Barriers And Facilitators Of Surgical Care In Rural Uganda: A Mixed Methods Study

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dc.contributor.authorNzewunwa, Obieze C. Nwanna
dc.contributor.authorAjiko, Mary-Margaret
dc.contributor.authorKirya, Fred
dc.contributor.authorEpodoi, Joseph
dc.contributor.authorKabagenyi, Fiona
dc.contributor.authorBatibwe, Emmanuel
dc.contributor.authorFeldhaus, Isabelle
dc.contributor.authorJuillard, Catherine
dc.contributor.authorDicker, Rochelle
dc.date.accessioned2022-01-31T19:20:59Z
dc.date.available2022-01-31T19:20:59Z
dc.date.issued2016
dc.description.abstractSurgical care delivery is poorly understood in resource-limited settings. To effectively move toward universal health coverage, there is a critical need to understand surgical care delivery in developing countries. This study aims to identify the barriers and facilitators of surgical care delivery at Soroti Regional Referral Hospital in Uganda.In this mixed methods study, we (1) applied the Surgeons OverSeas’ Personnel, Infrastructure, Procedures, Equipment, and Supplies tool to assess surgical capacity; (2) retrospectively reviewed inpatient records; (3) conducted four semistructured focus group discussions with 18 purposively sampled providers involved in perioperative care; and (4) observed the perioperative process of care using a time and motion approach. Descriptive statistics were generated from quantitative data. Qualitative data were thematically analyzed.The Personnel, Infrastructure, Procedures, Equipment, and Supplies survey revealed severe deficiencies in workforce (P-score = 14) and infrastructure (I-score = 5). Equipment, supplies, and procedures were generally available. Male and female wards were overbooked 83% and 60% of the time, respectively. Providers identified lack of space, patient overload, and superfluous patients' attendants as barriers to surgical care. Workforce challenges were tackled using teamwork and task sharing. Inadequate equipment and processes were addressed using improvisations. All observed subjects (n = 31) received interventions. The median decision-to-intervention time was 2.5 h (Interquartile Range [IQR], 0.4, 21.4). However, 48% of subjects experienced delays. Median decision-to-intervention delay was 14.8 h (IQR, 0.9, 26.6).Despite severe workforce and physical infrastructural deficiencies at Soroti Regional Referral Hospital, providers are adjusting and innovating to deliver surgical care.en_US
dc.identifier.citationNwanna-Nzewunwa, O. C., Ajiko, M. M., Kirya, F., Epodoi, J., Kabagenyi, F., Batibwe, E., ... & Dicker, R. (2016). Barriers and facilitators of surgical care in rural Uganda: a mixed methods study. journal of surgical research, 204(1), 242-250.https://doi.org/10.1016/j.jss.2016.04.051.en_US
dc.identifier.issn0022-4804
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1694
dc.language.isoenen_US
dc.publisherjournal of surgical researchen_US
dc.subjectGlobal surgery; Surgical capacity; Uganda; Capacity assessment; Quality; Low-income countryen_US
dc.titleBarriers And Facilitators Of Surgical Care In Rural Uganda: A Mixed Methods Studyen_US
dc.typeArticleen_US
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