Skip to main content
Log in

A Retrospective One-Year Estimation of the Volume and Nature of Surgical and Anaesthetic Services Delivered to the Populations of the Fako Division of the South-West Region of Cameroon: An Urgent Call for Action

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Surgery-related conditions account for the majority of admissions in primary referral hospitals in Sub-Saharan Africa. The role of surgery in the reduction of global disease burden is well recognized, but there is a great qualitative and quantitative disparity in the delivery of surgical and anaesthetic services between countries. This study aims at estimating the nature and volume of surgery delivered in an entire administrative division of Cameroon.

Methods

In this retrospective survey conducted during the year 2013, we used a standard tool to analyse the infrastructure and human resources involved in the delivery of surgical and anaesthetic services in the Fako division in the south-west region of Cameroon. We also estimated the nature and volume of surgical services as a rate per catchment population.

Results

Public, private and mission hospital contributed equally to the delivery of surgical services in the Fako. For every 100,000 people, there were <5 operative rooms. A total of 2460 surgical interventions were performed by 2.2 surgeons, 1.1 gynaecologists and 0.3 anaesthetists. These surgical interventions consisted mostly of minor and emergency procedures. Neurosurgery, paediatric, thoracic and endocrine surgery were almost non-existent.

Conclusions

The volume of surgery delivered in the Fako is far below the minimum rates required to meet up with the most basic requirements of the populations. It is likely that most of these surgical needs are left unattended. A community-based assessment of unmet surgical needs is necessary to accurately estimate the magnitude of the problem and guide surgical capacity improvements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Global Health 27(3):S8

    Article  Google Scholar 

  2. Debas HT, Donkor P, Gawande A et al (eds) (2015) Essential surgery: disease control priorities, vol 1, 3rd edn. The International Bank for Reconstruction and Development/The World Bank, Washington

    Google Scholar 

  3. Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386(9993):569–624

    Article  PubMed  Google Scholar 

  4. Mock C (2013) Confronting the global burden of surgical disease. World J Surg 37(7):1457–1459. doi:10.1007/s00268-013-2102-x

    Article  PubMed  Google Scholar 

  5. Kushner AL, Cherian MN, Noel L et al (2010) Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159

    Article  PubMed  Google Scholar 

  6. Zafar SN, Fatmi Z, Iqbal A et al (2013) Disparities in access to surgical care within a lower income country: an alarming inequity. World J Surg 37(7):1470–1477. doi:10.1007/s00268-012-1732-8

    Article  PubMed  Google Scholar 

  7. Rose J, Weiser TG, Hider P et al (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health 3(Suppl 2):S13–S20

    Article  PubMed  Google Scholar 

  8. Hoyler M, Finlayson SR, McClain CD et al (2014) Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature. World J Surg 38(2):269–280. doi:10.1007/s00268-013-2324-y

    Article  PubMed  Google Scholar 

  9. Markin A, Barbero R, Leow JJ et al (2013) A quantitative analysis of surgical capacity in Santa Cruz, Bolivia. J Surg Res 185(1):190–197

    Article  PubMed  Google Scholar 

  10. Notrica MR, Evans FM, Knowlton LM et al (2011) Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 35(8):1770–1780. doi:10.1007/s00268-011-1125-4

    Article  PubMed  Google Scholar 

  11. Chichom Mefire A, Atashili J, Mbuagbaw J (2013) Pattern of surgical practice in a regional hospital in Cameroon and implications for training. World J Surg 37(9):2101–2108. doi:10.1007/s00268-013-2116-4

    Article  PubMed  Google Scholar 

  12. Lebrun DG, Saavedra-Pozo I, Agreda-Flores F et al (2012) Surgical and anesthesia capacity in Bolivian public hospitals: results from a national hospital survey. World J Surg 36(11):2559–2566. doi:10.1007/s00268-012-1722-x

    Article  PubMed  Google Scholar 

  13. Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36(5):1056–1065. doi:10.1007/s00268-012-1482-7

    Article  PubMed  Google Scholar 

  14. Lebrun DG, Dhar D, Sarkar MI et al (2013) Measuring global surgical disparities: a survey of surgical and anesthesia infrastructure in Bangladesh. World J Surg 37(1):24–31. doi:10.1007/s00268-012-1806-7

