Background
The traditional tools to assess surgical capacity in low-income countries require
significant amounts of time and resources, and have thus not been utilized systematically
in this context. Proxy indicators have been suggested as a simpler tool to estimate
surgical volume. The aim of this study was to assess caesarean section and inguinal
hernia repair as proxy indicators of the total number of surgeries performed per capita
in a given region of sub-Saharan Africa.
Methods
Surgical data was compiled from 58 health institutions (96.7%) that performed major
surgery in Sierra Leone in 2012. In total, 24,152 operative procedures were included
in the study. Validity of proxy indicators was tested by logistic regression analyses
with the rate of caesarean sections compared with total operations (%CS), hernia repairs
(%HR) or both (%CS&HR) as dependent variables and the operations per 100,000 capita
as the covariate.
Results
There was significant correlation for each of the proxy indicators, with the estimated
odds ratio for %CS being 0.675 (95% CI, 0.520–0.876; P < .01), the estimated odds ratio for %HR being 0.822 (95% CI, 0.688–0.983; P < .05), and the estimated odds ratio for %CS&HR being 0.838 (95% CI, 0.731–0.962;
P < .05).
Conclusion
The unmet need for surgical services in a region of sub-Saharan Africa can be estimated
by using any of the 3 proxy indicators. However, it seems that %CS is more sensitive
for small changes in operations per 100,000 capita, compared with the %HR. There is
no obvious added benefit for using the combined proxy indicator.
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Article info
Publication history
Accepted:
December 18,
2014
Footnotes
Grant support: Project funded by the Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway, and CapaCare.
Conflict of interests: None.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
