Surge capacity is the ability to manage sudden patient influxes beyond routine levels and can be evaluated using the 4S Framework: staff, stuff, system, and space. While low-resource settings like Rwanda face frequent mass casualty incidents (MCIs), most surge capacity research comes from high-resource settings and lacks generalisability. This study assessed Rwanda’s hospital surge capacity using a cross-sectional survey of emergency and surgical departments in all referral hospitals. Descriptive statistics, t-tests, Fisher’s exact test, ANOVA, and linear mixed-model regression were used to analyze responses. Of the 39 invited participants, 32 (82%) responded. On average, respondents believed that they could manage 13 MCI patients (95% CI: 10–16) while maintaining routine care, with significant differences between tertiary and secondary hospitals (11 vs. 22; p = 0.016). The intra-class correlation was poor for most variables except for CT availability and ICU beds. Surge capacity perception did not vary significantly by professional category, though less senior staff reported higher capacity. Significantly higher capacity was reported by those with continuous access to imaging (p < 0.01). Despite limited resources, Rwandan hospitals appear able to manage small to moderate MCIs. For larger incidents, patient distribution across facilities is recommended, with critical cases prioritized for tertiary hospitals.

IntroductionThe aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.MethodThis study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.ResultsA total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58-1.82) among women registered for &gt;= 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49) and 1.70 (1.49-1.95) for FHR among women with two and &gt;= 3 registered deliveries, respectively.ConclusionIn the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.

Mer än hälften av världens befolkning saknar tillgång till säker och ekonomiskt överkomlig kirurgi.

Nästan tre fjärdedelar av all kirurgi utförs i den rika tredjedelen av världen.

En tredjedel av den globala sjukdomsbördan kan behandlas kirurgiskt.

Brister i organisation, utbildning och finansiering är några av anledningarna till den begränsade tillgången till kirurgi i världen.

För att öka tillgången till kirurgi krävs långsiktiga nationella planer, internationella samarbeten samt ledarskap som prioriterar att skapa kompletta och fungerande sjukvårdssystem.

More than 5 billion humans cannot access essential surgery if needed. Surgery was for a long time not a part of the global health agenda, generally considered a luxury. However, the realization that a large proportion of the global burden of disease can be reduced by surgery has gained momentum. The publication of the Lancet Commission on Global Surgery and the Disease Control Priorities volume on surgery, along with the WHO resolution on access to essential and emergency surgical care, has been pivotal in this paradigm shift.

Access to surgery is in many settings hampered by a mix of lack of leadership, skilled workforce, equipment, and financial risk protection for patients, to name a few. Importantly, the provision of surgery requires comprehensive health systems which, once established, allow for numerous other health interventions. This cannot be achieved without partnerships, responsible leadership and good governance that prioritizes health care in general and surgery in particular.

Historically, “global surgery” publications often circulated around short-term missions of surgeons from high-income countries visiting low-income countries. The reports would include a description of the high number of patients operated on during the mission, accompanied with a photo of the team in the operating room and a happy patient in colourful clothing. There would be very little additional information about the outcomes of these procedures, in particular in the longer term, as the teams usually left shortly after carrying out the surgeries. Volume of surgery was the main outcome measure in these reports.

Background: In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. Material and methods: 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. Results: Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*,0.37 - 4.27 *,0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 +/- 30.0-67.7 +/- 13.2 (SD) mm(2)). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p = 0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. Conclusion: At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non inferior to intramuscular gentamicin in reducing S. aureus colonization on the wounds surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.

Background The role of surgery in global health has gained greater attention in recent years. Approximately 1.8 billion children below 15 years live in low- and middle-income countries (LMIC). Many surgical conditions affect children. Therefore, paediatric surgery requires specific emphasis. Left unattended, the consequences can be dire. Despite this, there is a paucity of data regarding prevalence of surgical conditions in children in LMIC. The present objective was to investigate the prevalence of paediatric surgical conditions in children in a defined geographical area in Eastern Uganda. Method A cross-sectional study was carried out in the Iganga-Mayuge Health and Demographic Surveillance Site located in Eastern Uganda. Through a two-stage, cluster-based sampling process, 490 households from 49 villages were randomly selected, generating a study population of 1581 children. The childrens caregivers were interviewed, and the children were physically examined by two medical doctors to identify any surgical conditions. Results The interview was performed with 1581 children, and 1054 were physically examined. Among these, the overall prevalence of any surgical condition was 16.0 per cent (n = 169). Of these, 39 per cent had an unmet surgical need (66 of 169). This is equivalent to a 6.3 per cent prevalence of current unmet surgical need. The most common groups of surgical condition were congenital anomalies and trauma-related conditions. Conclusion Surgical conditions in children are common in eastern Uganda. The unmet need for surgery is high. With a growing population, the need for paediatric surgical capacity will increase even further. The health care system must be reinforced to provide services for children with surgical conditions if United Nations Sustainability Development Goal 3 is to be achieved by 2030.

Background

Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs.

Methods

Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development.

Results

Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress.

Conclusion

Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs.

Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance surgical capacity therefore needs to be complemented by promotion of rehabilitation interventions. We make the case for strengthening surgery-related rehabilitation in lower-resource countries, outlining the challenges but also potential solutions and policy directions. Proposed solutions include greater leadership and awareness, augmented by recent global efforts around the World Health Organization's Rehabilitation 2030 initiative, and professionalization of the rehabilitation workforce. More research on rehabilitation is needed in low- and middle-income countries, along with support for system approaches, notably on strengthening and integrating rehabilitation within the health systems. Finally, we outline a set of policy implications and recommendations, aligned to the components of the national surgical plan proposed by the Lancet Commission: infrastructure, workforce, service delivery, financing, and information management. Collaboration and sustained efforts to embed rehabilitation within national surgical plans is key to optimize health outcomes for patients with surgical conditions and ensure progress towards sustainable development goal 3: health and well-being for all.

Sjukdomar och tillstånd som kan behandlas med kirurgi var länge lågprioriterade i resursknappa miljöer. Kirurgi sågs inte som betydelsefull för folkhälsan och sjukvårdens fokus låg av hävd på infektionssjukdomar. Två viktiga skeenden har långsamt ändrat på detta. Sjukdomspanoramat i låg- och medelinkomstländer har påverkats av den ekonomiska utvecklingen samtidigt som alltfler studier i dessa länder har visat hur allvarligt folkhälsan påverkas på både kort och lång sikt när kirurgisk behandling är otillgänglig för majoriteten av en befolkning. I kapitlet behandlas kirurgins betydelse i fattigare länder liksom hälsoekonomi, etik, konsekvenser av medicinsk turism, kirurgins roll i krig och katastrofer liksom den avgörande frågan hur behovet av kirurgi globalt ska mötas i ljuset av en skriande brist på kirurger, narkosläkare och gynekologer.