Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 1/2019

01-01-2019 | Original Scientific Report

General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits

Authors: Adriana G. Ramirez, Nebil Nuradin, Fidele Byiringiro, Georges Ntakiyiruta, Andrew E. Giles, Robert Riviello

Published in: World Journal of Surgery | Issue 1/2019

Login to get access

Abstract

Background

Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training.

Methods

A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal–Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods.

Results

Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01).

Conclusions and relevance

Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.
Appendix
Available only for authorised users
Literature
1.
2.
Meara JG, Leather AJM, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 386:569–624CrossRef
3.
Rose J, Weiser TG, Hider P et al (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health 3:S13–S20CrossRefPubMedPubMedCentral
4.
Debas HT, Donkor P, Gawande A et al (2015) Essential Surgery: disease control priorities, vol 1, 3rd edn. The World Bank, WashingtonCrossRef
5.
Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. The Lancet 372:139–144CrossRef
6.
Weiser TG, Haynes AB, Molina G et al (2015) Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. The Lancet 385:S2–S11
7.
Tollefson TT, Larrabee WF (2012) Global surgical initiatives to reduce the surgical burden of disease. JAMA 307:667–668CrossRefPubMed
8.
World Health Organization, Section II. Ten Essential Objectives for Safe Surgery: Review of the Evidence and Recommendations (2009) In: WHO guidelines for safe surgery 2009: safe surgery saves lives. Geneva, pp 10–96
9.
Binagwaho A, Kyamanywa P, Farmer PE et al (2013) The human resources for health program in Rwanda—a new partnership. N Engl J Med 369:2054–2059CrossRef
10.
Cancedda C, Farmer PE, Kyamanywa P et al (2014) Enhancing formal educational and in-service training programs in rural Rwanda: a partnership among the public sector, a nongovernmental organization, and academia. Acad Med 89:1117–1124CrossRefPubMed
11.
12.
Deckelbaum DL, Gosselin-Tardif A, Ntakiyiruta G et al (2014) An innovative paradigm for surgical education programs in resource-limited settings. Can J Surg 57:298–299CrossRefPubMedPubMedCentral
13.
Livingston P, Bailey J, Ntakiyiruta G et al (2014) Development of a simulation and skills centre in East Africa: a Rwandan–Canadian partnership. Pan Afr Med J 17:315CrossRefPubMedPubMedCentral
14.
15.
16.
17.
18.
19.
Petroze RT, Groen RS, Niyonkuru F et al (2013) Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery 153:457–464CrossRefPubMed
20.
Zogg CK, Kamara TB, Groen RS et al (2015) Prevalence of thoracic surgical care need in a developing country: results of a cluster-randomized, cross-sectional nationwide survey. Int J Surg 13:1–7CrossRefPubMed
21.
Biccard BM, Madiba TE, Kluyts H-L et al (2018) Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet 391:1589–1598CrossRefPubMed
22.
23.
Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. BJS 99:436–443CrossRef
24.
Ramirez AG, Nuradin N, Byiringiro F et al (2018) Creation, implementation, and assessment of a general thoracic surgery simulation course in Rwanda. Ann Thorac Surg 105:1842–1849CrossRefPubMedPubMedCentral
25.
Schipper PH, Diggs BS, Ungerleider RM, Welke KF (2009) The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. Ann Thorac Surg 88:1566–1573CrossRefPubMed
26.
Parker RK, Dawsey SM, Abnet CC et al (2010) Frequent occurrence of esophageal cancer in young people in western Kenya. Dis Esophagus 23:128–135CrossRefPubMed
27.
White RE, Abnet CC, Mungatana CK et al (2002) Oesophageal cancer: a common malignancy in young people of Bomet District, Kenya. The Lancet 360:462–463CrossRef
28.
29.
Linegar AG (2008) A model for the development of thoracic surgery in central South Africa. Ph.D. thesis, University of the Free State
30.
Linegar A, Whittaker S, van Zyl G (2012) Academic hospital accreditation strengthens postgraduate training programmes: case study from Universitas Academic Hospital. S Afr Med J 102:146–148CrossRefPubMed
31.
Edwin F, Tettey M, Aniteye E et al (2011) The development of cardiac surgery in West Africa—the case of Ghana. Pan Afr Med J 9:15–27PubMedPubMedCentral
32.
Velebit V, Montessuit M, Bednarkiewicz M et al (2008) The development of cardiac surgery in an emerging country: a completed project. Tex Heart Inst J 25:301–306
33.
Ghosh P (2005) Setting up an open heart surgical program in a developing country. Asian Cardiovasc Thorac Ann 13:299–301CrossRefPubMed
34.
35.
Nyale GM, Anderson R, Patel AR et al (2016) A 10 years audit of cardiothoracic referrals from a pulmonology service in a developing country: impact of patient human immunodeficiency virus status. Ann Transl Med 4:2–132CrossRef
36.
Obaseki D, Adeniyi B, Kolawole T et al (2015) Gaps in capacity for respiratory care in developing countries. Nigeria as a case study. Ann Am Thorac Soc 12:591–598CrossRefPubMed
37.
Linegar A, Van Zyl G, Smit F et al (2010) Pleuro-pulmonary disease in central South Africa: a thoracicsurgical deficiency. SAMJ 100:510–512CrossRefPubMed
38.
Ekpe EE, Ette VF, Akpan A (2014) Pattern of cardiothoracic surgical diseases in a new cardiothoracic surgery unit in Nigeria. Nig J Med 23:77–82
Metadata
Title
General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits
Authors
Adriana G. Ramirez
Nebil Nuradin
Fidele Byiringiro
Georges Ntakiyiruta
Andrew E. Giles
Robert Riviello
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 1/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4771-y

Other articles of this Issue 1/2019

World Journal of Surgery 1/2019 Go to the issue

Original Scientific Report

Trends in Retention and Decay of Basic Surgical Skills: Evidence from Addis Ababa University, Ethiopia: A Prospective Case–Control Cohort Study

Invited Commentary

Ten Years and Counting: Sustaining Effectiveness of the Surgical Safety Checklist Through Ongoing Implementation Efforts

Original Scientific Report

Implementation of the World Health Organization Surgical Safety Checklist Correlates with Reduced Surgical Mortality and Length of Hospital Admission in a High-Income Country

Original Scientific Report

The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery

Original Scientific Report

The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies

Original Scientific Report

The Cost of Intramedullary Nailing Versus Skeletal Traction for Treatment of Femoral Shaft Fractures in Malawi: A Prospective Economic Analysis