Unmet Surgical Need in Malawi
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Introduction Globally, and especially in sub-Saharan Africa, including Malawi, surgical conditions receive a low level of priority in national health systems. The burden of surgical diseases is not well documented and the reasons for which people still live with treatable conditions and disabilities or sometimes present late for care have also not been studied. There is also little information on surgical deaths from untreated conditions in both adults and children, including trauma, as well as potential barriers to obtaining surgical care. Objectives The aim of this thesis was therefore to describe the untreated surgical conditions, in both adults and children, the barriers to surgical health care, as well as to document information about deaths from surgical conditions in Malawi. Methods This thesis is based on four papers. All four involved data collected using the SOSAS tool, which is a questionnaire-based data collection tool for documenting household information in the communities. The tool had three sections, the first section capturing demographic data for the households; including number of occupants, ages, gender, location and type of household, and tribe. The next two sections were similar but involved interviewing two different people and asking about information relating to surgical conditions present for both adults and paediatric age groups, including injuries, associated disability from acquired or congenital disorders, transportation to health facility and location of death from different surgical conditions. The two household members interviewed, included the head of household and another random member within the household. Data collection was centrally organized by a project group, and performed by third year medical students from the University of Malawi, College of Medicine. Data was collected as a national survey from the 28 districts in Malawi. The National Statistics Board helped us to identify the villages used in the study. Results We found that a third of the Malawian population were living with a surgical condition and were in need of a surgical consultation or treatment. These conditions were either congenital or the result of a traumatic or other non-traumatic condition. We also found that almost one fifth of the children with a surgical condition that could have been treated by surgery, instead remained with a disability that affected their daily lives. In addition, we found that transportation poses a barrier to timely access to surgical health care. Transportation barriers included the lack of efficient public transportation, cost implications, and long travel distances to get to a health facility capable of offering care by either consultation or surgical procedures. Other findings were that acute abdominal distention, body masses and trauma, contribute to surgical conditions that are highly associated with mortality in Malawian communities. We also noted that there are various reasons that lead to delays in obtaining formal health care, including initial consultations with traditional herbalists before going to the hospital. Conclusion Almost 6 million Malawian people, including an estimated 2 million children, are living with a condition that could be treated by either a surgical procedure or consultation. There are an estimated 1 million disabled children currently living with such surgically treatable conditions. The treatment of these conditions is hampered by transportation barriers. The transportation barriers have led to delays in obtaining timely surgical health care service, something that often leads to mortality. The common causes of these deaths are from injuries, but also other surgical emergencies. Most of these deaths occur outside a health facility environment.
Has partsPaper I: Carlos Varela, Sven Young, Reinou Groen, Leonard Banza, Nyengo C. Mkandawire, Asgaut Viste. Untreated Surgical Conditions in Malawi: A randomised cross-sectional nation-wide household survey. Malawi Medical Journal 29 (3):231-236 Sept 2017. The article is available in the thesis. The article is also available at: https://doi.org/10.4314/mmj.v29i3.1
Paper II: Carlos Varela, Asgaut Viste, Sven Young ,Reinou S. Groen, Leonard Banza, Bip Nandi, Nyengo Mkandawire, Bente Elisabeth Moen. Paediatric Surgical Conditions in Malawi: A cross-sectional nation-wide household survey. Malawi Medical Journal 33 (2): 73-81 June 2021. The article is available in the thesis. The article is also available at: https://doi.org/10.4314/mmj.v33i2.2
Paper III: Carlos Varela , Sven Young, Nyengo Mkandawire, Reinou S. Groen, Leonard Banza, Asgaut Viste. Transportation Barriers to Access Health Care for Surgical Conditions in Malawi. A cross-sectional nation-wide household survey. BMC Public Health (2019) 19:264. The article is available at: https://hdl.handle.net/1956/21692
Paper IV: Carlos Varela, Sven Young, Reinou S. Groen, Leonard Banza, Nyengo Mkandawire, Bente E. Moen and Asgaut Viste. Deaths from Surgical Conditions in Malawi – A randomised cross-sectional nation-wide household survey. BMC Public Health (2020) 20:1456. The article is available at: https://hdl.handle.net/11250/2739531