An Assessment of Surgical and Anesthesia Staff at 10 Government Hospitals in Sierra Leone

Vaughan, Emily; Sesay, Frances; Chima, Adaora; Meheš, Mira; Lee, Benjamin; Dordunoo, Dzifa; Sitch, Alice; Wildt, Gilles de; Kamara, Thaim B.; Leigh, Bailah; Sampson, J.B.

doi:10.1001/jamasurg.2014.2246

Cited by 17 publications

(19 citation statements)

References 16 publications

(15 reference statements)

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“…The STP was planned in 2009 as Sierra Leone was recovering from a devastating civil war. This country, with 5·5 million inhabitants, at that time had only 167 MDs in clinical practice, poor output from the medical school and no formal postgraduate training available in surgery or obstetrics. Surgical care was not prioritized in the national health agenda, despite an extensive surgical disease burden and mortality, and there was more than 90 per cent unmet surgical need.…”

Section: Methodsmentioning

confidence: 99%

Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone

Bolkan

Duinen

Waalewijn

et al. 2017

British Journal of Surgery

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BackgroundSurgical task‐sharing may be central to expanding the provision of surgical care in low‐resource settings. The aims of this paper were to describe the set‐up of a new surgical task‐sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume.MethodsThis prospective observational study from a consortium of 16 hospitals evaluated crude in‐hospital mortality over 5 years and productivity of operations performed during and after completion of a 3‐year surgical training programme.ResultsSome 48 trainees and nine graduated surgical assistant community health officers (SACHOs) participated in 27 216 supervised operations between January 2011 and July 2016. During training, trainees attended a median of 822 operations. SACHOs performed a median of 173 operations annually. Caesarean section, hernia repair and laparotomy were the most common procedures during and after training. Crude in‐hospital mortality rates after caesarean sections and laparotomies were 0·7 per cent (13 of 1915) and 4·3 per cent (7 of 164) respectively for operations performed by trainees, and 0·4 per cent (5 of 1169) and 8·0 per cent (11 of 137) for those carried out by SACHOs. Adjusted for patient sex, surgical procedure, urgency and hospital, mortality was lower for operations performed by trainees (OR 0·47, 95 per cent c.i. 0·32 to 0·71; P < 0·001) and SACHOs (OR 0·16, 0·07 to 0·41; P < 0·001) compared with those conducted by trainers and supervisors.Conclusion SACHOs rapidly and safely achieved substantial increases in surgical volume in Sierra Leone.

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Section: Methodsmentioning

confidence: 99%

Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone

Bolkan

Duinen

Waalewijn

et al. 2017

British Journal of Surgery

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“…Although it is widely known that patients maintain respiratory drive and airway protective reflexes with ketamine anaesthesia, further research is also needed to address anaesthesia safety. The capacity to provide safe anaesthesia has been reported as very low, even as nurse anaesthetists are being trained to increase access to anaesthesia across the country 48. Most facilities in Sierra Leone lack the human resources and infrastructure to provide care for patients who are critically ill, which may contribute further to the high perioperative mortality 49…”

Section: Discussionmentioning

confidence: 99%

“…In Sierra Leone, caesarean sections are carried out by both physicians and associate clinicians,50 and most of the anaesthesia is provided by nurse anaesthetists 48. Such task sharing has a long history on the African continent,51–53 particularly for caesarean delivery, and in many cases with good results 53.…”

Section: Discussionmentioning

confidence: 99%

The rate and perioperative mortality of caesarean section in Sierra Leone

et al. 2019

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IntroductionSierra Leone has the world’s highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.MethodsWe conducted a retrospective study of all caesarean sections and all reported in-facility maternal deaths in Sierra Leone in 2016. All facilities performing caesarean sections were visited. Data on in-facility maternal deaths were retrieved from the Maternal Death Surveillance and Response database. Caesarean section mortality was defined as in-facility perioperative mortality.ResultsIn 2016, there were 7357 caesarean sections in Sierra Leone. This yields a population rate of 2.9% of all live births, a 35% increase from 2012, with district rates ranging from 0.4% to 5.2%. The most common indications for surgery were obstructed labour (42%), hypertensive disorders (25%) and haemorrhage (22%). Ninety-nine deaths occurred during or after caesarean section, and the in-facility perioperative caesarean section mortality rate was 1.5% (median 0.7%, IQR 0–2.2). Haemorrhage was the leading cause of death (73%), and of those who died during or after surgery, 80% had general anaesthesia, 75% received blood transfusion and 22% had a uterine rupture diagnosed.ConclusionsThe caesarean section rate has increased rapidly in Sierra Leone, but the distribution remains uneven. Caesarean section mortality is high, but there is wide variation. More access to caesarean sections for maternal and neonatal complications is needed in underserved areas, and expansion should be coupled with efforts to limit late presentation, to offer assisted vaginal delivery when indicated and to ensure optimal perioperative care.

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“…Before the EVD outbreak, there were ten consultant surgeons in the public government hospitals and an estimated twenty-six in private non-profit hospitals in Sierra Leone (41,42). The LCoGS demonstrated that a surgical workforce density of less than 20 per 100,000 specialist surgeons, anaesthesiologists, and obstetricians correlates with lower rates of maternal survival (5).…”

Section: Surgical Volumementioning

confidence: 99%

Assessing the need for surgical treatments in Sierra Leone

Bolkan¹

2019

http://isrctn.com/

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An Assessment of Surgical and Anesthesia Staff at 10 Government Hospitals in Sierra Leone

Cited by 17 publications

References 16 publications

Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone

Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone

The rate and perioperative mortality of caesarean section in Sierra Leone

Assessing the need for surgical treatments in Sierra Leone

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