Assessing cesarean section and inguinal hernia repair as proxy indicators of the total number of surgeries performed in Sierra Leone in 2012.
BACKGROUND
The traditional tools to assess surgical capacity in low-income countries require significant amounts of time and resources, and have thus not been utilized systematically in this context. Proxy indicators have been suggested as a simpler tool to estimate surgical volume. The aim of this study was to assess caesarean section and inguinal hernia repair as proxy indicators of the total number of surgeries performed per capita in a given region of sub-Saharan Africa.


METHODS
Surgical data was compiled from 58 health institutions (96.7%) that performed major surgery in Sierra Leone in 2012. In total, 24,152 operative procedures were included in the study. Validity of proxy indicators was tested by logistic regression analyses with the rate of caesarean sections compared with total operations (%CS), hernia repairs (%HR) or both (%CS&HR) as dependent variables and the operations per 100,000 capita as the covariate.


RESULTS
There was significant correlation for each of the proxy indicators, with the estimated odds ratio for %CS being 0.675 (95% CI, 0.520-0.876; P < .01), the estimated odds ratio for %HR being 0.822 (95% CI, 0.688-0.983; P < .05), and the estimated odds ratio for %CS&HR being 0.838 (95% CI, 0.731-0.962; P < .05).


CONCLUSIONS
The unmet need for surgical services in a region of sub-Saharan Africa can be estimated by using any of the 3 proxy indicators. However, it seems that %CS is more sensitive for small changes in operations per 100,000 capita, compared with the %HR. There is no obvious added benefit for using the combined proxy indicator.
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: anders.wold.bjerring@vestreviken.no.
Anders W
AW
Bjerring
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Marius E
ME
Lier
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Siri Malene
SM
Rød
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Pia Fiskaa
PF
Vestby
The State Medical Department, Troms, Norway.
Klaus
K
Melf
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Birger H
BH
Endreseth
Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Øyvind
Ø
Salvesen
Karolinska Institute, Stockholm, Sweden.
Johan
J
von Schreeb
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Arne
A
Wibe
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Thaim Buim
TB
Kamara
St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Håkon Angell
HA
Bolkan
D002585:Cesarean Section / Q000706:statistics & numerical data*; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000706:statistics & numerical data*; D006801:Humans; D012807:Sierra Leone