Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
World J Surg. 2018 Jun;42(6):1610-1616. doi: 10.1007/s00268-017-4385-9.
District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
Baseline and 2-3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63-1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5), p = 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.
非洲的地区医院可以满足农村人口的基本外科需求。然而，鉴于在一些非洲国家，地区医院的手术通常由非医师临床医生进行，因此需要有关于手术结果的证据来证明对这一选择进行投资是合理的。
在马拉维的四家地区医院和两家中心医院，对 98 名接受疝修补术的患者进行了基线和 2-3 个月的随访测量，使用了改良后的生活质量工具。
在地区医院和中心医院的病例之间，结果没有显著差异，其中良好的结果定义为不超过一个严重症状和三个轻度症状。地区医院的结果略差（OR 0.79，95%CI 0.63-1.0）。然而，在 46 例在地区医院进行的择期手术中，严重症状的基线评分（平均值=3.5）比 23 例在中心医院进行的择期手术（平均值=2.5）更差，p=0.004。此外，在症状评分方面，地区医院的平均变化（改善）高于中心医院（3.9 对 2.3）。
研究结果支持在撒哈拉以南非洲投资地区医院手术的观点，以增加农村人口获得基本外科护理的机会。这可以将专家解放出来，以处理更复杂和转诊的病例，并减少急诊就诊。这将需要对地区医院的培训和资源以及来自更高层次的监督进行投资。
