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World Journal of Surgery

, Volume 42, Issue 6, pp 1610–1616 | Cite as

Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals

  • Jakub Gajewski
  • Ronan Conroy
  • Leon Bijlmakers
  • Gerald Mwapasa
  • Tracey McCauley
  • Eric Borgstein
  • Ruairi Brugha
Original Scientific Report

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.

Notes

Acknowledgements

Funding was provided by Seventh Framework Programme (Ref. FP7-AFRICA-2010, Grant Agreement No. 266417).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Royal College of Surgeons in IrelandDublin 2Ireland
  2. 2.Radboud University Medical Centre NetherlandsNijmegenThe Netherlands
  3. 3.College of MedicineBlantyreMalawi

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