African countries need 50 times more doctors to curb their surgery deaths

More surgeons needed.
More surgeons needed.
Image: Reuters/Jacky Naegelen
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Official correction: The Lancet corrected the reported rate of patient surgery deaths in Africa to 1% (previously 2%) and a global average of 0.5% (previously 1%).

new study has found that surgery patients are twice as likely to die in Africa compared to the global average. A lack of resources was to blame for the high mortality rate.

Only 12% of the world’s 2.1-million-strong specialist surgical work force, which includes surgeons, anesthesiologists, and obstetricians, practice in African or South East Asian countries. And about two out of every three people in the world do not have access to safe, affordable and timeous surgery.

“The resources information is just terrifying,” says professor Bruce Biccard, lead author on the African study, which was published on Jan. 3 in medical journal The Lancet. “There are about 20 to 50 times less human resources than what we would consider a minimum for post-surgery globally. That’s the scary part.”

The study recruited more than 11,400 patients from almost 250 hospitals in 25 African countries, including both low-income countries, such as Burundi and Zimbabwe, and middle-income countries, such as South Africa and Ghana. This is the largest study of its kind to investigate African surgical activity and outcomes. 

About 1% of the patients died, with infection being the primary cause of death. This is double the global average which is 0.5%. But, importantly, these figures are not adjusted for the patients’ risk profile: the African patients were on average younger, fitter and undergoing minor surgeries, meaning that they should have had a lower risk of dying compared to higher income countries where patients are usually older and sicker. 

“These are unadjusted comparisons,” Biccard told Quartz Africa. “In reality, the distance [between African countries and the global average] is even larger.” The study did not rank countries in terms of their surgery risk.

One commentary by a trio of doctors responding to the paper, also highlighted the resource problem: “Although the main aim of Biccard and colleagues’ study was to quantify surgical outcomes, the most alarming finding was how few people actually received surgery.”

According to the study, on average 212 operations were performed per 100,000 people. This is 20 times lower than the benchmark 5,000 operations per 100,000 people.

Biccard said that the study was a “call to action”: “It helps us focus on areas where we can make a difference.”

“There’s no way we can train the number of physicians to get to that global state minimum,” he said. Health systems needed to consider other ways of providing care, such as though non-physician healthcare providers.

“There is a lot of opportunity for nursing involvement in post-operative care and the identification of patient risk. Essentially there isn’t enough surveillance of patients in post-operative care,” he said.

The next step in the research was a trial, planned for 2019, investigating what could be done to improve post-operative care. “We’ve got an group of investigators across Africa, about 1,000 people at the moment,” Biccard said. In the trial, “we want to see if we can improve outcomes, and then we are one step closer”.