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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Girma T, Mude LG, Bekele A. Utilization and Completeness of Surgical Safety Checklist with Associated Factors in Surgical Units of Jimma University Medical Center, Ethiopia. Int J Gen Med 2022; 15:7781-7788. [PMID: 36258800 PMCID: PMC9572490 DOI: 10.2147/ijgm.s378260] [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: 06/21/2022] [Accepted: 10/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgical safety checklist is used for every patient undergoing a surgical procedure and is now employed by a majority of surgical providers around the world, but the utilization and completion of surgical safety checklists were low in lower- and middle-income countries. Objective The objective of this study was to evaluate the utilization and completeness of the surgical safety checklist in surgical units of Jimma University Medical Center, Ethiopia. Methods Hospital-based prospective cross-sectional study was conducted from October 1 to 30, 2020. A total of 384 surgical cases were included in the study. Checklists were kept as part of each patient's medical record, and consecutive post-operative patient charts were included in the study. The data were collected using the modified version of the WHO checklist constituted of 27 items. The collected data were cleaned, coded, and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Binary and multiple logistic regression analyses were computed, and the level of statistical significance was determined at p < 0.05. Results The use of a surgical safety checklist was 93.5%. The checklist was completed 17.3% of the time, with sign-in, time-out, and sign-out being completed 83%, 25%, and 35% of the time, respectively. Utilization of the surgical safety checklist was 87.4%, which is lower in elective surgeries (AOR = 0.126 95% CI (0.039-0.414)) compared with the emergency procedure. Once more, the completeness of the safety checklist was 63.3%, which is lower in elective surgery (AOR = 0.367 95% CI (0.208-0.65)) than in emergency procedures. Conclusion The use of a surgical safety checklist was promising, while the completeness of the checklist was poor that demands further improvement. Time-out was the least completed section of the checklist. Completion of the checklist was high in the first case on the positions of the theatre list.
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Affiliation(s)
- Tadesse Girma
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Jimma, Ethiopia,Correspondence: Tadesse Girma, Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Jimma, Ethiopia, Email
| | - Lidya Gemechu Mude
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Azmeraw Bekele
- Department of Social and Administrative Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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3
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Sykes AG, Seyi-Olajide J, Ameh EA, Ozgediz D, Abbas A, Abib S, Ademuyiwa A, Ali A, Aziz TT, Chowdhury TK, Abdelhafeez H, Ignacio RC, Keller B, Klazura G, Kling K, Martin B, Philipo GS, Thangarajah H, Yap A, Meara JG, Bundy DAP, Jamison DT, Mock CN, Bickler SW. Estimates of Treatable Deaths Within the First 20 Years of Life from Scaling Up Surgical Care at First-Level Hospitals in Low- and Middle-Income Countries. World J Surg 2022; 46:2114-2122. [PMID: 35771254 PMCID: PMC9334432 DOI: 10.1007/s00268-022-06622-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical care is an important, yet often neglected component of child health in low- and middle-income countries (LMICs). This study examines the potential impact of scaling up surgical care at first-level hospitals in LMICs within the first 20 years of life. METHODS Epidemiological data from the global burden of disease 2019 Study and a counterfactual method developed for the disease control priorities; 3rd Edition were used to estimate the number of treatable deaths in the under 20 year age group if surgical care could be scaled up at first-level hospitals. Our model included three digestive diseases, four maternal and neonatal conditions, and seven common traumatic injuries. RESULTS An estimated 314,609 (95% UI, 239,619-402,005) deaths per year in the under 20 year age group could be averted if surgical care were scaled up at first-level hospitals in LMICs. Most of the treatable deaths are in the under-5 year age group (80.9%) and relates to improved obstetrical care and its effect on reducing neonatal encephalopathy due to birth asphyxia and trauma. Injuries are the leading cause of treatable deaths after age 5 years. Sixty-one percent of the treatable deaths occur in lower middle-income countries. Overall, scaling up surgical care at first-level hospitals could avert 5·1% of the total deaths in children and adolescents under 20 years of age in LMICs per year. CONCLUSIONS Improving the capacity of surgical services at first-level hospitals in LMICs has the potential to avert many deaths within the first 20 years of life.
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Affiliation(s)
| | | | - Emmanuel A Ameh
- Division of Pediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Simone Abib
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Keller
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Greg Klazura
- Loyola University Medical Center, Chicago, IL, USA
| | - Karen Kling
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Benjamin Martin
- Department of Paediatric Surgery and Urology, Bristol Children's Hospital, Bristol, UK
| | | | - Hariharan Thangarajah
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA
| | - Ava Yap
- Division of Pediatric Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Donald A P Bundy
- Global Research Consortium for School Health and Nutrition, London School of Hygiene and Tropical Medicine, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego School of Medicine, 9500 Gilman Drive #0739, La Jolla, San Diego, CA, 92093-0739, USA.
