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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi
International Journal of Surgery, Volume 12, No. 5, Year 2014
Notification
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Description
Background: Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. Methods: We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. Results: A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Discussion: Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. © 2014 Surgical Associates Ltd.
Authors & Co-Authors
Tyson, Anna F.
Malawi, Lilongwe
Kamuzu Central Hospital
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Msiska, Nelson
Malawi, Lilongwe
Kamuzu Central Hospital
Kiser, Michelle M.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Samuel, Jonathan C.
Malawi, Lilongwe
Kamuzu Central Hospital
United States, Chapel Hill
The University of North Carolina at Chapel Hill
McLean, Sean E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Varela, Carlos G.
Malawi, Lilongwe
Kamuzu Central Hospital
Charles, Anthony G.
Malawi, Lilongwe
Kamuzu Central Hospital
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 36
Authors: 7
Affiliations: 2
Identifiers
Doi:
10.1016/j.ijsu.2014.02.009
ISSN:
17439191
e-ISSN:
17439159
Research Areas
Health System And Policy
Study Design
Cohort Study
Case-Control Study
Study Locations
Malawi
Participants Gender
Male