Methods
Situation Analysis data collection and tools
MALAWI
In Malawi all of the 18 government district hospitals in the Southern and central regions were considered for inclusion in the COST-Africa project. Field visits were carried out to conduct the situation analysis in all district hospitals in the Southern and Central regions. The overall objective of the, was to map and assess the nature, scale, distribution and consequences of current surgical capacity, volume and capacity gaps with respect to the safe and effective delivery of surgery at the central and district hospital levels.
Data collection - work done:
COST-Africa carried out an initial situation analysis at Chiradzulu, Mangochi, Mulanje and Thyolo district hospitals to pilot the data collection tools. The following WHO tools were piloted in the hospitals:
- WHO Surgical Care at the District Hospital
- WHO manual on Surgery at the District Hospital,
- WHO Integrated Management for Emergency and Essential Surgical Care (IMEESC) tool kit
The lessons learned and the feedback obtained from hospital personnel about the strengths and weaknesses of the WHO tools has been used by all COST-Africa researchers in revising the data collection tools. One of the conclusions was to draft a new set of tools that would be more suitable for the needs of COST-Africa SA. The data collection tools (described below) were designed to capture the objectives listed in the first paragraph.
A second pilot study was conducted at the following district hospitals: Balaka, Dedza, Mwanza, Mchinji, Thyolo, Ntchisi and Kasungu. This phase involved a short questionnaire administered by e-mail to gather data on the types of surgical procedures being referred, availability and functionality of surgical equipment and infrastructure to carry out surgery, the availability of staff to perform surgery, and the likely impact at the hospital of the placement of surgically trained COST-Africa Clinical Officers.
Subsequently, from March to May 2013 a revised questionnaire has been administered physically by College of Medicine COST-Africa researcher at the following 17 district hospitals: Balaka, Chikhwawa, Chiradzulu, Dedza, Dowa, Kasungu, Mchinji, Mulanje, Nkhotakota, Ntcheu, Ntchisi, Salima, Thyolo, Machinga, Mangochi, Mwanza and Nsanje.
Additional to the questionnaire 6 months data from July to December 2012 was collected in a COST-Africa surgical proforma tool.
CLICK HERE TO ACCESS COST AFRICA SITUATION ANALYSIS TOOL
The analysis of the data gathered using the COST-Africa situation analysis tool allowed the team to set up a randomized control trial design of the study. Pairs of hospitals are presented in the table below:
MALAWI
In Malawi all of the 18 government district hospitals in the Southern and central regions were considered for inclusion in the COST-Africa project. Field visits were carried out to conduct the situation analysis in all district hospitals in the Southern and Central regions. The overall objective of the, was to map and assess the nature, scale, distribution and consequences of current surgical capacity, volume and capacity gaps with respect to the safe and effective delivery of surgery at the central and district hospital levels.
Data collection - work done:
COST-Africa carried out an initial situation analysis at Chiradzulu, Mangochi, Mulanje and Thyolo district hospitals to pilot the data collection tools. The following WHO tools were piloted in the hospitals:
- WHO Surgical Care at the District Hospital
- WHO manual on Surgery at the District Hospital,
- WHO Integrated Management for Emergency and Essential Surgical Care (IMEESC) tool kit
The lessons learned and the feedback obtained from hospital personnel about the strengths and weaknesses of the WHO tools has been used by all COST-Africa researchers in revising the data collection tools. One of the conclusions was to draft a new set of tools that would be more suitable for the needs of COST-Africa SA. The data collection tools (described below) were designed to capture the objectives listed in the first paragraph.
A second pilot study was conducted at the following district hospitals: Balaka, Dedza, Mwanza, Mchinji, Thyolo, Ntchisi and Kasungu. This phase involved a short questionnaire administered by e-mail to gather data on the types of surgical procedures being referred, availability and functionality of surgical equipment and infrastructure to carry out surgery, the availability of staff to perform surgery, and the likely impact at the hospital of the placement of surgically trained COST-Africa Clinical Officers.
