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Bryce-Alberti M, Bosché M, Benavente R, Chowdhury A, Steel LB, Winslow K, Bain PA, Le T, Hamzah R, Ilkhani S, Pratt M, Carroll M, Nunes Campos L, Anderson GA. Examining nonmilitary and nongovernmental humanitarian surgical capacity and response in armed conflicts: A scoping review of the recent literature. Surgery 2024; 176:748-756. [PMID: 38955644 DOI: 10.1016/j.surg.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Armed conflicts pose a burden on health care services. We sought to assess the surgical capacity and responses of nonmilitary and nongovernmental humanitarian responders in armed conflicts through proxy indicators to identify strategies to address surgical needs. METHODS We searched 6 databases for articles/studies from January 1, 2013, to March 10, 2023. We included articles detailing the surgical capacity of nonmilitary, nongovernmental organizations operating in armed conflicts. We defined surgical capacity through indicators including the type and number of surgical procedures; number of operating rooms, surgical beds, surgeons, anesthesiologists, and surgical equipment; and type of anesthesia employed. RESULTS We screened 2,187 abstracts and 279 full texts and included 30 articles/studies. Our sample covered 23 countries and 17 surgical specialties. Most publications focused on surgical capacity assessment (63.3%, 19/30) and surgical and clinical outcomes (63.3%, 19/30). Most articles/studies reported surgical capacity indicators at the hospital (56.7%, 17/30) and multinational (26.7%, 8/30) levels. The number (86.7%, 26/30) and type (76.7%, 23/30) of surgical procedures performed were the most commonly reported. More than one half of the articles (53.3%, 16/30) described strategies to meet surgical needs in armed conflicts. Most strategies addressed information management (68.8%, 11/16), health workforce (62.5%, 10/16), and service delivery (62.5%, 10/16). CONCLUSION This review collated common approaches for strengthening health care services in armed conflicts. Several articles emphasized strategies for improving information management, service delivery, and workforce capacity. Hence, we call for standardization of response protocols and multilevel collaborations to maintain or even scale up surgical capacity in armed conflicts.
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Affiliation(s)
- Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
| | | | | | | | - Lili B Steel
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Kiana Winslow
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA
| | - Thalia Le
- Drexel College of Medicine, Philadelphia, PA
| | - Radzi Hamzah
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Saba Ilkhani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Malerie Pratt
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil
| | - Geoffrey A Anderson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; US Air Force Reserves, 439th Aeromedical Staging Squadron, Westover Air Reserve Base, Chicopee, MA
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Mykolaivna NI, Ahmad AO, Adebusoye FT, Awuah WA, Wellington J, Tenkorang PO, Abdul-Rahman T, Lansiaux E. War-induced obstetric emergencies necessitate improved global intervention. Postgrad Med J 2023; 99:1049-1051. [PMID: 37358414 DOI: 10.1093/postmj/qgad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Affiliation(s)
| | - Amal Olabisi Ahmad
- Faculty of Medicine, Sumy State University, Sumy State University , Sumy 40007, Ukraine
| | - Favour Tope Adebusoye
- Faculty of Medicine, Sumy State University, Sumy State University , Sumy 40007, Ukraine
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sumy State University , Sumy 40007, Ukraine
| | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Wales CF14 4XN, United Kingdom
| | - Pearl Ohenawaa Tenkorang
- Faculty of medicine, University of Ghana Medical School, University of Ghana Medical School, Accra 4236, Ghana
| | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sumy State University , Sumy 40007, Ukraine
| | - Edouard Lansiaux
- Faculty of Medicine, Lille University of Medecine, Lille University School of Medecine, Lille 59000, France
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Basha S, Socarras A, Akhter MW, Hamze M, Albaik A, Hussein I, Tarakji A, Hamadeh M, Loutfi R, Kewara M, Alahdab F, Abbara A. Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria. BMJ Glob Health 2022; 7:bmjgh-2021-008001. [PMID: 36041781 PMCID: PMC9438041 DOI: 10.1136/bmjgh-2021-008001] [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: 11/18/2021] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Syria’s protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria. Methods We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy. Results Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%–45%,) Damascus (16%–54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings. Conclusion The quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
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Affiliation(s)
- Sara Basha
- School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Alex Socarras
- Syrian American Medical Society, Washington, District of Columbia, USA
| | | | | | - Ahmad Albaik
- Syrian American Medical Society, Gaziantep, Turkey
| | - Imad Hussein
- Syrian American Medical Society, Gaziantep, Turkey
| | - Ahmad Tarakji
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Mufaddal Hamadeh
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Randa Loutfi
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Mazen Kewara
- Syrian American Medical Society, Gaziantep, Turkey
| | - Fares Alahdab
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Aula Abbara
- Syrian American Medical Society, Washington, District of Columbia, USA .,Department of Infection, Imperial College, London, UK
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