Advertisement

Assessing cesarean section and inguinal hernia repair as proxy indicators of the total number of surgeries performed in Sierra Leone in 2012

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Debas H.T.
        • Gosselin R.
        • McCord C.
        • Thind A.
        Surgery.
        in: Jamison D.T. Breman J.G. Measham A.R. Alleyne G. Claeson M. Evans D.B. Disease control priorities in developing countries. 2nd ed. World Bank Publications, Washington (DC)2006
        • Weiser T.G.
        • Regenbogen S.E.
        • Thompson K.D.
        • Haynes A.B.
        • Lipsitz S.R.
        • Berry W.R.
        • et al.
        An estimation of the global volume of surgery: a modelling strategy based on available data.
        Lancet. 2008; 372: 139-144
        • Funk L.M.
        • Weiser T.G.
        • Berry W.R.
        • Lipsitz S.R.
        • Merry A.F.
        • Enright A.C.
        • et al.
        Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.
        Lancet. 2010; 376: 1055-1061
        • Luboga S.
        • Macfarlane S.B.
        • von Schreeb J.
        • Kruk M.E.
        • Cherian M.N.
        • Bergstrom S.
        • et al.
        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; 6: e1000200
        • Ozgediz D.
        • Riviello R.
        The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa.
        PLoS Med. 2008; 5: e121
        • Kingham T.P.
        • Kamara T.B.
        • Cherian M.N.
        • Gosselin R.A.
        • Simkins M.
        • Meissner C.
        • et al.
        Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care.
        Arch Surg. 2009; 144: 122-127
        • Osen H.
        • Chang D.
        • Choo S.
        • Perry H.
        • Hesse A.
        • Abantanga F.
        • et al.
        Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana.
        World J Surg. 2011; 35: 500-504
        • Kwon S.
        • Kingham T.P.
        • Kamara T.B.
        • Sherman L.
        • Natuzzi E.
        • Mock C.
        • et al.
        Development of a surgical capacity index: opportunities for assessment and improvement.
        World J Surg. 2012; 36: 232-239
        • Knowlton L.M.
        • Chackungal S.
        • Dahn B.
        • LeBrun D.
        • Nickerson J.
        • McQueen K.
        Liberian surgical and anesthesia infrastructure: a survey of county hospitals.
        World J Surg. 2013; 37: 721-729
        • Notrica M.R.
        • Evans F.M.
        • Knowlton L.M.
        • Kelly McQueen K.A.
        Rwandan surgical and anesthesia infrastructure: a survey of district hospitals.
        World J Surg. 2011; 35: 1770-1780
        • Linden A.F.
        • Sekidde F.S.
        • Galukande M.
        • Knowlton L.M.
        • Chackungal S.
        • McQueen K.A.
        Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda's public hospitals.
        World J Surg. 2012; 36: 1056-1065
        • Kushner A.L.
        • Groen R.S.
        • Kingham T.P.
        Percentage of cesarean sections among total surgical procedures in sub-Saharan Africa: possible indicator of the overall adequacy of surgical care.
        World J Surg. 2010; 34: 2007-2008
        • Hughes C.D.
        • McClain C.D.
        • Hagander L.
        • Pierre J.H.
        • Groen R.S.
        • Kushner A.L.
        • et al.
        Ratio of cesarean deliveries to total operations and surgeon nationality are potential proxies for surgical capacity in Central Haiti.
        World J Surg. 2013; 37: 1526-1529
        • Dumont A.
        • de Bernis L.
        • Bouvier-Colle M.H.
        • Breart G.
        Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review.
        Lancet. 2001; 358: 1328-1333
      1. Chipande G, Blay P, Kargbo SB, Conteh AB, Konneh TS. Sierra Leone Human Development Report [updated 2007; cited 2014 Nov 23]. United Nations Development Programme. Available from: http://hdr.undp.org/sites/default/files/sierraleone_nhdr_20071.pdf.

        • Lofgren J.
        • Makumbi F.
        • Galiwango E.
        • Nordin P.
        • Ibingira C.
        • Forsberg B.C.
        • et al.
        Prevalence of treated and untreated groin hernia in eastern Uganda.
        Br J Surg. 2014; 101: 728-734
        • Magbity E.
        Service availability and readiness assessment. WHO Report: Ministry of Health and Sanitation.
        WHO, Geneva2011
      2. Ministry of Health and Sanitation (MOHS). Housing and population census. Sierra Leone 2004. [updated 2004; cited 2014 Nov 24]. Available from: http://www.sierra-leone.org/Census/ssl_final_results.pdf.

        • Maxmen A.
        Sierra Leone's free health-care initiative: work in progress.
        Lancet. 2013; 381: 191-192