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1.
Eric O’Flynn Judith Andrew Avril Hutch Caitrin Kelly Pankaj Jani Ignatius Kakande Miliard Derbew Sean Tierney Nyengo Mkandawire Krikor Erzingatsian 《World journal of surgery》2016,40(11):2620-2627
Background
In East, Central and Southern Africa accurate data on the current surgeon workforce have previously been limited. In order to ensure that the workforce required for sustainable delivery of surgical care is put in place, accurate data on the number, specialty and distribution of specialist-trained surgeons are crucial for all stakeholders in surgery and surgical training in the region.Methods
The surgical workforce in each of the ten member countries of the College of Surgeons of East, Central and Southern Africa (COSECSA) was determined by gathering and crosschecking data from multiple sources including COSECSA records, medical council registers, local surgical societies records, event attendance lists and interviews of Members and Fellows of COSECSA, and validating this by direct contact with the surgeons identified. This data was recorded and analysed in a cloud-based computerised database, developed as part of a collaboration programme with the Royal College of Surgeons in Ireland.Results
A total of 1690 practising surgeons have been identified yielding a regional ratio of 0.53 surgeons per 100,000 population. A majority of surgeons (64 %) practise in the main commercial city of their country of residence and just 9 % of surgeons are female. More than half (53 %) of surgeons in the region are general surgeons.Conclusions
While there is considerable geographic variation between countries, the regional surgical workforce represents less than 4 % of the equivalent number in developed countries indicating the magnitude of the human resource challenge to be addressed.2.
Background
Medical workforce shortages represent a major challenge in low- and middle-income countries, including those in Africa. Despite this, there is a dearth of information regarding the location and practice of African surgeons following completion of their training. In response to the call by the WHO Global Code of Practice on the International Recruitment of Health Personnel for a sound evidence base regarding patterns of practice and migration of the health workforce, this study describes the current place of residence, practice and setting of Ethiopian surgical residency graduates since commencement of their surgical training in Ethiopia or in Cuba.Methods
This study presents data from a survey of all Ethiopian surgical residency training graduates since the programme’s inception in 1985.Results
A total of 348 Ethiopians had undergone surgical training in Ethiopia or Cuba since 1985; data for 327 (94.0 %) of these surgeons were collected and included in the study. The findings indicated that 75.8 % of graduates continued to practice in Ethiopia, with 80.9 % of these practicing in the public sector. Additionally, recent graduates were more likely to remain in Ethiopia and work within the public sector. The average total number of surgeons per million inhabitants in Ethiopia was approximately three and 48.0 % of Ethiopian surgeons practiced in Addis Ababa.Conclusions
Ethiopian surgeons are increasingly likely to remain in Ethiopia and to practice in the public sector. Nevertheless, Ethiopia continues to suffer from a drastic surgical workforce shortage that must be addressed through increased training capacity and strategies to combat emigration and attrition.3.
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4.
OBJECTIVE: A five year retrospective review of medical records of newborns admitted for gastrointestinal surgical emergencies was done. This study was intended to see the pattern of presentation, mode of intervention and surgical outcome of these cases and for provision of feed-back to the surgeon-pediatrician team who are involved in the care of such newborns. METHODS: The study included cases admitted to the Neonatal Unit of the Department of Pediatrics and Child Health, Tikur Anbessa Specialized Hospital, Addis Ababa, during the period of January 1, 1997 to December 31, 2001. RESULTS: A total of 60 cases admitted during the above-mentioned period were reviewed. Thirty-six (60%) were males, 23 (38%) were females, while one newborn had ambiguous genitalia. Imperforate anus has accounted for 27 (45%) of the 60 cases; jejunoileal atresia and esophageal atresia with or without tracheoesophageal each accounted for 12 (20%) cases; while 9 (15%) had other lesions. Of the 60 cases surgical intervention was performed on 43 (72%) newborns. Of the 12 newborns with esophageal atresia with or with out tracheoesophageal fistula. only one newborn was discharged alive; 7 out of 12 newborns with jejunoileal atresia died, 4 cases discharged improved while the outcome for 1 newborn was not known. Of the newborns with imperforate anus, 8 (47%) of the 17 with the high type and 1 (10%) of the 10 with low-type died CONCLUSION: Early diagnosis, availability of diagnostic service and prompt surgical intervention with optimal pre- and post-operative care are necessary to increase survival of newborns with such problems. 相似文献
5.
