Provision of surgical care in Ethiopia: Challenges and solutions

Kelly, Caitrin M; Starr, Nichole; Raykar, Nakul; Yorlets, Rachel R; Liu, Charles; Derbew, Miliard

doi:10.1080/17441692.2018.1436720

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…Universally, intestinal obstruction varies from country to country in terms of incidence and management outcomes depending on ethnicity, age group, dietary habits, residence, geographic location, the living condition of the community, presentation, length of hospital stay, comorbid illness, duration of operation, duration of illness, presence of peritonitis, and service provision [ 5 , 17 – 19 ]. Difficulties in using the checklist, postoperative intra-abdominal infections, the inadequacy of training, and insufficient amount of anesthesiologists, nurses, and support staff [ 19 – 22 ] were some of the challenges which lead to poor management outcomes.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study

Derseh¹,

Dingeta

Yusouf³

et al. 2020

BioMed Research International

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Background. Despite the advancement in the healthcare system, the impact of surgical interventions on public health systems will continue to grow. But predicting the outcome is challenging. Concerns related to unexpected outcomes and delays in the diagnosis of postoperative complications are the major issue. Intestinal obstruction is a common life-threatening surgical condition followed by fatal and nonfatal postoperative complications. This study was aimed at assessing results after surgery for intestinal obstruction in a hospital of Ethiopia. Methodology. An institutional-based cross-sectional study was conducted among 254 postoperative patients admitted with intestinal obstruction from January 1, 2014, to December 31, 2017. Data were coded and entered into EpiData 4.2.0.0 software and exported to the Statistical Package for the Social Sciences version 22 for analysis. A binary logistic regression model was used for analysis. All variables with a p value < 0.25 during bivariable analysis were considered for multivariable logistic regression analysis. Results. The magnitude of poor surgical outcome of intestinal obstruction was 21.3% for patients enrolled into this investigation. The age group of ≥55 years ( adjusted odds ratio AOR = 2.9 , 95% CI: 1.03, 8.4), duration of illness of ≥24 hrs ( AOR = 3.1 , 95% CI: 1.03, 9.4), preoperative diagnosis of a gangrenous large bowel ( AOR = 3.6 , 95% CI: 1.3, 9.8), and a gangrenous small bowel ( AOR = 4.2 , 95% CI: 1.3, 13.7) were significantly associated with poor surgical outcome. Conclusions. The magnitude of poor surgical outcome was high. Age, late presentation of illness, and gangrenous bowel obstructions were significantly associated with poor outcomes. So, concern should be given in early detection and follow-up of patients who came late and older patients.

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Section: Introductionmentioning

confidence: 99%

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study

Derseh¹,

Dingeta

Yusouf³

et al. 2020

BioMed Research International

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“…Qualitative research with community members has been successful in Ethiopia, previously, including in this region and regarding barriers to surgical care, specifically. 8, [51][52][53][54][55][56][57] The two types of data will be triangulated to produce a joint display of our qualitative and quantitative findings. The same analytic methods that were used during the exploration phase will be used during the preparation phase.…”

Section: Methodsmentioning

confidence: 99%

A mobile caesarean birth center as a solution to improve access to surgical birth in rural Ethiopia: a mixed methods research protocol

Harrison

Yarinbab

Dorsey-Holliman

et al. 2021

Preprint

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Background As an evidence-based intervention to prevent maternal and neonatal morbidity and mortality, cesarean birth at rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem and represents an important disparity in use of this life-saving treatment compared to more developed regions. The objective of this study is to explore an innovative clinical solution (a mobile cesarean birth center) to low cesarean birth rates resulting from the Three Delays to emergency obstetric care in isolated and underserved regions of Ethiopia, and the world. Methods We will used mixed but primarily qualitative methods to explore and prepare the mobile cesarean birth center for subsequent implementation in communities in Bench Sheko and West Omo Zones. This will involve interviews and focus groups with key stakeholders and retreat settings for user-centered design activities. We will present stakeholders with a prototype surgical truck that will help them conceive of the cesarean birth center concept and discuss implementation issues related to staffing, supplies, referral patterns, pre- and post-operative care, and relationship to locations for vaginal birth. Discussion Completion of our study aims will allow us to describe participants’ perceptions about barriers and facilitators to cesarean birth and their attitudes regarding the appropriateness, acceptability, and feasibility of a mobile cesarean birth center as a solution. It will also result in a specific, measurable, attainable, relevant, and timely (SMART) implementation blueprint(s), with implementation strategies defined, as well as recruitment plans identified. This will include the development of a logic model and process map, a timeline for implementation with strategies selected that will guide implementation, and additional adaptation/adjustment of the mobile center to ensure fit for the communities of interest.

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“…Dif iculties in using the checklist, postoperative intraabdominal infections, the inadequacy of training, and insuf icient amount of anesthesiologists, nurses, and support staff were some of the challenges which lead to poor management outcomes [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Management outcome of intestinal obstruction done by integrated emergency surgical officers and its associated factors in selected district hospitals of South Wollo Zone, North East Ethiopia in 2019 G.C

Ademe¹,

Edmealem²,

Tegegne³

et al. 2021

Ann Clin Gastroenterol Hepatol

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Background: Intestinal obstruction (IO) is defined as a partial or complete blockage of the bowel that results in the failure of intestinal contents to pass through. It is a common cause of emergency surgical problems. IO has been the leading cause of acute abdomen in several African countries. Objective: To assess surgical management outcome of intestinal obstruction by IESO professionals and its associated factors of intestinal obstruction in surgically treated patients at South Wollo zone. Method: A cross-sectional study was done on 216 patients ‘the data was collected from medical cards of the patient by using a pretested data abstraction format. Three nurses were involved in the process of data collection. The collected data was cleaned, coded and analyzed by SPSS version 23 statistical package. First descriptive statics was done for categorical and analyzed using frequencies and percentage. Multivariable logistic regression models was used to determine the association factors on the management outcome of intestinal obstruction when p - value < 0.05 and the strength of statistical association was measured by adjusting odds ratio and 95% confidence interval. Statistical significance was taken at p - value < 0.05. Results: From all study participants about 177 (82%) of them had good surgical outcome. Study participants who were managed by 1-3 years of work experience of IESO {(p = 0.004, AOR (95% CI) = 7.2[1.89, 27.68]}, preoperatively diagnosed as small bowel obstruction {(p = 0.001, AOR (95% CI) = 4.5[1.91, 10.40], Surgery conducted at day time {(p = 0.03, AOR (95% CI) = 2.8[1.06, 7.16]} had shown positive association with management outcome of intestinal obstruction conducted by IESO professionals. Conclusion and recommendation: Majority patients with intestinal obstruction had good surgical outcome done by IESO professionals. Year of experience of IESO Workers, preoperative diagnosis and time of surgery of the respondents had shown positive association for the occurrence of chronic liver disease whereas. In this study we can conclude that surgeries of intestinal obstruction conducted by IESO professionals are as good as intestinal obstruction surgeries conducted by physicians so there is a need to train more IESO professionals to deliver decentralized surgical service for rural areas.

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Provision of surgical care in Ethiopia: Challenges and solutions

Abstract: LCoGS: The Lancet Commission on Global Surgery; LMIC: low- and middle-income country.

Cited by 14 publications

References 14 publications

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study

A mobile caesarean birth center as a solution to improve access to surgical birth in rural Ethiopia: a mixed methods research protocol

Management outcome of intestinal obstruction done by integrated emergency surgical officers and its associated factors in selected district hospitals of South Wollo Zone, North East Ethiopia in 2019 G.C

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