Work-related operating theatre accidents among surgical residents in Addis Ababa, Ethiopia

Background: With the Human Immunodeficiency virus (HIV) epidemic and infections with hepatitis B, C and D, occupational exposures to these infections is a cause of concern to all health care workers, especially those working in the operating theatre in low income countries.Methods: A cross-sectional study was conducted to investigate the prevalence and context of all work-related accidents that occurred as a result of contamination with blood and blood products, among surgical residents at the Black lion teaching specialized referral hospital, in Addis Ababa, Ethiopia. Data was collected from all 36 surgical residents who were at different stages of their specialty training in 2006/07.Results: Thirty two (88.9%) of the residents were males; 17 (47.2%) in their 3rd and 4th year, and the rest 19 (52.8%) were in their first and second year of training. Of the 36 respondents, 28(77.8%) had sustained a needle-stick injury inside the operating theatre at least twice during their residency (Range=2-10 times). For 13(36.1%), the accidents involved a high risk patient at least once. Cut with a sharp object, contact of blood to an unprotected skin and splash of blood to the eyes and face were reported by 11(30.6%), 27(75%) and 27(75%) of the respondents respectively. Information concerning the most recent occupational injury inside the operating theatre revealed that 31(86.1%) of the residents sustained work-related accident in the 6 months preceding the survey, 8(25.8%) of which involved a high risk patient. All of the 8 (100%) of the recent high risk injuries and 22(95.6%) of the non-high risk injuries were not reported to the hospital’s employee health service. The most frequently cited reasons for not reporting include; “The occupational health service doesn’t exist or I don’t know if it exists in the hospital” for 15 (50%), among others.Conclusions and Recommendations: Overall, the present study revealed that work-related accidents among surgical trainees constitute a substantial risk of acquiring and transmitting blood-borne infections which calls for well targeted educational and other preventive measures in the teaching hospital

The Gap between Surgical Resident and Faculty Surgeons Concerning Operating Theatre Teaching: Report from Addis Ababa, Ethiopia

Background: In a continent like Africa where the number of surgeons is alarmingly few, training of a large number of residents is the way forward. However, sudden expansion in the number of trainees in an existing teaching environment may bring the quality of the most fundamentaleducation i.e. operation room teaching into question.Method: We wanted to investigate the different perceptions of our surgeons-under-training and faculty concerning preoperative preparation, intra operative teaching and postoperative feedback. A validated questionnaire was administered to our surgical residents and faculty at the Addis Ababa University, School of Medicine, Department of Surgery. Results were analyzed with 2-sample t tests, comparing Likert scores. Findings were significant if the p value was < 0.05.Results: Forty residents (15 second year, 15 third years and 10 final years) and 30 faculty members completed the survey. With respect to preoperative preparation, faculty were significantly more likely to claim that residents’ preparation in terms of reading is low (3.77 vs 2.45; p=0.001) and anatomy review (3.73 vs 2.34; p=0.001) before the procedure. There was a very significant difference with regards to intra-operative teaching activities, i.e teaching of the operative steps (2.60 vs 3.79; p=0.048), instrument handling (2.30 vs 3.72; p=0.002), and surgical technique (2.23vs 3.83; p= 0.001). Residents’ perception of the effort of the faculty to act as a teacher in the operating room was significantly lower compared to the faculty (2.13 vs 3.94; p=0.002). Postoperatively, significant differences were found in perceptions of positive feedback (2.48 vs 3.86; p=0.01) and feedback on areas to improve (1.85 vs 3.34; p=0.001).Conclusion: There is a universal agreement on the need to improve the current residency training. However, the difference between resident and faculty in the teaching-learning process is alarmingly significant. As there is no substitute for the intra-operative training of residents, every effort must be made to not to trade off number of graduates with quality and  competence of surgeons-under-training.  Keywords: Resident, Surgeons, Operating, Theatre, Teachin

Methods for Assessing the Impacts of Natural Resource Management Research A Summary of the Proceedings of the ICRISAT-NCAP/ICAR International Workshop

The perceived risks to sustainability of production systems and livelihood security of the poor in the many developing countries in recent years have prompted increased investment in natural resource management (NRM) research and development efforts. The national and international agencies, and non-governmental organizations making these investments are anxious to assess the effectiveness of these interventions on attaining the stated environmental and livelihood objectives. But measuring changes in natural resource and environmental outcome is notoriously difficult, as is assigning a monetary value to those tangible and nontangible changes. Yet, accountability is impossible without measurement of impacts. These methodological difficulties have hindered impact assessment studies in this area. This publication contains a summary of papers and discussions from the international workshop 'Methods for Assessing the Impacts of Natural Resource Management Research' held at ICRISAT-Patancheru, 6-7 December 2002. The workshop aimed to review recent advances in methods for assessing the economic and environmental outcomes of NRM practices in agriculture. It was attended by researchers from various national and international agencies, with specific expertise in applied methods for assessing the impacts of integrated NRM innovations. The presentations and discussions highlighted the special features and challenges of NRM impact assessment; indicators for monitoring biophysical and environmental impacts; methods for valuation of various ecosystem services derived from NRM investments; and economic methodologies and approaches for integrated assessment of economic and environmental impacts of NRM interventions in agriculture. The opinions expressed in this publication are those of the authors and not necessarily those of ICRISAT. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of ICRISAT concerning the legal status of any country, territory, city, or area, or its authorities, or concerning the delimitation of its frontiers or boundaries. Where trade names are used this does not constitute endorsement of or discrimination against any product by ICRISAT

