Assessing the Validity of Using Caesarean Section and Inguinal Hernia Repairs as Proxy Indicators of the Level of Surgical Care in Sierra Leone

Abstract

Background: The traditional tools for assessing surgical capacity in low-income countries requires significant amounts of time and resources, and have thus not been systematically utilized in the poorest regions of the world. Proxy indicators have been suggested as a simpler and more accessible tool to achieve the same end. The aim of this study was to evaluate the use of proxy indicators to assess the number of operations per capita in a given region of Sub-Saharan Africa.

Method: We compiled surgical data from 57 health institutions in Sierra Leone that performed surgery in 2012 to evaluate the reliability of using the percentage of caesarean sections compared to total operations performed (%CS), hernia repairs (%HR) or both(%CS&HR) as indicators of total surgical activity. In total 23 496 cases were included in the study. We performed a logistic regression analysis with %CS, %HR and %CS&HR as the dependent variable and the operations per thousand capita as the co-variant.

Results: We found a strong significant correlation for each of the proxy indicators, with the estimated odds ratio for %HR being 0.864 (p <0,001), the estimated odds ratio for %CS being 0.942 (p <0,001) and the estimated odds ratio for %CS&HR being 0.856 (p <0,001).

Conclusions: Our data suggests that one can estimate the unmet need for surgical services in a region of Sub-Saharan Africa by using either of the three proxy indicators. However it seems that %HR is the most sensitive marker for small changes in operations per thousand capita.