Surgical services in low-income and middle-income countries
Division of Orthopedic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.The Lancet (Impact Factor: 39.21). 10/2007; 370(9592):1013-5. DOI: 10.1016/S0140-6736(07)61457-3
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ABSTRACT: The sequelae of acute musculoskeletal conditions, especially injuries and infections, are responsible for significant disability in low- and middle-income countries. This study characterizes the availability of selected musculoskeletal surgical services at different tiers of the health system in a convenience sample of 883 health facilities from 24 low- and lower-middle-income countries. Selected data points from the World Health Organization's (WHO) tool of situational analysis of surgical availability were extracted from the WHO's database in December, 2013. These included infrastructure, physical resources and supplies, interventions, and human resources. For a descriptive analysis, facilities were divided into two groups based on number of beds (<100, 100-300, and >300) and level of facility (primary referral, secondary/tertiary, and Private/NGO/Mission). Statistical comparison was made between public and Private/NGO/Mission facilities based on number of beds (≤100, 100-300, and >300) using a Chi-Square analysis, with statistical significance at p < 0.05. Significant deficiencies were noted in infrastructure, physical resources and supplies, and human resources for the provision of essential orthopedic surgical services at all tiers of the health system. Availability was significantly lower in public versus Private/NGO/Mission facilities for nearly all categories in facilities with ≤100 beds, and in a subset of measures in facilities with between 100 and 300 beds. Deficiencies in the availability of orthopedic surgical services were observed at all levels of health facility and were most pronounced at facilities with ≤100 beds in the public sector. Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if we are to reduce the burden of death and disability from a variety of emergent health conditions. There were no sources of funding.World Journal of Surgery 02/2015; 39(6). DOI:10.1007/s00268-015-2971-2 · 2.35 Impact Factor
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ABSTRACT: To calculate the cost-effectiveness of tension-free inguinal hernia repair with mosquito net mesh in the Western Region of Ghana. Prospective study. Four district hospitals in the Western Region of Ghana. A total of 113 referred or presenting patients from rural areas with inguinal hernias of various sizes. Lichtenstein method of tension-free repair using mosquito net mesh by European and African surgeons. Main Outcome Measure Disability-adjusted life-years (DALYs) averted with counterfactual definitions based on precedent and expert opinion. All operations were performed as day cases, with 81 of the patients (71.7%) under local anesthesia and few complications. An average of 9.3 (95% confidence interval [CI], 8.0-10.7) DALYs were averted per person, with a total of 1052 averted in the study. Average cost per patient was $120.02 (95% CI, $117.66-$122.39) from a provider perspective and $102.88 ($88.47-$117.29) from a patient perspective. Cost-effectiveness was $12.88 per DALY averted (95% CI, $10.98-$14.78), which is well below the Ghanaian per capita gross national income ($590). Results were robust to sensitivity analysis and may be refined as further work is done on the burden of disease due to hernias in Africa. Inguinal hernia repair was cost-effective in the Western Region of Ghana through international collaboration. Research in other settings should test the generalizability of results.Archives of surgery (Chicago, Ill.: 1960) 10/2010; 145(10):954-61. DOI:10.1001/archsurg.2010.208 · 4.30 Impact Factor
Article: Reply.Urology 03/2010; 75(3):705-6. DOI:10.1016/j.urology.2009.08.056 · 2.13 Impact Factor
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