Cesarean Section Surgical Site Infections in Sub-Saharan Africa: A Multi-Country Study from Medecins Sans Frontieres

Background: Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs. Methods: This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone. Women undergoing from August 1 2010 to January 31 2011 were included. CS post-operative SSI data were prospectively collected. Logistic regression was used to model SSI risk factors. Findings: In total, 1,276 women underwent CS. The incidence of SSI was 7.3 % (range 1.7–10.4 %). 93 % of SSI were superficial. The median length of stay of women without SSI was 7 days (range 3–63 days) compared to 21 days (range 5–51 days) in those with SSI (p < 0.001). In multivariate analysis, younger age, premature rupture of the membranes, and neonatal death were associated with an increased risk of SSI, while antenatal hemorrhage and the Lubutu, DRC project site were associated with a lower risk of developing an SSI. Conclusions: This study demonstrates that surgery can be performed with a low incidence of SSI, a proxy for surgical safety, in sub-Saharan Africa. Protocols such as perioperative antibiotics and basic infrastructure such as clean water and sterilization can be achieved. Simple data collection tools will assist policymakers with monitoring and evaluation as well as quality control assurance of surgical programs in low and middle income countries

Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres.

The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality

Improving Effective Surgical Delivery in Humanitarian Disasters: Lessons from Haiti

Kathryn Chu and colleagues describe the experiences of Médecins sans Frontières after the 2010 Haiti earthquake, and discuss how to improve delivery of surgery in humanitarian disasters

Building Research Capacity in Africa: Equity and Global Health Collaborations

Kathryn Chu and colleagues discuss the impact of high-income country investigators conducting research in low- and middle-income countries and explore lessons from the effective and equitable relationships that exist. Please see later in the article for the Editors' Summar

Providing surgical care in Somalia: A model of task shifting.

ABSTRACT

Community support for injured patients:A scoping review and narrative synthesis

Background: Community-based peer support (CBPS) groups have been effective in facilitating access to and retention in the healthcare system for patients with HIV/AIDS, cancer, diabetes, and other communicable and non-communicable diseases. Given the high incidence of morbidity that results from traumatic injuries, and the barriers to reaching and accessing care for injured patients, community-based support groups may prove to be similarly effective in this population.Objectives: The objective of this review is to identify the extent and impact of CBPS for injured patients.Eligibility: We included primary research on studies that evaluated peer-support groups that were solely based in the community. Hospital-based or healthcare-professional led groups were excluded.Evidence: Sources were identified from a systematic search of Medline / PubMed, CINAHL, and Web of Science Core Collection.Charting methods: We utilized a narrative synthesis approach to data analysis.Results: 4,989 references were retrieved; 25 were included in final data extraction. There was a variety of methodologies represented and the groups included patients with spinal cord injury (N = 2), traumatic brain or head injury (N = 7), burns (N = 4), intimate partner violence (IPV) (N = 5), mixed injuries (N = 5), torture (N = 1), and brachial plexus injury (N = 1). Multiple benefits were reported by support group participants; categorized as social, emotional, logistical, or educational benefits.Conclusions: Community-based peer support groups can provide education, community, and may have implications for retention in care for injured patients

Developing Luminescent Lanthanide Coordination Polymers and Metal-Organic Frameworks for Bioimaging Applications

This study focuses on the solvothermal synthesis of two lanthanide-based coordination polymer/metal-organic framework systems assembled from 1,3,5-benzenetricarboxylic acid (BTC) in the nano-sized regime for use as bioimaging agents. These materials were synthesized using two different lanthanide ions, a luminescent center (Eu, Tb) for optical imaging purposes and Gd, whose magnetic properties are particularly beneficial in magnetic resonance imaging (MRI) asa contrast agent. Together, these two features allow for multimodal imaging, useful in the study and diagnosis of disease. Under identical reaction conditions, two different compounds were formed upon changing the identity of the optically active lanthanide metal ion. Compound 1 ([EuGd(BTC)2(H2O)12]) emerged as a one dimensional coordination polymer, increasing in size with reaction time; while compound 2 ([TbGd(BTC)2(H2O)2]n•2DMF) emerged as a three dimensionalframework, decreasing in size with time. Both compounds displayed vibrant luminescence upon UV excitation, indicating potential as bioimaging agents

Estimating the specialist surgical workforce density in South Africa

Background: South Africa is an upper middle-income country with inequitable access to healthcare. There is a maldistribution of doctors between the private and public sectors, the latter which serves 86% of the population but has less than half of the human resources. Objective: The objective of this study was to estimate the specialist surgical workforce density in South Africa. Methods: This was a retrospective record-based review of the specialist surgical workforce in South Africa as defined by registration with the Health Professionals Council of South Africa for three cadres: 1) surgeons, and 2) anaesthesiologists, and 3) obstetrician/gynaecologists (OBGYN). Findings: The specialist surgical workforce in South Africa doubled from 2004 (N = 2956) to 2019 (N = 6144). As of December 2019, there were 3096 surgeons (50.4%), 1268 (20.6%) OBGYN, and 1780 (29.0%) anaesthesiologists. The specialist surgical workforce density in 2019 was 10.5 per 100,000 population which ranged from 1.8 in Limpopo and 22.8 per 100,000 in Western Cape province. The proportion of females and those classified other than white increased between 2004–2019. Conclusion: South Africa falls short of the minimum specialist workforce density of 20 per 100,000 to provide adequate essential and emergency surgical care. In order to address the current and future burden of disease treatable by surgical care, South Africa needs a robust surgical healthcare system with adequate human resources, to translate healthcare services into improved health outcomes