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Álvarez-Acuña AM, López-Álvarez LM, Lozada-Martínez ID, Narvaez-Rojas AR. Intraoperative finding of papyraceous twin fetus in pregnant woman without specialized follow-up: A summary of difficulties in accessing prenatal services in low- and middle-income countries. Int J Surg Case Rep 2022; 95:107234. [PMID: 35636212 PMCID: PMC9149187 DOI: 10.1016/j.ijscr.2022.107234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance The papyraceous fetus is the product of the intrauterine fetal death of a twin in early pregnancy, with retention of the fetus for a minimum of 10 weeks, resulting in mechanical compression of the small fetus. It is a finding that can be found early by ultrasound to avoid increased obstetric risk, but in low- to middle-income countries it is not always available. Case presentation We present the case of a 22-year-old multipara patient was remitted to the emergency department due to a one-hour history of premature rupture of the membranes. Only one control ultrasound was performed at 25 weeks of pregnancy. Cesarean section was performed and two products were found, one of them a papyraceous fetus. Clinical discussion Almost 50% of women in low- and middle-income countries don't receive adequate antenatal care. It has been estimated that up to half of twins and almost all triplets are born premature and have a higher risk of dying compared to those born at term; specifically, this risk is much higher if the pregnancy is accompanied by rare pathological conditions. Conclusion The papyraceous fetus is a rare condition that represents a risk to the health of the mother and other babies, in case of multiple pregnancy; but it can be diagnosed early through imaging studies. Socio-cultural, socio-economic and direct difficulties of the health system may be the cause of the delay in the diagnosis of this pathological entity, making it an unexpected finding during delivery or intraoperatively. The papyraceous fetus is a rare condition that can be diagnosed early through imaging studies. Enhanced access to prenatal care in third world countries is mandatory. Undiagnosed conditions during pregnancy may increase the risk of complications.
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Affiliation(s)
| | | | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia.
| | - Alexis Rafael Narvaez-Rojas
- Department of Surgery, Hospital Carlos Roberto Huembes, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua.
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Sykes AG, Brill JB, Wallace JD, Lee C, Lewis PR, Henry MC, Christman MS, Casey KM, Bickler SW, Ignacio RC. Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy. Mil Med 2021; 188:usab500. [PMID: 34908148 DOI: 10.1093/milmed/usab500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. MATERIALS AND METHODS Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. RESULTS A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician-gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. CONCLUSIONS Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.
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Affiliation(s)
- Alicia G Sykes
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jason B Brill
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - James D Wallace
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Clara Lee
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Marion C Henry
- Division of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL 60637, USA
| | - Matthew S Christman
- Department of Urology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Kevin M Casey
- Department of General Surgery, Cottage Hospital Santa Barbara, Santa Barbara, CA 93105, USA
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
| | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
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Neonatal encephalopathy: Focus on epidemiology and underexplored aspects of etiology. Semin Fetal Neonatal Med 2021; 26:101265. [PMID: 34305025 DOI: 10.1016/j.siny.2021.101265] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neonatal Encephalopathy (NE) is a neurologic syndrome in term and near-term infants who have depressed consciousness, difficulty initiating and maintaining respiration, and often abnormal tone, reflexes and neonatal seizures in varying combinations. Moderate/severe NE affects 0.5-3/1000 live births in high-income countries, more in low- and middle-income countries, and carries high risk of mortality or disability, including cerebral palsy. Reduced blood flow and/or oxygenation around the time of birth, as with ruptured uterus, placental abruption or umbilical cord prolapse can cause NE. This subset of NE, with accompanying low Apgar scores and acidemia, is termed Hypoxic-Ischemic Encephalopathy. Other causes of NE that can present similarly, include infections, inflammation, toxins, metabolic disease, stroke, placental disease, and genetic disorders. Aberrant fetal growth and congenital anomalies are strongly associated with NE, suggesting a major role for maldevelopment. As new tools for differential diagnosis emerge, their application for prevention, individualized treatment and prognostication will require further systematic studies of etiology of NE.
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Wasserman I, Peters AW, Roa L, Amanullah F, Samad L. Breaking Specialty Silos: Improving Global Child Health Through Essential Surgical Care. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:183-189. [PMID: 32606090 PMCID: PMC7326524 DOI: 10.9745/ghsp-d-20-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/19/2020] [Indexed: 01/17/2023]
Abstract
Children’s health care providers and children’s surgery providers can partner to improve children’s health by developing the surgical workforce, focusing on “best buy” surgeries, integrating children’s surgery into national plans, streamlining data collection and research, and leveraging financing.
