Eliah Edson, Lewallen Susan, Kalua Khumbo, Courtright Paul, Gichangi Michael, Bassett Ken
Hum Resour Health. 2014;12 Suppl 1(Suppl 1):S4. doi: 10.1186/1478-4491-12-S1-S4. Epub 2014 May 12.
This project examined the surgical productivity and attrition of non-physician cataract surgeons (NPCSs) in Tanzania, Malawi, and Kenya.
Baseline (2008-9) data on training, support, and productivity (annual cataract surgery rate) were collected from officially trained NPCSs using mailed questionnaires followed by telephone interviews. Telephone interviews were used to collect follow-up data annually on productivity and semi-annually on attrition. A detailed telephone interview was conducted if a surgeon left his/her post. Data were entered into and analysed using STATA.
Among the 135 NPCSs, 129 were enrolled in the study (Kenya 88, Tanzania 38, and Malawi 3) mean age 42 years; average time since completing training 6.6 years. Employment was in District 44%, Regional 24% or mission/ private 32% hospitals. Small incision cataract surgery was practiced by 38% of the NPCSs. The mean cataract surgery rate was 188/year, median 76 (range 0-1700). For 39 (31%) NPCSs their surgical rate was more than 200/year. Approximately 22% in Kenya and 25% in Tanzania had years where the cataract surgical rate was zero. About 11% of the surgeons had no support staff.
High quality training is necessary but not sufficient to result in cataract surgical activity that meets population needs and maintains surgical skill. Needed are supporting institutions and staff, functioning equipment and programs to recruit and transport patients.
本项目研究了坦桑尼亚、马拉维和肯尼亚非医师白内障外科医生（NPCSs）的手术效率和人员流失情况。
通过邮寄问卷随后进行电话访谈，从经过官方培训的NPCSs收集关于培训、支持和效率（年度白内障手术率）的基线（2008 - 2009年）数据。每年通过电话访谈收集效率方面的随访数据，每半年收集人员流失情况的数据。如果外科医生离职，则进行详细的电话访谈。数据录入STATA软件并进行分析。
在135名NPCSs中，129名纳入研究（肯尼亚88名，坦桑尼亚38名，马拉维3名），平均年龄42岁；完成培训后的平均时间为6.6年。就业于地区医院的占44%，区域医院的占24%，教会/私立医院的占32%。38%的NPCSs采用小切口白内障手术。平均白内障手术率为每年188例，中位数为76例（范围0 - 1700例）。39名（31%）NPCSs的手术率超过每年200例。肯尼亚约22%和坦桑尼亚约25%的人有白内障手术率为零的年份。约11%的外科医生没有辅助人员。
高质量的培训是必要的，但不足以实现满足人群需求并维持手术技能的白内障手术活动。还需要有支持机构和人员、运转良好的设备以及招募和运送患者的项目。
