Universal access to safe, affordable, timely surgical and anaesthetic care in Papua New Guinea: the six global health indicators

Estimating the carbon emissions from a resource-limited surgical suite in Papua New Guinea: The climate change potential

Introduction

The upscale of surgical service delivery in low to middle income countries will increase health sector greenhouse gas emissions globally. Understanding surgical greenhouse gas emissions from surgical suite activities can direct decarbonization strategies and achieve local, and global climate change objectives.

Material and methods

A prospective surgical suite carbon foot print study was conducted at the Alotau Provincial Hospital from the 28th March 2022 to the 28th of May 2022.

Results

The total carbon emission for the surgical suite in APH over the study period was 2,665.8 kgCO2e. The average carbon emission per surgical case within the boundary of the surgical suite was 8.4 kgCO2e. Scope one emissions (anaesthetic gases) accounted for 44.7% (1171.3 kgCO2e) of all carbon emissions.

Conclusion

If no action is taken, carbon emissions in the western pacific region will continue to increase from surgical suites. Therefore, proactive efforts to reduce greenhouse gas emissions must be prioritized.

Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

INTRODUCTION

The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs).

METHODOLOGY

We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed.

RESULTS

A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries.

CONCLUSION

Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.

Perioperative mortality in Colombia: perspectives of the fourth indicator in The Lancet Commission on Global Surgery - Colombian Surgical Outcomes Study (ColSOS) - a protocol for a multicentre prospective cohort study

INTRODUCTION

Death following surgical procedures is a global health problem, accounting for 4.2 million deaths annually within the first 30 postoperative days. The fourth indicator of The Lancet Commission on Global Surgery is essential as it seeks to standardise postoperative mortality. Consequently, it helps identify the strengths and weaknesses of each country's healthcare system. Accurate information on this indicator is not available in Colombia, limiting the possibility of interventions applied to our population. We aim to describe the in-hospital perioperative mortality of the surgical procedures performed in Colombia. The data obtained will help formulate public policies, improving the quality of the surgical departments.

METHODS AND ANALYSIS

An observational, analytical, multicentre prospective cohort study will be conducted throughout Colombia. Patients over 18 years of age who have undergone a surgical procedure, excluding radiological/endoscopic procedures, will be included. A sample size of 1353 patients has been projected to achieve significance in our primary objective; however, convenience sampling will be used, as we aim to include all possible patients. Data collection will be carried out prospectively for 1 week. Follow-up will continue until hospital discharge, death or a maximum of 30 inpatient days. The primary outcome is perioperative mortality. A descriptive analysis of the data will be performed, along with a case mix analysis of mortality by procedure-related, patient-related and hospital-related conditions ETHICS AND DISSEMINATION: The Fundación Cardioinfantil-Instituto de Cardiología Ethics Committee approved this study (No. 41-2021). The results are planned to be disseminated in three scenarios: the submission of an article for publication in a high-impact scientific journal and presentations at the Colombian Surgical Forum and the Congress of the American College of Surgeons.

TRIAL REGISTRATION NUMBER

NCT05147623.

Strengthening rural surgery in the Philippines: Essential in achieving universal health care

The Lancet Commission on Global Surgery (LCoGS) launched Global Surgery 2030 to address the surgical services inequities with a bias toward low-income and middle-income countries like the Philippines. The same inequity is observed particularly when it comes to the urban-rural divide. With more than half of the population living in rural areas, access to surgery becomes a major challenge that further impedes the much-needed health of an economically productive workforce. The Universal Health Care [UHC] Act (RA 11332) of 2019 ensures that all Filipinos have access to quality, cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing a financial burden. Recognizing the provision of essential surgery, in the context of primary healthcare is important. It should be accessible, continuous, comprehensive, and coordinated at the time of need - parallel to the principle of primary health care. Driven by this concept and experiences, the authors conceptualized and presented the Philippine Rural Surgery model for future development and implementation. This is envisioned to provide essential surgery among local rural primary health care settings that is universal, accessible, cost-effective and safe. As this is still new in the Philippines, we proposed tenets and recommendations based on WHO Health System Strengthening building blocks to guide stakeholders in creating formal plans towards institutionalization under the principles of UHC. Such access to surgical service in the context of a unique socio-demography of the Philippines would be essential in attaining the parameters and provisions set by the UHC Act.

Perinatal mortality and its predictors in Kersa Health and Demographic Surveillance System, Eastern Ethiopia: population-based prospective study from 2015 to 2020

OBJECTIVE

Perinatal mortality is an important outcome indicator for newborn care and directly mirrors the quality of prenatal, intra partum and newborn care. Therefore, this study was aimed at estimating perinatal mortality and its predictors in Eastern Ethiopia using data from Kersa Health and Demographic Surveillance System (KHDSS).