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Affiliation(s)
- Isaac Wasserman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
| | | | - Lubna Samad
- Center for Essential Surgical and Acute Care, Indus Health Network, Karachi, Pakistan
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8
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Consensus on international guidelines for management of groin hernias. Surg Endosc 2020; 34:2359-2377. [PMID: 32253559 DOI: 10.1007/s00464-020-07516-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Groin hernia management has a significant worldwide diversity with multiple surgical techniques and variable outcomes. The International guidelines for groin hernia management serve to help in groin hernia management, but the acceptance among general surgeons remains unknown. The aim of our study was to gauge the degree of agreement with the guidelines among health care professionals worldwide. METHODS Forty-six key statements and recommendations of the International guidelines for groin hernia management were selected and presented at plenary consensus conferences at four international congresses in Europe, the America's and Asia. Participants could cast their votes through live voting. Additionally, a web survey was sent out to all society members allowing online voting after each congress. Consensus was defined as > 70% agreement among all participants. RESULTS In total 822 surgeons cast their vote on the key statements and recommendations during the four plenary consensus meetings or via the web survey. Consensus was reached on 34 out of 39 (87%) recommendations, and on six out of seven (86%) statements. No consensus was reached on the use of light versus heavy-weight meshes (69%), superior cost-effectiveness of day-case laparo-endoscopic repair (69%), omitting prophylactic antibiotics in hernia repair, general or local versus regional anesthesia in elderly patients (55%) and re-operation in case of immediate postoperative pain (59%). CONCLUSION Globally, there is 87% consensus regarding the diagnosis and management of groin hernias. This provides a solid basis for standardizing the care path of patients with groin hernias.
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9
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Powell BL, Luckett R, Bekele A, Chao TE. Sex Disparities in the Global Burden of Surgical Disease. World J Surg 2020; 44:2139-2143. [PMID: 32189033 DOI: 10.1007/s00268-020-05484-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Brittany L Powell
- Stanford University School of Medicine, Stanford, CA, USA.,Program in Global Surgery and Social Change, Boston, MA, USA
| | - Rebecca Luckett
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | - Tiffany E Chao
- Stanford University School of Medicine, Stanford, CA, USA. .,Santa Clara Valley Medical Center, San Jose, CA, USA.
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10
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Santhirapala V, Peden CJ, Meara JG, Biccard BM, Gelb AW, Johnson WD, Lipnick MS, Makasa EM, Martin J, Maswime S, Mellin-Olsen J, McClain CD. Towards high-quality peri-operative care: a global perspective. Anaesthesia 2020; 75 Suppl 1:e18-e27. [PMID: 31903566 DOI: 10.1111/anae.14921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/22/2023]
Abstract
Article 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.
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Affiliation(s)
- V Santhirapala
- Harvard Medical School, Boston, MA, USA.,Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - C J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J G Meara
- Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A W Gelb
- Department of Anesthesia and Perioperative Care, University of California San Francisco, CA, USA
| | - W D Johnson
- World Health Organization, Geneva, Switzerland
| | - M S Lipnick
- Department of Anesthesia and Perioperative Care, University of California San Francisco, CA, USA
| | - E M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, School of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - J Martin
- Department of Anesthesia and Perioperative Medicine and Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - S Maswime
- University of Cape Town, South Africa
| | - J Mellin-Olsen
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
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Orser BA, Wilson CR, Rotstein AJ, Iglesias SJ, Spain BT, Ranganathan P, MacDonald WA, Ng V, O'Leary S, Lafontaine A. Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries. Anesth Analg 2020; 129:294-300. [PMID: 30855341 DOI: 10.1213/ane.0000000000004083] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.
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Affiliation(s)
- Beverley A Orser
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - C Ruth Wilson
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Stuart J Iglesias
- Department of Family Medicine, University of British Columbia, Bella Bella, British Columbia, Canada
| | - Brian T Spain
- Department of Anaesthesia and Perioperative Medicine, Royal Darwin Hospital, Flinders University, Darwin, Australia
| | - Pavithra Ranganathan
- Department of Anesthesiology, West Virginia University, Morgantown, West Virginia
| | - William A MacDonald
- Faculty of Medicine, Discipline of Family Medicine, Memorial University, St John's Newfoundland, Canada
| | - Victor Ng
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan O'Leary
- Department of Anesthesia and Pain Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alika Lafontaine
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ullrich SJ, Kakembo N, Grabski DF, Cheung M, Kisa P, Nabukenya M, Tumukunde J, Fitzgerald TN, Langer M, Situma M, Sekabira J, Ozgediz D. Burden and Outcomes of Neonatal Surgery in Uganda: Results of a Five-Year Prospective Study. J Surg Res 2019; 246:93-99. [PMID: 31562991 DOI: 10.1016/j.jss.2019.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/25/2019] [Accepted: 08/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.
