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Adde HA, Oghogho MD, van Duinen AJ, Grimes CE, Hampaye TC, Quaife M, Bolkan HA. The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures. BMJ Open 2024; 14:e076293. [PMID: 38191260 PMCID: PMC10806694 DOI: 10.1136/bmjopen-2023-076293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The economic consequences of untreated surgical disease are potentially large. The aim of this study was to estimate the economic burden associated with unmet surgical needs in Liberia. DESIGN A nationwide enumeration of surgical procedures and providers was conducted in Liberia in 2018. We estimated the number of disability-adjusted life years (DALYs) saved by operative activities and converted these into economic losses averted using gross national income per capita and value of a statistical life (VSL) approaches. The total, the met and the unmet needs for surgery were determined, and economic losses caused by unmet surgical needs were estimated. Finally, we valued the economic losses avoided by various surgical provider groups. RESULTS A total of 55 890 DALYs were averted by surgical activities in 2018; these activities prevented an economic loss of between US$35 and US$141 million. About half of these values were generated by the non-specialist physician workforce. Furthermore, a non-specialist physician working a full-time position for 1 year prevented an economic loss of US$717 069 using the VSL approach, while a specialist resident and a certified specialist saved US$726 606 and US$698 877, respectively. The burden of unmet surgical need was associated with productivity losses of between US$388 million and US$1.6 billion; these losses equate to 11% and 46% of the annual gross domestic product for Liberia. CONCLUSION The economic burden of untreated surgical disease is large in Liberia. There is a need to strengthen the surgical system to reduce ongoing economic losses; a framework where specialist and non-specialist physicians collaborate may result in better economic return than a narrower focus on training specialists alone.
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Affiliation(s)
- Håvard A Adde
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
| | | | - Alex J van Duinen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Surgery, ELWA Hospital, Monrovia, Liberia
| | - Caris E Grimes
- King's Centre for Global Health and Health Partnerships, King's College, London, UK
- Medway NHS Foundation Trust, Gillingham, UK
| | | | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Evidera Ltd, London, UK
| | - Håkon A Bolkan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- CapaCare, Trondheim, Norway, & Tappita, Liberia
- Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Thobani H, Shah MM, Ehsan AN, Khan S. Much room for change: access to surgical care for stateless individuals in Pakistan. Global Health 2023; 19:93. [PMID: 38017528 PMCID: PMC10685708 DOI: 10.1186/s12992-023-00972-3] [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: 08/01/2022] [Accepted: 09/05/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND As developing countries take steps towards providing universal essential surgery, ensuring the equitable distribution of such care for underrepresented populations is a vital function of the global surgery community. Unfortunately, in the context of the global "stateless", there remains much room for improvement. KEY ISSUES Inherent structural deficiencies, such as lack of adequate population data on stateless communities, absent health coverage policies for stateless individuals, and minimal patient-reported qualitative data on barriers to surgical service delivery prevent stateless individuals from receiving the care they require - even when healthcare infrastructure to provide such care exists. The authors therefore propose more research and targeted interventions to address the systemic issues that prevent stateless individuals from accessing surgical care. CONCLUSION It is essential to address the aforementioned barriers in order to improve stateless populations' access to surgical care. Rigorous empirical and qualitative research provides an important avenue through which these structural issues may be addressed.
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Affiliation(s)
- Humza Thobani
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mashal Murad Shah
- Centre of Global Surgical Care, Aga Khan University, Karachi, Pakistan
| | | | - Sadaf Khan
- Centre of Global Surgical Care, Aga Khan University, Karachi, Pakistan.
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Lindenbergh KC, van Duinen AJ, Ahlbäck JG, Kamoh J, Bah S, Ashley T, Löfgren J, Grobusch MP, Sankoh O, Bolkan HA. Prevalence, incidence, repair rate, and morbidity of groin hernias in Sierra Leone: cross-sectional household study. BJS Open 2023; 7:6991921. [PMID: 36655327 PMCID: PMC9849845 DOI: 10.1093/bjsopen/zrac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Knowledge about the prevalence of groin hernias in sub-Saharan Africa is limited. Previous studies have demonstrated a higher incidence of the condition than the annual repair rate. This study aimed to investigate prevalence, incidence, annual repair rate, morbidity, and health-seeking behaviour of persons with groin hernias in Sierra Leone. METHODS This population-based, cross-sectional household survey on groin hernias in Sierra Leone was part of the Prevalence Study on Surgical Conditions 2020 (PRESSCO 2020). Those who indicated possible groin hernia were asked problem-specific questions and underwent physical examination to confirm or exclude the diagnosis. RESULTS 3626 study participants were interviewed. The prevalence of untreated groin hernia was 1.1 per cent (95 per cent c.i. 0.8 to 1.5 per cent), whereas the prevalence of untreated and treated groin hernia was 2.5 per cent (95 per cent c.i. 2.0 to 3.0 per cent). The proportion of recurrence was 13.1 per cent. An incidence of 389 (95 per cent c.i. 213 to 652) groin hernia cases per 100 000 people per year was identified, while a population-based annual hernia repair rate estimation was 470 (95 per cent c.i. 350 to 620) per 100 000 people. Out of 39 participants with groin hernia, non-ignorable pain was reported by eight and 27 reported financial shortcomings as a reason for not seeking healthcare. CONCLUSIONS Groin hernias are common in Sierra Leone and although the repair rate might match the incidence, the existing backlog of untreated hernias is likely to remain. It may be possible to reduce the number of recurrences through improved management. Measures to reduce financial barriers to treatment seem crucial to improve the health of people with groin hernias in Sierra Leone.
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Affiliation(s)
| | - Alex J van Duinen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway,Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,CapaCare, Norway, Sierra Leone, The Netherlands
| | - Johan G Ahlbäck
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - Thomas Ashley
- CapaCare, Norway, Sierra Leone, The Netherlands,Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin P Grobusch
- Masanga Medical Research Unit, Masanga, Sierra Leone,Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands,Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany,Centre de Recherches Medicales en Lambarene (CERMEL), Lambarene, Gabon,Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa,Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Håkon A Bolkan
- Correspondence to: Håkon A. Bolkan, MD PhD, Norwegian University of Science and Technology, Postboks 8900, Torgarden, 7491 Trondheim, Norway (e-mail: )
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