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1.
BMC Health Serv Res ; 21(1): 943, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503503

RESUMO

BACKGROUND: The Gambia has one of the lowest survival rates for breast cancer in Africa. Contributing factors are late presentation, delays within the healthcare system, and decreased availability of resources. We aimed to characterize the capacity and geographic location of healthcare facilities in the country and calculate the proportion of the population with access to breast cancer care. METHODS: A facility-based assessment tool was administered to secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia. GPS coordinates were obtained, and proximity of service availability and population analysis were performed. Distance thresholds of 10, 20, and 45 km were chosen to determine access to screening, pathologic diagnosis, and surgical management. An additional population analysis was performed to observe the potential impact of targeted development of resources for breast cancer care. RESULTS: All 102 secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia were included. Breast cancer screening is mainly performed through clinical breast examination and is available in 52 facilities. Seven facilities provide pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis, and surgical management is 72, 53, and 62%, respectively. A hypothetical targeted expansion of resources would increase the covered population to 95, 62, and 84%. CONCLUSIONS: Almost half of the Gambian population does not have access to pathologic diagnosis and surgical management of breast cancer within the distance threshold utilized in the study. Mapping and population analysis can identify areas for targeted development of resources to increase access to breast cancer care.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Gâmbia/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento
3.
Int J MCH AIDS ; 9(1): 77-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32123631

RESUMO

Persistent global disparities in maternal and neonatal outcomes exist, in part, due to a lack of access to safe surgery. This commentary examines the relative need for increased focus on access to safe maternal and pediatric surgery globally, starting with a focus on cost-effective surgeries. There is a need to understand context-specific surgeries for regions, including understanding regional versus tertiary development. Most important is a need to understand the crucial role of supply chain management (SCM) in developing better access to maternal and pediatric surgery in limited resource settings. We evaluate the role of SCM in global surgery and global health, and the current landscape of inefficiency. We outline specific findings and takeaways from recent solutions developed in pediatric and maternal surgery to address SCM inefficiencies. We then examine the applicability to other settings and look at the future. Our goal is to summarize the challenges that exist today in a global setting to provide better access to maternal and pediatric surgery and outline solutions relying on structural, SCM-related framework.

4.
World J Surg ; 44(4): 1039-1044, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31848675

RESUMO

BACKGROUND: Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to study the safety and effectiveness of the ApriDec Medical Outreach Group (AMOG). METHODS: Data from the December 2017 and April 2018 outreaches were prospectively collected. Patient demographics, characteristics of surgery, complications of surgery, and patient quality of life were collected preoperatively and on postoperative days 15 and 30. Data were analyzed to determine complication rates and trends in quality of life. RESULTS: 260/278 (93.5%) of patients completed a 30-day follow-up. Of these, surgical site infection was the most common complication (8.0%), followed by hematoma (4.1%). Rates of urinary tract infection were 1.2% while all other complications occurred in less than 1% of patients. There were no mortalities. With increasing time after surgery (0 to 15 days to 30 days), there was a significant improvement across each of the dimensions of quality of life (p < 0.001). All patients reported satisfaction with their procedure. CONCLUSION: This study demonstrated that the care provided by AMOG group to the underserved populations of northern Ghana, yielded complication rates similar to others in low-resourced communities, leading to improved quality of life.


Assuntos
Missões Médicas , Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Feminino , Gana/epidemiologia , Humanos , Masculino , Área Carente de Assistência Médica , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Resultado do Tratamento
5.
6.
World J Surg ; 43(2): 346-352, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30242458

RESUMO

BACKGROUND: Improving access to surgical services and understanding the barriers to receiving timely care are necessary to save lives. The aim of this study was to assess barriers to timely presentation to an appropriate medical facility using the Three-Delay model, for patients presenting to Tamale Teaching Hospital, in northern Ghana. METHODS: In 2013, patients with delays in seeking surgical care were prospectively identified. Pairwise correlation coefficients between delay in presentation and factors associated with delay were conducted and served as a foundation for a multivariate log-linear regression model. RESULTS: A total of 718 patients presented with an average delay of 22.1 months. Delays in receiving care were most common (56.4%), while delays in seeking care were seen in 52.3% of patients. "Initially seeking treatment at the nearest facility, but appropriate care was unavailable" was reported by 56.4% and predicted longer delays (p < 0.001). 42.9% of patients had delays secondary to treatment from a traditional or religious healer, which also predicted longer delays (p < 0.001). On multivariate regression, emergent presentation was the strongest predictor of shorter delays (OR 0.058, p = 0.002), while treatment from a traditional or religious healer and initially seeking treatment at another hospital predicted longer delays (OR 7.6, p = 0.008, and OR 4.3, p  = 0.006, respectively). CONCLUSIONS: Barriers to care leading to long delays in presentation are common in northern Ghana. Interventions should focus on educating traditional and religious healers in addition to building surgical capacity at district hospitals.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios , Adulto , Feminino , Gana , Acesso aos Serviços de Saúde , Hospitais de Ensino , Humanos , Masculino , Fatores de Tempo
7.
PLoS One ; 13(11): e0206465, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30462684

