Addressing the Millennium Development Goals From a Surgical Perspective Essential Surgery and Anesthesia in 8 Low- and Middle-Income Countries
Addressing the Millennium Development Goals From a Surgical Perspective Essential Surgery and Anesthesia in 8 Low- and Middle-Income Countries
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DOI：
10.1001/archsurg.2009.263
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发表时间：
2010-02-01
影响因子：
--
通讯作者：
Etienne, Carissa
中科院分区：
文献类型：
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作者：
Kushner, Adam L.;Cherian, Meena N.;Etienne, Carissa
假设：手术和麻醉护理越来越被认为是低收入和中等收入国家 (LMIC) 初级卫生保健中被忽视但具有成本效益的组成部分。加强服务交付有助于实现千年发展目标 4、5 和 6。中低收入国家在获得基本外科护理方面存在巨大差距，导致发病率和死亡率相当高。本研究的目的是提供多个中低收入国家地区级卫生机构基本手术和麻醉能力的基线概述。 设计：调查。背景：多个中低收入国家地区级卫生机构主要成果指标：在选定的地区级医院使用标准化世界卫生组织工具来评估与基本外科和麻醉能力相关的基础设施、用品和程序。该分析包括评估了 5 个以上卫生机构的国家的机构。所有数据均经过汇总和盲法处理，以避免国家间比较。结果：对来自 8 个国家 132 个设施的数据进行了分析：斯里兰卡民主社会主义共和国 (n = 32)、蒙古 (n = 31)、坦桑尼亚联合共和国 (n = 25)、阿富汗伊斯兰国 (n = 13)、塞拉利昂共和国 (n = 11)、利比里亚共和国 (n = 9）、冈比亚共和国（n = 6）和圣多美和普林西比民主共和国（n = 5）。普遍而言，设施显示出基本基础设施（水、电、氧气）和功能麻醉机的短缺。尽管 73% 的机构报告可以进行脓肿切开和引流，但只有 48% 的机构能够进行阑尾切除术。根据千年发展目标 4、5 和 6，只有 32% 的设施进行了先天性疝气修复，44% 的设施进行了剖腹产，很少有设施始终配备护目镜和围裙来保护外科医护人员免受人类免疫缺陷病毒的感染。 结论： 基础设施、用品和所进行的程序严重短缺在地区级卫生机构中很常见 中低收入国家。
Hypothesis: Surgical and anesthetic care is increasingly recognized as a neglected but cost-effective component of primary health care in low- and middle-income countries (LMICs). Strengthening delivery can help achieve Millennium Development Goals 4, 5, and 6. Large gaps in access to essential surgical care in LMICs result in considerable morbidity and mortality. The goal of this study was to provide a baseline overview of essential surgical and anesthetic capacity at district-level health facilities in multiple LMICs.Design: Survey.Setting: District-level health facilities in multiple LMICsMain Outcome Measures: A standardized World Health Organization tool was used at selected district-level hospitals to assess infrastructure, supplies, and procedures relating to essential surgical and anesthetic capacity. The analysis included facilities from countries that assessed more than 5 health facilities. All data were aggregated and blinded to avoid intercountry comparisons.Results: Data from 132 facilities were analyzed from 8 countries: Democratic Socialist Republic of Sri Lanka (n = 32), Mongolia (n = 31), United Republic of Tanzania (n = 25), Islamic State of Afghanistan (n = 13), Republic of Sierra Leone (n = 11), Republic of Liberia (n = 9), Republic of The Gambia (n = 6), and Democratic Republic of Sao Tome and Principe (n = 5). Universally, facilities demonstrated shortfalls in basic infrastructure ( water, electricity, oxygen) and functioning anesthesia machines. Although 73% of facilities reported performing incision and drainage of abscesses, only 48% were capable of undertaking an appendectomy. In line with Millennium Development Goals 4, 5, and 6, only 32% of facilities performed congenital hernia repairs, 44% of facilities performed cesarean sections, and few facilities always had goggles and aprons to protect surgical health care workers from human immunodeficiency virus.Conclusion: Enormous shortfalls in infrastructure, supplies, and procedures undertaken are common at district-level health facilities in LMICs.