Surgery in Malawi - A national survey of activity in rural and urban hospitals

Article (PDF Available)inAnnals of The Royal College of Surgeons of England 89(7):722-4 · November 2007with48 Reads
DOI: 10.1308/003588407X209329 · Source: PubMed
Abstract
Malawi is a poor country with few doctors. It has 21 district hospitals all of which have operating theatres but none of which has a permanent surgeon. It also has 4 central hospitals, each with one or more surgeons. Most district hospitals are manned by a single doctor and two or more paramedical clinical officers. All district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded. In 2003, a total of 48,696 surgical operations were recorded, of which 25,053 were performed in 21 district hospitals and 23,643 in 4 central hospitals. Caesarean section is the commonest major surgical procedure in district hospitals and is performed in approximately 2.8% of all births, compared to 22% in the UK. Very few major general surgical or orthopaedic procedures are carried out in district hospitals. This study underlines Malawi's need for more surgeons to be trained and retained.

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    • "Daily, locally trained surgeons and general practitioners perform the procedure routinely, in many health institutions across the country [3, 4]. Over 50% of all hernia cases reported to health care institutions may be untreated in African countries, due to lack of adequate or affordable surgical care[4, 29, 30, 31]. In Ghana trained surgeons, gynaecologists and general practitioners perform surgical and gynaecological procedures including caesarean sections, ectopic operations and laparotomy for typhoid intestinal perforations, appendectomy, acute abdomen among other indications and operations [32]. "
    [Show abstract] [Hide abstract] ABSTRACT: The use of alloplastic-mesh is now a common practice in hernia repair around the world especially in the developed and industrialized countries [4].However in developing countries like Ghana, this methodology is either unknown by many local surgeons and general practitioners, or for fear of the unknown,it is not practiced. This study aimed to assess the appropriateness, outcomes and suitability of polypropylene-mesh (Prolene, Ethicon, Belgium) for large incisional hernia and recurrent incisional hernia repair in Northern Ghana as a " Tension-free " operation procedure. All patients undergoing incisional hernia repair of the anterior abdominal wall defects measuring greater than or equal to 5cm in diameter or any recurrent incisional hernia case from January 2010 to December 2013 were eligible for the study.The " Sublay-technique " was adopted for the use of polypropylene-mesh implantation procedure. A total of 270 patients underwent the polypropylene-mesh, " Tension-free " , abdominal wall hernia repair in Tania specialist hospital. The two main indications for the previous laparotomies, prior to the incisional hernia repair in Tania specialist hospital, were median incision for caesarean sections and laparotomy for typhoid intestinal perforations. Patients' age ranged from 14 to 70 years. All cases were done under spinal anaesthesia. Post-operatively, one patient (0,37%) had superficial wound infection, six patients (2,22%) had seroma formation and three patients (1,11%) had haematoma formation. No patient developed fistula, net dislocation, strangulation, or recurrent hernia in the immediate post-operative six months period. The study recorded no death. Conclusion: Polypropylene-mesh for large incisional hernia and recurrent incisional hernia repair, is effective, safe and suitable in Ghana, just as it is good for the developed countries.
    Full-text · Article · Jan 2015 · BMC Health Services Research
    • "To reduce the high rates of childhood morbidity and mortality in LMICs [5], several authors have noted the importance of providing optimal access to pediatric surgical care678. Yet, little is known about the pediatric surgical capacity in the LMICs, where surveys of surgical capacity tend to be heavily weighed on adults91011121314151617181920 . Also, the relatively few published reports on pediatric surgical capacity have been based on tools designed for adults [21, 22]. "
    [Show abstract] [Hide abstract] ABSTRACT: While some data exist for the burden of pediatric surgical disease in low- and middle-income countries (LMICs), little is known about pediatric surgical capacity. In an effort to better plan and allocate resources for pediatric surgical care in LMICs, a survey of pediatric surgical capacity using specific tool was needed. Based on the previously published Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey, a pediatric PIPES (PediPIPES) survey was created. To ensure relevance to local needs and inclusion of only essential items, a draft PediPIPES survey was reviewed by nine pediatric surgeons and modifications were incorporated into a final tool. The survey was then distributed to surgeons throughout sub-Saharan Africa. Data from West Africa (37 hospitals in 10 of the 16 countries in the subregion) were analyzed. Fewer than 50 % (18/37) of the hospitals had more than two pediatric surgeons. Neonatal or general intensive care units were not available in 51.4 % (19/37) of hospitals. Open procedures such as appendectomy were performed in all the hospitals whereas less-invasive interventions such as non-operative intussusception reduction were done in only 41 % (15/37). Life-saving pediatric equipment such as apnea monitors were not available in 65 % (24/37) of the hospitals. The PediPIPES survey was useful in documenting the pediatric surgical capacity in West Africa. Many hospitals in West Africa are not optimally prepared to undertake pediatric surgery. Our study showed shortages in personnel, infrastructure, procedures, equipment, and supplies necessary to adequately and appropriately provide surgical care for pediatric patients.
    Full-text · Article · Dec 2014
    • "Table 2 gives the sense of the scope and frequencies of procedures encountered in these study sites. There is recognition that other countries in the region, including Malawi, Mozambique and Tanzania, have had success with the practice [12-16]. "
    [Show abstract] [Hide abstract] ABSTRACT: The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting. Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.
    Full-text · Article · Aug 2013
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