Assessment Of Common Surgical Conditions Encountered By Medical Officers Based In Rural Hospitals In East Africa.

Background: Medical officers and specialists based in rural hospitals must have skills and knowledge to handle the most common emergency and elective surgical problems in their catchment population. The aim of this study was to assess the common surgical problems faced by medical officers in rural hospitals in Kenya and Tanzania that are supported by AMREF specialist outreach services and CCM-Comitato Collaborazione Medica surgeons and to assess how such training may be provided.
Methods: This study covered 31 rural district, Church, NGO and overnment Hospitals in East Africa. A cross-sectional survey using self-administered open-ended questionnaire was used. Forty-two questionnaires were administered to medical officers in charge of the hospitals. The data received was entered in EPlNFO and analysed using SPSS to show the frequency of distribution of different variables.
Results: Of the 31 hospitals, 84% had 50 - 200 beds and 1-3 doctors; 40% had less than two : Most (80%) had outpatients load of 10,000 -30,000 per year and inpatients load of 3,000-10,000 per year;79% of the hospital carried out 500-2000 deliveries per year. A third (35%) of the hospitals had no anaesthetist. Between 200-400 patients per year required emergency and elective surgery in 50% of hospitals. Common emergency surgical conditions and procedures were Ectopic pregnancy, Caesarean section, strangulated hernia, appendectomy and bowel resection. Hernia repair, Hydrocelectomy, Hysterectomy, prostatectomy and appendectomy were the commonest elective procedures. A total of 79% of rural based medical officers preferred a combination of on-the-job training by visiting specialists and training at a referral facility as the best method to improve their surgical skills so as to competently deal with major surgical problems in their area. The majority (85%) of the respondents preferred that training should take 6-12 months. Medical officers, supported by periodic visits by specialists to perform complicated elective surgery and refresher training, can adequately manage majority of surgical problems in' rural areas.
Conclusion: 1. There is need for a critical review of the current institution-based surgical training for rural based medical officers.
2. There is shortage of health workers who can administer safe anaesthesia in rural hospitals
3. Medical officers prefer combined approach to surgical training, on-the-job training by visiting specialist and institution-based training for a short period 6-12 months.