Assessing the Impact of NRM Research: Methodological Paucity Recent Progress and Future Directions.

Thirty years ago, the focus of the Consultative Group on International Agricultural Research (CGIAR) was almost exclusively on improving agricultural productivity and increasing input-use efficiency (reducing costs) for its mandate crops via genetic improvement. Yet, natural resource management (NRM) research can enhance crop productivity growth and sustainable use of natural resources (soils, water, forestry, etc.), and significantly contribute to poverty reduction and improving human welfare. These considerations have prompted the CGIAR to expand its research portfolio in the area of NRM...........

Technology adoption under seed access constraints and the economic impacts of improved pigeonpea varieties in Tanzania

Dry-land legumes, well adapted to drought-prone areas, have largely been neglected in the past despite the good opportunities they offer for income growth and food (and nutritional) security for the poor. This study evaluated the adoption and impact of two farmer and market-preferred and disease-resistant pigeonpea varieties that were developed and promoted in semi-arid Tanzania. The new varieties were resistant to fusarium wilt, a fungal disease devastating the crop. However, farmers wanting to adopt new varieties did not adopt due to seed access constraints and under-developed seed delivery systems. Adoption of new varieties is therefore analyzed using an augmented double hurdle model that allows estimating variety adoption conditional on seed access thresholds accounting for the additional information on sample separation. The study identifies the crucial role of seed access (local supply), extension, education, participatory decision making, capital, and household assets in determining adoption. The social economic benefits of the technology and policies for improved seed access were further analyzed using the extended economic surplus method (DREAM model). Even under restrictive assumptions, overall discounted benefits were found to be quite attractive, indicating the need for additional efforts to scale-up the success story. Analysis of changes in research benefits from relaxing the seed access constraint showed that net gains would increase by up to 30% if farmer access to improved seeds can be assured. Smallholder farmers are the major beneficiaries along with consumers and rural net-buyers who gain from productivity-induced lower market prices

Leveraging Rural Institutions for Collective Action to Improve Markets for the Poor: Lessons and Policy Options

Market transactions in rural areas of sub-Saharan Africa (SSA) are usually small, because the markets are thin and point-to-point transportation of commodities is difficult. The prices offered are not competitive and volumes traded are usually season dependent. Where market infrastructure is weak and under-developed, liberalization and structural adjustment policies have not been able to improve market access; and the private sector has failed to make the investments needed for proper and effective market coordination

Valuation methods and approaches for assessing natural resource management impacts

This chapter provides an overview of the valuation methods and methodological approaches used to evaluate the economic and environmental impacts of natural resource management (NRM) interventions. First, the multiple agro-ecosystem services associated with NRM are summarized. The core issues involved in the valuation of agro-ecosystem services are then discussed. This is followed by a presentation of the theoretical foundations of valuation methods along with some examples of applications in the area of natural resources. The next part summarizes how economic and environmental impacts can be integrated to provide an assessment of the social net benefits from NRM interventions, and the conclusion highlights the major issues and most promising valuation method

Solvable model of a polymer in random media with long ranged disorder correlations

We present an exactly solvable model of a Gaussian (flexible) polymer chain in a quenched random medium. This is the case when the random medium obeys very long range quadratic correlations. The model is solved in $d$ spatial dimensions using the replica method, and practically all the physical properties of the chain can be found. In particular the difference between the behavior of a chain that is free to move and a chain with one end fixed is elucidated. The interesting finding is that a chain that is free to move in a quadratically correlated random potential behaves like a free chain with $R^2 \sim L$, where $R$ is the end to end distance and $L$ is the length of the chain, whereas for a chain anchored at one end $R^2 \sim L^4$. The exact results are found to agree with an alternative numerical solution in $d=1$ dimensions. The crossover from long ranged to short ranged correlations of the disorder is also explored.Comment: REVTeX, 28 pages, 12 figures in eps forma

Towards comprehensive approaches in assessing NRM impacts: what we know and what we need to know

This chapter synthesizes the conceptual, methodological and empirical issues for evaluating the impacts of natural resource management (NRM) technology and policy interventions. It offers insights on key lessons, policy conclusions, knowledge gaps, and areas that need further researc