RESUMO

INTRODUCTION: Inguinal hernia repair is a common procedure and a priority for public health efforts in Ghana. It is essential that inguinal hernia repair be performed in a safe, efficient manner to justify its widespread use. Local anesthesia has many favorable properties and has been shown to be superior, compared to regional or general anesthesia, in terms of pain control, safety profile, cost-effectiveness, resources required, and time to discharge. Local anesthesia is recommended for open repair of reducible hernias, provided clinician experience, by multiple international guidelines. Regional anesthesia is associated with myocardial infarction and other complications, and its use is discouraged by multiple guidelines, especially in older patients. This study aims to assess the current state of anesthesia for inguinal hernia repair in the northern and transitional zone of Ghana. In addition we will assess the perceptions of different types of anesthesia along with understanding of evidence-based guidelines among clinicians participating in inguinal hernia repair. METHODS: We performed a retrospective review of all inguinal hernia repairs for male patients, 18 and older, in over 90% of hospitals in northern Ghana. All 41 hospitals were visited and caselogs and patient charts were manually reviewed to extract data. Multivariate logistic regression was used to determine predictors of local anesthesia use. We designed a survey instrument to assess the perceptions of physicians and anesthetists regarding different types of anesthesia for inguinal hernia repair. The survey was designed by a Ghanaian surgeon, reviewed by all co-authors, and tested prior to implementation using a sample (n = 8) of clinicians having similar practices to those of the survey population. Of 70 clinicians, 66 responded, yielding a response rate of 94%. RESULTS: 8080 patients underwent hernia repair of which 37% were performed under local anesthesia, while the majority, 60%, were performed under regional anesthesia. Negative predictors of local anesthesia were emergent repair (OR = 0.258, p < 0.001), surgery performed at a teaching hospital (OR = 0.105, p < 0.001), and bilateral hernia repair (OR = 0.374, p < 0.001). 1,839 (22.8%) of IH repairs were done on patients age 65 or older and RA was most frequently used among the elderly population (57.8%), while local anesthesia was used 39.5% of the time. Sixty-six clinicians participated in the survey with the majority reporting that local anesthesia requires fewer staff, less equipment, has a shorter recovery, is more cost-effective, and might be safer for patients. However 66% were unfamiliar with or incorrectly perceived international guidelines. CONCLUSION: To our knowledge, this study is the largest assessment of anesthesia use for inguinal hernia repair in an LMIC. Although the selection of anesthetic technique should be guided by a patient's general health, the anatomy of the hernia, and clinician judgment, local anesthesia appears to be underutilized in northern Ghana. Survey responses demonstrate high rates of unfamiliarity or incorrectly perceived evidence-based guidelines. Future research should assess how education on the benefits and technique of local anesthesia administration may further increase rates for inguinal hernia repair, especially for older patients.


Assuntos
Anestesia Local/estatística & dados numéricos , Hérnia Inguinal/cirurgia , Idoso , Feminino , Gana , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Surg Res ; 230: 137-142, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100030

RESUMO

BACKGROUND: Despite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. MATERIALS AND METHODS: A retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed. Multivariate logistic regression was used to determine predictors of mesh use. RESULTS: Eight thousand eighty male patients underwent IH repair. The range of IH repair in each region was 96 to 295 (overall 123) per 100,000 population. Most cases were performed at district hospitals (84%) and repaired nonurgently (93%) by nonsurgeon physicians (66%). Suture repair was most common (85%) although mesh was used in 15%. The strongest predictor of mesh use was when a surgeon performed surgery (odds ratio [OR] 3.13, P <0.001), followed by surgery being performed in a teaching hospital (OR 2.31, P <0.001). Repair at a regional hospital was a negative predictor of mesh use (OR 0.08, P <0.001) as was the use of general anesthesia (OR 0.40, P = 0.001). CONCLUSIONS: Most IH repairs are performed in district hospitals, by nonsurgeon physicians, and without mesh. Rates of repair and the use of mesh are higher than previous estimates in Ghana and Sub-Saharan Africa but not as high as high-income countries.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Próteses e Implantes/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Gana , Hérnia Inguinal/economia , Herniorrafia/economia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/economia , Estudos Retrospectivos , Telas Cirúrgicas/economia
9.
J Surg Res ; 229: 186-191, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29936988

