title: Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews.
abstract: BACKGROUND
  For most of the population in Africa, district hospitals represent the first level of access for emergency and essential surgical services. The present study documents the number and availability of surgical and obstetrical care providers as well as the types of surgical and obstetrical procedures being performed at 10 first-referral district hospitals in Ghana.
  
  
  METHODS
  After institutional review board and governmental approval, a study team composed of Ghanaian and American surgeons performed on-site surveys at 10 district hospitals in 10 different regions of Ghana in August 2009. Face-to-face interviews were conducted documenting the numbers and availability of surgical and obstetrical personnel as well as gathering data relating to the number and types of procedures being performed at the facilities.
  
  
  RESULTS
  A total of 68 surgical and obstetrical providers were interviewed. Surgical and obstetrical care providers consisted of Medical Officers (8.5%), nurse anesthetists (6%), theatre nurses (33%), midwives (50.7%), and others (4.5%). Major surgical cases represented 37% of overall case volumes with cesarean section as the most common type of major surgical procedure performed. The most common minor surgical procedures performed were suturing of lacerations or episiotomies.
  
  
  CONCLUSIONS
  The present study demonstrates that there is a substantial shortage of adequately trained surgeons who can perform surgical and obstetrical procedures at first-referral facilities. Addressing human resource needs and further defining practice constraints at the district hospital level are important facets of future planning and policy implementation.
authors.affiliation: Department of Surgery, Johns Hopkins University, Baltimore, Maryland 212105, USA. fa@jhmi.edu
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Shelly
authors.initials: S
authors.lastname: Choo
authors.forename: Afua A J
authors.initials: AA
authors.lastname: Hesse
authors.forename: Francis
authors.initials: F
authors.lastname: Abantanga
authors.forename: Elias
authors.initials: E
authors.lastname: Sory
authors.forename: Hayley
authors.initials: H
authors.lastname: Osen
authors.forename: Julie
authors.initials: J
authors.lastname: Ng
authors.forename: Colin W
authors.initials: CW
authors.lastname: McCord
authors.forename: Meena
authors.initials: M
authors.lastname: Cherian
authors.forename: Charles
authors.initials: C
authors.lastname: Fleischer-Djoleto
authors.forename: Henry
authors.initials: H
authors.lastname: Perry
mesh_terms: D004632:Emergency Medical Services / Q000600:supply & distribution; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D005869:Ghana / Q000453:epidemiology; D019538:Health Care Surveys; D006767:Hospitals, District / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006801:Humans; D008505:Medical Staff, Hospital / Q000600:supply & distribution; D008880:Midwifery; D009719:Nurse Anesthetists / Q000600:supply & distribution; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D009774:Obstetrics / Q000706:statistics & numerical data*; D009871:Operating Room Nursing; D011247:Pregnancy; D000078329:Workforce