title: The impact of launching surgery at the district level in Niger.
abstract: BACKGROUND
  In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery.
  
  
  METHODS
  Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.
  
  
  RESULTS
  During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training.
  
  
  CONCLUSIONS
  Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.
authors: Department of Surgery, Faculty of Medicine, University of Niamey, Niamey, Niger, West Africa. sani_rachid@yahoo.fr
authors: Rachid
authors: R
authors: Sani
authors: Babadi
authors: B
authors: Nameoua
authors: Abou
authors: A
authors: Yahaya
authors: Idé
authors: I
authors: Hassane
authors: Roua
authors: R
authors: Adamou
authors: Renee Y
authors: RY
authors: Hsia
authors: Patrick
authors: P
authors: Hoekman
authors: Amadou
authors: A
authors: Sako
authors: Abarchi
authors: A
authors: Habibou
mesh_terms: D017558:Elective Surgical Procedures; D004630:Emergencies; D005194:Family Practice; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D009548:Niger / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data; D012424:Rural Population; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D000078329:Workforce