RESUMO

BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for biliary disease in developed countries. LC in resource-limited countries is increasing. This prospective, observational study evaluates costs, outcomes, and quality of life (QoL) associated with laparoscopic versus open cholecystectomy (OC) in Mongolia. METHODS: Patient demographics, outcomes, and total payer and patient costs were elicited from a convenience sample of patients undergoing cholecystectomy at four urban and three rural hospitals (February 2016-January 2017). QoL was assessed preoperatively and postoperatively using the five-level EQ-5D instrument. Perioperative complications, surgical fees, and QoL scores were evaluated for LC versus OC. Multivariate regression models were generated to adjust for differences between these groups. RESULTS: Two hundred and fifteen cholecystectomies were included (LC 122, OC 93). LC patients were more likely to have attended college and have insurance. Preoperative symptoms were comparable between groups. Total complication rate was 21.8% (no difference between groups); LC patients had less superficial infections (0% versus 10.8%). Median hospital length of stay (HLOS) and days to return to work were shorter after LC. QoL improved after surgery for both groups. Mean total payer and patient costs were higher for LC, but not significant (P-value 0.126). After adjustment, LC had significantly less complications, shorter HLOS, fewer days to return to work, greater improvement in QoL scores, and no increase in cost. CONCLUSIONS: LC is safe and beneficial to patients with biliary disease in Mongolia, and cost effective from the patient's and payer's perspective. Although equipment costs for LC may be more expensive than OC, there are likely significant cost savings related to reduced HLOS, shorter time off work, fewer complications, and improved QoL.


Assuntos
Doenças Biliares/cirurgia , Colecistectomia Laparoscópica/economia , Análise Custo-Benefício , Período Perioperatório/economia , Complicações Pós-Operatórias/epidemiologia , Adulto , Doenças Biliares/economia , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Redução de Custos/economia , Redução de Custos/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mongólia/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo
10.
Int J Health Policy Manag ; 7(11): 1058-1060, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624880

RESUMO

In 2015 the Lancet Commission on Global Surgery (LCoGS) argued that surgical care is important to national health systems along with the economic viability of countries. Gajewski and colleagues outlined how the Commission's blueprint has been implemented in sub-Saharan Africa, including two funded research projects that were integrated into national surgical plans. Here, we outline how the five processes proposed by Gajewski and colleagues are critical to integrate research, policy, and on-the-ground implementation. We also propose that, moving forward, the most pressing adjunct in many low- and middle-income countries (LMICs) may be a better characterization of rural surgical practices through rigorous research along with models that enable lessons to inform national policy.


Assuntos
Atenção à Saúde , Pesquisa , África ao Sul do Saara , Humanos
11.
Prehosp Disaster Med ; 32(6): 593-595, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28797317

RESUMO

By 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks. Debenham S , Fuller M , Stewart M , Price RR . Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593-595.


Assuntos
Cuidadores , Serviços Médicos de Emergência , Acesso aos Serviços de Saúde , Área Carente de Assistência Médica , Países em Desenvolvimento , Humanos , Estados Unidos , United States Public Health Service , Recursos Humanos
13.
World J Surg ; 41(10): 2417-2422, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28492996

RESUMO

BACKGROUND: An estimated 5 billion people worldwide lack access to timely safe surgical care (Gawande in Lancet 386(9993):523-525, 2015). A mere 6% of all surgical procedures occur in the poorest countries where over a third of the world's population lives (Meara et al. in Surgery 158(1):3-6, 2015). Mobile surgical units like the Cinterandes Foundation endeavor to bring surgical care directly to these communities who otherwise would lack access to safe surgery. This study examines the barriers patients encounter in seeking surgical care in rural communities of Ecuador and their impressions on how mobile surgery addresses such barriers. METHODS: Open interviews were conducted with Cinterandes' patients who had undergone an operation in the mobile surgical unit between 06/25/2013 and 06/25/2014 (n = 101). Interviews were structured to explore two main domains: (1) examining barriers patients have in accessing surgery, (2) assessing patients' opinion of how mobile surgery helped in overcoming such barriers. RESULTS: Patient inconvenience (70%), cost (21%), and lack of trust in local hospitals (24%) were the main cited barriers to surgical access. Increased patient convenience (53%), cheaper surgical care (34%), and trust in Cinterandes (47%) were the main cited benefits to mobile surgery. CONCLUSION: Mobile surgery provided by Cinterandes effectively overcomes many barriers patients encounter when seeking surgical care in rural Ecuador: decreased patient wait times, limited number of referrals to multiple locations, and decreased cost. Partnering with local clinics within the communities and bringing care much closer to patients' homes may provide a better patient friendly health care delivery system for rural Ecuador.


