Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions.

Elissa K Butler,Tu M Tran,Jeffrey G Chipman,Moses Galukande,Samuel Luboga,Christine Muhumuza,Sarah Williams,Anthony T Fuller,Joao R N Vissoci,Michael M Haglund,Fredrick Makumbi

doi:10.5334/aogh.2427

Abstract

Background:Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce.Objective:In this study, our objective was to quantify the burden of surgically treatable abdominal conditions in Uganda.Methods:In 2014, we administered a two-stage cluster-randomized Surgeons OverSeas Assessment of Surgical Need survey to 4,248 individuals in 105 randomly selected clusters (representing the national population of Uganda).Findings:Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7% (95% CI: 1.3 to 2.3%). Obstructed labor (52.9%) accounted for most of the 238 abdominal conditions reported and was untreated in only 5.6% of reported conditions. In contrast, 73.3% of reported abdominal masses were untreated.Conclusions:Individuals in Uganda with nonobstetric abdominal surgical conditions are disproportionately undertreated. Major health system investments in obstetric surgical capacity have been beneficial, but our data suggest that further investments should aim at matching overall surgical care capacity with surgical need, rather than focusing on a single operation for obstructed labor.

Highlights

Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce
In the third edition of Disease Control Priorities, global surgery experts recommended a package of essential surgical procedures to be delivered at the level of a first-referral hospital, of which 10 of 18 address abdominal conditions [8]
Of those 185 respondents, 76 reported an untreated condition, giving an untreated prevalence of 1.7%, which extrapolates to 597,202 individuals with an untreated abdominal surgical condition

Summary

Introduction

Abdominal operations account for a majority of surgical volume in low-income countries, yet population-level prevalence data on surgically treatable abdominal conditions are scarce. Findings: Of the 4,248 respondents, 185 reported at least one surgically treatable abdominal condition in their lifetime, giving an estimated lifetime prevalence of 3.7% (95% CI: 3.0 to 4.6%). Abdominal operations account for at least two-thirds of surgical volume in low-income countries, and cesarean sections, account for 30%. The College of Surgeons of East, Central, and Southern Africa (COSECSA) has proposed task-shifting essential surgical procedures to trained nonphysician providers—citing decades of positive experience training clinical officers to perform emergency cesarean sections, in Uganda [7]. Further efforts are needed to improve overall surgical capacity; currently, except for certain prioritized operations such as cesarean sections, most individuals do not have access to highquality surgical care.

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Conclusion