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Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea

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Abstract

Background

Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided.

Methods

We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep–Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization’s Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity.

Results

EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies.

Conclusions

Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and essential surgical care. This is despite a relatively low surgical volume and limited numbers of trained surgical anaesthesia obstetric providers, and likely underservicing. The ability of surgical care to avert disease in Papua New Guinea highlights its importance to public health in LMICs.

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Acknowledgments

Dr. Stephen Lane—Statistician, Barwon Health and Deakin University.

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Authors and Affiliations

  1. School of Medicine, Deakin University, Kings Way, Waurn Ponds, VIC, 3216, Australia

    Matthew A. R. Stokes, Glenn D. Guest & David A. K. Watters

  2. Department of Surgery, The University Hospital Geelong, Bellarine Street, PO BOX 281, Geelong, VIC, 3220, Australia

    Matthew A. R. Stokes, Glenn D. Guest & David A. K. Watters

  3. Alotau General Hospital, PO Box 402, Alotau, Milne Bay Province, Papua New Guinea

    Perista Mamadi, Westin Seta, Noel Yaubihi, Grace Karawiga & Billy Naidi

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  1. Matthew A. R. Stokes
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Appendix: Example of McCord et al. Approach to DALY Estimation, Simplified by Gosselin et al.

Appendix: Example of McCord et al. Approach to DALY Estimation, Simplified by Gosselin et al.

  • YLL (based on actual age and sex of patient, derived from age weightings from GBD study) X severity of disease X effectiveness of treatment X chance of permanent disability (weighting) = DALYs averted.

  • 12-year-old male with acute appendicitis with perforation and generalised peritonitis who undergoes successful surgery (>95 % mortality or disability without treatment, with >95 % chance of cure from disease), 37.54 (YLL for males aged 12) X 1.0 X 1.0 = 31.10 DALYs averted by surgery.

  • 20-year-old female in obstructed labour who undergoes successful caesarean section (>95 % mortality without surgical treatment, >95 % chance of cure from condition) 31.10 (YLL for woman aged 20) X 1.0 X 1.0 = 35.24 DALYs averted by surgery.

  • 18-year-old male who undergoes manipulation and plaster of paris application for closed tibial and fibular fracture (< 95 % and > 50 % disabling without treatment with disability weight of 0.27 < 95 % and > 50 % effectiveness of treatment) 35.84 (YLL for males aged 18) X 0.7 X 0.7 X 0.2 = 17.56 DALYs averted by surgical intervention.

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Stokes, M.A.R., Guest, G.D., Mamadi, P. et al. Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea. World J Surg 41, 650–659 (2017). https://doi.org/10.1007/s00268-016-3769-6

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