A Tool and Index to Assess Surgical Capacity in Low Income Countries: An Initial Implementation in Sierra Leone

Groen, Reinou S.; Kamara, Thaim B.; Dixon-Cole, Richmond; Kwon, Steven; Kingham, T. Peter; Kushner, Adam L.

doi:10.1007/s00268-012-1591-3

Cited by 87 publications

(110 citation statements)

References 23 publications

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“…Before the Ebola epidemic, Sierra Leone had 30 surgical providers and 32 anaesthesia providers for a country of six million. 21 Now, sadly, there are many fewer. Most of these providers are located in the larger urban centres which have only 39% of the population.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is recognized that surgery and anaesthesia services in low-and middle-income countries (LMICs) are un-der-equipped and under-staffed. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Most of this data comes from assessments of personnel, supplies and workload at institutions throughout the low resource world. It clearly demonstrates that surgical and anaesthesia services are unable to meet the current need, but gives no sense as to the true extent and nature of unmet need.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey

Harris

Kamara

Hanciles³

et al. 2015

Afr H. Sci.

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Objectives: To determine the unmet anaesthesia need in a low resource region. Introduction: Surgery and anaesthesia services in low-and middle-income countries (LMICs) are under-equipped, under-staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of unmet need. Without such an understanding it is impossible to formulate solutions. Therefore, we re-examined Surgeons OverSeas (SOSAS) unmet surgical need data to extrapolate unmet anaesthesia need. Methods: For the untreated surgical conditions identified by SOSAS, we assigned anaesthetic technique required to carry out the procedure. The chosen anaesthetic was based on common practice in the region. Procedures were categorized into minimal anaesthesia, spinal anaesthesia, regional anaesthesia, ketamine/monitored anaesthesia care (MAC), and general endotracheal anaesthesia (GETA Sci. 2015;15(3):1028-33. doi: http://dx.doi. org/10.4314/ahs.v15i3.43

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey

Harris

Kamara

Hanciles³

et al. 2015

Afr H. Sci.

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“…This has been the basis for developing alternative models. [10][11][12][13][14] These emphasize the measurement of inputs in facility-based assessments, whereas our proposed framework includes input and process indicators across all levels of the LMIC health system.…”

Section: Inputs and Processesmentioning

confidence: 99%

Improving surgical systems in low- and middle-income countries: an inclusive framework for monitoring and evaluation

Bendix

Anderson

Rose

et al. 2015

International Health

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High disease burden and inadequate resources have formed the basis for advocacy to improve surgical care in low-and middle-income countries (LMICs). Current measures are heavily focused on availability of resources rather than impact and fail to fully describe how surgery can be more integrated into health systems. We propose a new monitoring and evaluation framework of surgical care in LMICs to integrate surgical diseases into broader health system considerations and track efforts toward improved population health. Although more discussion is required, we seek to broaden the dialogue of how to improve surgical care in LMICs through this comprehensive framework.

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“…Amputation is an ultimate form (last option) of treatment. Alternatives are usually less satisfactory and are only adopted in circumstances such as lack of patients' consent and or funds (Udosen AM et al 2009 Sierra Leone is one of the poorest countries in the world and studies have documented its profound lack of surgical capacity (Kingham TP et al 2009;Groen RS et al 2012) According to the Sierra Leone National Health Sector Strategic Plan 2010-15, at least 20 surgeons should be trained to meet the unmet need; however, with fewer than 30 medical doctors graduating annually and few training opportunities, such goals are unlikely to be achieved soon.…”

Section: Introductionmentioning

confidence: 99%

Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.

Nabieu¹,

Massaquoi²,

Massaquoi³

et al. 2016

Sierra Leone j. biomed. res.

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The global prevalence of diabetes mellitus is increasing substantially. This overall increment leads to the growth in the number of individuals with diabetic complications including peripheral arterial disease and lower extremity amputation. In low-income countries like Sierra Leone, the lack of access to adequate health care, poverty and social stigma attached to the term "Amputation" all prevent people from seeking early medical treatment for diabetic foot lesions. The purpose of this study was to establish and document the causes, risk factors, indications and complications of lower limb amputations and to make appropriate recommendations to the health sector of Sierra Leone for it prevention.This retrospective study was conducted at 34 Military Hospital, one of the major referral hospitals in Freetown, between January 2011 and December 2014. A team of medical staff was trained. The operating theatre records, anesthetists' books and ward case notes were searched for information of all the patients who underwent amputation during period under review. The findings were statistically documented in tables.Twenty-seven (27) patients were involved in the study. There were 24 males and 3 females. The age distribution was 15-65 (Mean 43 years). Majority (77.7%) of the patients presented with gangrenous and infected diabetic feet, 18.5 % was due to Road Traffic Accident and 3.8% due to complication of HIV infection. The commonest procedure was transtibial amputation (85%) and (67%) was on the right side. Hospital stay was 20-50 days (35 days). There was no postoperative mortality.As most amputations were done for diabetic feet, there is a need for diabetes sensitization and prevention campaigns for the general public and improvement of diabetic care for individual patients including proper glycemic control and risk factors prevention. Prevention of road traffic accidents by training of drivers and motorbike riders should also be considered. Increased funding is needed by the health sector of Sierra Leone to implement these measures.

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A Tool and Index to Assess Surgical Capacity in Low Income Countries: An Initial Implementation in Sierra Leone

Abstract: The PIPES tool was easily administered at hospitals in Sierra Leone and an index was found useful. Surgical capacity in Sierra Leone improved between 2008 and 2011, as demonstrated by an increase in the overall PIPES indices.

Cited by 87 publications

References 23 publications

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey

Improving surgical systems in low- and middle-income countries: an inclusive framework for monitoring and evaluation

Lower Limb Amputation at the 34 Military Hospital in Freetown, Sierra Leone: Causes and Indications.

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