Browsing by Author "Wladis, Andreas"
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Item Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries(PLoS Medicine, 2010) Galukande, Moses; Schreeb, Johan von; Wladis, Andreas; Mbembati, Naboth; Miranda, Helder de; Kruk, Margaret E.; Luboga, Sam; Matovu, Alphonsus; McCord, Colin; Ndao-Brumblay, S. Khady; Ozgediz, Doruk; Rockers, Peter C.; Quinones, Ana Roman; Vaz12, Fernando; Debas, Haile T.; Macfarlane, Sarah B.Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub- Saharan African countries. Methods and Findings: In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population. Conclusion: The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality.Item 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.Item 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].Item Prevalence of Paediatric Surgical Conditions in Eastern Uganda: A Cross-Sectional Study(Springer International Publishing, 2022-01-01) Ajiko, Mary Margaret; Weidman, Viking; Nordin, Pär; Wladis, Andreas; Löfgren, JennyBackground The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda. Method A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The children’s caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions. Results The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n=169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions. Conclusion Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.Item A Randomized Trial of Low-Cost Mesh in Groin Hernia Repair(New England Journal of Medicine, 2016) Löfgren, Jenny; Nordin, Pär; Ibingira, Charles; Matovu, Alphonsus; Galiwango, Edward; Wladis, AndreasThe most effective method for repair of a groin hernia involves the use of a synthetic mesh, but this type of mesh is unaffordable for many patients in low- and middle-income countries. Sterilized mosquito meshes have been used as a lower cost alternative but have not been rigorously studied.