Tiffany E. Chao MacKenzie Burdic Karan Ganjawalla Miliard Derbew Christopher Keshian John Meara Kelly McQueen 《World journal of surgery》2012,36(11):2545-2553
Background
Information regarding surgical capacity in the developing world is limited by the paucity of available data regarding surgical care, infrastructure, and human resources in the literature. The purpose of this study was to assess surgical and anesthesia infrastructure and human resources in Ethiopia as part of a larger study by the Harvard Humanitarian Initiative examining surgical and anesthesia capacity in ten low-income countries in Africa.Methods
A comprehensive survey tool developed by the Harvard Humanitarian Initiative was used to assess surgical capacity of hospitals in Ethiopia. A total of 20 hospitals were surveyed through convenience sampling. Eight areas of surgical and anesthesia care were examined, including access and availability, access to human resources, infrastructure, outcomes, operating room information and procedures, equipment, nongovernmental organization delivery of surgical services, and pharmaceuticals. Results were obtained over a 1-month period during October 2011.Results
There is wide variation in accessibility, with hospital-to-population ratios ranging from 1:99,010 to 1:1,082,761. The overall physician to population ratio ranges from 1:4715 to 1:107,602. The average hospital has one to two operating rooms, 4.2 surgeons, one gynecologist, and 4.5 anesthesia providers—although in all but three hospitals anesthesiology was provided by nonphysician personnel only (i.e., a nurse anesthetist). Access to continuous electricity, running water, essential medications, and monitoring systems is very limited in all hospitals surveyed, although such access did vary across regions.Conclusions
This survey of Ethiopia’s hospital resources attempts to identify specific areas of need where resources, education, and development can be targeted. Because the major surgical mortality comes from late presentations, increasing accessibility through infrastructure development would likely provide a major improvement in surgical morbidity and mortality rates. Infrastructure limitations of electricity, water, oxygen, and blood banking do not prove to be significant barriers to surgical care. The increasing number of physicians is promising, although efforts should be directed specifically toward increasing the number of anesthesiologists and surgeons in the country. 相似文献6.
David M Silvestri Meridith Blevins Arfan R Afzal Ben Andrews Miliard Derbew Simran Kaur Mwapatsa Mipando Charles A Mkony Philip M Mwachaka Nirju Ranjit Sten Vermund 《Bulletin of the World Health Organization》2014,92(10):750-759
Objective
To assess medical and nursing students’ intentions to migrate abroad or practice in rural areas.Methods
We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students’ intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models.Findings
Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25–2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21–6.29) and rural (OR: 4.84; 95% CI: 3.52–6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19–1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50–0.96).Conclusion
A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas. 相似文献7.
OBJECTIVES: To assess the pattern and extent of pediatric surgical problems. PATIENTS AND METHODS: A retrospective analysis of all pediatric patients who had surgery at the TAUH over a five-year period RESULTS: A total of 6070 surgical procedures were done, accounting for 31% of all operations and 33% of all pediatric admissions to the hospital The patients were predominantly male (M:F ratio of 2:1) with a mean age of 68 months. Congenital anomalies, trauma and inflammation cause most of the diseases, 37%, 17.1% and 16.8% respectively. The gastrointestinal system was most commonly affected (41.8%) followed by the musculoskeletal system (23%). The study demonstrates the presence of a wide range of pediatric surgical conditions that may cause significant health problems among children. Acute appendicitis was the commonest surgical condition, seen in 729 (12%) children and foreign body aspiration or swallowing in 331 (5.5%) cases. Several diagnoses were related with poor surgical care such as: post burn contracture (177), post circumcision phimosis (71) and chronic osteomyelitis (71). CONCLUSION: It is suggested that improving the management of pediatrics surgical conditions would significantly reduce morbidity. 相似文献
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Fisseha Temesgen Abay Gosaye Nichole Starr Woubedil Kiflu Hana Getachew Belachew Dejene Amezene Tadesse Miliard Derbew Tihitena Negussie 《Ethiopian journal of health sciences》2021,31(1):111
BackgroundSurgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.MethodsWe performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher''s exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.ResultsOf 114 patients, median age was 46 months [range: 1day-13 years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, >1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96, p=0.003). Age (p=0.004) and malnutrition (p<0.001) were significantly associated with wound dehiscence.ConclusionSSI and wound dehiscence are common in this setting. Wound contamination, antibiotics administration >1 hour before surgery and operative time >2 hours are independent predictors of SSI. 相似文献
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Tsion Assefa Damen Haile Mariam Wubegzier Mekonnen Miliard Derbew 《Human resources for health》2017,15(1):86