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. 2009 Oct;33(10):2063-8.
doi: 10.1007/s00268-009-0160-x.

The impact of launching surgery at the district level in Niger

Rachid Sani  1 , Babadi Nameoua, Abou Yahaya, Idé Hassane, Roua Adamou, Renee Y Hsia, Patrick Hoekman, Amadou Sako, Abarchi Habibou
Affiliations

The impact of launching surgery at the district level in Niger

Rachid Sani et al. World J Surg. 2009 Oct.

Abstract

Background: In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery.

Methods: Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.

Results: During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training.

Conclusions: Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.

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Figures

Fig. 1
Fig. 1
Profile of the surgical emergencies treated in the three district hospitals
Fig. 2
Fig. 2
Number of emergencies transferred from district hospitals to regional hospitals since the assignment of Capacity of District Surgery in district hospitals at the end of 2006
See this image and copyright information in PMC

Comment in

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