Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries

In the first of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues find low levels of surgical care provision suggesting unmet need for surgical services

Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

In the second of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues describe the range of providers of surgical care and anesthesia and estimate the related costs

Wide-area near-real-time monitoring of tropical forest degradation and deforestation using sentinel-1

The use of Sentinel-1 (S1) radar for wide-area, near-real-time (NRT) tropical-forest-change monitoring is discussed, with particular attention to forest degradation and deforestation. Since forest change can relate to processes ranging from high-impact, large-scale conversion to low-impact, selective logging, and can occur in sites having variable topographic and environmental properties such as mountain slopes and wetlands, a single approach is insufficient. The system introduced here combines time-series analysis of small objects identified in S1 data, i.e., segments containing linear features and apparent small-scale disturbances. A physical model is introduced for quantifying the size of small (upper-) canopy gaps. Deforestation detection was evaluated for several forest landscapes in the Amazon and Borneo. Using the default system settings, the false alarm rate (FAR) is very low (less than 1%), and the missed detection rate (MDR) varies between 1.9% ± 1.1% and 18.6% ± 1.0% (90% confidence level). For peatland landscapes, short radar detection delays up to several weeks due to high levels of soil moisture may occur, while, in comparison, for optical systems, detection delays up to 10 months were found due to cloud cover. In peat swamp forests, narrow linear canopy gaps (road and canal systems) could be detected with an overall accuracy of 85.5%, including many gaps barely visible on hi-res SPOT-6/7 images, which were used for validation. Compared to optical data, subtle degradation signals are easier to detect and are not quickly lost over time due to fast re-vegetation. Although it is possible to estimate an effective forest-cover loss, for example, due to selective logging, and results are spatiotemporally consistent with Sentinel-2 and TerraSAR-X reference data, quantitative validation without extensive field data and/or large hi-res radar datasets, such as TerraSAR-X, remains a challenge

Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.

BackgroundSurgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries.Methods and findingsIn a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population.ConclusionThe findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality. Please see later in the article for the Editors' Summary

Slantwise: Beyond Domination and Resistance on the Border

Drawing on extensive participant observation and interviews concerned with barriers to census enumeration in colonias (irregular migrant settlements along the United States-Mexico border) and Mexican migration to the United States, we argue that recent ethnography has overemphasized the role of domination and resistance. While power is fundamental to cultural analysis, we also need to examine behavior we call slantwise, that is, actions that are obliquely or only indirectly related to power relations. Ethnographic fieldwork from both sides of the United States-Mexico border uncovered a range of behaviors (including unorthodox building techniques in colonias, hybrid language practices, complex and fluid household structures, nonlinear mobility patterns, and unpredictable political loyalties of migrants) that do not fit neatly into the domination-resistance axis. We argue for the relevance of the slant-wise concept for understanding such behaviors, not as a replacement for studies of naturalized domination and resistance, but as a complement to them

Providers of major surgery, minor surgery, and anesthesia across eight hospitals in three Sub-Saharan African countries.

<p>(A) Major surgeries; (B) minor surgeries; (C) anesthesia for major surgeries. Note: MLPs highlighted.</p

Training and clinical scope of practice of MLPs in Tanzania, Mozambique, and Uganda.

<p>Training and clinical scope of practice of MLPs in Tanzania, Mozambique, and Uganda.</p

Distribution of health care facilities by study site and population served.

a<p>Ugandan hospitals are referred to as “General Hospitals” rather than “District Hospitals.” The “Other” hospital in Mubende district is another “General” hospital.</p>b<p><a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000242#pmed.1000242-US1" target="_blank">[41]</a>.</p>c<p>2002 country-level census data.</p>d<p>2007 country-level census data.</p