World Journal of Surgery

, Volume 36, Issue 9, pp 2074–2079

Ratio of Cesarean Sections to Total Procedures as a Marker of District Hospital Trauma Capacity

  • Robin T. Petroze
  • Winta Mehtsun
  • Albert Nzayisenga
  • Georges Ntakiyiruta
  • Robert G. Sawyer
  • J. Forrest Calland
Article

Abstract

Background

There are few established metrics to define surgical capacity in resource-limited settings. Previous work hypothesizes that the relative frequency of cesarean sections (CS) at a hospital, expressed as a proportion of total operative procedures (%CS), may serve as a proxy measure of surgical capacity. We attempted to evaluate this hypothesis as it specifically relates to hospital capacity for emergency interventions for injury.

Methods

We conducted a WHO survey of emergency surgical capacity at 40 Rwandan district hospitals in November 2010 and extracted annual operative volume for 2010 from the Ministry of Health centralized statistical system. We dichotomized the 40 hospitals into low and high %CS groups below and above the median proportion of CS performed. We compared low and high %CS groups across self-reported capabilities related to facility characteristics, trauma supplies, procedural capacity, and surgical training using bivariate χ2 statistics with significance indicated at p ≤ 0.05. We evaluated herniorrhaphy proportion of total procedures (%Hernia) as a representative general surgery procedure in the same manner.

Results

High %CS hospitals were less likely to report capability related to blood banking (p = 0.05), amputation (p = 0.04), closed fracture repair (p = 0.04), inhalational anesthesia (p = 0.05), and chest tube insertion (p = 0.05). Availability of reliable electricity was the only measure that showed statistical significance with the %Hernia measure (p = 0.02).

Conclusions

Cesarean section proportion shows some utility as a marker for district hospital injury-care capacity in resource-limited settings.

References

  1. 1.
    Farmer PE, Kim JY (2008) Surgery and global health: a view from beyond the OR. World J Surg 32(4):533–536PubMedCrossRefGoogle Scholar
  2. 2.
    Ozgediz D, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5(6):e121PubMedCrossRefGoogle Scholar
  3. 3.
    Bickler SW, Spiegel DA (2008) Global surgery—defining a research agenda. Lancet 372(9633):90–92PubMedCrossRefGoogle Scholar
  4. 4.
    Weiser TG, Makary MA, Haynes AB et al (2009) Standardised metrics for global surgical surveillance. Lancet 374(9695):1113–1117PubMedCrossRefGoogle Scholar
  5. 5.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144PubMedCrossRefGoogle Scholar
  6. 6.
    World Health Organization (WHO) situational analysis tool. www.who.int/entity/surgery/publiations/QuickSitAnalysisEESCsurvey.pdf. Accessed 24 Nov 2009
  7. 7.
    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)PubMedCrossRefGoogle Scholar
  8. 8.
    Osen H, Chang D, Choo S et al (2011) Validation of the world health organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35(3):500–504PubMedCrossRefGoogle Scholar
  9. 9.
    Kushner AL, Groen RS, Kingham TP (2010) Percentage of cesarean sections among total surgical procedures in sub-Saharan Africa: possible indicator of the overall adequacy of surgical care. World J Surg 34(9):2007–2008PubMedCrossRefGoogle Scholar
  10. 10.
    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):436–443PubMedCrossRefGoogle Scholar
  11. 11.
    Ozgediz D, Kijjambu S, Galukande M et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371(9613):627–628PubMedCrossRefGoogle Scholar
  12. 12.
    Ozgediz D, Hsia R, Weiser T et al (2009) Population health metrics for surgery: effective coverage of surgical services in low-income and middle-income countries. World J Surg 33(1):1–5PubMedCrossRefGoogle Scholar
  13. 13.
    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):e1000242PubMedCrossRefGoogle Scholar
  14. 14.
    Rasch V (2007) Maternal death and the Millennium Development Goals. Dan Med Bull 54(2):167–169PubMedGoogle Scholar
  15. 15.
    Pitt C, Greco G, Powell-Jackson T, Mills A (2010) Countdown to 2015: assessment of official development assistance to maternal, newborn, and child health, 2003–08. Lancet 376(9751):1485–1496PubMedCrossRefGoogle Scholar
  16. 16.
    Ministry of Health (MOH) [Rwanda] NISR, ICF Macro (2006) Rwanda demographic and health survey 2005. MOH, NISR, and ICF Macro, CalvertonGoogle Scholar
  17. 17.
    National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], ICF International (2011) Rwanda Demographic and Health Survey 2010. NISR, MOH, and ICF International, CalvertonGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Robin T. Petroze
    • 1
    • 2
  • Winta Mehtsun
    • 3
  • Albert Nzayisenga
    • 4
  • Georges Ntakiyiruta
    • 2
  • Robert G. Sawyer
    • 1
  • J. Forrest Calland
    • 1
  1. 1.Department of SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Department of Surgery, Faculty of MedicineNational University of RwandaButareRwanda
  3. 3.University of VirginiaCharlottesvilleUSA
  4. 4.Department of Orthopedic SurgeryKing Faisal HospitalKigaliRwanda

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