Abstract
Background
The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world’s poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services.
Methods
A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center.
Results
Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services.
Conclusion
There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world’s developing regions.
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Acknowledgements
Sharonya L. Vadakattu, BA: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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AP (Premkumar) conceptualized the study, collected and analysed the data, and drafted the manuscript. XY, MH assisted with data collection and analysis. HM, DM FM, AP (Pallangyo), RT, GM all assisted with data collection and worked on the final manuscript. DAS worked on the final manuscript. NPS conceptualized the study with AP (Premkumar) and finalized the manuscript.
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Premkumar, A., Ying, X., Mack Hardaker, W. et al. Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study. World J Surg 42, 3081–3088 (2018). https://doi.org/10.1007/s00268-018-4630-x
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DOI: https://doi.org/10.1007/s00268-018-4630-x