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Affiliation(s)
- Sarah J Ullrich
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Mary Nabukenya
- Department of Anesthesiology, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Janat Tumukunde
- Department of Anesthesiology, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Monica Langer
- Department of Surgery, Lurie Children's Hospital, Chicago, Illinois
| | - Martin Situma
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - John Sekabira
- Department of Surgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Doruk Ozgediz
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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13
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Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7] [Citation(s) in RCA: 7199] [Impact Index Per Article: 1199.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Ärnlöv J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Ayala Quintanilla BP, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Belachew AB, Belay YA, Bell ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cárdenas R, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castro F, Catalá-López F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang HY, Chang JC, Charlson FJ, Chattopadhyay A, Chattu VK, Chaturvedi P, Chiang PPC, Chin KL, Chitheer A, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Cicuttini FM, Ciobanu LG, Cirillo M, Claro RM, Collado-Mateo D, Cooper C, Coresh J, Cortesi PA, Cortinovis M, Costa M, Cousin E, Criqui MH, Cromwell EA, Cross M, Crump JA, Dadi AF, Dandona L, Dandona R, Dargan PI, Daryani A, Das Gupta R, Das Neves J, Dasa TT, Davey G, Davis AC, Davitoiu DV, De Courten B, De La Hoz FP, De Leo D, De Neve JW, Degefa MG, Degenhardt L, Deiparine S, Dellavalle RP, Demoz GT, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dinberu MT, Dirac MA, Djalalinia S, Doan L, Dokova K, Doku DT, Dorsey ER, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Echko MM, Edvardsson D, Effiong A, Ehrlich JR, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Elyazar IRF, Enayati A, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Esteghamati S, Fakhim H, Fallah Omrani V, Faramarzi M, Fareed M, Farhadi F, Farid TA, Farinha CSES, Farioli A, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fox J, Frank TD, Fukumoto T, Fullman N, Fürst T, Furtado JM, Futran ND, Gall S, Ganji M, Gankpe FG, Garcia-Basteiro AL, Gardner WM, Gebre AK, Gebremedhin AT, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadiri K, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Ghosh R, Ghoshal AG, Giampaoli S, Gill PS, Gill TK, Ginawi IA, Giussani G, Gnedovskaya EV, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goulart AC, Goulart BNG, Grada A, Grams ME, Grosso G, Gugnani HC, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gyawali B, Haagsma JA, Hachinski V, Hafezi-Nejad N, Haghparast Bidgoli H, Hagos TB, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hawley CN, Hay RJ, Hay SI, Hedayatizadeh-Omran A, Heibati B, Hendrie D, Henok A, Herteliu C, Heydarpour S, Hibstu DT, Hoang HT, Hoek HW, Hoffman HJ, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huynh CK, Iburg KM, Ikeda CT, Ileanu B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Javanbakht M, Jayatilleke AU, Jeemon P, Jha RP, Jha V, Ji JS, Johnson CO, Jonas JB, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Kanchan T, Karami M, Karami Matin B, Karch A, Karema C, Karimi N, Karimi SM, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kawakami N, Karyani AK, Keighobadi MM, Keiyoro PN, Kemmer L, Kemp GR, Kengne AP, Keren A, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khazaei M, Khoja AT, Khosravi A, Khosravi MH, Kiadaliri AA, Kiirithio DN, Kim CI, Kim D, Kim P, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lalloo R, Lallukka T, Lami FH, Lansingh VC, Latifi A, Lau KMM, Lazarus JV, Leasher JL, Ledesma JR, Lee PH, Leigh J, Leung J, Levi M, Lewycka S, Li S, Li Y, Liao Y, Liben ML, Lim LL, Lim SS, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Lucchesi LR, Lunevicius R, Lyons RA, Ma S, Macarayan ERK, Mackay MT, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Mahotra NB, Mai HT, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Manhertz T, Mansournia MA, Mantovani LG, Mapoma CC, Maravilla JC, Marcenes W, Marks