The economic burden associated with unmet surgical needs in Liberia: a retrospective macroeconomic analysis based on a nationwide enumeration of surgical procedures.

Objectives: The economic consequences of untreated surgical disease are potentially large. The aim of this study was to estimate the economic burden associated with unmet surgical needs in Liberia.

Design: A nationwide enumeration of surgical procedures and providers was conducted in Liberia in 2018.

Rapidly evolving gangrenous vasculitis in a critically ill patient with ulcerative colitis: a case report.

Ulcerative colitis is a disease characterised by non-granulomatous submucosal inflammation ranging from isolated proctitis to colitis. Extra-intestinal manifestations of the condition occur in multiple organ systems, with dermatological complications occurring commonly. This case report aims to highlight an uncommon dermatological complication of ulcerative colitis with particular focus on patient care and management.

High quality care following orthopaedic injury in Zambia: A qualitative, patient-centred study.

Background: Injuries are a significant cause of mortality and morbidity, particular in low- and middle-income countries (LMICs). While there is a focus on increasing injury care capacity, less attention is given to assessing, improving, and understanding the quality of care provided, especially from a patient perspective. This study therefore aims to understand what patients from a Zambian orthopaedic ward believe good quality care to be, to identify its key components, and contribute to better understanding what patients believe local healthcare priorities could be.

The role of exclusive enteral nutrition in the pre-operative optimisation of adult patients with Crohn's disease. A systematic review.

Aim: To conduct a systematic review in order to bring together the current knowledge about the use of exclusive enteral nutrition (EEN) in the pre-operative optimisation of adult patients with Crohn's disease undergoing intestinal resection.

Methods: We searched Pubmed, Cochrane Library, ClinicalTrials.gov and the EU clinical trial register to identify experimental and observational studies on the effect of pre-operative EEN on nutritional and clinical outcomes of patients undergoing surgery.

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure.

Objectives: To measure the financial burden associated with accessing surgical care in Sierra Leone.

Design: A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical and indirect costs for surgical care, and summary household assets.

Living with a hernia: A qualitative study of patient experience of abdominal wall hernias in Ndola, Zambia.

Despite hernias being one of the most common surgical problems in low and middle income countries, very little is known about the impact that having a hernia has on the quality of life of patients in these settings. We performed a pilot study to understand how living with a hernia impacts on the quality of life. Twelve semistructured interviews were performed.

Economic impact of surgery on households and individuals in low income countries: A systematic review.

Background: Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) - the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household.

Simple and powerful: a consultant and governance-led bereavement service.

Background: Following bereavement, families can be left with unanswered questions or issues of concern. We piloted a bereavement service model which was consultant and governance-led with the aim to reduce complaints, reduce litigation, reduce coroners' inquests and support families.

Methods: Following the death of a patient, the next of kin was sent an invitation.

Macroeconomic costs of the unmet burden of surgical disease in Sierra Leone: a retrospective economic analysis.

Objectives: The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist.

Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the Ponseti method.

Background: Club foot is a common congenital deformity affecting 150 000-200 000 children every year. Untreated patients end up walking on the side or back of the affected foot, with severe social and economic consequences. Club foot is highly treatable by the Ponseti method, a non-invasive technique that has been described as highly suitable for use in resource-limited settings.

Cost-Effectiveness of Two Government District Hospitals in Sub-Saharan Africa.

Background: District hospitals in sub-Saharan Africa are in need of investment if countries are going to progress towards universal health coverage, and meet the sustainable development goals and the Lancet Commission on Global Surgery time-bound targets for 2030. Previous studies have suggested that government hospitals are likely to be highly cost-effective and therefore worthy of investment.

Methods: A retrospective analysis of the inpatient logbooks for two government district hospitals in two sub-Saharan African hospitals was performed.

The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis.

Background: There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact.

Methods: We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period.

Demographics of patients affected by surgical disease in rural hospitals in two sub-Saharan African countries: a retrospective analysis.

Background: Awareness is growing of both the importance of surgical disease as a major cause of death and disability in low-income and middle-income countries (LMICs) and the cost-effectiveness of fairly simple surgical interventions. We hypothesised that surgical disease predominantly affects young adults and is therefore significant in both the macroeconomic effect of untreated disease and the microeconomic effects on patients and families in low-resource settings.

Methods: We retrospectively reviewed all admission data from two rural government district hospitals, Bo District Hospital in Sierra Leone and Thyolo District Hospital in Malawi.

Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries.

Background: Trauma contributes significantly to the global burden of disease. We analysed published trauma registries to assess the demographics of those most affected in low and middle-income countries (LMICs).

Methods: We performed a systematic review of published trauma registry studies according to PRISMA guidelines.

The cost-effectiveness of orthopaedic clinical officers in Malawi.

Background: In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program.

Methods: Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period.

Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.

Background: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions.

Guidelines for surgeons on establishing projects in low-income countries.

Background: There is increasing interest by surgeons in high-income countries to support colleagues in low-income countries to improve the provision of surgical care, particularly in rural areas. Such interest may be demonstrated by single individuals, short-term surgical missions, or establishment of partnerships. Such altruistic efforts may cause problems unless properly planned and carried out.

Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa.

Background: Little is known about the burden of surgical disease in rural sub-Saharan Africa, where district and rural hospitals are the main providers of care. The present study sought to analyze what is known about the met and unmet need of surgical disease.

Methods: The PubMed and EMBASE databases were searched for studies of surveys in rural areas, information on surgical admissions, and operations performed within rural and district hospitals.