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


      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.


      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.


      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).


      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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