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J Surg Res. 2019 Nov 2. pii: S0022-4804(19)30729-2. doi: 10.1016/j.jss.2019.10.013. [Epub ahead of print]

Benchmarking Global Trauma Care: Defining the Unmet Need for Trauma Surgery in Ghana.

Author information

1
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: drgyedu@gmail.com.
2
Department of Surgery, University of Washington, Seattle, Washington; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
3
Department of Surgery, University of Washington, Seattle, Washington.
4
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
5
Department of Surgery, University of Washington, Seattle, Washington; Harborview Injury Prevention & Research Center, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington.

Abstract

BACKGROUND:

The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma operations/100,000 persons, providing a benchmark for trauma surgery needs. We sought to determine Ghana's annual trauma operation rate compared with this benchmark.

METHODS:

Data on all operations performed in Ghana from June 2014 to May 2015 were obtained from representative sample of 48/124 district (first level), 8/11 regional, and 3/5 tertiary hospitals and scaled up for nationwide estimates. Trauma operations were grouped by hospital level and categorized into "essential" (most cost-effective, highest population impact) versus "other" (specialized) as per the World Bank's Disease Control Priorities Project. Ghana's annual trauma operation rate was compared with the New Zealand benchmark to quantify current met needs for trauma surgery.

RESULTS:

About 232,776 operations were performed in Ghana; 35,797 were for trauma. Annual trauma operation rate was 134/100,000 (95% UI: 98-169), only 12% of the New Zealand benchmark. District hospitals performed 62% of all operations in the country, but performed only 38% of trauma operations. Eighty seven percentage of trauma operations were deemed "essential". Among specialized trauma operations, only open reduction and internal fixations had even modest numbers (3483 operations). Most other specialized trauma operations were rare.

CONCLUSIONS:

Ghana has a large unmet need for operative trauma care. The low percentage of trauma operations in district hospitals indicates an even greater unmet need in rural areas. Future global surgery benchmarking should consider benchmarks for trauma and other specialties, as well as for different hospital levels.

KEYWORDS:

Ghana; Global health; Low- and middle-income countries; Surgery; Trauma

PMID:
31690530
DOI:
10.1016/j.jss.2019.10.013

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