A, Martins-Melo FR, Martopullo I, März W, Marzan MB, Mashamba-Thompson TP, Massenburg BB, Mathur MR, Matsushita K, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mejia-Rodriguez F, Mekonen T, Melese A, Melku M, Meltzer M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezerji NMG, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miltz B, Mini GK, Mirarefin M, Mirrakhimov EM, Misganaw AT, Mitchell PB, Mitiku H, Moazen B, Mohajer B, Mohammad KA, Mohammadifard N, Mohammadnia-Afrouzi M, Mohammed MA, Mohammed S, Mohebi F, Moitra M, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mountjoy-Venning WC, Mousavi SM, Mruts KB, Muche AA, Muchie KF, Mueller UO, Muhammed OS, Mukhopadhyay S, Muller K, Mumford JE, Murhekar M, Musa J, Musa KI, Mustafa G, Nabhan AF, Nagata C, Naghavi M, Naheed A, Nahvijou A, Naik G, Naik N, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngunjiri JW, Nguyen AQ, Nguyen HT, Nguyen HLT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen NB, Nguyen SH, Nichols E, Ningrum DNA, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nsoesie EO, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Ong KL, Ong SK, Oren E, Ortiz A, Ota E, Otstavnov SS, Øverland S, Owolabi MO, P A M, Pacella R, Pakpour AH, Pana A, Panda-Jonas S, Parisi A, Park EK, Parry CDH, Patel S, Pati S, Patil ST, Patle A, Patton GC, Paturi VR, Paulson KR, Pearce N, Pereira DM, Perico N, Pesudovs K, Pham HQ, Phillips MR, Pigott DM, Pillay JD, Piradov MA, Pirsaheb M, Pishgar F, Plana-Ripoll O, Plass D, Polinder S, Popova S, Postma MJ, Pourshams A, Poustchi H, Prabhakaran D, Prakash S, Prakash V, Purcell CA, Purwar MB, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman MA, Rahman SU, Rai RK, Rajati F, Ram U, Ranjan P, Ranta A, Rao PC, Rawaf DL, Rawaf S, Reddy KS, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro ALP, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Roth GA, Roy A, Rubagotti E, Sachdev PS, Sadat N, Saddik B, Sadeghi E, Saeedi Moghaddam S, Safari H, Safari Y, Safari-Faramani R, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi HS, Salam N, Salama JS, Salamati P, Saleem K, Saleem Z, Salimi Y, Salomon JA, Salvi SS, Salz I, Samy AM, Sanabria J, Sang Y, Santomauro DF, Santos IS, Santos JV, Santric Milicevic MM, Sao Jose BP, Sardana M, Sarker AR, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Saylan M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi H, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma M, Sharma R, She J, Sheikh A, Shi P, Shibuya K, Shigematsu M, Shiri R, Shirkoohi R, Shishani K, Shiue I, Shokraneh F, Shoman H, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Silveira DGA, Singam NSV, Singh JA, Singh NP, Singh V, Sinha DN, Skiadaresi E, Slepak ELN, Sliwa K, Smith DL, Smith M, Soares Filho AM, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Soosaraei M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steiner TJ, Stokes MA, Stovner LJ, Subart ML, Sudaryanto A, Sufiyan MB, Sunguya BF, Sur PJ, Sutradhar I, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Tadakamadla SK, Tadesse BT, Tandon N, Tassew SG, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekalign TG, Tekelemedhin SW, Tekle MG, Temesgen H, Temsah MH, Temsah O, Terkawi AS, Teweldemedhin M, Thankappan KR, Thomas N, Tilahun B, To QG, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Towbin JA, Tran BX, Tran KB, Troeger CE, Truelsen TC, Tsilimbaris MK, Tsoi D, Tudor Car L, Tuzcu EM, Ukwaja KN, Ullah I, Undurraga EA, Unutzer J, Updike RL, Usman MS, Uthman OA, Vaduganathan M, Vaezi A, Valdez PR, Varughese S, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vosoughi K, Vujcic IS, Wagnew FS, Waheed Y, Waller SG, Wang Y, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Weldegebreal F, Weldegwergs KG, Werdecker A, West TE, Whiteford HA, Widecka J, Wijeratne T, Wilner LB, Wilson S, Winkler AS, Wiyeh AB, Wiysonge CS, Wolfe CDA, Woolf AD, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yeshaneh A, Yimer EM, Yip P, Yisma E, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang K, Zhao Z, Zhou M, Zodpey S, Zucker I, Vos T, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1789-1858. [PMID: 30496104 PMCID: PMC6227754 DOI: 10.1016/s0140-6736(18)32279-7#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 08/12/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING Bill & Melinda Gates Foundation.
