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Patil P, Nathani P, Bakker JM, van Duinen AJ, Bhushan P, Shukla M, Chalise S, Roy N, Gadgil A. Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review. World J Surg 2023; 47:1930-1939. [PMID: 37191692 PMCID: PMC10310578 DOI: 10.1007/s00268-023-07029-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs). METHODOLOGY We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed. RESULTS A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries. CONCLUSION Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.
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Affiliation(s)
- Priti Patil
- Department of Statistics, BARC Hospital, Mumbai, 400094, India
| | - Priyansh Nathani
- Department of Surgery, Hinduhridaysamrat Balasaheb Thackeray Medical College, Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, India
| | - Juul M Bakker
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alex J van Duinen
- Clinic of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pranav Bhushan
- Department of Public Health, Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Minal Shukla
- Department of Maternal Health, UNICEF, Bhopal, India
| | - Samir Chalise
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institute, 171 77, Stockholm, Sweden.
- The George Institute for Global Health, New Delhi, India.
| | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
- Department of Surgery, BARC Hospital, Mumbai, 400094, India
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Kumeh OW, Fallah MP, Desai IK, Gilbert HN, Silverstein JB, Beste S, Beste J, Mukherjee JS, Richardson ET. Literacy is power: structural drivers of child malnutrition in rural Liberia. BMJ Nutr Prev Health 2020; 3:295-307. [PMID: 33521541 PMCID: PMC7841815 DOI: 10.1136/bmjnph-2020-000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country's civil war and were further exacerbated by the 2014-2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations. METHODS Between July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers' experiences, as well as health workers' understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data. RESULTS Mothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition. DISCUSSION The lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.
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Affiliation(s)
- Odell W Kumeh
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Ministry of Health of Liberia, Monrovia, Montserrado, Liberia
| | - Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia, Montserrado, Liberia
| | - Ishaan K Desai
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Hannah N Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B Silverstein
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Beste
- Partners In Health, Harper, Liberia
- Division of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason Beste
- Partners In Health, Harper, Liberia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Joia S Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
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