PubMed · 10325774
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A A Alemi. 1999. Teaching paediatrics for the developing world.. https://doi.org/10.1136/adc.80.1.100a
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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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Women who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH), Calabar, but delivered outside orthodox health facilities were studied. The aims were to determine the pattern of maternal morbidity and mortality in them and to compare this with the pattern in women who booked and delivered at UCTH. One hundred and eighteen of the defaulters traced (35.1%) had complications compared with 34 (10.1%) of the control. Only 32.2% of these defaulters with complications presented in orthodox health facilities for treatment. The major complications in the study group were: perineal tear (19.0%); primary postpartum haemorrhage (12.5%); and puerperal sepsis (5.4%). These were significantly higher in the study group than in the controls (P<0.001). Maternal mortality ratio of 6.0 per 1000 live births was recorded in the study group, but there was no death in the control. Health education and public enlightenment campaigns emphasising universal antenatal care along with delivery in orthodox health facilities are strongly advocated.