Assuntos
Acesso aos Serviços de Saúde , Unidades Móveis de Saúde , Serviços de Saúde Rural , Procedimentos Cirúrgicos Operatórios , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Equador , Honorários e Preços , Humanos , Lactente , Entrevistas como Assunto , Pessoa de Meia-Idade , Unidades Móveis de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/economia , Confiança , Adulto Jovem
14.
Surgery ; 160(2): 509-17, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27238353

RESUMO

BACKGROUND: The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. METHODS: A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. RESULTS: We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). CONCLUSION: By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources.


Assuntos
Fortalecimento Institucional , Colecistectomia Laparoscópica/estatística & dados numéricos , Países em Desenvolvimento , Doenças da Vesícula Biliar/cirurgia , Acesso aos Serviços de Saúde , Adulto , Idoso , Colecistectomia Laparoscópica/educação , Estudos Transversais , Feminino , Doenças da Vesícula Biliar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mongólia/epidemiologia , Estudos Retrospectivos
15.
BMJ Glob Health ; 1(1): e000011, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28588908

RESUMO

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

16.
Lancet ; 385 Suppl 2: S1, 2015 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-26313055

RESUMO

BACKGROUND: Surgical care needs in low-resource countries are increasingly recognised as an important aspect of global health, yet data for the size of the problem are insufficient. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a population-based cluster survey previously used in Nepal, Rwanda, and Sierra Leone. METHODS: Using previously published SOSAS data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of overall prevalence of surgically treatable conditions was estimated and the number of deaths that could have been avoided by providing access to surgical care was calculated for the broader community of low-resource countries. Such conditions included, but were not limited to, injuries (road traffic incidents, falls, burns, and gunshot or stab wounds), masses (solid or soft, reducible), deformities (congenital or acquired), abdominal distention, and obstructed delivery. Population and health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with a per capita health expenditure of US$100 or less annually. The overall prevalence estimate from the previously published SOSAS data was extrapolated to each low-resource country. Using crude death rates for each country and the calculated proportion of avoidable deaths, a total number of deaths possibly averted in the previous year with access to appropriate surgical care was calculated. FINDINGS: The overall prevalence of surgically treatable conditions was 11·16% (95% CI 11·15-11·17) and 25·6% (95% CI 25·4-25·7) of deaths were potentially avoidable by providing access to surgical care. Using these percentages for the 48 low-resource countries, an estimated 288·2 million people are living with a surgically treatable condition and 5·6 million deaths could be averted annually by the provision of surgical care. In the Nepal SOSAS study, the observed agreement between self-reported verbal responses and visual physical examination findings was 94·6%. Such high correlation helps to validate the SOSAS tool. INTERPRETATION: Hundreds of millions of people with surgically treatable conditions live in low-resource countries, and about 25% of the mortality annually could be avoided with better access to surgical care. Strengthening surgical care must be considered when strengthening health systems and in setting future sustainable development goals. FUNDING: None.

