title: Snapshot of surgical activity in rural Ethiopia: is enough being done?
abstract: BACKGROUND
  Surgical conditions are responsible for a significant burden of the disease prevalence in sub-Saharan Africa. However, there is a paucity of data surrounding the amount and availability of surgical care. Few surveys exist that document current rates of surgical activity in the low-income setting, and most figures rely on the country estimates. We aim to document accurately the rates of surgery at the district level.
  
  
  METHODS
  We performed a retrospective survey of surgical activity in 10 hospitals in the Southern Nation and Nationalities Peoples' Region of Ethiopia using a standardized data collection form. We also performed structured interviews with hospital directors.
  
  
  RESULTS
  Surgical output varied across the hospitals from 56 to 421 operations per year per 100,000 catchment population. The most commonly performed operation was cesarean section (29% of major procedures). Emergency surgery accounted for 55% of operations, with the most frequent emergency operation being cesarean section. The overall cesarean section rate was alarmingly low at 0.6%. There are only 76 health workers that are providing a surgical service to this sample population of 12.9 million people.
  
  
  CONCLUSIONS
  The rates of surgery found here were very low, consistent with the huge shortage of health workers providing a surgical service. The low cesarean section rate indicates that there is a large unmet surgical disease burden at the population level, and more comprehensive surveys are required to investigate this further. The most important steps to tackle the problem of deficiencies in global surgery are to increase access to surgical care and the surgical workforce capacity.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. sreshamwalla@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Reshamwalla
authors.affiliation: Department of General Surgery, Hawassa University Referral Hospital, Hawassa, Ethiopia.
authors.forename: Aberra A
authors.initials: AA
authors.lastname: Gobeze
authors.affiliation: Department of General Surgery, Neville Hall Hospital, Brecon Road, Abergavenny, NP7 7EG, UK.
authors.forename: Sunirmal
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Epsom & St Helier Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK.
authors.forename: Caris
authors.initials: C
authors.lastname: Grimes
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lavy
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005002:Ethiopia; D005260:Female; D013502:General Surgery; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D008507:Medically Underserved Area; D009774:Obstetrics; D011247:Pregnancy; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D000078329:Workforce