Moving from data collection to application: a systematic literature review of surgical capacity assessments and their applications.

BACKGROUND: Over the past decade, assessments of surgical capacity in low- and middle-income countries (LMICs) have contributed to our understanding of barriers to the delivery of surgical services in a number of countries. It is yet unclear, however, how the findings of these assessments have been applied and built upon within the published literature. METHODS: A systematic literature review of surgical capacity assessments in LMICs was performed to evaluate current levels of understanding of global surgical capacity and to identify areas for future study. A reverse snowballing method was then used to follow-up citations of the identified studies to assess how this research has been applied and built upon in the literature. RESULTS: Twenty-one papers reporting the findings of surgical capacity assessments conducted in 17 different LMICs in South Asia, East Asia and Pacific, Latin America and the Caribbean, and sub-Saharan Africa were identified. These studies documented substantial deficits in human resources, infrastructure, equipment, and supplies. Only seven additional papers were identified which applied or built upon the studies. Among these, capacity assessment findings were most commonly used to develop novel tools and intervention strategies, but they were also used as baseline measurements against which updated capacity assessments were compared. CONCLUSIONS: While the global surgery community has made tremendous progress in establishing baseline values of surgical capacity in LMICs around the world, further work is necessary to build upon and apply the foundational knowledge established through these efforts. Capacity assessment data should be coordinated and used in ongoing research efforts to monitor and evaluate progress in global surgery and to develop targeted intervention strategies. Intervention strategy development may also be further incorporated into the evaluation process itself.

Female health and family planning in Sierra Leone.

OBJECTIVE: To describe the current status of access to maternal care, family planning use, and place of delivery in Sierra Leone, one of the poorest countries in the world with one of the highest maternal mortality rates. METHODS: Data from the Surgeons OverSeas Assessment of Surgical Need, a cross-sectional two-stage cluster-based household survey conducted in Sierra Leone in 2012, were analyzed to determine access to maternal care, family planning use, and location of delivery. RESULTS: Of 3,318 females of reproductive age (12-50 years of age), 1,205 participants were interviewed in depth. Twenty percent (95% confidence interval [CI] 17.9-22.5) of respondents reported using family planning methods; injectables were the most frequently used method. Fifty-nine percent (95% CI 54.0-63.0) of the recalled deliveries took place outside of a health facility. Of the total births, 1.9% (95% CI 1.3-2.5) were reportedly delivered by cesarean and 0.4% (9/2,316) with instrumental delivery. There were 53 reported maternal deaths in the 12 months before the survey, resulting in a maternal mortality rate of 1,600 per 100,000 females per year. Of the maternal deaths, 30 females (56.6%) did not receive any type of modern health care with 53% (16/30) of families citing financial constraints. CONCLUSION: This study reaffirms a low family planning uptake and very low instrument deliveries and cesarean delivery rates in Sierra Leone. Additionally, financial barriers hinder access to health care and indicate that the free health care initiative for pregnant females is not yet fully covering the reproductive needs of the females of Sierra Leone. LEVEL OF EVIDENCE: III.

Admission test as precursor of perinatal outcome: a prospective study.

PURPOSE: To test the reliability of the admission test to identify the compromised fetus and thus reduce the neonatal morbidity and mortality by early intervention. METHODS: A prospective analysis over a period of 1 year from December 2007 to December 2008 included 100 antepartum patients and were evaluated for perinatal outcome in two groups. RESULTS: In both low and high risk groups the incidence of meconium staining was 25 and 37.5% in patients with nonreactive traces as compared to 8.6 and 9.5%, respectively, in reactive traces with specificity of 90.9%. Clinically detected fetal distress was more common in patients with nonreactive test. Operative interference for fetal distress was more in patients with nonreactive test. Occurence of low Apgar score was more in patients with nonreactive test. Admission to neonatal unit was more in nonreactive than reactive traces. Incidence of neonatal death was more in nonreactive test. Incidence of low birth weight was more in nonreactive trace group and more so in high risk group than in low risk group. CONCLUSION: Admission test may be best recommended in all patients irrespective whether they are in low or high risk as incidence of neonatal morbidity is high 33.3% babies required NICU admission and 33% babies expired in nonreactive tracing, in centers where advance facilities are not available. Whenever there is a nonreactive tracing further test should be carried out.