PubMed · 10243976
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L R Whittaker. 1979. X-ray records in developing countries.. https://pubmed.ncbi.nlm.nih.gov/10243976/
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BACKGROUND: Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems. METHODS: We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability. RESULTS: A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings. CONCLUSION: This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.
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Haiti and other developing countries do not have sufficient meteorological data to evaluate if they meet the solar disinfection (SODIS) threshold of 3-5 h of solar radiation above 500 W/m2, which is required for adequate microbial inactivation in drinking water. We have developed a mathematical model based on satellite-derived daily total energies to simulate monthly mean, minimum, and maximum 5-h averaged peak solar radiation intensities. This model can be used to assess if SODIS technology would be applicable anywhere in the world. Field measurements were made in Haiti during January 2001 to evaluate the model and test SODIS efficacy as a point-of-use treatment option. Using the total energy from a measured solar radiation intensity profile, the model recreated the intensity profile with 99% agreement. NASA satellite data were then used to simulate the mean, minimum, and maximum 5-h averaged peak intensities for Haiti in January, which were within 98.5%, 62.5%, and 86.0% agreement with the measured values, respectively. Most of the discrepancy was attributed to the heterogeneous nature of Haiti's terrain and the spatial resolution of the NASA data. Additional model simulations suggest that SODIS should be effective year-round in Haiti. Actual SODIS efficacy in January was tested by the inactivation of total coliform, E. coli, and H2S-producing bacteria. Exposure period proved critical. One-day exposure achieved complete bacterial inactivation 52% of the time, while a 2-day exposure period achieved complete microbial inactivation 100% of the time. A practical way of providing people with cold water every morning that has undergone a 2-day exposure would be to rotate three groups of bottles every morning, so two groups are out in the sun and one is being used for consumption.