ArticleWorld journal of surgery2018
Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals.
Article in World journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
17 citing papers in PubMed, 33 citations in OpenAlex.
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Economics of Task-Shifting in Surgery: A Systematic Review.Health science reports · 2025Review
- Factors that influence locum practice in public and faith-based hospitals in Malawi.Health SA = SA Gesondheid · 2024Article
- Doctor Retention in a COVID-World: An Opportunity to Reconfigure the Health Workforce, or "Plus ça change plus c'est la meme chose"? A Response to the Recent Commentaries.International journal of health policy and management · 2022Article
- Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study.BMJ quality & safety · 2021Article
- Article
- Authors' Reply: Which Surgical Operations Should be Performed in District Hospitals in East, Central and Southern Africa? Results of a Survey of Regional Clinicians.World journal of surgery · 2021Article
- Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science.PloS one · 2021Article
- Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa-a scoping review.Human resources for health · 2020Article
- Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia.Human resources for health · 2020Article
- Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi - A cross-sectional patient survey.Annals of medicine and surgery (2012) · 2019Article
- Barriers to Timely Presentation of Patients with Surgical Conditions at Tamale Teaching Hospital in Northern Ghana.World journal of surgery · 2019Article
- Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial.Pilot and feasibility studies · 2019Article
- Surgical referral systems in low- and middle-income countries: A review of the evidence.PloS one · 2019Review
- Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016.World journal of surgery · 2018Article
- Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa.International journal of health policy and management · 2018Article
- Accountability in global surgery missions.BMJ global health · 2018Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundDistrict hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.
methodsBaseline and 2-3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.
resultsThere was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63-1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5), p = 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).
conclusionThe study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.