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Epiu I, Alia G, Mukisa J, Tavrow P, Lamorde M, Kuznik A. Estimating the cost and cost-effectiveness for obstetric fistula repair in hospitals in Uganda: a low income country. Health Policy Plan 2018; 33:999-1008. [PMID: 30252051 PMCID: PMC6263022 DOI: 10.1093/heapol/czy078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
In Africa, about 33 000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Obstetric fistula repair competes for scarce resources with other healthcare interventions in resource-limited settings, even though it is surgically efficacious. There is limited documentation of its cost-effectiveness in the most affected settings. We therefore sought to assess the cost-effectiveness of surgical intervention for obstetric fistula in Uganda so as to provide appropriate data for policy-makers to prioritize fistula repair and reduce women's suffering in similarly burdened countries. We built a decision-analytic model from the perspective of Uganda's National Health System to estimate the cost-effectiveness of vesico-vaginal and recto-vaginal fistula surgery vs a competing strategy of no surgery for Ugandan women with fistula. Long-term disability outcomes were assessed based on a lifetime Markov state-transition cohort and effectiveness of surgery. Surgical costs were estimated by micro-costing local Ugandan health resources. Disability weights associated with vesico-vaginal, recto-vaginal fistula and mortality rates among the general population in Uganda were based on published sources. The cost of providing fistula repair surgery in Uganda was estimated at $378 per procedure. For a hypothetical 20-year-old woman, surgery was estimated to decrease the lifetime disability burden from 8.53 DALYs to 1.51 DALYs, yielding a cost per DALY averted of $54. The results were robust to variations in model inputs in one-way and probabilistic sensitivity analyses. Surgery for obstetric fistula appears highly cost-effective in Uganda. In similar low-income countries, governments and non-governmental organizations need to prioritize training and strengthening surgical capacity to increase access to fistula surgical care, which would be an important step towards achieving universal health coverage.
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Affiliation(s)
- Isabella Epiu
- NIH Fogarty Global Health Fellow, University of California Global Health Institute, CA, USA and Director Health Solutions International, Kampala, Uganda
| | - Godfrey Alia
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - John Mukisa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Uganda
| | - Paula Tavrow
- Bixby Program in Population and Reproductive Health, University of California at Los Angeles, CA, USA
| | - Mohammed Lamorde
- Prevention Care and Treatment, Infectious Disease Institute, Makerere University College of Health Sciences, Uganda
| | - Andreas Kuznik
- Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Leow JJ, Riviello R, Rulisa S. Access to Safe Obstetric Surgical Care in Low-Income Countries. World J Surg 2017; 40:2289-90. [PMID: 27431318 DOI: 10.1007/s00268-016-3638-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jeffrey J Leow
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA.
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
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Ellard DR, Chimwaza W, Davies D, Simkiss D, Kamwendo F, Mhango C, Quenby S, Kandala NB, O'Hare JP. Up-skilling associate clinicians in Malawi in emergency obstetric, neonatal care and clinical leadership: the ETATMBA cluster randomised controlled trial. BMJ Glob Health 2017; 1:e000020. [PMID: 28588915 PMCID: PMC5321302 DOI: 10.1136/bmjgh-2015-000020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/08/2022] Open
Abstract
Background The ETATMBA (Enhancing Training And Technology for Mothers and Babies in Africa) project-trained associate clinicians (ACs/clinical officers) as advanced clinical leaders in emergency obstetric and neonatal care. This trial aimed to evaluate the impact of training on obstetric health outcomes in Malawi. Method A cluster randomised controlled trial with 14 districts of Malawi (8 intervention, 6 control) as units of randomisation. Intervention districts housed the 46 ACs who received the training programme. The primary outcome was district (health facility-based) perinatal mortality rates. Secondary outcomes included maternal mortality ratios, neonatal mortality rate, obstetric and birth variables. The study period was 2011–2013. Mortality rates/ratios were examined using an interrupted time series (ITS) to identify trends over time. Results The ITS reveals an improving trend in perinatal mortality across both groups, but better in the control group (intervention, effect −3.58, SE 2.65, CI (−9.85 to 2.69), p=0.20; control, effect −17.79, SE 6.83, CI (−33.95 to −1.64), p=0.03). Maternal mortality ratios are seen to have improved in intervention districts while worsening in the control districts (intervention, effect −38.11, SE 50.30, CI (−157.06 to 80.84), p=0.47; control, effect 11.55, SE 87.72, CI (−195.87 to 218.98), p=0.90). There was a 31% drop in neonatal mortality rate in intervention districts while in control districts, the rate rises by 2%. There are no significant differences in the other secondary outcomes. Conclusions This is one of the first randomised studies looking at the effect of structured training on health outcomes in this setting. Notwithstanding a number of limitations, this study suggests that up-skilling this cadre is possible, and could impact positively on health outcomes. Trial registration number ISRCTN63294155; Results.
