Estimating obstetric and gynecologic surgical rate: A benchmark of surgical capacity building in Ghana

Gyedu, Adam; Lester, Lynette; Stewart, Barclay T; Danso, Kwabena A.; Salia, Emmanuella L.; Quansah, Robert; Donkor, Peter; Mock, Charles

doi:10.1002/ijgo.13019

Cited by 7 publications

(2 citation statements)

References 19 publications

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“…Caesarean sections are common in Ghana and national rates have increased from 9.8% in 2003 to 16%-18.5% in 2014 [ 21 – 23 ]. Eighty percent (80%) of about 90,000 obstetric and gynaecological surgeries performed in Ghana over 2014–2015 were caesarean sections [ 24 ]. In spite of these numbers, there is no known study on postoperative pain assessment conducted solely on post-CS patients in Ghana.…”

Section: Introductionmentioning

confidence: 99%

Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana

et al. 2022

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Introduction Caesarean sections (CS) feature prominently in obstetric care and have impacted positively on maternal / neonatal outcomes globally including Ghana. However, in spite of documented increasing CS rates in the country, there are no studies assessing the adequacy of post-CS pain control. This study assessed the adequacy of post-CS pain management as well as factors influencing this outcome. Additionally, post-CS analgesia prescription and serving habits of doctors and nurses were also described to help fill existing knowledge gaps. Methods Pain scores of 400 randomly selected and consenting post-CS women at a tertiary facility in Ghana were assessed at 6–12 hours post-CS at rest and with movement and at 24–36 hours post-CS with movement using a validated visual analog scale (VAS) from February 1, 2015 to April 8, 2015. Participant characteristics including age, marital status and duration of CS were obtained using pretested questionnaires and patient records review. Descriptive statistics were presented as frequencies and proportions. Associations between background characteristics and the outcome variables of adequacy of pain control at 6–12 hours post-CS at rest and with movement and at 24–36 hours post-CS with movement were analysed using Chi-square and Fisher’s exact tests and logistic regression methods. Adequate pain control was defined as VAS scores ≤5. Results At 6–12 hours post-CS (at rest), equal proportions of participants had adequate and inadequate pain control (50.1% vrs 49.9%). Over the same time period but with movement, pain control was deemed inadequate in 93% of respondents (369/396). Women who had one previous surgery [OR 0.47 95%CI 0.27, 0.82; p = 0.008] and those whose CS lasted longer than 45 mins [OR 0.39 95% CI 0.24, 0.62; p<0.001] had lower odds of reporting adequate pain control. Women prescribed 12-hourly and 8-hourly doses of pethidine had only 23.5% (12/51) and 10.3% (3/29) served as prescribed respectively. At 24–36 hours post CS, adequate pain control was reported by 85.3% (326/382) of participants. Conclusions Pain management was deemed inadequate within the first 12 hours post-CS with potential implications for early mother-child interaction. Appreciable numbers of participants did not have their analgesics served as prescribed. Adjunct pain control measures should be explored and healthcare workers must be encouraged to pay more attention to patients’ pain relief needs.

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Section: Introductionmentioning

confidence: 99%

Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana

et al. 2022

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“…Most of the literature around CS deliveries includes studies discussing CS rates per 1000 live births, overuse of CS, and appropriateness of Robson's criteria. Our aim was not to enter that debate, and hence, we mainly focused on the absolute number of CS and their contribution to overall surgical volumes [14, 15].…”

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confidence: 99%

Authors’ Reply: Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

Patil,

Nathani,

Bakker

et al. 2023

World j. surg.

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

et al. 2023

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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.

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Estimating obstetric and gynecologic surgical rate: A benchmark of surgical capacity building in Ghana

Cited by 7 publications

References 19 publications

Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana

Assessment and determinants of acute post-caesarean section pain in a tertiary facility in Ghana

Authors’ Reply: Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

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

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