Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100, Parma, Italy.
World J Surg. 2010 Mar;34(3):473-9. doi: 10.1007/s00268-010-0406-7.
In Afghanistan, the number of surgically amenable injuries related to civil unrest and ongoing conflict or consequent to road traffic accidents, trauma, or pregnancy-related complications is rising and becoming a major cause of death and disability. This study was designed to evaluate availability of basic lifesaving and disability-preventive emergency surgical and anesthesia interventions representing most of the country.
Evaluation was performed outside Kabul to represent a cross-section of the country. Data were collected from Afghanistan health facilities, using the WHO Tool for Situation Analysis to Assess Emergency and Essential Surgical Care, covering case volume, travel distances, infrastructures, human resources, supplies, equipment, and interventions characterizing basic trauma, surgery, and anesthesia capacities.
In 30% of the 17 facilities examined, oxygen supply is limited and irregular; uninterrupted running water is not accessible in 40%; electrical power is not available continuously in 66%. Shortage of equipment and personnel is evident in peripheral health facilities: certified surgeons are present in 63.6% and certified anesthesiologists in 27.2%. Continuous 24 h surgical service is available in 29.4%. Lifesaving procedures are performed in 17-42% of peripheral hospitals; 23.5% are without emergency obstetric service.
Limited access to surgery is highly remarkable in Afghanistan, with a severe shortage of emergency surgical capacities in provincial and district hospitals, where availability of basic and emergency surgical care is far from satisfactory. A comprehensive approach for strengthening basic surgical capacities at the primary health care level should be introduced.
在阿富汗，与内乱和持续冲突相关的、或因道路交通意外、创伤或与妊娠相关的并发症而导致的可通过手术治疗的损伤数量正在上升，成为导致死亡和残疾的主要原因。本研究旨在评估基本救命和预防残疾的紧急外科和麻醉干预措施的提供情况，这些干预措施代表了该国的大部分地区。
在喀布尔以外进行评估，以代表该国的一个横断面。使用世界卫生组织紧急和基本外科护理情况分析工具收集阿富汗卫生设施的数据，涵盖病例量、旅行距离、基础设施、人力资源、用品、设备以及特征为基本创伤、手术和麻醉能力的干预措施。
在所检查的 17 个设施中，有 30%的设施氧气供应有限且不稳定；40%的设施无法获得不间断的自来水；66%的设施无法持续供电。设备和人员短缺在周边卫生设施中显而易见：有认证外科医生的占 63.6%，有认证麻醉师的占 27.2%。仅有 29.4%的设施提供 24 小时连续手术服务。在 17-42%的周边医院进行救命手术；23.5%的医院没有紧急产科服务。
在阿富汗，手术机会有限的情况非常显著，省级和地区医院的紧急外科能力严重短缺，基本和紧急外科护理的提供远不能令人满意。应引入一种加强初级卫生保健层面基本外科能力的综合方法。
