Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana

The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (hereafter called the WHO Tool) has been used in more than 25 countries and is the largest effort to assess surgical care in the world. However, it has not yet been independently validated. Test–retest reliability is one way to validate the degree to which tests instruments are free from random error. The aim of the present field study was to determine the test–retest reliability of the WHO Tool. The WHO Tool was mailed to 10 district hospitals in Ghana. Written instructions were provided along with a letter from the Ghana Health Services requesting the hospital administrator to complete the survey tool. After ensuring delivery and completion of the forms, the study team readministered the WHO Tool at the time of an on-site visit less than 1 month later. The results of the two tests were compared to calculate kappa statistics for each of the 152 questions in the WHO Tool. The kappa statistic is a statistical measure of the degree of agreement above what would be expected based on chance alone. Ten hospitals were surveyed twice over a short interval (i.e., less than 1 month). Weighted and unweighted kappa statistics were calculated for 152 questions. The median unweighted kappa for the entire survey was 0.43 (interquartile range 0–0.84). The infrastructure section (24 questions) had a median kappa of 0.81; the human resources section (13 questions) had a median kappa of 0.77; the surgical procedures section (67 questions) had a median kappa of 0.00; and the emergency surgical equipment section (48 questions) had a median kappa of 0.81. Hospital capacity survey questions related to infrastructure characteristics had high reliability. However, questions related to process of care had poor reliability and may benefit from supplemental data gathered by direct observation. Limitations to the study include the small sample size: 10 district hospitals in a single country. Consistent and high correlations calculated from the field testing within the present analysis suggest that the WHO Tool for Situational Analysis is a reliable tool where it measures structure and setting, but it should be revised for measuring process of care

Anorectal malformation: Audit of management in a major tertiary institution in Ghana

Background: Anorectal malformation (ARM) remains a significant challenge to the child and paediatric surgeons. Its rarity is relative in Sub-Saharan Africa, where there are few specialized centres for management. This study aimed to describe the presentations, management, and preliminary outcomes of ARM in a major specialized centre. Methods: A prospective observational study, with a two-year follow-up was conducted for children (up to 15 years) who presented with ARM at the Paediatric Surgery Unit between November 2020 and July 2021. Results: Sixty-one (61) patients (M: F = 1:0.96) were studied. 28.27 % of the ARM's were detected on day one of birth. More than two thirds of the cohort (70.5 %) was first detected by mothers. The remainder (29.5 %) were detected by health professionals. Majority, 88.2 %, presented late (>24hours). 34(55.4 %) presented in a stable state, 20(32.79 %) with acute intestinal obstruction and 4(6.56 %) with sepsis. Associated congenital anomalies were observed in 7(11.48 %) of patients. All the children had a staged procedure (colostomy, PSARP and closure of colostomy). The mean duration between colostomy creation and PSARP was 7.02 +/- 2.05 months, while the mean duration between PSARP and colostomy reversal was eight months. The complication and mortality rates after all the staged procedures were 39.3 % and 2.2 %, respectively. 5.2 % had persistent faecal soiling while 3.5 % had persistent constipation at 2 years. There were no anal strictures or rectal prolapse. Conclusion: Surgical outcomes of children with ARM are generally good, although there were late and unstable presentations to the hospital. Late identification of ARM by health professionals lead to late presentation

Complications of hypospadias surgery: Experience in a tertiary hospital of a developing country

Background: Over 300 different operations have been described for the management of hypospadias. In recent times, the numbers of operations used in various centres have gradually reduced as the principles necessary to ensure adequate cosmetic and functional results with minimum complications are better understood. The aim of this article was to review the different types of operations used for managing hypospadias in a tertiary hospital in a developing country, to analyse the complications of surgery and discuss the factors that contribute to complications. Materials and Methods: Patient folders, theatre, and ward records were used to obtain the required information. The age at surgery, types of hypospadias at presentation, types of operations done and complications were analysed. Results and Conclusion: With three main types of operations, tubularised incised plate urethroplasty and meatal advancement and glanuloplasty incorporated for anterior hypospadias (glanular, coronal, subcoronal, distal, midpenile), and lateral based flap urethroplasty for posterior hypospadias (proximal penile, penoscrotal, scrotal, perineal), most hypospadias were corrected with acceptable complication rates