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Affiliation(s)
- David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | | | - David Davies
- Educational Development & Research Team, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Doug Simkiss
- Division of Mental Health & Wellbeing, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Francis Kamwendo
- Obstetrics and Gynaecology Department, Malawi University, College of Medicine, Blantyre, Malawi
| | - Chisale Mhango
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Siobhan Quenby
- Division of Reproductive Health, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Ngianga-Bakwin Kandala
- Faculty of Engineering and Environment, Department of Mathematics and Information sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Joseph Paul O'Hare
- Division of Metabolic & Vascular Health, Warwick Medical School, The University of Warwick, Coventry, UK
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Ellis R, Izzuddin Mohamad Nor A, Pimentil I, Bitew Z, Moore J. Improving Surgical and Anaesthesia Practice: Review of the Use of the WHO Safe Surgery Checklist in Felege Hiwot Referral Hospital, Ethiopia. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu207104.w6251. [PMID: 28321296 PMCID: PMC5337669 DOI: 10.1136/bmjquality.u207104.w6251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/10/2017] [Indexed: 12/20/2022]
Abstract
Development of surgical and anaesthetic care globally has been consistently reported as being inadequate. The Lancet Commission on Global Surgery highlights the need for action to address this deficit. One such action to improve global surgical safety is the introduction of the WHO Surgical Checklist to Operating Rooms (OR) around the world. The checklist has a growing body of evidence supporting its ability to assist in the delivery of safe anaesthesia and surgical care. Here we report the introduction of the Checklist to a major Ethiopian referral hospital and low-resource setting and highlight the success and challenges of its implementation over a one year period. This project was conducted between July 2015 and August 2016, within a wider partnership between Felege Hiwot Hospital and The University of Aberdeen. The WHO Surgical Checklist was modified for appropriate and locally specific use within the OR of Felege Hiwot. The modified Checklist was introduced to all OR's and staff instructed on its use by local surgical leaders. Assessment of use of the Checklist was performed for General Surgical OR in three phases and Obstetric OR in two phases via observational study and case note review. Training was conduct between each phase to address challenges and promote use. Checklist utilisation in the general OR increased between Phase I and 2 from 50% to 97% and remained high at 94% in Phase 3. Between Phase I and 2 partial completion rose from 27% to 77%, whereas full completion remained unchanged (23% to 20%). Phase 3 resulted in an increase in full completion from 20% to 60%. After 1 year the least completed section was "Sign In" (53%) and "Time Out" was most completed (87%). The most poorly checked item was "Site Marked" (60%). Use of the checklist in Obstetrics OR increased between Phase I and Phase II from 50% to 100% with some improvement in partial completion (50% to 60%) and a notable increase in full completion (0% to 40%). The least completed section was "Time Out" (50%) and "Sign In" was the most completed (90%). The most poorly checked item was "Recovery Concerns" (70%). There was considerable enthusiasm for use of the checklist among staff. The greatest challenge was communication difficulties between teams and high staff turnover. This study records a locally driven, successful introduction of the WHO Surgical Safety Checklist modified for the specific locale and illustrates an increase in use of the checklist over a one year period in both General Surgical and Obstetric OR's. Local determination and ownership of the Checklist with regular intervention to promote use and train users contributed to this success.
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Bendix P, Havens JM. The Global Burden of Surgical Disease. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maheu-Giroux M, Filippi V, Maulet N, Samadoulougou S, Castro MC, Meda N, Pouliot M, Kirakoya-Samadoulougou F. Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data. BMC Pregnancy Childbirth 2016; 16:82. [PMID: 27098261 PMCID: PMC4839076 DOI: 10.1186/s12884-016-0871-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. METHODS We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. RESULTS Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13% (95% Credible Intervals (CrI): 1% to 23%), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95% CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95% CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95% CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95% CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant. CONCLUSIONS Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.
