Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy and treatment of open fractures

O'Neill, Kathleen M, Greenberg, Sarah L M, Cherian, Meena, Gillies, Rowan D, Daniels, Kimberly M, Roy, Nobhojit, Raykar, Nakul P, Riesel, Johanna N, Spiegel, David, Watters, David A and Gruen, Russell L 2016, Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy and treatment of open fractures, World journal of surgery, vol. 40, no. 11, pp. 2611-2619, doi: 10.1007/s00268-016-3614-y.

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Title Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy and treatment of open fractures
Author(s) O'Neill, Kathleen M
Greenberg, Sarah L M
Cherian, Meena
Gillies, Rowan D
Daniels, Kimberly M
Roy, Nobhojit
Raykar, Nakul P
Riesel, Johanna N
Spiegel, David
Watters, David AORCID iD for Watters, David A orcid.org/0000-0002-5742-8417
Gruen, Russell L
Journal name World journal of surgery
Volume number 40
Issue number 11
Start page 2611
End page 2619
Total pages 9
Publisher Springer
Place of publication Berlin, Germany
Publication date 2016-11
ISSN 1432-2323
Summary BACKGROUND: Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care.

METHODS: We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures-which we term "bellwether procedures"-was associated with performing a full range of essential surgical procedures.

FINDINGS: The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures.

INTERPRETATION: Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.
Language eng
DOI 10.1007/s00268-016-3614-y
Field of Research 1103 Clinical Sciences
110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920499 Public Health (excl. Specific Population Health) not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Société Internationale de Chirurgie
Persistent URL http://hdl.handle.net/10536/DRO/DU:30085103

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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