Premkumar Ajay, Ying Xiaohan, Mack Hardaker W, Massawe Honest H, Mshahaba David J, Mandari Faiton, Pallangyo Anthony, Temu Rogers, Masenga Gileard, Spiegel David A, Sheth Neil P
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, 800 Spruce Street, 8th Floor Preston Building, Philadelphia, PA, 19107, USA.
World J Surg. 2018 Oct;42(10):3081-3088. doi: 10.1007/s00268-018-4630-x.
The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services.
A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center.
Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services.
There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world's developing regions.
肌肉骨骼疾病及其导致的残疾所带来的全球负担极为巨大，且预计在未来几十年内还会增加。在世界最贫困地区，缺乏界定和量化当前获得骨科手术治疗情况的信息，这是制定有效解决方案时的一个主要问题。本研究估算了坦桑尼亚北部无法充分获得骨科手术服务的人数。
构建了一个机会树，以模拟坦桑尼亚北部阿鲁沙、乞力马扎罗、坦噶、辛吉达和曼亚拉等地区获得骨科手术服务的概率，涉及四个维度：及时性、手术能力、安全性和可承受性。及时性通过居住在距有骨科外科医生的医院4小时车程内的人口比例来估算，能力通过比较实际进行的手术数量与所需手术数量来评估，安全性通过应用世界卫生组织的急诊和基本外科护理基础设施及设备检查表来衡量，可承受性通过估算免受灾难性自付医疗费用影响的人口比例来确定。我们通过单向和概率敏感性分析来考虑模型中的不确定性。数据来源包括坦桑尼亚国家统计局和财政部、世界银行、世界卫生组织、新西兰卫生部、谷歌公司、美国国家航空航天局人口估算器以及2015年乞力马扎罗基督教医疗中心、马查梅医院、恩科罗安加医院、梅鲁山医院和阿鲁沙路德医疗中心的医院记录。
在最保守的假设下，坦桑尼亚北部超过90%的人口无法获得骨科手术服务。
坦桑尼亚北部几乎无法获得骨科手术治疗。这些发现使用了更精确的国家和地区特定数据，并且与先前发表的关于撒哈拉以南非洲手术可及性的全球趋势一致。由于全球卫生界必须制定创新解决方案来应对不断上升的肌肉骨骼疾病负担并支持全民健康覆盖的推进，增加骨科手术服务的可及性将在改善世界发展中地区的医疗保健方面发挥核心作用。
