General surgical services at an urban teaching hospital in Mozambique

Abstract

Background As surgery becomes incorporated into global health programs, it will be critical for clinicians to take into account already existing surgical care systems within low-income countries. In order to inform future efforts to expand the local system and systems in comparable regions of the developing world, we aimed to describe current patterns of surgical care at a major urban teaching hospital in Mozambique. Methods We performed a retrospective review of all general surgery patients treated between August 2012 and August 2013 at Hospital Central Maputo in Maputo, Mozambique. We reviewed emergency and elective surgical logbooks, inpatient discharge records, and death records to report case volume, disease etiology, and mortality. Results There were 1,598 operations (910 emergency, 688 elective) and 2,606 patient discharges during our study period. The most common emergent surgeries were for non-trauma laparotomy (22%) followed by all trauma procedures (18%), while the most common elective surgery was hernia repair (31%). The majority of lower extremity amputations were above knee (69%). The most common diagnostic categories for inpatients were infectious (31%), trauma (18%), hernia (12%), neoplasm (10%), and appendicitis (5%). The mortality rate was 5.6% (146 deaths), approximately half of which were related to sepsis. Conclusions Our data demonstrate the general surgery caseload of a large, academic, urban training and referral center in Mozambique. We describe resource limitations that impact operative capacity, trauma care, and management of amputations and cancer. These findings highlight challenges that are applicable to a broad range of global surgery efforts.

Midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city: a qualitative study

“…They blame us for all their bad experiences with hospitals, it is all our fault." (Midwife, FGD 7, age group [24][25][26][27][28][29][30] Insults and aggression by patients was a daily reality according to the midwives, mostly by upper-class patients who demanded a better service.…”

“…"If you are dealing with three patients and one has eclampsia, another needs a caesarean section and the third suddenly has a haemorrhage, for sure one will be abandoned. "(Midwife, FGD 2, age group [24][25][26][27][28][29][30] They also linked this to the stress of being accused afterwards of making medical errors.…”

“…It is noteworthy that midwives in Maputo City often combine a job in the public sector with extra hours in the private sector to increase their income. HCM is the only hospital in the country equipped to handle advanced operations, thereby serving as the last referral centre for the entire country [26]. The principle investigator (AG) has been leading a cross sectional study about RMC in the same hospital [14] and was involved in various projects in the hospital between 2014-2019, witnessing the evolutions in terms of equipment, infrastructure and quality of care over this period.…”

“…And the mother will even thank us for that afterwards." (Midwife, FGD 1, age group [24][25][26][27][28][29][30] If the expulsion phase is taking too long they were convinced that it is necessary and acceptable to use force. Surprisingly, midwives unanimously tend to blame the women for a di cult delivery.…”

A qualitative study on midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city

“…It is noteworthy that midwives in Maputo City often combine a job in the public sector with extra hours in the private sector to increase their income. HCM is the only hospital in the country equipped to handle advanced operations, thereby serving as the last referral center for the entire country [23]. The principle investigator (AG) has been leading a cross sectional study about RMC in the same hospital [18] and was involved in various projects in the hospital between 2014-2019, witnessing the evolutions in terms of equipment, infrastructure and quality of care over this period.…”