Chokotho Linda, Jacobsen Kathryn H, Burgess David, Labib Mohamed, Le Grace, Peter Noel, Lavy Christopher B D, Pandit Hemant
Beit CURE International Hospital, Blantyre, Malawi.
Department of Global & Community Health, George Mason University, Fairfax, VA, USA.
Injury. 2016 Sep;47(9):1990-5. doi: 10.1016/j.injury.2015.10.036. Epub 2015 Oct 26.
We conducted an assessment of orthopaedic surgical capacity in the following countries in East, Central, and Southern Africa: Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.
We adapted the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care with questions specific to trauma and orthopaedic care. In May 2013-May 2014, surgeons from the College of Surgeons of East, Central and Southern Africa (COSECSA) based at district (secondary) and referral (tertiary) hospitals in the region completed a web-based survey. COSECSA members contacted other eligible hospitals in their country to collect further data.
Data were collected from 267 out of 992 (27%) hospitals, including 185 district hospitals and 82 referral hospitals. Formal accident and emergency departments were present in 31% of hospitals. Most hospitals had no general or orthopaedic surgeons or medically-qualified anaesthetists on staff. Functioning mobile C-arm X-ray machines were available in only 4% of district and 27% of referral hospitals; CT scanning was available in only 3% and 26%, respectively. Closed fracture treatment was offered in 72% of the hospitals. While 20% of district and 49% of referral hospitals reported adequate instruments for the surgical treatment of fractures, only 4% and 10%, respectively, had a sustainable supply of fracture implants. Elective orthopaedic surgery was offered in 29% and Ponseti treatment of clubfoot was available at 42% of the hospitals.
The current capacity of hospitals in sub-Saharan Africa to manage traumatic injuries and orthopaedic conditions is significantly limited. In light of the growing burden of trauma and musculoskeletal impairment within this region, concerted efforts should be made to improve hospital capacity with equipment, trained personnel, and specialist clinical services.
我们对东非、中非和南非的以下国家的骨科手术能力进行了评估:布隆迪、埃塞俄比亚、肯尼亚、马拉维、莫桑比克、卢旺达、坦桑尼亚、乌干达、赞比亚和津巴布韦。
我们采用了世界卫生组织的情景分析工具来评估急诊和基本外科护理,并针对创伤和骨科护理提出了特定问题。2013年5月至2014年5月,来自东非、中非和南非外科医生学院(COSECSA)的外科医生在该地区的地区(二级)和转诊(三级)医院完成了一项基于网络的调查。COSECSA成员联系了本国其他符合条件的医院以收集更多数据。
从992家医院中的267家(27%)收集了数据,包括185家地区医院和82家转诊医院。31%的医院设有正规的急诊科。大多数医院的工作人员中没有普通外科医生或骨科医生,也没有具备医学资质的麻醉师。只有4%的地区医院和27%的转诊医院有可用的移动式C型臂X光机;CT扫描分别仅在3%和26%的医院可用。72%的医院提供闭合性骨折治疗。虽然20%的地区医院和49%的转诊医院报告有足够的器械用于骨折的手术治疗,但分别只有4%和10%的医院有可持续的骨折植入物供应。29%的医院提供择期骨科手术,42%的医院提供庞塞蒂法治疗马蹄内翻足。
撒哈拉以南非洲地区医院目前管理创伤性损伤和骨科疾病 的能力明显有限。鉴于该地区创伤和肌肉骨骼损伤的负担不断加重,应齐心协力通过设备、训练有素的人员和专业临床服务来提高医院能力。