"Problems you can live with" versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery.

BACKGROUND: 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models. METHODS: Our study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman's explanatory models framework and decided to use this to guide the final stages of analysis. RESULTS: We found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care. CONCLUSIONS: We found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.

Financial risk of emergency abdominal surgery: a cross sectional study from Ethiopia.

BACKGROUND: The Lancet Commission on Global Surgery suggested six indicators every country should use to measure their surgical systems. One of these indicators, catastrophic expenditure (CE), is defined as money paid for service which amounts to more than 10% of the patient's total annual expenditure, or more than 40% of annual non-food household expenditure. Ethiopian Ministry of Health has set a target of 100% protection from CE by 2030. However, so far there is lack of studies that assess financial risk of surgery. METHODS: Using a cross sectional study design, financial risk assessment was carried out on 142 patients from Yekatit 12 and Zewditu Memorial hospitals in Addis Ababa, Ethiopia from May 15 to September 15, 2021. RESULTS: Appendectomy (69.0%), emergency laparotomy (26.1%) and cholecystectomy (4.9%) resulted in mean direct medical expenditures of 111.7USD, 200.70USD and 224.60USD, respectively. Medications and imaging accounted for 60.8 and 13.9% of total treatment cost. By applying the two definitions of catastrophic expenditure, 67.6 and 62.7% of patients sustained CE, respectively Overall rates of CE across procedures were 67.3 and 59.1% for appendectomy, 70.2 and 70.2% for laparotomy, 57.0 and 71.2% for cholecystectomy. Thirty-five (24.6%) patients had some form of insurance, with Community Based Health Insurance being the most common form (57%). Insured patients were less likely to sustain CE with both definitions (AOR 0.09, p = 0.002 and AOR 0.10, p = 0.006 respectively). CONCLUSION AND RECOMMENDATIONS: Substantial proportion of patients undergoing emergency abdominal surgery sustain CE in Addis Ababa. Medications and imaging take major share of total cost mainly because patients have to acquire them from private set ups. Policy makers should work on availing medications and imaging in public hospitals as well as expand insurance and other forms of surgical care financing to protect patients from CE.

Malpractice Awareness among Surgeons and Surgical Trainees in Ethiopia.

BACKGROUND: In Ethiopia, a country where seeing medical errors is not rare, there is a lack of data concerning the overall awareness of medical malpractice issues among physicians. A recent study showed that 80% of malpractice claims in Ethiopia are related to some form of surgery or operation room activities. METHODS: A cross-sectional survey was conducted among surgeons and surgical trainees. Data were collected anonymously by an online survey using Google forms through a 56-items structured questionnaire. Subsequently, the data were analyzed and reported employing nonparametric statistical methods with SPSS software package 26. RESULTS: In our sample, the overall awareness regarding medical malpractice was relatively low. Surgery on a wrong patient (71.1%) was the most commonly reported form of malpractice, whereas unintended damage to adjacent organs (10.8%) was the most frequently disagreed up on form. In the event of a medical error, the majority (59.6%) reported readiness to disclose their error to the patient. The most common mentioned reason for not revealing a mistake was a threat of physical or verbal assault (68%). A significant number of respondents, i.e., 120(59.1%), reported being physically/verbally assaulted by a patient or their attendants at some point in their practice. CONCLUSION: The findings of our study provided a general picture of surgeons' and surgical trainees' knowledge, attitude, and practice regarding medical malpractice. This study recommends more robust ethics and law training modules to surgical trainees, refresher courses to surgeons, and advanced training programs in ethics and law.

Assessment of Level of Patient Satisfaction after Prostatectomy for Benign Prostatic Hyperplasia in Referral Hospitals in Addis Ababa.

BACKGROUND: Benign Prostatic hyperplasia is a very common problem in aging men. TURP comprises 95% of all surgical procedures and is the treatment of choice for prostates sized between 30ml and 80-100ml. Open surgery is the treatment of choice for large glands (bigger than 80-100ml) and for those with associated complications that have indication for open surgery. Many literatures show that the overall patient satisfaction rate and clinical outcome of TURP for BPH are very good. The objective of this study was 'assessing the level of patient satisfaction after undergoing TURP and TVP for BPH. METHODS: In this research, convenient sampling technique was used. The study design was prospective cohort study. Standardized questioner was prepared in English and later translated into Amharic. Information about demographic characteristics, preoperative data, intraoperative data, and immediate postoperative data were taken while the patient was in the hospital. At the first and the third months after the prostatectomy, patients were inquired on their level of satisfaction about their disease specific satisfaction on the urinary function and their sexual function. We used HCAHPS Measure of Patient Satisfaction Tool, to collect data and analyzed using SPSS version 18. RESULTS: A total of 89 patients were enrolled in the study among which 65.2% had undergone TURP. The rate of major perioperative complication was found to be low. Over half of the patients had postoperative hospital stay of three or less days. Majority of the patients were satisfied with the care given by the nurses (68.2%) and doctors (84.3%) with relatively higher physicians' care satisfaction level. More than 60% of the patients were highly satisfied with their urinary surgical outcome. With regard to hospital environment, around 60% of the patients reported that they were very satisfied with cleanliness of the rooms, bath rooms and the quietness of the rooms at night. CONCLUSIONS: Both TURP and TVP have high level of patient satisfaction associated with low perioperative major complications. Therefore both can be recommended for patients with clear indications for prostatectomy.