Subsequently, from March to May 2013 a revised questionnaire has been administered physically by College of Medicine COST-Africa researcher at the following 17 district hospitals: Balaka, Chikhwawa, Chiradzulu, Dedza, Dowa, Kasungu, Mchinji, Mulanje, Nkhotakota, Ntcheu, Ntchisi, Salima, Thyolo, Machinga, Mangochi, Mwanza and Nsanje.
Additional to the questionnaire 6 months data from July to December 2012 was collected in a COST-Africa surgical proforma tool.
CLICK HERE TO ACCESS COST AFRICA SITUATION ANALYSIS TOOL
The analysis of the data gathered using the COST-Africa situation analysis tool allowed the team to set up a randomized control trial design of the study. Pairs of hospitals are presented in the table below:
|
|
Intervention hospital |
Control hospital |
|
Central Region |
Nkhotakota |
Salima |
|
Dowa |
Kasungu |
|
|
Dedza |
Ntcheu |
|
|
Mchinji |
Ntchisi |
|
|
Southern Region |
Mulanje |
Machinga |
|
Mangochi |
Thyolo |
|
|
Nsanje |
Chikhwawa |
|
|
Mwanza |
Chiradzulu |
ZAMBIA
In Zambia a questionnaire was developed by SSZ and RCSI with input from RUNMC and a telephone survey was conducted (November 2013-February 2013) with hospital managers in 59 level 1 hospitals in 8 provinces to ascertain: the availability of staff involved in surgery (General Medical Officers, Specialist Doctors, Clinical Officers/Medical Licentiates, Theatre nurses and Anaesthetic Clinical Officers), the number of patients and major surgical cases (per month or year), and the distance to the second level referral hospitals. The analysis of the data from this survey provided the information needed to select suitable hospitals for the COST-Africa intervention and to pair them for subsequent randomization.
In Zambia a questionnaire was developed by SSZ and RCSI with input from RUNMC and a telephone survey was conducted (November 2013-February 2013) with hospital managers in 59 level 1 hospitals in 8 provinces to ascertain: the availability of staff involved in surgery (General Medical Officers, Specialist Doctors, Clinical Officers/Medical Licentiates, Theatre nurses and Anaesthetic Clinical Officers), the number of patients and major surgical cases (per month or year), and the distance to the second level referral hospitals. The analysis of the data from this survey provided the information needed to select suitable hospitals for the COST-Africa intervention and to pair them for subsequent randomization.
|
|
Intervention Hospital |
Control Hospital |
|
Southern Province |
Maamba DH (non RCT) |
Zimba MH |
|
|
Siavonga DH (RCT) |
Yeta DH |
|
|
Mtendere MH (RCT) |
Mazabuka DH |
|
|
Choma GH (RCT) |
Itezhi tezhi DH |
|
North Western Province |
Mwinilunga DH (RCT) |
Chavuma MH |
|
|
Kalene MH (RCT) |
Kabompo DH |
|
Central Province |
Serenje DH (RCT) |
Liteta MH |
|
Northern Province |
Isoka DH (non RCT) |
Mpika DH |
|
Luapula Province |
St. Margaret’s MH (non RCT) |
Lubwe MH |
Surgical data collection
In both countries an extended theatre register was developed based on a review of the standard operating theatre register used in Malawi and Zambia. Apart from routinely collected surgical data (details for all cases of surgery in the operating theatre) this tool covers additional fields such as:
In both countries an extended theatre register was developed based on a review of the standard operating theatre register used in Malawi and Zambia. Apart from routinely collected surgical data (details for all cases of surgery in the operating theatre) this tool covers additional fields such as:
- the immediate outcome of surgery at the time the patient leaves theatre
- surgical outcomes / common complications, while patients are on admission / by the time of discharge (follow-up on the ward); and
- onward referrals to other hospitals (follow up of selected obstetric and hernia repair cases after discharge).
- TO ACCESS COST-AFRICA EXTENDED THEATRE REGISTER CLICK HERE
- TO ACCESS COST-AFRICA Baseline Situation Analysis Tool A CLICK HERE
- TO ACCESS COST-AFRICA Annex to Baseline Situation Analysis Tool A CLICK HERE
- TO ACCESS COST-AFRICA Quality of life after surgery Tool CLICK HERE
- TO ACCESS COST-AFRICA Supervisory visit report CLICK HERE