17.
Lancet ; 385 Suppl 2: S2, 2015 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-26313066

RESUMO

BACKGROUND: Trauma has become a worldwide pandemic. Without dedicated public health interventions, fatal injuries will rise 40% and become the 4th leading cause of death by 2030, with the burden highest in low-income and middle-income countries (LMICs). The aim of this study was to estimate the prevalence of traumatic injuries and injury-related deaths in low-resource countries worldwide, using population-based data from the Surgeons OverSeas Assessment of Surgical Need (SOSAS), a validated survey tool. METHODS: Using data from three resource-poor countries (Nepal, Rwanda, and Sierra Leone), a weighted average of injury prevalence and deaths due to injury was calculated and extrapolated to low-resource countries worldwide. Injuries were defined as wounds from road traffic injuries (bus, car, truck, pedestrian, and bicycle), gunshot or stab or slash wounds, falls, work or home incidents, and burns. The Nepal study included a visual physical examination that confirmed the validity of the self-reported data. Population and annual health expenditure per capita data were obtained from the World Bank. Low-resource countries were defined as those with an annual per capita health expenditure of US$100 or less. FINDINGS: The overall prevalence of lifetime injury for these three countries was 18·03% (95% CI 18·02-18·04); 11·64% (95% CI 11·53-11·75) of deaths annually were due to injury. An estimated prevalence of lifetime injuries for the total population in 48 low-resource countries is 465·7 million people; about 2·6 million fatal injuries occur in these countries annually. INTERPRETATION: The limitations of this observational study with self-reported data include possible recall and desirability bias. About 466 million people at a community level (18%) sustain at least one injury during their lifetime and 2·6 million people die annually from trauma in the world's poorest countries. Trauma care capacity should be considered a global health priority; the importance of integrating a coordinated trauma system into any health system should not be underestimated. FUNDING: None.

18.
J Surg Res ; 198(1): 115-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26055214

RESUMO

BACKGROUND: Many general surgical residency programs lack a formal international component. We hypothesized that most surgery programs do not have international training or do not provide the information to prospective applicants regarding electives or programs in an easily accessible manner via Web-based resources. MATERIALS AND METHODS: Individual general surgery program Web sites and the American College of Surgeons residency tool were used to identify 239 residencies. The homepages were examined for specific mention of international or global health programs. Ease of access was also considered. Global surgery specific pages or centers were noted. Programs were assessed for length of rotation, presence of research component, and mention of benefits to residents and respective institution. RESULTS: Of 239 programs, 24 (10%) mentioned international experiences on their home page and 42 (18%) contained information about global surgery. Of those with information available, 69% were easily accessible. Academic programs were more likely than independent programs to have information about international opportunities on their home page (13.7% versus 4.0%, P = 0.006) and more likely to have a dedicated program or pathway Web site (18.8% versus 2.0%, P < 0.0001). Half of the residencies with global surgery information did not have length of rotation available. Research was only mentioned by 29% of the Web sites. Benefits to high-income country residents were discussed more than benefits to low- and middle-income country residents (57% versus 17%). CONCLUSIONS: General surgery residency programs do not effectively communicate international opportunities for prospective residents through Web-based resources and should seriously consider integrating international options into their curriculum and better present them on department Web sites.


Assuntos
Cirurgia Geral/educação , Internet , Internato e Residência , Saúde Global , Humanos
19.
J Surg Res ; 197(1): 112-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25940158

RESUMO

BACKGROUND: Surgical care has made limited inroads on the public health and global health agendas despite increasing data showing the enormous need. The objective of this study was to survey interested members of a global surgery community to identify patterns of thought regarding barriers to political priority. MATERIALS AND METHODS: All active members of the nongovernmental organization Surgeons OverSeas were surveyed and asked why surgical care is not receiving recognition and support on the public health and global health agenda. Responses were categorized using the Shiffman framework on determinants of political priority for global initiatives by two independent investigators, and the number of responses for each of the 11 factors was calculated. RESULTS: Seventy-five Surgeons OverSeas members replied (75 of 176; 42.6% response rate). A total of 248 individual reasons were collected. The most common responses were related to external frame, defined as public portrayals of the issue (60 of 248; 24.2%), and lack of effective interventions (48 of 248; 19.4%). Least cited reasons related to global governance structure (4 of 248; 2.4%) and policy window (4 of 248; 1.6%). CONCLUSIONS: This survey of a global surgery community identified a number of barriers to the recognition of surgical care on the global health agenda. Recommendations include improving the public portrayal of the problem; developing effective interventions and seeking strong and charismatic leadership.


Assuntos
Saúde Global , Política de Saúde , Prioridades em Saúde , Saúde Pública , Procedimentos Cirúrgicos Operatórios , Atitude do Pessoal de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Política , Cirurgiões
20.
World J Surg ; 39(9): 2132-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25561195

RESUMO

BACKGROUND: While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health. METHODS: We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms "surgery," "health system," "developing country," "health systems strengthening," "health information system," "financing," "governance," and "integration." RESULTS: The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization's conceptual model of a health system. CONCLUSIONS: Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Países em Desenvolvimento , Cirurgia Geral/organização & administração , Prestação Integrada de Cuidados de Saúde/economia , Cirurgia Geral/economia , Sistemas de Informação em Saúde , Humanos , Modelos Organizacionais
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