Who accesses surgery at district level in sub‐Saharan Africa? Evidence from Malawi and Zambia

Gajewski, Jakub; Dharamshi, Rachel; Strader, Michael Brad; Kachimba, John; Borgstein, Eric; Mwapasa, Gerald; Cheelo, Mweene; McCauley, Tracey; Bijlmakers, Leon; Brugha, Ruairı́

doi:10.1111/tmi.12989

Cited by 20 publications

(30 citation statements)

References 40 publications

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“…This finding, however surprising, was confirmed by data validation, interviews with surgical staff and consultations with surgical supervisors who participated in delivery of the training. The population that receives surgical care in Malawi is young, and district hospitals undertake only relatively basic procedures, which may explain the low surgical mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…This is the highest rate of rural dwellers in sub‐Saharan Africa. A network of 24 government‐owned district hospitals and 23 faith‐based district‐level hospitals provide surgical services to rural areas, where almost all surgery is undertaken by COs. In urban areas of Malawi there are four central hospitals, which are staffed by specialist surgeons.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, MDs can be considered a valid comparator when the quality of service is measured. The analysis was undertaken for hernia procedures, which served as an example of the most commonly performed general surgical procedure at district level in sub‐Saharan Africa. Before and after the training, differences in means of self‐reported surgical confidence scores in performing operations unsupervised, measured on a scale from 0 to 20, were compared using paired t tests.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of a surgical training programme for clinical officers in Malawi

Gajewski

Borgstein²,

Bijlmakers

et al. 2019

British Journal of Surgery

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Background Shortages of specialist surgeons in African countries mean that the needs of rural populations go unmet. Task‐shifting from surgical specialists to other cadres of clinicians occurs in some countries, but without widespread acceptance. Clinical Officer Surgical Training in Africa (COST‐Africa) developed and implemented BSc surgical training for clinical officers in Malawi. Methods Trainees participated in the COST‐Africa BSc training programme between 2013 and 2016. This prospective study done in 16 hospitals compared crude numbers of selected numbers of major surgical procedures between intervention and control sites before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals between the COST‐Africa trainees and other surgically active cadres. Results Seventeen trainees participated in the COST‐Africa BSc training. The volume of surgical procedures undertaken at intervention hospitals almost doubled between 2013 and 2015 (+74 per cent), and there was a slight reduction in the number of procedures done in the control hospitals (–4 per cent) (P = 0·059). In the intervention hospitals, general surgery procedures were more often undertaken by COST‐Africa trainees (61·2 per cent) than other clinical officers (31·3 per cent) and medical doctors (7·4 per cent). There was no significant difference in postoperative wound infection rates for hernia procedures at intervention hospitals between trainees and medical doctors (P = 0·065). Conclusion The COST‐Africa study demonstrated that in‐service training of practising clinical officers can improve the surgical productivity of district‐level hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Evaluation of a surgical training programme for clinical officers in Malawi

Gajewski

Borgstein²,

Bijlmakers

et al. 2019

British Journal of Surgery

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“…). Following assessment, 68 articles, involving 708 032 patients across 71 LMICs, were included in the review ( Tables S1 and S2 , supporting information). Country‐specific patient numbers were reported in 60 studies but were absent from six and two provided total LMIC patient numbers only.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the use of big data to improve surgery in low- and middle-income countries

Knight

Ots

Maimbo

et al. 2019

British Journal of Surgery

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Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.

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“…Malawi, where 84% of the 18 million people reside outside of main cities , is an example of a country where access to surgical services is insufficient for rural dwellers . Surgical care is offered through a network of 50 district level hospitals (DLHs), of which 27 are government‐owned .…”

Section: Introductionmentioning

confidence: 99%

‘I think we are going to leave these cases’. Obstacles to surgery in rural Malawi: a qualitative study of provider perspectives

Gajewski

Bijlmakers

Mwapasa

et al. 2018

Tropical Med Int Health

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This study demonstrates how the motivation of surgical team members is a key factor in deciding whether or not to perform operations; and that shortages of supplies or infrastructure need not be an absolute obstacle to service delivery. Scale-up of surgical services at district level requires investments to improve surgical and anaesthetic skills, to strengthen human resources and facility management, and to ensure the availability of reliable infrastructure and essential supplies.

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Who accesses surgery at district level in sub‐Saharan Africa? Evidence from Malawi and Zambia

Cited by 20 publications

References 40 publications

Evaluation of a surgical training programme for clinical officers in Malawi

Evaluation of a surgical training programme for clinical officers in Malawi

Systematic review of the use of big data to improve surgery in low- and middle-income countries

‘I think we are going to leave these cases’. Obstacles to surgery in rural Malawi: a qualitative study of provider perspectives

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