospital, Boston, Massachusetts. D.E. Golan is dean for basic science and graduate education, special advisor for global programs, George R. Minot Professor of Medicine, and professor of biological chemistry and molecular pharmacology, Harvard Medical School, and senior physician, Brigham and Women's Hospital, Boston, Massachusetts
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Anderson GA, Ilcisin L, Abesiga L, Mayanja R, Portal Benetiz N, Ngonzi J, Kayima P, Shrime MG. Surgical volume and postoperative mortality rate at a referral hospital in Western Uganda: Measuring the Lancet Commission on Global Surgery indicators in low-resource settings. Surgery 2017; 161:1710-1719. [PMID: 28259351 DOI: 10.1016/j.surg.2017.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data. METHODS For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics. RESULTS Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths. CONCLUSION Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data.
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Affiliation(s)
- Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA
| | - Lenka Ilcisin
- Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA
| | - Lenard Abesiga
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Mayanja
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Kayima
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark G Shrime
- Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
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Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, Casey DC, Charlson FJ, Coates MM, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kemmer L, Khalil IA, Kinfu Y, Kutz MJ, Kyu HH, Leung J, Liang X, Lim SS, Lozano R, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Naghavi M, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Rankin Z, Reinig N, Salomon JA, Sandar L, Smith A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Troeger C, Truelsen T, VanderZanden A, Wagner JA, Wanga V, Whiteford HA, Zhou M, Zoeckler L, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Achoki T, Ackerman IN, Adebiyi AO, Adedeji IA, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agarwal SK, Ahmed MB, Kiadaliri AA, Ahmadieh H, Akseer N, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Ali R, Alkerwi A, Alla F, Allebeck P, Allen C, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Anderson GM, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu S, Bayou TA, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Benjet C, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Abdulhak AAB, Biryukov S, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brugha TS, Buchbinder R, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carabin H, Carapetis JR, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Chang JC, Chiang PPC, Chibalabala M, Chibueze CE, Chisumpa VH, Choi JYJ, Choudhury L, Christensen H, Ciobanu LG, Colistro V, Colomar M, Colquhoun SM, Cortinovis M, Crump JA, Damasceno A, Dandona R, Dargan PI, das Neves J, Davey G, Davis AC, Leo DD, Degenhardt L, Gobbo LCD, Derrett S, Jarlais DCD, deVeber GA, Dharmaratne SD, Dhillon PK, Ding EL, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Ellenbogen RG, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Foigt N, Fowkes FGR, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gabbe B, Gankpé FG, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gibney KB, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Hay RJ, Hedayati MT, Heredia-Pi IB, Heydarpour P, Hoek HW, Hoffman DJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Huang H, Huang JJ, Iburg KM, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jauregui A, Jayatilleke AU, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jin Y, Jonas JB, Kabir Z, Kajungu DK, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kim YJ, Kissoon N, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Koul PA, Koyanagi A, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lalloo R, Lallukka T, Larsson A, Latif AA, Lavados PM, Lawrynowicz AEB, Leasher JL, Leigh J, Leung R, Li Y, Li Y, Lipshultz SE, Liu PY, Liu Y, Lloyd BK, Logroscino G, Looker KJ, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Razek HMAE, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Marcenes W, Martinez-Raga J, Masiye F, Mason-Jones AJ, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Mitchell PB, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Monasta L, Hernandez JCM, Montico M, Moradi-Lakeh M, Mori R, Mueller UO, Mumford JE, Murdoch ME, Murthy GVS, Nachega JB, Naheed A, Naldi L, Nangia V, Newton JN, Ng M, Ngalesoni FN, Nguyen QL, Nisar MI, Pete PMN, Nolla JM, Norheim OF, Norman RE, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Ota E, Oyekale AS, PA M, Park EK, Parsaeian M, Patten SB, Patton GC, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pishgar F, Plass D, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai D, Rai RK, Rajsic S, Raju M, Ram U, Ranganathan K, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Reynolds A, Ribeiro AL, Ricci S, Roba HS, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Roy A, Sackey BB, Sagar R, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shahraz S, Shaikh MA, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Sigfusdottir ID, Silva DAS, Silverberg JI, Simard EP, Singh A, Singh JA, Singh PK, Skirbekk V, Skogen JC, Soljak M, Søreide K, Sorensen RJD, Sreeramareddy CT, Stathopoulou V, Steel N, Stein DJ, Stein MB, Steiner TJ, Stovner LJ, Stranges S, Stroumpoulis K, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tandon N, Tanne D, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tegegne TK, Tekle DY, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tsilimbaris M, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Gool CH, van Os J, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Wallin MT, Wang L, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Xu G, Yadav AK, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zeeb H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1603-1658. [PMID: 27733283 PMCID: PMC5388857 DOI: 10.1016/s0140-6736(16)31460-x] [Citation(s) in RCA: 1387] [Impact Index Per Article: 173.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING Bill & Melinda Gates Foundation.
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Ndayizeye L, Ngarambe C, Smart B, Riviello R, Majyambere JP, Rickard J. Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality. Surgery 2016; 160:1645-1656. [PMID: 27712880 DOI: 10.1016/j.surg.2016.08.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. METHODS Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. RESULTS A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). CONCLUSION Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital.
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Affiliation(s)
| | | | - Blair Smart
- University Teaching Hospital of Kigali, Kigali, Rwanda
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