DESIGN, SETTINGS AND PARTICIPANTS

An open dynamic cohort design was employed among pregnant women from 2015 to 2020 at KHDSS. A total of 19 687 women were observed over the period of 6 years, and 29 719 birth outcomes were registered.

OUTCOME MEASURES

Perinatal mortality rate was estimated for each year of cohort and the cumulative of 6 years. Predictors of perinatal mortality are identified.

RESULTS

From a total of 29 306 births 783 (26.72 deaths per 1000 births; 95% CI 24.88 to 28.66) deaths were occurred during perinatal period. Rural residence (adjusted OR (AOR)=3.43; 95% CI 2.04 to 5.76), birth weight (low birth weight, AOR=3.98; 95% CI 3.04 to 5.20; big birth weight, AOR=2.51; 95% CI 1.76 to 3.57), not having antenatal care (ANC) (AOR=1.67; 95% CI 1.29 to 2.17) were associated with higher odds of perinatal mortality whereas the parity (multipara, AOR=0.46; 95% CI 0.34 to 0.62; grand multipara, AOR=0.31; 95% CI 0.21 to 0.47) was associated with lower odds of perinatal mortality.

CONCLUSIONS

The study revealed relatively high perinatal mortality rate. Place of residence, ANC, parity and birth weight were identified as predictors of perinatal mortality. Devising strategies that enhance access to and utilisations of ANC services with due emphasis for rural residents, primipara mothers and newborn with low and big birth weights may be crucial for reducing perinatal mortality.

The direct medical cost of trauma aetiologies and injuries in a resource limited setting of Papua New Guinea: A prospective cost of illness study

Background

Injuries are a significant public health concern globally. Papua New Guinea has failed to achieve all eight health millennium development goals, and in doing so has not prioritized injuries in previous health policies. Understanding costs related to injuries can ultimately guide policies for surgical service delivery in achieving local, and universal health coverage objectives.

Methods

A prospective cost of illness study was conducted at Alotau Provincial Hospital (only major referral hospital), in the Milne Bay Province of Papua New Guinea, from the 1st of June 2020 to the 21st of December 2020. A bottom up approach of micro costing was used to estimate the direct medical cost of trauma aetiologies, and injuries of patients admitted to the surgical ward at Alotau Provincial Hospital.

Findings

The mean cost of managing traumatic injuries was K45, 900.40 (US$13,311.12) per patient. The most common cause of injury was alcohol related injuries (n=32) with a total direct medical cost of K1, 417, 023.73 (US$410,936.88). The most common injury was fractures (n=40) with a total direct medical cost of K1, 907, 531.88 (US$553,184.25). The highest cost for trauma aetiologies were MVAs with a mean cost of K48, 687.40 (US$14, 119.35) per patient. The highest cost for injuries was abdominal trauma with a mean cost K55,929.69(US$16,219.61) per patient.

Interpretation

Poor regulation of alcohol and road safety is associated with high surgical costs. In an era of financial instability, reducing injuries is economical in acheiving health care objectives that rely heavily on adequate funding, and financing.

Funding

No funding source.

The Direct Medical Cost of Acute Appendicitis Surgery in a Resource-Limited Setting of Papua New Guinea

BACKGROUND

Acute appendicitis is a common surgical emergency, and challenges in access to surgery in a low middle-income country can direct cost implications.

METHODS

A prospective cost of illness study was conducted at Alotau Provincial Hospital (APH) from October 14, 2019, to June 1, 2020. A bottom-up approach of microcosting was used to estimate the direct medical cost of consecutive patients with acute appendicitis undergoing surgery.

RESULTS

The mean cost of acute appendicitis surgery for each patient was K39,517.66 (US$11,460.12) for uncomplicated appendicitis, K45,873.99 (US$13,303.46) for complicated appendicitis and K38,838.80 (US$ 11,263.25) for a normal appendix. In total, the direct medical cost for acute appendicitis in this study was K4,562,625.29 (US$ 1,323,161.33) with the majority of expenditure incurred by surgical ward expenses.

CONCLUSION

This study demonstrates that direct medical costs for uncomplicated appendicitis surgery in a resource-limited hospital are less expensive. As the pathology progresses, the cost also exponentially increases. Policy makers and clinicians must establish appropriate curative surgical services at secondary (NOM of acute appendicitis and laparoscopic surgery) and primary health-care levels to address acute appendicitis surgery as this can reduce costs.