Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals
Background District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians. Me...
Gespeichert in:
| Veröffentlicht in: | World journal of surgery 2018-06, Vol.42 (6), p.1610-1616 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1616 |
|---|---|
| container_issue | 6 |
| container_start_page | 1610 |
| container_title | World journal of surgery |
| container_volume | 42 |
| creator | Gajewski, Jakub Conroy, Ronan Bijlmakers, Leon Mwapasa, Gerald McCauley, Tracey Borgstein, Eric Brugha, Ruairi |
| description | Background
District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
Methods
Baseline and 2–3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
Results
There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63–1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5),
p
= 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
Conclusion
The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels. |
| doi_str_mv | 10.1007/s00268-017-4385-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1973461511</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1973461511</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4221-4e8a557e63d7e1d3313f9519a64b1c2d4f5482dc3ba5101387add75ccfcef3723</originalsourceid><addsrcrecordid>eNqFkU9v1DAQxS0EokvhA3BBlrhwCfhf4oRbu9AuqKgtBXG0vM4EuUrs1Ha02mO_eR2lVKgS4jRz-L2nN_MQek3Je0qI_BAJYVVdECoLweuyaJ6gFRWcFYwz_hStCK9E3ik_QC9ivCYZrEj1HB2whpFGcr5Ct5eT7m3aY9_hqyn8hrDH1uFvutc7-xGv_TDqYKN3M3ChkwWXiu8w-pCgxedTMn6AiI-6BAFvIDirH3yOIe0AHP5kYwrWJKxdi9fZIOgeb3wcbdJ9fImedXnAq_t5iH6efP6x3hRn56df1kdnhRGM0UJArctSQsVbCbTl-aquKWmjK7GlhrWiK0XNWsO3uqSE8lrqtpWlMZ2BjkvGD9G7xXcM_maCmNRgo4G-1w78FBXNDxEVLSnN6NtH6LWfgsvpZorVUkhSZooulAk-xgCdGoMddNgrStTcj1r6Ufntau5HNVnz5t552g7QPij-FJKBZgF2tof9_x3Vr69Xxyekls0cmy3amGUuV_BX7H8mugM4jqxW</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1972874705</pqid></control><display><type>article</type><title>Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals - AutoHoldings</source><creator>Gajewski, Jakub ; Conroy, Ronan ; Bijlmakers, Leon ; Mwapasa, Gerald ; McCauley, Tracey ; Borgstein, Eric ; Brugha, Ruairi</creator><creatorcontrib>Gajewski, Jakub ; Conroy, Ronan ; Bijlmakers, Leon ; Mwapasa, Gerald ; McCauley, Tracey ; Borgstein, Eric ; Brugha, Ruairi</creatorcontrib><description>Background
District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
Methods
Baseline and 2–3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
Results
There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63–1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5),
p
= 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
Conclusion
The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-017-4385-9</identifier><identifier>PMID: 29209733</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Adult ; Cardiac Surgery ; Female ; General Surgery ; Hernia ; Hernia, Abdominal - surgery ; Herniorrhaphy - standards ; Herniorrhaphy - statistics & numerical data ; Hospitals ; Hospitals, District - standards ; Hospitals, District - statistics & numerical data ; Hospitals, Public - statistics & numerical data ; Humans ; Maintenance ; Malawi - epidemiology ; Male ; Medicine ; Medicine & Public Health ; Original Scientific Report ; Patient Reported Outcome Measures ; Populations ; Prospective Studies ; Quality of Health Care - standards ; Quality of Health Care - statistics & numerical data ; Rural Population ; Rural populations ; Surgery ; Surgical instruments ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2018-06, Vol.42 (6), p.1610-1616</ispartof><rights>Société Internationale de Chirurgie 2017</rights><rights>2018 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>World Journal of Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4221-4e8a557e63d7e1d3313f9519a64b1c2d4f5482dc3ba5101387add75ccfcef3723</citedby><cites>FETCH-LOGICAL-c4221-4e8a557e63d7e1d3313f9519a64b1c2d4f5482dc3ba5101387add75ccfcef3723</cites><orcidid>0000-0003-0440-6051</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-017-4385-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-017-4385-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,41486,42555,45572,45573,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29209733$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gajewski, Jakub</creatorcontrib><creatorcontrib>Conroy, Ronan</creatorcontrib><creatorcontrib>Bijlmakers, Leon</creatorcontrib><creatorcontrib>Mwapasa, Gerald</creatorcontrib><creatorcontrib>McCauley, Tracey</creatorcontrib><creatorcontrib>Borgstein, Eric</creatorcontrib><creatorcontrib>Brugha, Ruairi</creatorcontrib><title>Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
Methods
Baseline and 2–3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
Results
There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63–1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5),
p
= 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
Conclusion