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Affiliation(s)
- Mathieu Maheu-Giroux
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, UK
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Maulet
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Sékou Samadoulougou
- Pôle Épidemiologie et Biostatistique, Institute de recherche expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Marcia C Castro
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicolas Meda
- Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,UFR Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Mariève Pouliot
- Institute of Food and Resources Economics, Section for Global Development, University of Copenhagen, Copenhagen, Denmark
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Sih AM, Kopp DM, Tang JH, Rosenberg NE, Chipungu E, Harfouche M, Moyo M, Mwale M, Wilkinson JP. Association between parity and fistula location in women with obstetric fistula: a multivariate regression analysis. BJOG 2016; 123:831-6. [PMID: 26853525 PMCID: PMC4860061 DOI: 10.1111/1471-0528.13901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location. DESIGN Cross-sectional study. SETTING Fistula Care Centre at Bwaila Hospital, Lilongwe, Malawi. POPULATION Women with OF who presented between September 2011 and July 2014 with a complete obstetric history were eligible for the study. METHODS Women with OF were surveyed for their obstetric history. Women were classified as multiparous if prior vaginal or caesarean delivery was reported. The location of the fistula was determined at operation: OF involving the urethra, bladder neck, and midvagina were classified as low; OF involving the vaginal apex, cervix, uterus, and ureters were classified as high. MAIN OUTCOME MEASURES Demographic information was compared between primiparous and multiparous women using chi-squared and Mann-Whitney U-tests. Multivariate logistic regression models were implemented to assess the relationship between variables of interest and fistula location. RESULTS During the study period, 533 women presented for repair, of which 452 (84.8%) were included in the analysis. The majority (56.6%) were multiparous when the fistula formed. Multiparous women were more likely to have laboured <1 day (62.4 versus 44.5%, P < 0.001), delivered a live-born infant (26.8 versus 17.9%, P = 0.026), and have a high fistula location (37.5 versus 11.2%, P < 0.001). Multiparity [adjusted odds ratio (aOR) = 4.55, 95% confidence interval (CI) 2.27-9.12)] and history of caesarean delivery (aOR = 4.11, 95% CI 2.45-6.89) were associated with development of a high fistula. CONCLUSIONS Multiparity was common in our cohort, and these women were more likely to have a high fistula. Additional research is needed to understand the aetiology of high fistula including potential iatrogenic causes. TWEETABLE ABSTRACT Multiparity and caesarean delivery were associated with a high tract fistula in our Malawian cohort.
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Affiliation(s)
- Allison M. Sih
- UNC Project-Malawi Scholar, SUNY Downstate Medical Center, College
of Medicine, Brooklyn, NY
| | - Dawn M. Kopp
- Global Women’s Health Fellow, UNC Department of Obstetrics
& Gynecology, Lilongwe, Malawi
| | - Jennifer H. Tang
- Assistant Professor, Division of Global Women’s Health, UNC
Department of Obstetrics & Gynecology, Lilongwe, Malawi
| | - Nora E. Rosenberg
- Postdoctoral Research Associate, UNC Project-Malawi, Lilongwe,
Malawi
| | - Ennet Chipungu
- Obstetrics and Gynaecology Specialist, Fistula Care Centre, Bwaila
Maternity Hospital, Lilongwe, Malawi
| | - Melike Harfouche
- Doris Duke Clinical Research Fellow 2011, Temple University
Department of Surgery, Philadelphia, PA
| | - Margaret Moyo
- Country Coordinator, Fistula Care Center, Bwaila Maternity
Hospital, Lilongwe, Malawi
| | - Mwawi Mwale
- District Health Officer, Bwaila Maternity Hospital, Lilongwe,
Malawi
| | - Jeffrey P. Wilkinson
- Professor, Baylor College of Medicine, Department of Obstetrics and
Gynecology, Lilongwe, Malawi
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Access to Cesarean Section Will Reduce Maternal Mortality in Low-Income Countries: A Mathematical Model. World J Surg 2016; 40:1537-41. [DOI: 10.1007/s00268-016-3479-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harrison MS, Mabeya H, Goldenberg RL, McClure EM. Urogenital fistula reviewed: a marker of severe maternal morbidity and an indicator of the quality of maternal healthcare delivery. Matern Health Neonatol Perinatol 2015; 1:20. [PMID: 27057337 PMCID: PMC4823691 DOI: 10.1186/s40748-015-0020-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND While obstetric fistula has been recognized as a major maternal morbidity since the 1980s, it has become an indicator of access to and quality of women' s health care. FINDINGS Obstetric fistula still exists in low-income countries (LIC) because health care systems fail to provide adequate family planning, skilled birth attendance, basic and emergency obstetric care, and affordable treatment of fistula, while concurrently lacking social networks to serve as safety nets for affected girls and women [WHO, 2007]. CONCLUSION This review explores the most recent published experience with respect to the definition of fistula, its diagnosis, treatment, and management, and further steps for prevention of fistula on a global scale.
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Affiliation(s)
- Margo S. Harrison
- />Department of Obstetrics/Gynecology, Columbia University, New York, NY USA
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