Browsing by Author "Hsia, Renee Y."

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    Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy
    (International journal of emergency medicine, 2010) Hsia, Renee Y.; Ozgediz, Doruk; Mutto, Milton; Jayaraman, Sudha; Kyamanywa, Patrick; Kobusingye, Olive C.
    Despite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality. Aim To estimate the epidemiology of the injury seen in patients presenting to the government hospital inKampala, the capital city of Uganda. Methods A secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005. Results From 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance. Conclusions Road traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development.
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    Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey
    (PLoS Med, 2010) Kruk, Margaret E.; Wladis, Andreas; Mbembati, Naboth; Ndao-Brumblay, S. Khady; Hsia, Renee Y.; Galukande, Moses; Luboga, Sam; Matovu, Alphonsus; Miranda, Helder de; Ozgediz, Doruk; Roman Quinones, Ana; Rockers, Peter C.; Schreeb, Johan von; Vaz, Fernando; Debas, Haile T.; Macfarlane, Sarah B.
    There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. Methods and Findings: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. Conclusion: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas.
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    Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group
    (PLoS Med, 2009) Luboga, Sam; Macfarlane, Sarah B.; Schreeb, Johan von; Kruk, Margaret E.; Cherian, Meena N.; Bergstrom, Staffan; Bossyns, Paul B. M.; Denerville, Ernest; Dovlo, Delanyo; Galukande, Moses; Hsia, Renee Y.; Jayaraman, Sudha P.; Lubbock, Lindsey A.; Mock, Charles; Ozgediz, Doruk; Sekimpi, Patrick; Wladis, Andreas; Zakariah, Ahmed; Babadi Dade, Nameoua; Donkor, Peter; Kabutu Gatumbu, Jane; Hoekman, Patrick; IJsselmuiden, Carel B.; Jamison, Dean T.; Jessani, Nasreen; Jiskoot, Peter; Kakande, Ignatius; Mabweijano, Jacqueline R.; Mbembati, Naboth; McCord, Colin; Mijumbi, Cephas; Miranda, Helder de; Mkony, Charles A.; Mocumbi, Pascoal; Ndihokubwayo, Jean Bosco; Ngueumachi, Pierre; Ogbaselassie, Gebreamlak; Okitombahe, Evariste Lodi; Tidiane Toure, Cheikh; Vaz, Fernando; Zikusooka, Charlotte M.; Debas, Haile T.
    In sub-Saharan Africa, only 46% of births are attended by skilled personnel, compared to 96% in Europe (according to data for the African Region of the World Health Organization [WHO] from 2000 to 2008 [1]). In 2005, slightly over one quarter of a million women died from complications of childbirth [1]; most of these deaths could have been avoided by providing women with access to basic obstetric care and obstetric surgical care. On average, across sub- Saharan Africa, a population of 10,000 is served by two doctors and 11 nursing and midwifery personnel, compared to 32 and 79 respectively serving the same number of people in Europe (WHO data 2000–2007 [1]). A child born in sub- Saharan Africa in 2007 could expect to live only 52 years, which is 22 years less than its European counterpart [1].