The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Cardiac Surgery</subject><subject>Female</subject><subject>General Surgery</subject><subject>Hernia</subject><subject>Hernia, Abdominal - surgery</subject><subject>Herniorrhaphy - standards</subject><subject>Herniorrhaphy - statistics & numerical data</subject><subject>Hospitals</subject><subject>Hospitals, District - standards</subject><subject>Hospitals, District - statistics & numerical data</subject><subject>Hospitals, Public - statistics & numerical data</subject><subject>Humans</subject><subject>Maintenance</subject><subject>Malawi - epidemiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Scientific Report</subject><subject>Patient Reported Outcome Measures</subject><subject>Populations</subject><subject>Prospective Studies</subject><subject>Quality of Health Care - standards</subject><subject>Quality of Health Care - statistics & numerical data</subject><subject>Rural Population</subject><subject>Rural populations</subject><subject>Surgery</subject><subject>Surgical instruments</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkU9v1DAQxS0EokvhA3BBlrhwCfhf4oRbu9AuqKgtBXG0vM4EuUrs1Ha02mO_eR2lVKgS4jRz-L2nN_MQek3Je0qI_BAJYVVdECoLweuyaJ6gFRWcFYwz_hStCK9E3ik_QC9ivCYZrEj1HB2whpFGcr5Ct5eT7m3aY9_hqyn8hrDH1uFvutc7-xGv_TDqYKN3M3ChkwWXiu8w-pCgxedTMn6AiI-6BAFvIDirH3yOIe0AHP5kYwrWJKxdi9fZIOgeb3wcbdJ9fImedXnAq_t5iH6efP6x3hRn56df1kdnhRGM0UJArctSQsVbCbTl-aquKWmjK7GlhrWiK0XNWsO3uqSE8lrqtpWlMZ2BjkvGD9G7xXcM_maCmNRgo4G-1w78FBXNDxEVLSnN6NtH6LWfgsvpZorVUkhSZooulAk-xgCdGoMddNgrStTcj1r6Ufntau5HNVnz5t552g7QPij-FJKBZgF2tof9_x3Vr69Xxyekls0cmy3amGUuV_BX7H8mugM4jqxW</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Gajewski, Jakub</creator><creator>Conroy, Ronan</creator><creator>Bijlmakers, Leon</creator><creator>Mwapasa, Gerald</creator><creator>McCauley, Tracey</creator><creator>Borgstein, Eric</creator><creator>Brugha, Ruairi</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0440-6051</orcidid></search><sort><creationdate>201806</creationdate><title>Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals</title><author>Gajewski, Jakub ; Conroy, Ronan ; Bijlmakers, Leon ; Mwapasa, Gerald ; McCauley, Tracey ; Borgstein, Eric ; Brugha, Ruairi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4221-4e8a557e63d7e1d3313f9519a64b1c2d4f5482dc3ba5101387add75ccfcef3723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Cardiac Surgery</topic><topic>Female</topic><topic>General Surgery</topic><topic>Hernia</topic><topic>Hernia, Abdominal - surgery</topic><topic>Herniorrhaphy - standards</topic><topic>Herniorrhaphy - statistics & numerical data</topic><topic>Hospitals</topic><topic>Hospitals, District - standards</topic><topic>Hospitals, District - statistics & numerical data</topic><topic>Hospitals, Public - statistics & numerical data</topic><topic>Humans</topic><topic>Maintenance</topic><topic>Malawi - epidemiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Scientific Report</topic><topic>Patient Reported Outcome Measures</topic><topic>Populations</topic><topic>Prospective Studies</topic><topic>Quality of Health Care - standards</topic><topic>Quality of Health Care - statistics & numerical data</topic><topic>Rural Population</topic><topic>Rural populations</topic><topic>Surgery</topic><topic>Surgical instruments</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gajewski, Jakub</creatorcontrib><creatorcontrib>Conroy, Ronan</creatorcontrib><creatorcontrib>Bijlmakers, Leon</creatorcontrib><creatorcontrib>Mwapasa, Gerald</creatorcontrib><creatorcontrib>McCauley, Tracey</creatorcontrib><creatorcontrib>Borgstein, Eric</creatorcontrib><creatorcontrib>Brugha, Ruairi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gajewski, Jakub</au><au>Conroy, Ronan</au><au>Bijlmakers, Leon</au><au>Mwapasa, Gerald</au><au>McCauley, Tracey</au><au>Borgstein, Eric</au><au>Brugha, Ruairi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2018-06</date><risdate>2018</risdate><volume>42</volume><issue>6</issue><spage>1610</spage><epage>1616</epage><pages>1610-1616</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
Methods
Baseline and 2–3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
Results
There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63–1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5),
p
= 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
Conclusion
The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29209733</pmid><doi>10.1007/s00268-017-4385-9</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-0440-6051</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2313 |
| ispartof | World journal of surgery, 2018-06, Vol.42 (6), p.1610-1616 |
| issn | 0364-2313 1432-2323 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1973461511 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adult Cardiac Surgery Female General Surgery Hernia Hernia, Abdominal - surgery Herniorrhaphy - standards Herniorrhaphy - statistics & numerical data Hospitals Hospitals, District - standards Hospitals, District - statistics & numerical data Hospitals, Public - statistics & numerical data Humans Maintenance Malawi - epidemiology Male Medicine Medicine & Public Health Original Scientific Report Patient Reported Outcome Measures Populations Prospective Studies Quality of Health Care - standards Quality of Health Care - statistics & numerical data Rural Population Rural populations Surgery Surgical instruments Thoracic Surgery Vascular Surgery |
| title | Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T12%3A58%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Quality%20of%20Surgery%20in%20Malawi:%20Comparison%20of%20Patient-Reported%20Outcomes%20After%20Hernia%20Surgery%20Between%20District%20and%20Central%20Hospitals&rft.jtitle=World%20journal%20of%20surgery&rft.au=Gajewski,%20Jakub&rft.date=2018-06&rft.volume=42&rft.issue=6&rft.spage=1610&rft.epage=1616&rft.pages=1610-1616&rft.issn=0364-2313&rft.eissn=1432-2323&rft_id=info:doi/10.1007/s00268-017-4385-9&rft_dat=%3Cproquest_cross%3E1973461511%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1972874705&rft_id=info:pmid/29209733&rfr_iscdi=true |