    Article  PubMed  Google Scholar 

  15. Iddriss A, Shivute N, Bickler S et al (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89(8):565–572

    Article  PubMed  PubMed Central  Google Scholar 

  16. Esquivel MM, Molina G, Uribe-Leitz T et al (2015) Proposed minimum rates of surgery to support desirable health outcomes: an observational study based on three strategies. World J Surg 39(9):2126–2131. doi:10.1007/s00268-015-3092-7

    Article  PubMed  Google Scholar 

  17. Gupta S, Ranjit A, Shrestha R et al (2014) Surgical needs of Nepal: pilot study of population based survey in Pokhara, Nepal. World J Surg 38(12):3041–3046. doi:10.1007/s00268-014-2753-2

    Article  PubMed  Google Scholar 

  18. Groen RS, Samai M, Petroze RT, Kamara TB, Yambasu SE, Calland JF, Kingham TP, Guterbock TM, Choo B, Kushner AL (2012) Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg 36(4):771–774. doi:10.1007/s00268-012-1448-9

    Article  PubMed  Google Scholar 

  19. von Elm E, Altman DG, Egger M, Initiative STROBE (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12(12):1495–1499

    Article  Google Scholar 

  20. Petroze RT, Mehtsun W, Nzayisenga A et al (2012) Ratio of cesarean sections to total procedures as a marker of district hospital trauma capacity. World J Surg 36(9):2074–2079. doi:10.1007/s00268-012-1629-6

    Article  PubMed  PubMed Central  Google Scholar 

  21. Anderson JE, Erickson A, Funzamo C et al (2014) Surgical conditions account for the majority of admissions to three primary referral hospitals in rural Mozambique. World J Surg 38(4):823–829. doi:10.1007/s00268-013-2366-1

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nordberg E (1990) Surgical operations in eastern Africa: a review with conclusions regarding the need for further research. East Afr Med J 67(3 Suppl):1–28

    CAS  PubMed  Google Scholar 

  23. LeBrun DG, Chackungal S, Chao TE et al (2014) Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries. Surgery 155(3):365–373

    Article  PubMed  Google Scholar 

  24. Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443

    Article  CAS  PubMed  Google Scholar 

  25. Reshamwalla S, Gobeze AA, Ghosh S et al (2012) Snapshot of surgical activity in rural Ethiopia: Is enough being done? World J Surg 36(5):1049–1055. doi:10.1007/s00268-012-1511-6

    Article  PubMed  Google Scholar 

  26. Nabembezi JS, Nordberg E (2001) Surgical output in Kibaale district, Uganda. East Afr Med J 78(7):379–381

    Article  CAS  PubMed  Google Scholar 

  27. Lavy C, Tindall A, Steinlechner C et al (2007) Surgery in Malawi—a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl 89(7):722–724

    Article  PubMed  PubMed Central  Google Scholar 

  28. Patel HD, Groen RS, Kamara TB et al (2014) An estimate of hernia prevalence in Sierra Leone from a nationwide community survey. Hernia 18(2):297–303

    Article  CAS  PubMed  Google Scholar 

  29. Galukande M, von Schreeb J, Wladis A et al (2010) Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PLoS Med 7(3):e1000243

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144(2):122–127 (discussion 128)

    Article  PubMed  Google Scholar 

  31. Steinlechner C, Tindall A, Lavy C et al (2006) A national survey of surgical activity in hospitals in Malawi. Trop Dr 36(3):158–160

    Article  Google Scholar 

  32. Abdullah F, Choo S, Hesse AA et al (2011) Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews. J Surg Res 171(2):461–466

    Article  PubMed  Google Scholar 

  33. Petroze RT, Calland JF, Niyonkuru F et al (2014) Estimating pediatric surgical need in developing countries: a household survey in Rwanda. J Pediatr Surg 49(7):1092–1098

    Article  PubMed  Google Scholar 

  34. Van Buren NC, Groen RS, Kushner AL et al (2014) Untreated head and neck surgical disease in Sierra Leone: a cross-sectional, countrywide survey. Otolaryngol Head Neck Surg 151(4):638–645

    Article  PubMed  Google Scholar 

  35. Groen RS, Samai M, Petroze RT et al (2013) Household survey in Sierra Leone reveals high prevalence of surgical conditions in children. World J Surg 37(6):1220–1226. doi:10.1007/s00268-013-1996-7

