An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan

Bruno, Emily; White, Michelle; Baxter, Linden; Ravelojaona, Vaonandianina A; Rakotoarison, Hasiniaina N; Andriamanjato, Hery Harimanitra; Close, Kristin L.; Herbert, Alison; Raykar, Nakul; Saluja, Saurabh; Shrime, Mark G.

doi:10.1007/s00268-016-3847-9

Cited by 45 publications

(36 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is, to our knowledge, the first project to study the implementation of capnography and its impact in a low‐income country. The 97% gap in capnography provision in the operating theatres and the 100% gap in capnography provision in intensive care reflects the results of surveys in other low‐income countries . The oximetry gap in operating theatres at the start of the Global Oximetry Project in Uganda was 64% .…”

Section: Discussionmentioning

confidence: 60%

Global Capnography Project (GCAP): implementation of capnography in Malawi – an international anaesthesia quality improvement project

et al. 2018

View full text Add to dashboard Cite

Summary The Lancet Commission on Global Surgery emphasised the importance of access to safe anaesthesia care. Capnography is an essential monitor for safe anaesthesia, but is rarely available in low‐income countries. The aim of this study was twofold: to measure the prevalence of capnography in the operating theatres and in intensive care units; and to determine whether its introduction was feasible and could improve the early recognition of critical airway incidents in a low‐income country. This is the first project to do this. Forty capnographs were donated to eight hospitals in Malawi. Thirty‐two anaesthesia providers received a 1‐day capnography training course with pre‐ and post‐course knowledge testing. Providers kept logbooks of capnography use and recorded their responses to abnormal readings. On follow‐up at 6 months, providers completed questionnaires on any significant patient safety incidents identified using capnography. In January 2017, at the commencement of the project, only one operating theatre had a capnograph. Overall, 97% and 100% ‘capnography gaps’ were identified in the theatres and intensive care units, respectively. The mean (SD) scores of our capnography multiple choice questionnaires improved after training from 15.00 (3.16) to 18.70 (0.99), p = < 0.001. The capnography equipment was appropriately robust and performed well. Six months following implementation, 24 (77%) anaesthesia providers reported recognising 44 oesophageal intubations and 28 (90%) believed that capnography had saved lives. This study has shown it is feasible to introduce capnography in a low‐income country, resulting in early recognition of critical airway incidents and ultimately helping to save lives. Building on the experience of the first trial of pulse oximetry implementation in low‐income countries in 2007, we believe this is one of the most important projects in anaesthesia safety in the last decade.

show abstract

Section: Discussionmentioning

confidence: 60%

Global Capnography Project (GCAP): implementation of capnography in Malawi – an international anaesthesia quality improvement project

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Although the proportion of the population protected from impoverishing and catastrophic expenditure has been modelled previously for 186 countries, no primary national‐level data were found. Some primary subnational data have enabled estimation of these indicators but, without country‐level primary data, comparability and utility of this indicator remain low. Primary data could be obtained relatively simply by collecting information on out‐of‐pocket cost of surgery through interviewing samples of patients who have undergone surgery (exit interviews) and using nationally representative sampling strategies; household income data are likely to be collected as part of monitoring for the broader universal health coverage financing agenda.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the collection, comparability and findings of six global surgery indicators

Holmer

Bekele

Hagander

et al. 2019

Journal of British Surgery

102

View full text Add to dashboard Cite

Background In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. Methods Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. Results Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916–2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. Conclusion Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

show abstract

“…The study was a collaboration between the non‐governmental organization Mercy Ships, the Benin Ministry of Health and the academic institution, King's College London. Mercy Ships visits countries at the invitation of the Head of State, typically spending 10 months delivering free operations and training in partnership with the Ministry of Health, aiming to strengthen the surgical ecosystem, and advocate access to safe affordable timely surgery and development of national surgical plans.…”

Section: Methodsmentioning

confidence: 99%

Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist

White

Randall

Capo-Chichi

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low‐income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally. Methods This study had a longitudinal embedded mixed‐methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty‐six hospitals received 3‐day multidisciplinary training and 4‐month follow‐up. Seventeen hospitals were sampled purposively for evaluation at 12–18 months. The primary outcome was sustainability of checklist use at 12–18 months measured by questionnaire. Secondary outcomes were CFIR‐derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups. Results At 12–18 months, 86·0 per cent of participants (86 of 100) reported checklist use compared with 31·1 per cent (169 of 543) before training and 88·8 per cent (158 of 178) at 4 months. There was high‐fidelity use (median WHOBARS score 5·0 of 7; use of basic safety processes ranged from 85·0 to 99·0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76·7, 81·1 and 82·2 per cent before, and at 4 and 12–18 months after training respectively; P < 0·001). Acceptability, adoption, appropriateness and feasibility scored 9·6–9·8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully. Conclusion This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.

show abstract

An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan

Cited by 45 publications

References 44 publications

Global Capnography Project (GCAP): implementation of capnography in Malawi – an international anaesthesia quality improvement project

Global Capnography Project (GCAP): implementation of capnography in Malawi – an international anaesthesia quality improvement project

Evaluating the collection, comparability and findings of six global surgery indicators

Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist

Contact Info

Product

Resources

About