    Article  PubMed  Google Scholar 

  36. Chichom-Mefire A, Mbarga-Essim NT, Monono ME et al (2014) Compliance of district hospitals in the Center Region of Cameroon with WHO/IATSIC guidelines for the care of the injured: a cross-sectional analysis. World J Surg 38(10):2525–2533. doi:10.1007/s00268-014-2609-9

    Article  PubMed  Google Scholar 

  37. Merchant A, Hendel S, Shockley R et al (2015) Evaluating progress in the global surgical crisis: contrasting access to emergency and essential surgery and safe anesthesia around the world. World J Surg 39(11):2630–2635. doi:10.1007/s00268-015-3179-1

    Article  PubMed  Google Scholar 

  38. Funk LM, Conley DM, Berry WR et al (2013) Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals. World J Surg 37(11):2520–2528. doi:10.1007/s00268-013-2172-9

    Article  PubMed  Google Scholar 

  39. Stewart BT, Gyedu A, Abantanga F et al (2015) Barriers to essential surgical care in low- and middle-income countries: a pilot study of a comprehensive assessment tool in Ghana. World J Surg 39(11):2613–2621. doi:10.1007/s00268-015-3168-4

    Article  PubMed  Google Scholar 

  40. Ilbawi AM, Einterz EM, Nkusu D (2013) Obstacles to surgical services in a rural Cameroonian district hospital. World J Surg 37(6):1208–1215. doi:10.1007/s00268-013-1977-x

    Article  PubMed  Google Scholar 

  41. Kwon S, Groen RS, Kamara TB et al (2013) Nationally representative household survey of surgery and mortality in Sierra Leone. World J Surg 37(8):1829–1835. doi:10.1007/s00268-013-2035-4

    Article  PubMed  Google Scholar 

  42. Kruk ME, Wladis A, Mbembati N et al (2010) Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 7(3):e1000242

    Article  PubMed  PubMed Central  Google Scholar 

  43. Henry JA, Windapo O, Kushner AL et al (2012) A survey of surgical capacity in rural southern Nigeria: opportunities for change. World J Surg 36(12):2811–2818. doi:10.1007/s00268-012-1764-0

    Article  PubMed  Google Scholar 

  44. Burke T, Manglani Y, Altawil Z et al (2015) A safe-anesthesia innovation for emergency and life-improving surgeries when no anesthetist is available: a descriptive review of 193 consecutive surgeries. World J Surg 39(9):2147–2152. doi:10.1007/s00268-015-3118-1

    Article  PubMed  Google Scholar 

  45. McQueen K, Coonan T, Ottaway A et al (2015) The bare minimum: the reality of global anaesthesia and patient safety. World J Surg 39(9):2153–2160. doi:10.1007/s00268-015-3101-x

    Article  PubMed  Google Scholar 

  46. Groen RS, Samai M, Stewart KA et al (2012) Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 380(9847):1082–1087

    Article  PubMed  Google Scholar 

  47. Wong EG, Kamara TB, Groen RS et al (2015) Prevalence of surgical conditions in individuals aged more than 50 years: a cluster-based household survey in Sierra Leone. World J Surg 39(1):55–61. doi:10.1007/s00268-014-2620-1

    Article  PubMed  Google Scholar 

  48. Grimes CE, Law RS, Borgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36(1):8–23. doi:10.1007/s00268-011-1330-1

    Article  PubMed  Google Scholar 

  49. Elliott IS, Groen RS, Kamara TB et al (2015) The burden of musculoskeletal disease in Sierra Leone. Clin Orthop Relat Res. 473(1):380–389

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are extremely grateful to the directors and chief executive of all hospitals and health institutions who accepted to contribute to this important survey.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alain Chichom-Mefire.

Annex

Annex

figure a
figure b
figure c

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chichom-Mefire, A., Mbome Njie, V., Verla, V. et al. A Retrospective One-Year Estimation of the Volume and Nature of Surgical and Anaesthetic Services Delivered to the Populations of the Fako Division of the South-West Region of Cameroon: An Urgent Call for Action. World J Surg 41, 660–671 (2017). https://doi.org/10.1007/s00268-016-3775-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3775-8

Keywords

Navigation